Comparison of Outcomes between Marsupialization and Lay-Open Techniques in the Management of Pilonidal Sinus

Background and objectives: Different surgical strategies emerged for pilonidal disease, but no ideal one. Thus, this study aimed to compare the outcomes of marsupialization vs laying open techniques in the management of pilonidal sinus. Methods: This case series study was conducted on 200 consecutive patients with chronic pilonidal sinus who has operated either with excision and marsupialization technique (Group 1, no.=100) or excision and lay-open technique (Group 2, no.=100) in different hospitals at Sulaimaniyah city, Iraq, from January 2012 to January 2022. The patients' socio-demographics, perioperative data, complications and recurrences were collected using a special questionnaire prepared for this study. Also, the patient’s data was evaluated after surgery regarding postoperative pain, satisfaction, healing and dressing time, incapacity to work and postoperative complications. Results: Most patients aged 20-29 years (40.5%), males (71.5%), had working hours for ?6 hours (57%), with no family history of pilonidal disease (86.0%), presented with pain (44.83%), and with hirsutism (41.5%). In total, 39.5% of the patients had severe pain, 38% had moderate, and 22.5% had mild (p=0.000). Concerning patient postoperative satisfaction, most patients (32.5%) had good and least had excellent (6.0%) satisfaction (p=0.000). Moreover, for the association between the outcomes of both used techniques, a substantial correlation between both groups was found for incapacity for regular daily activity (p=0.046), healing time (p=0.000), dressing time (p=0.000), infection, dehiscence, bleeding and recurrence (p=0.045). Conclusions: Marsupialization was the preferred technique over lay-open regarding postoperative patient satisfaction/severity, healing duration, and dressing time, as it had fewer complications with a recurrence rate.