Karydakis Flap With Compressing Tie-over Interrupted Sutures Without Drain versus Standard Karydakis for Treatment of Sacrococcygeal Pilonidal Sinus Disease

BACKGROUND: Sacroccygeal pilonidal sinus disease is a worldwide health problem, affecting young adults, mainly males, with a tendency for recurrence. Various modalities have been used for treating this condition. The Karydakis procedure is one of most commonly used asymmetric flaps for treating this condition. OBJECTIVE: The study aimed to evaluate the Karydakis procedure with tie-over compressing sutures instead of the routine use of a drain in the treatment pilonidal sinus. DESIGN: This prospective randomized controlled clinical study was conducted between January 2010 and January 2015. SETTINGS: The study was conducted at Minia University Hospital. PATIENTS: The study included 154 patients. Patients were randomly assigned into 2 equal groups. INTERVENTIONS: The patients in group 1 were operated on by the standard Karydakis procedure, and the patients in group 2 were operated on by the Karydakis procedure with tie-over compressing sutures without a drain. MAIN OUTCOMES AND MEASURES: The primary outcomes measured were the incidence of seroma formation, wound complications, length of hospital stay, off-work time, and recurrence rate. RESULTS: All patients were discharged on the same day of surgery in group 2 compared with a mean hospital stay of 4.9 +/- 2.4 days in group 1. No patients developed seroma in group 2 compared with 7.8% in group 1. In group 2, 1.3% of patients developed wound infection compared with 9.1% in group 1. The average time for return to work in group 2 was 10.2 +/- 1.4 days compared with 12.6 +/- 4 days in group 1. No recurrences were noted in group 2 compared with 2.6% in group 1. LIMITATIONS: The feedback about postoperative pain and patient satisfaction about the scar were not investigated. The extent of the disease in both groups was not investigated. The duration of follow-up too short to accurately weight recurrence rate. CONCLUSION: Karydakis flap with tie-over compressing interrupted sutures without a drain is safe, 1-day surgery with the lowest complications rate.