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MUZI'S TENSION FREE PRIMARY CLOSURE OF PILONIDAL SINUS DISEASE: LONG-TERM RESULTS ON 450 PATIENTS
Marco Gallinella Muzi*, Claudia Mosconi, Marco Colella, Agnese Cianfarani, Pietro Mascagni, Mostafa Shalaby, Pierpaolo Sileri
University of Rome Tor Vergata, Rome, Italy
BACKGROUND:
Chronic pilonidal disease is a debilitating condition that typically affects young adults. Controversy still exists regarding the best surgical technique for the treatment of pilonidal disease. Having described the technique and the good short-term results (Colorectal Disease 2009) and having compared it versus Limberg flap procedure (The American Journal of Surgery 2010), in this six year long retrospective study on 450 consecutive patients, we evaluate the long-term results of Muzi’s tension-free primary closure of pilonidal sinus disease in terms of patient discomfort and recurrence rate.
METHODS:
From January 2004 to January 2010, 450 consecutive patients with pilonidal sinus disease were treated with the modified tension-free primary closure, first described by M. G. Muzi in 2009. Clinically, no patients showed relevant comorbidities and 143 patients (31.8%) presented with chronic infection and multiple fistulas. All patients were treated with the following technique: infiltration with local anesthetic; identification of fistula tract using methylene blue staining; elliptical skin excision to the presacral fascia; closure of the cavity by a double layer of interrupted Polysorb 2-0 resorbable sutures; antibiotic collagen sponge was used in every patient, avoiding drains.
Patients where studied retrospectively between the second and the seventh year after the procedure by telephone interview and/or clinical examination to asses recurrence rate and procedure satisfaction, the latter evaluated with a questionnaire including a score ranging from zero (not satisfied) to 12 (greatly satisfied).
RESULTS:
We surgically treated 354 males (median age 25 y.o.) and 96 females (median age 21 y.o.). Median long-term follow-up time was 54 months (range, 24 to 84 months). 391 patients completed the questionnaire (87% response rate). Complete wound healing without recurrence was achieved in 98.2% cases. Recurrence occurred in 2 patients (0.5%) during the median long-term follow-up of 54 months. Eight (2,1%) patients with a chronic active abscess (n=4) and chronic infection (n=4) required minor debridement of the infected wound. At 12 months, the mean satisfaction score was 10.4 ± 1.8/12; this results were confirmed at 22 and 54 months follow- when 94% of the patients were satisfied and would recommend the technique to others.
CONCLUSIONS:
Muzi’s technique of tension free primary closure of pilonidal sinus disease has proved to be an effective treatment for pilonidal disease showing also in the long-term assessment of a low recurrence rate and a high degree of patient satisfaction. Therefore, we propose Muzi’s technique as the gold standard for the treatment of pilonidal sinus disease.
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