Comparative outcomes of primary closure, rhomboid flap reconstruction, and open excision for pilonidal sinus disease: a retrospective cohort study
- 1Department of General Surgery, Faculty of Medicine, Luxor University, Luxor, Egypt
- 2Department of General Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt
Abstract
Background: Pilonidal sinus disease (PSD) is a common surgical condition with multiple operative options, each associated with different recurrence and recovery profiles. Objective: We aimed to compare postoperative outcomes and recurrence rates of primary closure, rhomboid flap reconstruction, and open excision for PSD. Methods: This retrospective cohort study included 300 patients with primary or recurrent PSD treated with primary closure (n = 100), rhomboid flap reconstruction (n = 100), or open excision (n = 100). Demographic characteristics, operative variables, postoperative pain, length of hospital stay, wound healing time, time to return to work, postoperative complications, and recurrence were analyzed. Continuous variables were compared using the Kruskal–Wallis test, while categorical variables were analyzed using the χ2 test or the Fisher exact test. Risk ratios (RRs) and risk differences with 95% CIs were calculated for comparative outcomes, and multivariable logistic regression was performed to identify independent factors associated with recurrence. Results: Baseline demographic and clinical characteristics were comparable across the treatment groups. Operative time and early postoperative pain did not differ significantly according to disease status within each surgical technique. Open excision was associated with a significantly lower overall recurrence risk than primary closure (RR, 0.29; 95% CI, 0.11–0.77), including in the patients with primary disease. Rhomboid flap reconstruction demonstrated the shortest healing time (approximately 30 d), followed by primary closure (approximately 36 d), whereas open excision was associated with substantially longer healing (>75 d) and delayed return to work. Postoperative complication rates were similar among the techniques. Higher body mass index and positive family history were associated with increased recurrence. Conclusions: Surgical technique was a major determinant of recurrence and recovery outcomes in PSD. Open excision achieved the lowest recurrence risk, but required prolonged healing and delayed return to work. Rhomboid flap reconstruction provided faster recovery without a significant recurrence advantage over primary closure. These findings support individualized surgical decision-making based on recurrence risk, recovery expectations, and patient-related factors.
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BibTeX
@article{abdullah2026comparative,
title = {{Comparative outcomes of primary closure, rhomboid flap reconstruction, and open excision for pilonidal sinus disease: a retrospective cohort study}},
author = {Abdullah A. A. Abdullah and Mohamed T. M. Sayed},
journal = {Przegląd Lekarski Jagiellonian Medical Review},
year = {2026},
month = oct,
doi = {10.20452/jmr.2026.20065},
url = {https://doi.org/10.20452/jmr.2026.20065},
note = {CC BY},
}
RIS
TY - JOUR
TI - Comparative outcomes of primary closure, rhomboid flap reconstruction, and open excision for pilonidal sinus disease: a retrospective cohort study
AU - Abdullah A. A. Abdullah
AU - Mohamed T. M. Sayed
PY - 2026
DA - 2026/10/01
JO - Przegląd Lekarski Jagiellonian Medical Review
DO - 10.20452/jmr.2026.20065
UR - https://doi.org/10.20452/jmr.2026.20065
AB - Background: Pilonidal sinus disease (PSD) is a common surgical condition with multiple operative options, each associated with different recurrence and recovery profiles. Objective: We aimed to compare postoperative outcomes and recurrence rates of primary closure, rhomboid flap reconstruction, and open excision for PSD. Methods: This retrospective cohort study included 300 patients with primary or recurrent PSD treated with primary closure (n = 100), rhomboid flap reconstruction (n = 100), or open excision (n = 100). Demographic characteristics, operative variables, postoperative pain, length of hospital stay, wound healing time, time to return to work, postoperative complications, and recurrence were analyzed. Continuous variables were compared using the Kruskal–Wallis test, while categorical variables were analyzed using the χ2 test or the Fisher exact test. Risk ratios (RRs) and risk differences with 95% CIs were calculated for comparative outcomes, and multivariable logistic regression was performed to identify independent factors associated with recurrence. Results: Baseline demographic and clinical characteristics were comparable across the treatment groups. Operative time and early postoperative pain did not differ significantly according to disease status within each surgical technique. Open excision was associated with a significantly lower overall recurrence risk than primary closure (RR, 0.29; 95% CI, 0.11–0.77), including in the patients with primary disease. Rhomboid flap reconstruction demonstrated the shortest healing time (approximately 30 d), followed by primary closure (approximately 36 d), whereas open excision was associated with substantially longer healing (>75 d) and delayed return to work. Postoperative complication rates were similar among the techniques. Higher body mass index and positive family history were associated with increased recurrence. Conclusions: Surgical technique was a major determinant of recurrence and recovery outcomes in PSD. Open excision achieved the lowest recurrence risk, but required prolonged healing and delayed return to work. Rhomboid flap reconstruction provided faster recovery without a significant recurrence advantage over primary closure. These findings support individualized surgical decision-making based on recurrence risk, recovery expectations, and patient-related factors.
SN - 3072-0036
ER -