eP802 - Case Series Presentation Of A Traditional Minimal Sinectomy With Medicated Cutting Seton (Ksharasutra) In The Management Of Pilonidal Sinus

Image or Table (Do Not add text here):

Purpose/Background: Piloniddal Sinus [PNS] is a common condition managed with surgical interventions, but has a high recurrence rate of up to 40%, depending on the surgical methods employed . Traditional Indian system of medicine (Ayurveda) advocates a simple but effective method of minimal sinectomy using medicated alkaline seton ( Ksharasutra) for successful management of PNS.
The purpose of this study is to evaluate efficacy and safety of minimal sinectomy using medicated alkaline seton (ksharasutra) in cases of PNS and to compare to same with conventional surgical methods.Methods/Interventions: This is a case series presentation. A total of 145 surgical cases managed with traditional minimal sinectomy using medicated cutting seton [Ksharasutra ] over the last 10 years [2013-2023] were assessed primarily for recurrence rate, the number of days required for recovery, no of days of hospital stay, no of working days lost. The surgical method (carried out under general -GA/spinal anesthesia-SA) employed (minimal sinectomy) making a small incision in the natal region/ at the site of the opening followed by hair extraction (if it is there ) and further tract scooped, created another opening . Medicated alkaline seton (Kshaarsutra) was passed through the tract and both the ends were tied. The seton was changed at regular intervals till the complete excision of the tract. All patients were followed regularly for 6 months and again were called telephonically after 3 years and 5 years.Results/Outcomes: A total of 115 males (79.31%) and 30 females (20.69%) between the age of 17 years to 45 years (mean age 21.22 ±8.13) having an average body weight of 69.12 ±10.23 and BMI of 25.32 ±4.31 suffering from PNS for an average duration of 13.12 ±4.56 months were considered for assessment. The average length of the sinus tract was 5.15-±2.02 cm. There were 42 patients (28.96%) who had PNS recurrence post surgery, while the other 103 patients (70.03%) were fresh cases. Of the 145 patients 131 patients (90.34%) were discharged within 8 to 10 hours (operated under GA) while the other 14 patients (9.65%) were discharged from the hospital within 24 hours (operated under SA). The average time for surgery was 21.20 ±4.34 minutes. Medicated Seton change was done on weekly basis (7 days) and the requirement of Seton change was 5.25 ±2.34 times for the entire duration of treatment. None of the patients had any post surgical complications. The average complete healing time was observed to be 35.45 ±10.23 days. Of the 145 patients, 143 patients (98.62%) did not have recurrence while 2 (1.37%) experienced recurrence.Conclusion/

Discussion: The study concludes that traditional Minimal sinectomy method using medicated alkaline seton (Ksharasutra ) helps to avoid recurrence of pilonidal sinus requiring lesser number of days of hospitalization and minimal complications.

Key-Words: Ksharasutra (medicated cutting seton) , Pilonidal sinus, setonThe image shows , pre op, immediately after surgery & after six months of complete healing of the woundPatients mri image in various views