Appraisal of “off-midline” Techniques for Pilonidal Disease

Background: Pilonidal disease is a common faced problem in the surgical practice; it usually affects young males. Several surgical techniques have been described for its management with an agreed superiority of the “off-midline” techniques over the midline closure or secondary healing; however there is still an open race between those “off-midline” techniques to be the gold standard one. In this study, we aimed to evaluate the results of those commonly used “off-midline” surgical techniques namely Karydakis, modified Bascom, and Rhomboid flap.Material and Methods: Results of 115 patients presented with primary pilonidal disease operated on between January 2021 and March 2023 were evaluated in a retrospective study. All patients were operated by the same surgeon; 45 patients in the Karydakis group, 35 patients in modified Bascom group and the last 35 patients in the Rhomboid flap group. All patients were evaluated with respect to the postoperative complications, healing time (time till removal of stitches), operative time, hospital stay, timing of drain removal and recurrence rates (recurrence of symptoms after complete wound healing).Results: Of all patients, 100 were male and 15 were female. The mean age of our patients was 23±2 years and the mean follow-up was 16±4 months. Karydakis group (G1= 45 patients) has showed 13.3% complication rate compared to 5.7% in modified Bascom group (G2= 35 patients), and 8.5% in Rhomboid flap group (G3= 35 patients). The recurrence rate was 8.8% in G1 compared to2.8 % in G2, and to5.7% in G3. The mean hospital stay was 24±5 hours for G1, 24±3 hours for G2 and 24±8 hours for G3. The mean operative time was48±2min for G1, 45±5min for G2 and 54±6min for G3. The mean duration for drain was 14±4 days for G1, 7±2 days for G2 and14±3 days for G3.Conclusion: Wound healing, recovery and recurrence rate are the main issues in the surgical management of the pilonidal disease. The three frequently used off-midline surgical procedures are single staged, technically complex, and not free of complications.