What Is The Role of Mechanical Bowel Preparation in Patients with Pilonidal Sinus Undergoing Surgery? Prospective, Randomized, Surgeon-blinded Trial Cem Terzi, MD, Aras Emre Canda, MD, Tarkan Unek, MD, Esra Dalgic, MD, Mehmet Fuzun, MD Department of Surgery, Medical Faculty, Dokuz Eylul University, Inciralti, 35340 Izmir, Turkey Abstract The aim of this study was to determine the effect of a mechanical bowel preparation on postop- erative surgical wound infections in patients treated with identical antimicrobial prophylaxis undergoing wide excision and primary closure for chronic pilonidal sinus disease. Patients more than 18 years old were included in the study. All patients had intravenous antimicrobial prophylaxis at the time of anesthesia induction. In a prospective, randomized setting, patients were allocated to either the bowel preparation group or the no-bowel-preparation group. Mechanical bowel preparation was performed using an oral sodium phosphate solution. On the morning of the procedure a rectal enema was performed with the phosphate solution. The primary outcome measure was the rate of wound infection, but all postoperative complications and recurrences were recorded. All patients were actively observed for 1 year after discharge. The overall infection rate for the entire study population was 12.8% (13/101) including 14.3% (7/49) of those who had had the bowel preparation and 11.5% (6/52) of those with no bowel preparation. There was no statistically significant difference between groups (P = 0.680). The mean rate of recurrence for all 101 patients was 4.9% (5/101) at 19.2 months (range 12–32 months) of follow-up. The recurrence rate was 6.1% (3/49) in the bowel preparation group and 3.8% (2/52) in the no-bowel-preparation group (P = 1.000). Although the number of patients is small in this study, our results showed that the mechanical bowel preparation does not cause a decrease in the rate of surgical wound infections after excision and primary closure in patients with chronic pilonidal sinus disease. W ide excision and a primary closure is a favorite surgical option in patients with chronic pilonidal sinus without signs of acute infection. This simple proce- dure, however, is associated with wound-related compli- cations such as failure of primary wound healing and late pilonidal recurrence. Wound infection is the major cause of failure of primary wound healing, occurring in up to 38.5% of patients with chronic pilonidal sinus undergoing surgical treatment. 1 Cultures of the wound infection commonly reveal colonic flora pathogens, mainly anaerobes, Escherichia coli, and other coliforms, as well as skin flora pathogens. 2 This may be ascribed to the proximity of the sacral region to the perineum and resultant contamination. Known high concentrations of bacteria in normal feces hypothetically pose a risk of infection of the surgical wound. Because wound infections after surgery for pilonidal si- nus are mainly caused by endogenous colonic bacteria, it seems logical that reducing the fecal load and the bacterial count in the lumen, in conjunction with tissue therapeutic Correspondence to: Cem Terzi, MD, VasfC ¸ nar Bouevard 13/4, Al- sancak, 35220 Izmir, Turkey, e-mail: cem.terzi@deu.edu.tr Ó World Journal of Surgery 2005 World J Surg (2005) 29: 1465–1471 Published Online: 30 September 2005 DOI: 10.1007/s00268-005-0007-z