Closure of pilonidal sinus by the modified off-midline method in the Kurdistan Region, Iraq

Background and objective: Sacrococcygeal pilonidal sinus disease is an inflammation in the natal cleft of the sacrococcygeal region, which develops to abscesses and sinus formation. The incidence of sacrococcygeal pilonidal sinus disease notably increased in the last 50 years, however, there is no accurate data about the frequency of the disease and incidence rate among the Kurdistan region-Iraq population. In this study, we have introduced a simplified off-midline surgical technique without flap reconstruction. The main objective was to find out the rate of postoperative complications, hospitalization time, the recovery time to daily activity and work, and esthetic satisfaction. Methods: This study was conducted in Kurdistan region, Iraq from March 2016 to September 2019 on individuals suffering from sacrococcygeal pilonidal sinus disease. Two hundred ninety-eight individuals from different gender and ages enrolled for operation by modified simple closure of sacrococcygeal pilonidal sinus disease. Results: The median age of the patients was 22.4 years (24.1 male and 20.5 female). 33.9% of our patients were female students (P = 0.002). Most of the patients (89.2%) did not have postoperative complications. However, wound infection was detected in 3.0% of patients. Sacrococcygeal pilonidal sinus disease recurred in 5.4% of patients; furthermore, the disease recurred twice in 7 females (2.4%). All the recurrences happened in the patients that had a severe form of sacrococcygeal pilonidal sinus disease. Conclusion: Significant number of our patients were students, and female students for unclear reasons are at risk in our region. The post-surgical complications only occur in patients with a severe form of sacrococcygeal pilonidal sinus disease. In terms of simplicity, hospitalization time, the recovery time to daily activity and work, esthetic satisfaction, and post-surgical complications, our surgery technique was superior to other open wound surgery such as V-Y Advancement flap, and Karydakis flap.