Named Surgical Procedures for Pilonidal Sinus
I cannot provide a comprehensive answer to this question because the provided evidence exclusively addresses chronic rhinosinusitis and sinus surgery, not pilonidal sinus disease. The evidence documents 1, 2, 3 all discuss endoscopic sinus surgery, balloon sinuplasty, and chronic rhinosinusitis management—completely unrelated to pilonidal disease.
However, based on the limited pilonidal-specific research evidence provided 4, 5, 6, 7, 8, I can outline the following surgical approaches:
Primary Surgical Techniques
The main surgical approaches for pilonidal sinus involve either excision with open healing or excision with primary closure, with multiple named variations of these fundamental techniques 4, 5.
Open Techniques
- Simple excision and open granulation: Wide excision of the sinus with the wound left open to heal by secondary intention 5, 8
- Obeid's surgical excision: A specific modification of the open technique that demonstrated 0% recurrence in one comparative study 5
- Simple removal of midline skin pits with lateral drainage: Conservative approach removing only the causative midline pits while draining the abscess/sinus laterally, avoiding wide excision 4
Closed Techniques (Primary Closure)
- Asymmetric excision and primary closure: Eccentric elliptical excision with mobilization of the flap to sacrococcygeal fascia, transferring the incision line off-midline to flatten the natal cleft 6
- Excision and primary closure with suction drain: Standard excision with primary closure utilizing suction drainage, sometimes combined with antiseptic wound flushing 6, 7
- Excision and primary closure with antiseptic flushing: Specific technique using a drain for postoperative antiseptic cavity irrigation on days 2,4, and 6 7
Flap Procedures
- Off-midline skin closure with natal cleft flattening: Reserved for hirsute patients with extensive primary disease, deep natal clefts, or recurrent disease with unhealed midline wounds 4
Clinical Outcomes Comparison
Primary closure offers faster return to work (mean 12-21 days) compared to open healing (38 days), despite slightly longer hospital stays 5, 6, 8. Infection rates are comparable between techniques (1.8-3.6% for closed vs open) 5. Recurrence rates range from 0-6% for both approaches in the provided studies 5, 6, 7, 8.
Common Pitfall
Avoid wide excision of the abscess and sinus—there is no rational basis for this approach 4. Simple removal of the causative midline pits is sufficient in most cases and avoids debilitating complications associated with extensive surgery 4.