TOTAL SURGICAL EXCISION FOR CHRONIC PILONIDAL SINUS DISEASE WITH BRANCHING TRACTS: A CASE REPORT

A 24-year-old male with chronic pilonidal sinus disease presented with recurrent pain, persistent purulent discharge and swelling for approximately one year. He was a taxi driver with prolonged daily sitting and had a BMI of 28.4 kg/m². Examination revealed two midline sinus openings, purulent discharge, induration, tenderness and suspected branching disease. Complete excision of the sinus tract, branching extensions and surrounding fibrotic tissue was performed under spinal anesthesia. The wound was left open for healing by secondary intention. Operative time was 45 minutes. Postoperative pain was initially greater and recovery was prolonged, with approximately ten weeks required for complete wound healing and return to work after 21 days. Nevertheless, the wound healed completely without infection or recurrence during six months of follow-up. This case demonstrates the role of total excision as a definitive option for chronic or complex pilonidal disease.