Background
Pilonidal disease is a pathology that has variable presentations, each of them may have different modalities of treatment and variable surgical approaches, and this is always a matter of debate, which is why there were always difficulty to get a perfect classification or staging system in most of the available studies.
Patients and methods
This prospective study was conducted on 25 adult patients admitted to the Surgery Department, Tanta University. The study was carried out over 6 months; these patients had extensive pilonidal disease (multiple pits in the midline with or without pits lateral to the midline). All surgeries were done by wide local excision with off-midline closure.
Results
The follow-up period ranged from 6 to 11 months and wound complications in the picture of wound infection and minor disruption of the stitches in the lower part of the wound (near the anus) were recorded. These complications were noticed in six (24%) patients and managed conservatively by antibiotics and wound dressing. They healed completely in four patients, but two (8%) patients did not respond to conservative measures and after failure, they were considered a recurrence of the disease. There was significant relation between the number of midline pits (especially if >10) and wound complications. Also, diabetes had a significant role in the development of wound complications that may predispose to the recurrence of the disease.
Conclusion
Wide local excision and off-midline closure is a feasible treatment for extensive pathology of the pilonidal disease. Also, the number of midline pits is an important influential factor on the results of surgery and should have a role in the journey to settle a widely accepted classification system besides other factors such as diabetes, recurrence, and lateral extension of the disease.