title: Randomized prospective comparison of midline and off-midline closure techniques in pilonidal sinus surgery.
abstract: BACKGROUND
  Pilonidal sinus is a chronic inflammatory disorder of the intergluteal sulcus. The disorder often negatively affects patients' quality of life, and there are numerous possible methods of operative treatment for pilonidal sinus. The aim of our study was to compare the results of 3 different operative procedures (tension-free primary closure, Limberg flap, and Karydakis technique) used in the treatment of pilonidal disease.
  
  
  METHODS
  The study was conducted via a prospective randomized design. The patients were randomized into 3 groups via a closed envelope method. Patients were included in the study after admission to our clinic with pilonidal sinus disease and operative treatment already were planned. The 2 main outcomes of the study were early complications from the methods used and later recurrences of the disease.
  
  
  RESULTS
  A total of 150 patients were included in the study, and the groups were similar in terms of age, sex, and American Society of Anesthesiologists scores. The median follow-up time of the study was 24.2 months (range, 18.5-34.27) postsurgery. The recurrence rates were 6% for both the Limberg and Karydakis groups and 4% for the tension-free primary closure group. Therefore, there was no substantial difference in the recurrence rates.
  
  
  CONCLUSIONS
  The search for an ideal treatment modality for pilonidal sinus disease is still ongoing. The main conclusion of our study is that a tension-free healing side is much more important than a midline suture line. Also, tension-free primary closure is as effective as a flap procedure, and it is also easier to perform.
authors.affiliation: Department of General Surgery, Sarıkaya State Hospital, Yozgat, Turkey. Electronic address: drbarissevinc@gmail.com.
authors.forename: Barış
authors.initials: B
authors.lastname: Sevinç
authors.affiliation: Department of General Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Karahan
authors.affiliation: Department of General Surgery, Faculty of Medicine, Mevlana University, Konya, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Okuş
authors.affiliation: Department of General Surgery, Malazgirt State Hospital, Mus, Turkey.
authors.forename: Serden
authors.initials: S
authors.lastname: Ay
authors.affiliation: Department of General Surgery, Konya Training and Research Hospital, Konya, Turkey.
authors.forename: Nergis
authors.initials: N
authors.lastname: Aksoy
authors.affiliation: Department of General Surgery, Konya Training and Research Hospital, Konya, Turkey.
authors.forename: Gürcan
authors.initials: G
authors.lastname: Şimşek
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D010864:Pilonidal Sinus / Q000175:diagnosis / Q000601:surgery*; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation*; D013530:Surgical Wound Infection / Q000503:physiopathology / Q000628:therapy; D013536:Suture Techniques; D014421:Turkey; D058106:Wound Closure Techniques; D014945:Wound Healing / Q000502:physiology*; D055815:Young Adult