Publication:

Comparative study between excision with primary closure versus Z-plasty in the management of pilonidal sinus in the natal cleft

Background Pilonidal sinus disease (PSD) is a chronic inflammatory condition of the sacrococcygeal region with significant morbidity and recurrence. Although excision with primary closure is technically simple and facilitates faster recovery, off-midline techniques such as Z-plasty aim to reduce wound complications and recurrence by altering natal cleft anatomy. This study compares outcomes between primary closure and Z-plasty in the management of pilonidal sinus.

Methods A randomized controlled study was conducted in the Department of General Surgery, Mahatma Gandhi Medical College and Hospital, Jaipur, from March 2024 to January 2026. Patients aged 18-75 years diagnosed with pilonidal sinus were allocated to excision with primary closure or Z-plasty. Demographic variables, intraoperative parameters, and postoperative outcomes including wound infection, flap necrosis, and recurrence were analyzed. Statistical analysis was performed using SPSS v26.0, with p<0.05 considered significant.

Results Baseline characteristics were comparable between groups. Operative time was significantly shorter in the primary closure group (49.07±12.79 min) compared to Z-plasty (66.80±14.56 min; p<0.001). Wound length was also significantly less with primary closure (p<0.001), while blood loss was similar (p=0.260). Early postoperative infection was more frequent in the primary closure group, though not statistically significant. No flap necrosis was observed. At 6 months, recurrence occurred in 3.3% of the primary closure group and none in the Z-plasty group (p=1.000).

Conclusions Both techniques are safe and effective for sacrococcygeal pilonidal sinus. Primary closure offers shorter operative time, whereas Z-plasty shows a favorable trend toward reduced postoperative infection and recurrence. Procedure selection should be individualized based on patient and surgical factors.