SCALPELLESS MINIMAL INVASIVE TECHNIQUE, 'LEAST IS BEST IN ALL WEATHERS' FOR SACRAL PILONIDAL SINUS, PART TWO – VERBUM SAT SAPIENTI EST. I.E., A WORD TO THE WISE IS SUFFICIENT

Background: Complication/recurrence free scalpelless ambulatory technique suitable in all types of sacral pilonidal sinus disease (SPSD). Random online search for relevant articles under pilonidal disease treatment, surgical anatomy with articles received from various colleagues and reference lists. The Hypothesis: Chronic SPSD (CSPSD) is two layered structure, deeper friendly fibrous connective tissue and unfriendly superficial endo/epithelial or granular tissue layer; while acute SPSD (ASPSD) consists of inflamed edematous wall of cavity with intracavitary necrotic detritus. THE Operative Technique: Ambulatory technique of ‘curettage’ of unfriendly superficial endo/epithelial or granulation tissue with detritus ‘only’ leaving friendly deeper fibrous tissue layer intact is advocated in CSPSD. ASPSD has detritus with inflamed wall of cavity treated by off midline tiny incision unless an opening is there with drainage and curetting. It can either heal fully or form CSPSD. Acute-on-chronic SPSD (A/CSPSD) is first dealt as ASPSD followed as CSPSD. Recurrent SPSD and/or postoperative wound complication can be either CSPSD or ASPSD dealt accordingly. An Exemplary Case: 50 year’s lady had total hysterectomy with bilateral salpingo- ovariectomy on 05/12/2000, developed wound problems and lower abdomen became sieve of sinuses despite several surgical attempts. This was curetted without anesthesia/analgesia in few ambulatory sessions with relief and recurrence free for over two decades. Discussion/Conclusion: SPSD is treated by multiple modalities without satisfaction that led surgeons search for conservative techniques, yet complications or recurrences are persisting. Simple curetting is ambulatory technique for all cases; repeated until full healing and easily reproducible; hence ‘least is best in all weathers’.