Karydakis Flap as a Simple Surgical Method in the Treatment of Pilonidal Disease V.S Open Surgery with Average 30-month-follow up: A Clinical Trial.

Background: Two common types of treatment for pilonidal disease include open and closed surgery. Closed surgery can be done with a Karydakis flap. The aim of this study was to compare the outcomes of pilonidal sinus management between Karydakis flap and open surgery.

Methods: This clinical trial was conducted on patients diagnosed with pilonidal sinus referred to the surgical clinics of Imam Reza Hospital in Mashhad from 2021 to 2022. Patients were nonrandomly divided into closed and open surgical treatment groups. Demographic information was collected from patients' medical records, the severity of the disease was obtained from operation notes, and time to recovery and time to return to work was obtained during follow-up visits. Pain intensity was collected on the first, tenth, and one month after surgery. To describe the data, the number and percentage for qualitative variables and mean± standard deviation for quantitative variables have been used. Normality of variables investigated by Shapiro-Wilk test. A comparison of quantitative variables was done with an independent sample t-test. The comparison of pain changes within each group was done using Friedman's test. A comparison of qualitative variables in two groups was done with the Chi-Square test. The significance level of the tests is 5%, and the software used is SPSS25.

Results: Sixty patients (43 men and 17 women) with a mean age of 23.90 ± 6.57 years were included. The frequency of wound paresthesia (P=0.023), and recovery delay (P<0.001) was lower in closed surgery compared to the open surgery group, and the frequency of discharge and superficial SSI (Surgical Site Infection) was higher in closed surgery (P=0.038). Pain severity decreased during the study (P=0.029) among the closed surgery group.

Conclusion: Closed surgical treatment was associated with shorter hospitalization time and return to work time than open surgery. Therefore, Karydakis flap can be a simple and acceptable method for the treatment of pilonidal sinus.