SURGICAL MANAGEMENT OF PILONIDAL SINUS: A COMPARATIVE REVIEW OF APPROACHES AND OUTCOMES IN A TERTIARY CARE HOSPITAL

Background: Pilonidal sinus disease is a chronic condition affecting the sacrococcygeal region, often caused by friction and shearing forces between the buttocks, leading to hair penetration and subsequent infection. Various surgical approaches are used for treatment, each with distinct outcomes. Objective: This study aims to assess and compare the outcomes of different surgical techniques in the management of pilonidal sinus disease, specifically evaluating simple excision with closure and excision with flap reconstruction. Methods: This retrospective observational study included 20 patients treated at a tertiary care hospital in Chamarajanagar from May 2022 to April 2023. The collected data included age, gender, duration of symptoms, history of prior surgery, and early postoperative complications. Patients who underwent simple excision with primary closure or excision with flap reconstruction (Limberg flap) were included. Descriptive statistics were used to analyze patient demographics, surgical outcomes, and complications. Results: The mean age of the patients was 24.4 years (range: 12-37). Of the 20 patients, 13 were male (65%) and 7 were female (35%). Symptoms ranged from 1 to 8 months (mean: 4.6 months). The majority of patients (70%) presented with seropurulent discharge, followed by pain in 30% of cases. Simple excision with closure required a longer healing time and was associated with wound dehiscence (33%), necessitating outpatient wound care. Excision with Limberg flap reconstruction was performed in 12 patients, with a procedure time of 100 minutes and a hospital stay of 6-8 days. The Limberg flap procedure showed minimal complications, with one case of seroma (8%). Conclusion: Limberg flap reconstruction was found to be superior to primary closure in the management of pilonidal sinus disease, with fewer complications, lower rates of recurrence, and faster recovery. The modified Limberg flap provides a simple, effective, and reliable solution for treating pilonidal sinus, especially in patients with minimal complications.