الفهرس 
ANATOMY OF N ATAL CLEFTOnly 14 pages are availabe for public view
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Abstract
Background: Sacrococcygeal pilonidal disease is a very common anorectal problem that commonly arises in the hair follicles of the natal cleft of the sacrococcygeal area. Absence of the exact aetiology explains the diversity of treatment lines and failure of treatment options. Radical treatment has been wide excision of the chronic tracts with or without closure. The main problem is the high rate of recurrence, which can diminish the patient’s quality of life. Aim of the Work: is to compare between excision with primary closure versus Limberg flap for reconstruction of sacrococcygeal pilonidal disease as regard operative time, postoperative pain, hospital stay, duration of incapacity for work, postoperative complications (infection, flap edema, wound dehiscence), patient satisfaction, and postoperative recurrence. Patients and Methods: This prospective randomized clinical study has been performed on sixty patients with pilonidal sinus disease who were admitted to general surgery, plastic and reconstructive surgery departments in Ahmed Maher Teaching Hospital within the period between July to December 2017. There were two groups that patients were randomized into; group I had been treated with excision and off midline primary closure and this group included 30 patients. group II patients, had been treated with excision with Limberg rhomboid flap reconstruction and these group included 30 patients. Results: In our randomized control study. We aimed to compare the 2 groups (The off midline primary closure group vs the rhomboid flap group). This prospective RCT (randomized controlled trial) comprised 60 patients; 48 with 1ry &12 with recurrent sacrococcygeal pilonidal sinus disease. There were 52 males (86.6%) and eight females (13.3%).The mean age of patients was 24.1±6.7 (range, 15 -49) years. The mean BMI was 27.3±1.4 (range, 20-35) Kg/m2. Conclusion: Primary closure achieved much shorter operative time, hospital stay and return to work. Both techniques had similar complication rate with better cosmetic result on favour of primary closure. Hirsute body nature, diabetes mellitus, positive family history and previous pilonidal sinus surgery were recognized as significant risk factors for recurrence.