Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World Journal of Gastrointestinal Surgery. Sep 27, 2015; 7(9): 214-218
Published online Sep 27, 2015. doi: 10.4240/wjgs.v7.i9.214
Laying open (deroofing) and curettage under local anesthesia for pilonidal disease: An outpatient procedure
Pankaj Garg, Mahak Garg, Vikas Gupta, Sudhir Kumar Mehta, Paryush Lakhtaria
Pankaj Garg, Mahak Garg, Department of Colorectal Surgery, Indus Super Specialty Hospital, Mohali 160055, Punjab, India
Pankaj Garg, Mahak Garg, Sudhir Kumar Mehta, Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula, Haryana 134113, India
Vikas Gupta, Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Paryush Lakhtaria, Department of Colorectal Surgery, New York Hospital Medical Centre of Queens, Colorectal Surgery, New York, NY 10461, United States
Author contributions: Garg P thought of the concept; Garg P, Garg M, Gupta V, Mehta SK and Lakhtaria P designed the study, acquired the data, analyzed it, drafted, revised and finally approved the draft; Garg P submitted the manuscript.
Institutional review board statement: The study was reviewed and approved by the Indus Hospital Ethical Committee.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None of the authors have received fees for serving as a speaker or as a position (such as consultant and/or an advisory board member) which could have a conflict of interest with this study. None of the authors have received research funding from any organization or individual. None of the authors is an employee of an organization, or owns stocks and/or shares in name of an organization which has potential conflict of interest with the study.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at drgargpankaj@yahoo.com. No consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Pankaj Garg, Department of Colorectal Surgery, Garg Fistula Research Institute, Sector-15, Panchkula, Haryana 134113, India. drgargpankaj@yahoo.com
Telephone: +91-950-1011000 Fax: +91-172-2594556
Received: May 4, 2015
Peer-review started: May 5, 2015
First decision: June 3, 2015
Revised: June 10, 2015
Accepted: July 21, 2015
Article in press: July 23, 2015
Published online: September 27, 2015
Processing time: 147 Days and 19.7 Hours
Abstract

AIM: To test the efficacy of lay open (deroofing, not excision) with curettage under local anesthesia (LOCULA) for pilonidal sinus as an outpatient procedure.

METHODS: LOCULA procedure was done for all types of pilonidal disease. The primary outcome measure was cure rate. The secondary outcome measures were hospital stay, operating time, return to work, healing time and complication rate.

RESULTS: Thirty-three (M/F-30/3, mean age-23.4 ± 5.8 years) consecutive patients were operated and followed for 24 mo (6-46 mo). Eleven were pilonidal abscess and 22 were chronic pilonidal disease. Six had recurrent disease. Operating time and the hospital stay was 22.3 ± 5.6 min and 63.8 ± 22.3 min respectively. The patients could resume normal work in 4.3 ± 3.2 d and the healing time was 42.9 ± 8.1 d. Thirty (93.8%) patients had complete resolution of the disease and two (6.2%) had a recurrence. Both the recurrences happened in patients who had complete healing but ignored the prescribed recommendations. One out of these got cured after getting operated again with the same procedure. Thus the overall success rate of this procedure was 96.9%.

CONCLUSION: Lay open (deroofing) with curettage procedure under local anesthesia is an effective procedure to treat both simple and complicated pilonidal sinus and abscess. It is a simple procedure, has a high cure rate (up to 97%), doesn’t require admission and is associated with minimal morbidity and scarring. Considering the distinct advantages, this procedure has the potential to become the first line procedure for treating pilonidal disease.

Keywords: Pilonidal; Lay open; Deroofing; Curettage; Sinus

Core tip: This study demonstrates that lay open with curettage under local anesthesia is a simple procedure to treat simple and complicated pilonidal disease. It is quite effective with high cure rate and can be done as an outpatient procedure. Apart from this, this procedure has distinct advantages - can be learnt easily, less time to operate, almost pain free, back to work faster, minimum incision, simple dressings after operation, small scar, minimal change in body shape, economically better and easy to repeat after a recurrence. This procedure can potentially become the frontline operation for all types of pilonidal disease.