COMBINED OPEN AND CLOSED APPROACH FOR MANAGEMENT OF PILONIDAL SINUS BY SPECIAL U-SHAPED SUTURES WITHOUT DRAIN. RANDOMIZED CONTROLLED CLINICAL TRIAL.

Introduction: Pilonidal sinus disease (PSD) is a common surgical disease frequently seen in the intergluteal cleft. The treatment of this problem is mainly surgical. Aim: introduce a novel technique of combined open and closed approach for management of primary pilonidal sinus (non-recurrent) by special U-shaped sutures and compare it with other techniques as regard operative time, time of complete wound healing, postoperative pain, time to stop analgesic drugs and evaluate the result of surgery without drain. Patients: this study was conducted on 160 patients with PSD in the sacrococcygeal region who underwent operation between December 2015 and December 2017. All cases are divided randomly into four groups each consists of 40 patients. Results: There were 160 patients, 135 males and 25 females, with a mean age of 23 years. The mean operative time was 37?10 minutes in group A and group D while the mean operative time was 45?10 in group B and group C. There were ten wound dehiscence, two cases occurred in each group A, C, D and four cases occurred in group B. Seroma occurred in 2 cases of Rhomboid flap technique. six patients experienced recurrence ,one in each group A,B and 2 cases occurred in each group C and D. pain score was low and no major complications were recorded in group A. Most wounds heal within 3-8 weeks. Four patients recurred at 7th month and 2 cases recurred at 12th month. Conclusion: combined open and closed approach for management of pilonidal sinus by special U-sutures without drain is simple ,minimal postoperative pain, require short a hospitalization and minimal wound care, allow a rapid return to normal activity, and have a low recurrence rate.