EXCISION WITH MIDLINE CLOSURE VERSUS MODIFIED BASCOM PROCEDURE IN TREATMENT OF SACROCOCYGEAL PILONIDAL SINUS
Ahmed Falih Noori*, Nasseif Jassim Mohammed# & Zeki A AL-Faddag@
*MB, ChB, #CABMS, FICS, Dept.of Surgery, Al-Sadir Teaching Hospital. @CABS, FRCS, Professor of General Surgery, Dept. of Surgery, Basrah College of Medicine, University of Basrah, IRAQ.
Pilonidal sinus is a frequently encountered condition in young adults. It is commonly found in the mid-line skin that covers sacrum and coccyx. Sinus can be found elsewhere, sometimes between the fingers in hair dressers, and in the umbilicus. It is characterized by chronic inflammation in one or more sinuses in the mid-line of the natal cleft that contain hairs and debris. Pilonidal disease is a significant social and economic problem affecting predominantly young males in the second decade of life.
This study aimed to compare the results of excision and midline closure with those of lateral approach (Modified Bascom's procedure) in the treatment of sacro-coccygeal pilonidal sinus in regard to the duration of the procedure and wound complication.
This prospective randomized study was performed on 53 patients operated upon for a pilonidal sinus between June 2014 and December 2015 in Al-Sadir Teaching Hospital in Basrah. Patients were divided into two groups randomly. Group A (25) patients underwent modified Bascom procedure and group B (19) patients underwent excision and midline closure.
The modified Bascom technique showed a significantly short wound healing time (30±10 days) compared to primary closure (55±25 days), p<0.01. The duration of this procedure was significantly longer(50±15 minute) in comparison with excision and midline closure (30±15 minutes) p< 0.01.
No significant differences between the two groups regarding bleeding, wound infection, seroma formation and recurrence were recorded.
In conclusion, modified Bascom procedure is feasible, effective and applicable for all patients with pilonidal sinus. It is of particular advantages in the treatment of complex, recurrent and chronic non-healing pilonidal sinuses when wound healing remains an important dilemma in the surgical treatment.