The position of primary radical surgery for pilonidal cysts in the acute inflammatory phase

Introduction . Pilonidal abscesses are common surgical emergencies, typically managed through incision and drainage, requiring re-surgery after relief acute inflammation. The literature describes the use of primary-radical techniques, the essence of which lies in the one-stage economical excision of the suppurating epithelial tract with subsequent open management of the wound, which leads to its complete healing by secondary intention. Routine use of primary-radical operations in emergency proctological practice is limited by an insufficient number of studies that fully reflect the effectiveness of pilonidal disease treatment in the acute inflammatory phase. Aim . To evaluate the effectiveness of using primary radical operations in patients with acute inflammation of the pilonidal disease. Results . The average duration of the surgical intervention was 8.4 minutes (5 to 17 minutes), no intraoperative complications were recorded. The average hospital stay was less than 3 days. In 5 patients (3.9%), the postoperative period was complicated by bleeding from the postoperative wound at the hospital stage, which was stopped in the dressing room under local anesthesia. During the average observation period of 9.4 months (from 6 to 42 months), recurrence-free healing was recorded in 125 (97.6%) patients. The duration of postoperative scar formation ranged from 1.5 to 2.3 months (on average 1.7 months). Discussion . Drainage the purulent cavity during treatment of acute inflammation of the pilonidal cyst transforms the disease into a chronic form, which often requires a second stage of surgical treatment after stopping the symptoms of the acute phase of inflammation. One-stage excision of the suppurating pilonidal cyst allows performing surgical treatment of the pilonidal disease in one stage, which gives reason to consider the possibilities of a wider use of primary-radical operations. Conclusion . Primary radical surgeries can be safely used in patients with acute inflammation of the ECC.