Umbilical Pilonidal Disease;Predisposing Factors & Best Modality of Management

Umbilical pilonidal sinus is an unusual variant of the pilonidal diseases. It occurs with an incidence thought to be 0.6%. Little was reported in literature about the disease. This study is a prospective one that aims at investigating factors predisposing to the development of disease and comparing different modalities of treatment. All patients for more than fourteen years, were involved &assessed for age, gender, family history, hirsute state, obesity, local hygiene, and the presence of deep umbilical cleft were reported & compared with a control group Three modalities in treatment were compared ; conservative measures only (group A), curettage and conservative measures (group B), and omphalectomy with reconstruction of new umbilicus (group C). Seventy eight cases were presented. Significant differences were present in age, sex, lack of local hygiene, & deep umbilicus compared to control group. Conservative modalities are quite efficient modality for treatment that was successful in 77% of the patients. Recurrence occurred in nine patients (23%) of group A & six patients 20% in group B. No recurrence reported in group C (19 cases) , with only one (4%) with minor complications (seroma) The cosmetic acceptance was good in seventeen patients (68%), accepted in six patients (24%) and not accepted in one patient (4%). The study concluded that; deep navel, hairiness, and poor local umbilical hygiene are necessary for the umbilical pilonidal disease to be developed. Conservative management is a well efficient modality of treatment and should be considered as an initial modality of choice. Surgical treatment should be only confined to those fail to tolerate conservative measures. We prefer to remove the umbilicus and fashioning of new umbilicus with base and cylinder rather thancone shaped to be less risky for trapping hair to avoid the recurrence & cosmetically accepted by the patient.