Comparison between outcomes of Marsupialization and Lay Open Techniques in the Management of Pilonidal Sinus

Background: Different surgical strategies emerged as a pilonidal disease (PNS) became more prevalent. There is considerable debate over the best surgical management. Objective This study aimed to compare the outcomes of marsupialization (MP) vs laying open (LO) techniques in studied patients. Patients and Methods This study was conducted on 200 consecutive patients with chronic PNS who operated either the excision and MP technique (Group 1, no.=100) or excision and LO technique (Group 2, no.=100) in Hospital, Sulaimaniyah, Iraq, from January 2012 to January 2022. The patients' socio-demographics, perioperative data, complications and recurrences were collected using a well-designed, self-prepared questionnaire. Also, the patient’s data was evaluated after surgery regarding postoperative pain, satisfaction, healing and dressing time, incapacity to work and overall postoperative complications. Results Most patients were aged 20–29 years (40.5%), males (71.5%), had working hours for > 6 hours (57%), had no family history of PNS (86.0%), presented with pain (44.83%), and with hirsutism (41.5%). For postoperative pain, 39.5% of the patients had severe pain, 38% had moderate, and 22.5% had mild, with highly significant differences (p = 0.000) between both studied groups. Concerning patient postoperative satisfaction, most patients (32.5%) had good and least had excellent (6.0%) satisfaction, with highly significant differences (p = 0.000) between both studied groups. Moreover, for the association between the outcomes of both used techniques, a substantial correlation between both groups was found for incapacity for regular daily activity (p = 0.046), healing time (p = 0.000), dressing time (p = 0.000), infection, dehiscence, bleeding and recurrence (p = 0.045). Conclusion MP was the preferred technique over LO in managing postoperative patient satisfaction, pain severity, duration of healing, and dressing time, as it had fewer complications with less recurrence rate.