Effects of a tissue sealing-cutting device versus monopolar electrocautery on early pilonidal wound healing: a prospective randomized controlled trial.

Parlakgumus, Alper; Ezer, Ali; Caliskan, Kenan; Emeksiz, Servet; Karakaya, Jale; Colakoglu, Tamer; Belli, Sedat; Yildirim, Sedat

BACKGROUND Monopolar electrocauterization produces thermal effects on neighboring tissues, causing tissue damage. Recently, tissue sealing-cutting devices, which are easy to use and achieve simultaneous selective sealing and cutting with less production of heat, have been used. OBJECTIVE The aim of this study was to investigate the effects of a tissue sealing-cutting device vs monopolar electrocautery on wound healing in the early postoperative period after pilonidal sinus surgery. DESIGN This study was a prospective randomized clinical trial. SETTING This study was conducted at Military Hospital, Eskisehir, Turkey. PATIENTS In total, 128 patients with chronic pilonidal disease were randomly assigned into 2 clinically comparable groups between December 2009 and June 2010. INTERVENTION Pilonidal sinus excision was performed with monopolar electrocautery in the control group (n = 64) and with a tissue sealing-cutting device in the study group (n = 64). Data regarding wound healing, demographic variables, history, physical examination findings, defect dimensions, and scores for a visual analog scale were recorded. MAIN OUTCOME MEASURES The main outcomes measured were surgical site infection, early wound failure (dehiscence), and unhealed wound rate. RESULTS : Wound infection and dehiscence rates were significantly lower (P = .01 and .02), but the duration of surgery was significantly longer (P < .01) in the tissue sealing-cutting group. The unhealed wound rate was 12.5% in the electrocautery group and 4.7% in the tissue sealing-cutting group (P = .01). When the distance from the lowest margin to the anus was 5 cm or less, wound infection and dehiscence rates were lower in the tissue sealing-cutting group (P < .01 and .03). LIMITATIONS We could not obtain data regarding the cost-effectiveness of the instruments. CONCLUSIONS A tissue sealing-cutting device in pilonidal sinus surgery yields better wound healing than monopolar electrocautery.