title: Sinusectomy for primary pilonidal sinus: less is more.
abstract: BACKGROUND
  Wide excision with secondary wound healing is a frequently performed surgical procedure for pilonidal sinus. This intervention requires general anesthesia and has a wound healing time of up to several months with a long time to return to work. Sinusectomy of the track is an alternative operation. We here describe the long-term outcome of 257 patients operated between 2001 and 2010.
  
  
  METHODS
  Sinusectomy consisted of a selective minimal invasive excision of the sinus after marking the track with methylene blue. Data were collected retrospectively with questionnaires and telephone survey. The main endpoints of the study were recurrence and time off work.
  
  
  RESULTS
  With a median follow-up of 3.6 years, the overall recurrence rate was 7%. The median time to return to work was 7 days. The proportion of sinusectomies performed under local anesthesia increased from 59% to 93%. Consistently, the proportion of patients treated in 1-day surgery setting increased from 53% to 93%. One-day surgery had a clear impact on time to return to work in uni- and multivariate analyses (HR 1.959 {1.224, 3.137}, P = .005).
  
  
  CONCLUSIONS
  Sinusectomy for pilonidal sinus can be performed with a low recurrence rate. An outpatient setting, including operations under local anesthesia, allows a fast return to normal activity. Sinusectomy should become the first choice for primary non-infected symptomatic pilonidal sinus.
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Christopher
authors.initials: C
authors.lastname: Soll
authors.forename: Daniel
authors.initials: D
authors.lastname: Dindo
authors.forename: Daniel
authors.initials: D
authors.lastname: Steinemann
authors.forename: Till
authors.initials: T
authors.lastname: Hauffe
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
authors.forename: Dieter
authors.initials: D
authors.lastname: Hahnloser
mesh_terms: D000038:Abscess / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D000772:Anesthesia, Local; D018572:Disease-Free Survival; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010864:Pilonidal Sinus / Q000534:rehabilitation / Q000601:surgery*; D012189:Retrospective Studies; D055502:Secondary Prevention; D018582:Sick Leave; D011795:Surveys and Questionnaires; D014945:Wound Healing; D055815:Young Adult