Surgical Intervention and Outcome of Patients with Sacrococcygeal Pilonidal Sinus Disease

A BSTRACT Background: Pilonidal sinus management remains controversial, with debate over optimal surgical techniques balancing recurrence risk, morbidity, and patient satisfaction. This study compares outcomes of various surgical procedures used for the management of pilonidal sinuses. Materials and Methods: A study entitled, “surgical intervention and outcome of patients with sacrococcygeal pilonidal Sinus disease,” was conducted in the department of surgery Skims medical college over a period of 2 years from April 2022 to June 2024. It was a prospective observational study comprising 86 patients. Karydakis flap was done in 29 patients, primary excision with midline closure was done in 14 patients, Limberg flap in 27 patients and Z-plasty in 16 patients. Outcome parameters compared included blood loss, operative time, postoperative complications, pain scores, duration of hospitalization, functional recovery, and long-term outcomes in terms of recurrence, hypertrophic scarring, and patient satisfaction. Results: Among the various surgical, excision with midline closure demonstrated the shortest operative time (48.57 min) and shortest hospitalization (3.57 days) but the highest recurrence (28%), wound complications (35% discharge, 21% dehiscence), and lowest satisfaction (71%). Flap-based techniques exhibited superior long-term outcomes: all exhibited 3% recurrence rate, with Z -plasty excelling in satisfaction (95%), minimal scarring (3%), and low complications (5%–6% infection/dehiscence). Karydakis matched Z -plasty’s satisfaction (95%) but required prolonged recovery (18.86 days to return to normal activity). The Limberg flap incurred the highest morbidity in the form of altered sensation (14%), hypertrophic scarring (14%), and elevated early pain (Day 1: 6.1). Operative blood loss was comparable across the various techniques (21-24 mL), although primary excision showed the least variability (±3.63 standard deviation). Conclusion: While primary excision offers short-term efficiency, its prohibitive recurrence risk and morbidity render it inferior to flap-based techniques. Z -plasty and Karydakis flap optimize the balance of durability, patient satisfaction, and cosmesis, whereas the Limberg flap’s sensory trade-offs limit its utility to complex cases. Surgical strategy should prioritize tension-free, off-midline closures to ensure durable outcomes and patient-centered care.