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  Global Journal of Surgery 2012, 3: 17
  Research Article
Pilonidal sinus in Kuwait: Analysis of 801 consecutive patients
  Mahmoud F. Sakra,b, Hossam M. Hamedb, Mohammad A. Ramadanb,c, Hisham E. Kantoushb, Hisham M. Al-Torkyb  
a Department of Surgery, University of Alexandria, Alexandria, Egypt
b Surgical Division, Ahmadi Hospital, KOC, Ahmadi, Kuwait
c Department of Surgery, Medical Research Institute, University of Alexandria, Alexandria, Egypt

  Objectives: To report the clinical features and outcome of surgical treatment of 801 patients with pilonidal sinus (PNS) treated at Ahmadi Hospital, Kuwait between Jan 2001-Jan 2011. Experimental: Patients were categorized, and treated accordingly, into 3 groups by clinical presentation; namely, acute PNS (n=160), chronic PNS (n=504), and recurrent disease (n=137). All data were prospectively collected and included patient demographics, body mass index (BMI), medical history, clinical presentation, sinus characteristics, previous management, operative details, post-operative course (hospital stay, time off-work, complications and recurrence), and duration of follow-up. Results: There were 692 males and 109 females. Their mean age was 22.8±7.1 years, and mean BMI was 32.4. More than half of patients (60.6%) were obese, approximately three quarters (75.3%) were hirsute, and one quarter (26.6%) had a positive family history of PNS. The overall complication rate was 16.6% and overall recurrence rate (RR) was 13.0%. Patients with acute PNS treated with incision and drainage (I&D) and healing by secondary intention (n=81) had a mean healing time of 32.1 days and a complication rate of 4.9% as compared to 10.4 days and 17.7%, respectively (P<0.05) in patients treated with I&D followed by delayed excision and direct closure (DE/DC). Both groups had similar failure rate (32.1% vs 30.4%, respectively). Patients treated with Karydakis flap for chronic PNS (n=182) and recurrent PNS (n=62) had a complication rate of 8.8% and 12.9% respectively, and a RR of 2.2% and 1.6% respectively, while those treated with excision and midline closure for chronic PNS (n=315) or recurrent PNS (n=63) had a complication rate of 21% and 36.5% respectively, and a RR of 12.1% and 14.3% respectively (P<0.01). Conclusions: (1) PNS affects mainly young male adults who are usually, obese and hirsute, (2) I&D of PNS abscess followed by DE/DC provides more rapid healing and a similar RR as I&D and secondary healing, albeit with a significantly higher complication rate, and (3) Karydakis technique for the management of chronic or recurrent PNS is a non-lengthy, efficient procedure that has less overall complications and a lower RR than conventional excision and midline closure, irrespective of the location of the sinuses.
  Pilonidal sinus; Chronic; Karydakis; Midline closure; Recurrence  

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