The effect of obesity on the results of Karydakis technique for the management of chronic pilonidal sinus.

Background And Aims: Body mass index (BMI) was assessed as an objective indicator of obesity to determine whether it has an effect on the results of the Karydakis technique for managing chronic pilonidal sinus.

Patients And Methods: The prospective study included 41 consecutive patients with chronic pilonidal sinus categorized according to their BMI as obese (BMI >/=26.5, n=32) or nonobese (BMI <26.5, n=9). Patient data included demographics, symptoms, duration of disease, previous management, postoperative course, morbidity, and recurrence. All patients were treated by the Karydakis flap and were discharged on the 2nd-4th day postoperatively. Patients were followed-up for a mean of 25.7 months (range 3-38).

Results: The mean operating time was significantly longer in obese patients, and there was a trend to mean hospital stay being longer in them than in nonobese patients. Minor postoperative complications were encountered in four patients: two in the obese group had a seroma that resolved in 2 weeks with conservative measures, and two others, one in each group, suffered from wound infection that resulted in partial wound dehiscence in the obese patient but healed with secondary intention after 20 days without prolonging hospital stay. In the obese group the mean BMI of patients with complications (excluding recurrence) was significantly higher than that in patients without complications. Recurrence, at 13 months postoperatively, was observed in only one patient (3.1%) who had a BMI of 32.2.

Conclusion: These findings show that (a) the Karydakis procedure for managing chronic pilonidal sinus in obese patients is easy to perform, has a fast healing time, short hospital stay, rapid return to work, and a low recurrence rate, (b) the results are similar between nonobese and obese patients, with no recurrence seen in these patients, and (c) complications occur in patients with a BMI greater than 30; in such patients a dietary regimen before operation is advisable, and inserting a suction drain during operation is recommended to avoid seroma formation.