Comparison between drainage and curettage in the treatment of acute pilonidal abscess

OBJECTIVE: Simple incision and drainage of a sacrococcygeal pilonidal abscess is associated with more than 40% recurrence. Definitive treatment of the chronic pilonidal sinus is recommended 4-8 weeks after incision and drainage. The present prospective clinical trial study was designed to compare the curettage and drainage of the acute abscess of the pilonidal sinus. Hospital stay, wound healing, and recurrence were noted. METHODS: This study was performed in Kerman University of Medical Sciences and Health Services, Iran from March 1999 to May 2004. One hundred and fifty patients who had an acute sacrococcygeal pilonidal abscess were randomly assigned to receive one of 2 drainage or curettage surgical procedures. All the surgical wounds were laid open, and daily sitting in a warm tub together with douche was recommended postoperatively. The 2 treatment modalities were compared in terms of the wound healing period, hospital stay, and postoperative complications using Chi-square and Student-t test. Patients with completed wound repair, consisting of 72 subjects in the curettage and 59 subjects in the drainage groups, were followed up to 65 months for the detection of recurrence by means of life table and Gehan s generalized Wilcoxon test. RESULTS: Most patients spent only one day in the hospital, with initial healing occurring in <2 months. Healing process in the curettage cases occurred more quickly than the drainage patients (96% versus 78.7%, p<0.001). In all cases, the treatment relieved symptoms, and all the patients returned to work 7-10 days after the treatment. Three patients in the curettage group (4%) and 16 patients in the drainage group (21.3%) did not complete wound healing within 10 weeks (p<0.001). Recurrence of disease was encountered significantly less in the curettage subjects than the drainage ones (11% versus 42%) (p<0.001). CONCLUSION: Unroofing and curettage, which is associated with higher rates of healing and lower rates of recurrence, may be the treatment of choice in the acute pilonidal abscess.