Pilonidal Sinus Surgery Names
The surgical procedures for pilonidal sinus include excision with primary closure, excision with open healing (marsupialization), flap techniques (Limberg flap, Karydakis flap), and minimally invasive sinus excision—with the specific technique chosen based on disease extent and recurrence risk 1.
Primary Surgical Approaches
Excision Techniques
Midline excision is a common approach but has significantly higher recurrence and infection rates compared to off-midline techniques 1. The procedure involves:
- Excision with primary closure (closed technique): Complete removal of the sinus tract with immediate wound closure, allowing faster return to work (mean 1.9 days) but requiring longer hospital stays 2, 3
- Excision with open healing (open technique/marsupialization): Removal of diseased tissue leaving the wound open to heal by secondary intention, with lower infection rates (1.8%) and zero recurrence in some series 3
Flap Reconstruction Procedures
Off-midline closure techniques demonstrate superior outcomes compared to midline approaches 1:
- Limberg flap: Shows significantly lower recurrence rates compared to midline closure (RR=6.15,95% CI 2.40-15.80, P=0.0002) and lower infection rates (RR=4.14,95% CI 1.86-9.23, P=0.0005) 1
- Karydakis flap: Demonstrates lower recurrence compared to open healing (RR=6.04,95% CI 1.37-26.55, P=0.02) with comparable infection rates to Limberg flap 1
Minimally Invasive Approach
Sinus excision technique is appropriate for limited pilonidal disease (fewer than four visible pits) 4:
- Performed under local anesthesia with mean operation time of 9.7 minutes 4
- Allows return to work in 1.9 days despite longer healing period (43 days) 4
- Recurrence rate of only 1.6% with high patient satisfaction (79% would recommend) 4
Critical Decision Points
Avoid midline closure as the primary technique due to substantially higher recurrence (6-12 times higher) and infection rates (4 times higher) compared to off-midline techniques 1.
For limited disease, sinus excision offers excellent outcomes with minimal invasiveness and can be performed as outpatient ambulatory surgery with at-home irrigation 4, 5.
For extensive or recurrent disease, flap techniques (Limberg or Karydakis) provide the lowest recurrence rates with no statistically significant difference between them 1.
Common Pitfalls
The choice between open and closed techniques involves trade-offs: closed techniques require longer hospitalization but enable faster return to work, while open techniques have longer healing times but lower infection and recurrence rates 3. The healing period for open techniques ranges from 4-21 weeks, which patients must understand preoperatively 2.