Surgical Science, 2010, 1, 24-26
doi:10.4236/ss.2010.11005 Published Online July 2010 (http://www.SciRP.org/journal/ss)
Combined Single Step Definitive Treatment in Acute
Pilonidal Sinus Abscess Running Head: Single Step
Treatment of Pilonidal Abscess
Dogan Yildirim1, Oguzhan Sunamak2, Ahmet Pergel3, Mourad Mounla1
1General Surgeon, Private Yildiztabya Bilge Hospital, General Surgery Clinics, Istanbul, Turkey
2General Surgeon, Izmir Kemalpasa Hospital, General Surgery Clinics, Izmir, Turkey
3General Surgeon, Private Avrasya hospital, General Surgery Clinics, Istanbul, Turkey
Received February 20, 2010; accepted July 7, 2010
Abstract
Backgrounds: The treatment of choice has been drainage and definitive surgical treatment after an interval
for acute pilonidal sinus abscess till now. Because of the high incidence of chronic pilonidal sinus disease
following drainage and aiming the cure in one step, synchronous treatment choices to drainage have been
attempted recently. We analyzed retrospectively 20 patients with pilonidal sinus abscess on whom we carried
out drainage + marsupialization as single-step treatment. Methods: Drainage + synchronous marsupializa-
tion results of 20 patients (17 male, 3 female) between 20 to 37 years of age (mean 28) were analyzed retro-
spectively on the parameters of operation time, recov ery period, time to work-r eturn and recurrence ratios.
Results Operation times were between 15 to 25 minutes. Mean recovery period was 45 days (30-50 days),
the mean period from operation to work-return was 24 (22-30) days. There were full recovery in 18 patients
(90%) and recurrence in 2 patients (10%). Silver nitrate ablation treatment achieved cure in recurrences.
Conclusion: Drainage + Marsupialization is an applicable and successful combined choice in the treatment
of Pilonidal sinus abscess.
Keywords: Pilonidal Sinus Abscess, Drainage, Marsupialization, Definitive Treatment, Combined Treatment
1. Introduction
Pilonidal sinus disease (PSD) is an acquired disease in
especially young men with continuous oozing at inter-
gluteal sulcus [1]. The risk factors increasing PSD inci-
dence are white race, young age, familial tendency, ex-
cessive sweating, long sitting periods, sedative life style,
bad body sanitation, fatness, male gender and trauma to
the coccyx region [2].
In spite of proposed different treatment modalities,
there is no standardized treatment due to high recurrence
ratio.
Pilonidal sinus abscess (PSA) (Figure 1) is seen as the
first finding in half of the patients [3]. PSA may cause
widening of lesion, increasing of sinus number and sep-
sis [1,2]. It may be fatal if remains untreated. Various
complications like Septic arthritis, osteomyelitis, DIC,
and toxic shock syndrome were reported [2,4,5,6].The
treatment of PSA has been simple drainage and definitive
surgery after healing of abscess [7]. Because the recur-
rence is high following simple drainage, definitive sur-
gery is necessary for total cure [8]. Today, alternative
approaches that combine drainage and definitive surgery
in one step get popularity. We reported 20 patients with
PSA to whom we performed definitive surgery at th e
same time with drainage.
2. Methods
20 patients (17 (85%) male and 3 (15%) female) between
20 to 37 years of age (median 28) who came to our out-
patient clinics with acute pilonidal sinus abscess (PSA)
and operated between 2007 and 2009 were analyzed ret-
rospectively.
All patients were treated with skin excision, curettage
and intraflexion operation under spinal anesthesia. Met-
ronidazole 0.5 mg IV and gentamicin 80 mg IV were
given to the pts 30 minutes before operation for infection
treatment. Gluteal skin stretched to both sides with plas-
ter traction and the area was shaved. Abscess was dra-

D. YILDIRIM ET AL.
25
ined at midline where it gave fluctuation and the skin
around the area was removed by a vertical rhomboid
excision paralleling the intergluteal sulcus (Figure 2).
The abscess pouch was washed out with physiologic
saline and 10% povidine iodine solutions. The wall of
cavity was curetted and chronic granulation tissue was
excised (Figure 3). Healthy skin was fixed to the sacral
fascia with 2/0 polypropylene single stitch at superior,
inferior and both lateral sides (marsupialization) (Figure
4). The mean operation time was between 15 to 25 min-
utes. Pts were given po ampicillin 375 mg three times a
day for 5 days and discharged at post operative 2nd day.
Serum physiologic dressing of the wound was made on
every 2 days for first 10 post operative days and on every
3 day-interval after then until total wound healing oc-
curred. Pts were advised to take shower before every
dressing. Stitches were removed on 15th day and periodi-
cal controls were made at 1st 2nd 3rd 6th and 12th months
(Figure 5).
3. Findings
Abscess pouch was running toward to the right gluteal
region in 13 (65%), to the left in 5 (25%) and to the su-
perior in 2 (2%) of pts. Mean recovery period was 45
Figure 1: Pilonidal sinus abscess.
Figure 2. Line of excision.
Figure 3. Cavity after curettage and washing.
Figure 4. Marsupialization.
Figure 5. Healing scar at the 6th month.
days (between 30 to 50 days); the mean work-return pe-
riod was 24 days (22-30). 18 (90%) of pts shown total
recovery though 2 pts (10%) developed chronic pilonidal
sinus disease on midline. These 2 pts were treated with
silver nitrate 20% solution ablation and recovered well.
There was no recurrence in follow up period.

D. YILDIRIM ET AL.
26
4. Results and Discussion
Mainstay of the treatment is drainage for PSA. Simple
drainage and definitive surgery after an interval period
has been accepted treatment. But, many of the patients,
treated with simple drainage, develop chronic PDS until
definitive surgery and any delay in definitive surgery
may result in expansion of diseased area and develop-
ment of new tracts, therefore, widening the operative
field. To decrease chronic PSD development risk, drain-
age and combined definitive surgery concept was pro-
posed. Drainage + marsupialization was performed by
Licheri on 43 patients with acute abscess and succeeded
in 81.3% of them. In this study, 4.7% of the pts devel-
oped chronic fistulas and 14.6 developed recurrence.
95% of the pts got totally recovered within 6 to 10 weeks
[9]. Our pts number was half of that series, but still, op-
eration times were similar. Our recurrence ratio was
twice.
Midline skin excision provided easier drainage, cavity
curettage and excision of chronic granulation tissue.
Disadvantages of the method were long recovery and
work-return periods.
Another method reported as successful was drainage +
primary closure with 82% total recovery and 18% recur-
rence [10]. Drainage + laying open was another recom-
mended method [11].
Midline location of the sinus openings mostly in
chronic and recurred PSD suggest that focus of the dis-
ease is midline. Thus, two studies which closed wound
off-midline shown that this type of closure improved
wound healing [12,13].
5. Conclusions
PSA needs definitive treatment after drainage so that it
should not become chronic disease. Draina ge and com-
bined definitive surgery (skin excision curettage and in-
traflexion operation) as a single step is a good alternative
method in its treatment. This treatment provides the pa-
tient to be cured in one step surgery and excludes the
complications of delay in definitive surgery, like risk of
getting chronic disease and forming more sinus tracts.
The results are promising with low recurrence rate and
small and g ood scar formation and future studies on
more patients will show its efficiency.
5. References
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