Professional Med J 2019;26(8):1306-1310. www.theprofesional.com PILONIDAL SINUS 1306 The Professional Medical Journal www.theprofesional.com COMPARISON OF PRIMARY REPAIR WITH HEALING BY SECONDARY INTENTION FOR THE TREATMENT OF PILONIDAL SINUS, AT A TERTIARY CARE HOSPITAL IN KARACHI, PAKISTAN. ORIGINAL PROF-0-3874 Muhammad Ghayasuddin 1 , Fareya Usmani 2 , Amtullah Sheikh 3 , Hamid Raza 4 ABSTRACT… The aim of our study is to assess the surgical outcome of healing by primary intention and compare it with primary repair for the treatment of pilonidal sinus. Study Design: Randomized controlled trial. Setting: Tertiary Care Center in Karachi Pakistan. Period: Two years from April 2015 to April 2017. Materials and Methods: 60 patients were divided into two groups by utilizing a Random Allocation Software. All the patients involved in the study signed a duly informed consent. The inclusion criteria were patients who presented to us with a pilonidal sinus and agreed to participate in the study. All the procedures were performed by the same team of surgeons. Patient follow up was bi-weekly at the outpatient. Data were collected in a predesigned proforma with various variables such as patient demographics, clinical fndings, treatment option used, postoperative results, complications (if any), healing time, length of hospital stay and time for a return to function among others. The data were analyzed using IBM SPSS version 21.0. A p value of less than 0.05 was considered to be statistically signifcant. Results: N= 60 patients were included in the study. There were n= 51 men (85%) and n= 9 women (15%). The mean age of patients in group A was 26.45 +/- 5.81 years and the mean age of participants in group B was 27.10 +/- 5.75 years. Symptoms lasted for 6.52 +/- 2.03 days, the most common presenting complaint was pain in 51.66% of patients followed by discharge in 40% and swelling in 33.33% respectively. The mean length of stay at the hospital for both the groups was 4.40 +/- 2.11 days (4.09 +/- 1.96 days in group A and 4.85 +/- 2.33 days in group B), mean time to return to normal functioning was 17.88 +/- 8.46 days (14.50 +/- 7.30 days in group A and 23.80 +/- 6.50 days in group B). The mean healing time postoperatively for both the groups was 39.98 +/- 24.46 days (21.90 +/- 10.15 days in group A and 67.30 +/- 9.09 days in group B. Early postoperative infection was found in n=7 (11.66%) patients, wound necrosis was found in n= 2 (3.33%) patients, and recurrence of the pilonidal sinus was found in n= 3 (5%) of the patients respectively. Conclusion: According to the results of our study primary closure technique provides better outcomes in terms of early return to functioning, shorter duration of wound healing and lower rates of wound infection as compared to excision and healing by secondary intention. Key words: Healing by Secondary Intention, Open Healing, Pilonidal Sinus, Primary Closure, Surgical Outcome. 1. MBBS, FCPS Assistant Professor & Head Department of General Surgery Hamdard College of Medicine and Dentistry. 2. MBBS, FCPS (General Surgery), Assistant Professor Department of General Surgery Sir Syed College for Medical Sciences for Girls. 3. MBBS, FRCS (Edinburgh), FRCS (Glasgow), FCPS. Consultant Department of General Surgery 4. MBBS, FCPS Assistant Professor Department of Anesthesiology & ICU, Liaquat University of Medical and Health Sciences Jamshoro. Correspondence Address: Dr. Hamid Raza B 15 Samanabad Bhitai Town Qasimabad Hyderabad, Pakistan. drhamidraza1@gmail.com Article received on: 17/07/2018 Accepted for publication: 15/12/2018 Received after proof reading: 31/07/2019 Article Citation: Ghayasuddin M, Usmani F, Sheikh A, Raza H. Comparison of primary repair with healing by secondary intention for the treatment of pilonidal sinus, at a Tertiary Care Hospital in Karachi, Pakistan. Professional Med J 2019; 26(8):1306-1310. DOI: 10.29309/TPMJ/2019.26.08.3874 INTRODUCTION Chronic trauma from hair follicles most commonly in the area of the natal cleft causes an abnormal cystic infolding to form this abnormal cystic infolding is called a pilonidal sinus. The incidence of pilonidal sinus is 26 per 100,000 and is more common in young males. 44% of the patients work at jobs which involve prolonged sitting and 38% report a positive family history of pilonidal sinus. 1 It presents as a swelling with abscess, cellulitis and sometimes with a discharging sinus. 2 The infected area is tender and the patient often reports fever as well. 3 The local tenderness causes hindrance to the patient’s daily activities and is an uncomfortable condition for the patient and it may hinder occupational performance as well. 4 In young adults, a quick and effective treatment of pilonidal sinus is required to minimize morbidity and return to functioning. Therefore, a surgeon’s priority is effective relief from symptoms and DOI: 10.29309/TPMJ/2019.26.08.3874