Pilonidal disease in Singapore: Clinical features and management

Background: Pilonidal disease has not been well documented in Asian people. The aims of the present study were to investigate any variations in the clinical features and effectiveness of various surgical treatments in such a population. Methods: A prospectively collected computerized database of 61 consecutive patients admitted to a specialist colorectal unit over a 9-year period was studied. The five methods of surgical treatment used during this period (incision and drainage; laying open; marsupialization; primary closure; and the flap procedure) were compared. Results: There were 38 men and 23 women with a mean age of 27 +/- 1.02 years. Pilonidal disease was significantly more common among the Indian people (52.5% of patients) than the other ethnic races in the Singaporean community (P < 0.001). Chronic discharging sinuses were the most common presentation (93.4%). There were no differences between the various surgical techniques employed with regard to the time required for wound healing (mean: 48 +/- 21 days) and recurrence rates (4/61, 6.6%). Wound dehiscence after primary wound closure (10%) and flap procedures (42%) meant that the overall healing rate was not faster than when the wound was just laid open. Furthermore, flap procedures required a longer hospitalization than other procedures (P = 0.005). Conclusion: Pilonidal disease was more common among Indian people, the more hirsute among the Singaporean population. Primary closure and flap procedure did not improve overall wound healing because of dehiscence.