CLINICAL OUTCOMES OF PRIMARY CLOSURE IN THE MANAGEMENT OF CHRONIC PILONIDAL SINUS DISEASE

Background: Chronic pilonidal sinus disease is a common inflammatory condition of the natal cleft that predominantly affects young adults and is associated with considerable morbidity, reduced quality of life, and loss of productivity. Excision with primary closure is widely performed because it facilitates faster wound healing and earlier return to normal activities; however, postoperative complications and recurrence remain important concerns. Objective: To evaluate the clinical outcomes of primary closure following excision of chronic pilonidal sinus disease and to identify factors associated with adverse postoperative outcomes. Study Design: Hospital-based observational study. Setting: Department of Surgery, a tertiary care hospital. Duration of Study: January 2025 to June 2025. Methods: This study included 70 patients diagnosed with chronic pilonidal sinus disease who underwent surgical excision followed by primary closure. Patients with acute pilonidal abscess, uncontrolled diabetes mellitus, immunosuppression, inflammatory bowel disease, anorectal fistula, hidradenitis suppurativa, previous flap surgery, or suspected malignancy were excluded. Demographic, clinical, operative, and postoperative data were recorded prospectively. Patients were followed at 1, 2, 4, 8, and 12 weeks after surgery. The primary outcome was successful wound healing. Secondary outcomes included surgical site infection, seroma, hematoma, wound dehiscence, delayed healing, recurrence, time to return to routine activities, return to work or study, and patient satisfaction. Data were analyzed using SPSS version 26. Descriptive statistics were used to summarize patient characteristics and outcomes, while multivariable logistic regression analysis was performed to identify independent predictors of adverse postoperative outcomes. A p-value of <0.05 was considered statistically significant. Results: The mean age of the patients was 26.4 ± 6.8 years, and 58 (82.9%) were male. Complete primary wound healing without clinically significant complications was achieved in 55 patients (78.6%). Postoperative wound complications occurred in 15 patients (21.4%). Surgical site infection was observed in 7 (10.0%) patients, seroma in 5 (7.1%), partial wound dehiscence in 6 (8.6%), complete wound dehiscence in 2 (2.9%), and delayed wound healing beyond four weeks in 8 (11.4%). Recurrence during the follow-up period was observed in 4 patients (5.7%). The mean hospital stay was 1.7 ± 0.8 days, mean time to return to routine activities was 11.6 ± 4.2 days, and mean time to return to work or study was 15.3 ± 5.1 days. Overall, 61 patients (87.1%) reported good or excellent satisfaction with the procedure. Multivariable logistic regression identified smoking history, obesity, and the presence of three or more sinus openings as independent predictors of adverse postoperative outcomes. Conclusion: Primary closure following excision of chronic pilonidal sinus disease demonstrated satisfactory short-term outcomes, with successful wound healing in the majority of patients, low recurrence rates, short hospital stay, and high patient satisfaction. Smoking, obesity, and multiple sinus openings were significant predictors of adverse postoperative outcomes. Optimization of modifiable risk factors and meticulous surgical technique may further improve treatment outcomes.