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Secondary Healing versus Delayed Excision and Direct Closure after Incision and Drainage of Acute Pilonidal Abscess: A Controlled Randomized Trial

Mahmoud F. Sakr, Mohammad A. Ramadan, Hossam M. Hamed, Hisham E. Kantoush.

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Objective: To compare drainage and healing by secondary intention with drainage, delayed excision and direct closure (DE/DC).
Methods: Between January 2003 and January 2010, 130 patients admitted with an acute pilonidal abscess were randomized to undergo either elliptical incision and drainage (I&D) and healing by secondary intention (Group 1, n=66) or I&D and DE/DC (Group 2, n=64). Data regarding patient and sinus characteristics, hospital stay, healing time, postoperative complications, and recurrence were prospectively collected. Patients were followed-up for a mean of 62.4 months.
Results: Ninety percent of patients were men and 10% were women, with a mean age of 26.4 years and a mean body mass index of 31.5. There was no difference in hospital stay between both groups. Mean healing time was significantly (p=0.035) longer for patients in group 1 (32.2 days), compared to those in group 2 (10.7 days). Group 1 patients had significantly fewer postoperative complications (4.5% versus 17.2%, respectively) (p=0.020). The 2 groups had a similar recurrence rate of a pilonidal abscess (6.1% versus 6.3%, p=0.984), and a rate of development of a chronic pilonidal sinus (PNS) (25.8% versus 23.4%, p=0.840).
Conclusions: Although there is more rapid healing and fewer visits for dressing with I&D and DE/DC of an acute pilonidal abscess, this is accompanied by a significantly higher overall complication rate than with I&D and secondary healing. Recurrence of an acute abscess or development of a chronic pilonidal sinus is similar with both procedures.

Key words: Pilonidal abscess, drainage, delayed excision, direct closure, recurrence

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