✦ EXCISION WITH DIRECT CLOSURE

Excision with Primary Closure

Q: Why is primary closure not always recommended?

Midline primary closure has higher recurrence rates than off-midline flap techniques because it does not address the deep natal cleft. It is reserved for limited disease where it offers the best balance for that patient.

Q: How quickly will I recover?

Most patients return to office work within a week. Avoiding prolonged sitting and heavy strain for 2–3 weeks supports complete healing.

Q: What if the wound opens up?

If the wound partially opens, it can be managed with simple dressings and will heal by secondary intention. In some cases, conversion to open healing or another technique may be needed.

Q: Will my pilonidal sinus come back?

Recurrence is more common with simple midline closure than with off-midline techniques. Good hygiene, hair removal in the area, and avoiding prolonged sitting reduce the chance of recurrence.

Complete surgical removal of the pilonidal sinus followed by direct closure of the wound — single-stage procedure with quicker recovery in carefully selected cases.

30–60 min PROCEDURE

Day Care – 1 Day HOSPITAL STAY

>80% SUCCESS RATE

1 Week RETURN TO WORK

What is Excision with Primary Closure?

Excision with Primary Closure is a single-stage technique for pilonidal sinus in which all diseased tissue is excised and the wound is sutured closed directly. While faster healing is the main advantage, this technique has higher recurrence rates than off-midline flap procedures, and is therefore reserved for selected primary cases with limited disease. Dr. Tejasree Vengala carefully evaluates each patient at Lux Hospitals, Hyderabad, and recommends primary closure only when it offers the best balance of recovery and long-term outcome.

Suitable for select patients with limited primary pilonidal disease, those with shallow natal clefts, and where the surgeon assesses that midline primary closure is appropriate.

How the Procedure Works

Anaesthesia & Examination

Surgery is performed under spinal or general anaesthesia. The disease is mapped using probes.

Sinus Excision

The entire pilonidal sinus and surrounding unhealthy tissue are excised completely down to healthy fat or fascia.

Haemostasis

Any bleeding points are carefully controlled to prevent post-operative haematoma.

Layered Closure

The wound is closed in layers with absorbable sutures for the deeper tissue, and skin closed with absorbable subcuticular sutures.

Discharge & Recovery

A simple dressing is applied. Most patients are discharged the same day or next with simple wound care instructions.

Outcomes

30–60 minDURATION

Day Care – 1 DayHOSPITAL STAY

>80%SUCCESS RATE

2–3 WeeksFULL HEALING

Who Needs This Treatment?

→Single-stage procedure with quicker recovery
→Day-care or short-stay surgery
→Faster return to office work
→Simpler wound care than open healing
→Suitable for select limited primary disease
→Avoids weeks of dressings

Primary closure has its place — but only in carefully chosen patients with limited disease and favourable anatomy. Recurrence is the real enemy in pilonidal disease, and choosing the right operation for the right patient is what protects them long term.

— — Dr. Tejasree Vengala, Consultant Proctologist & Laparoscopic Surgeon, Lux Hospitals, Hyderabad

Common Questions

Frequently Asked Questions

Why is primary closure not always recommended?+

How quickly will I recover?+

What if the wound opens up?+

Will my pilonidal sinus come back?+

Not sure which treatment is right for you?

Book a consultation with Dr. Tejasree Vengala and get a personalised treatment plan.

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