Abstract

Aims: Pilonidal disease (PD) is a debilitating illness that remains a challenging surgical condition. We aim to evaluate the relationship between blood loss and patient factors in those who underwent the Anderson Modified Karydakis Flap.

Methods: Consecutive patients who underwent the Anderson Modified Karydakis Flap from a prospective database were evaluated. Patient factors analyzed were age, gender, smoking status, body mass index, and American Society of Anesthesiologists Score. Patient's history of PD such as location of disease in relation to the navicular area, number of primary sinuses, secondary fistulas and dimensions of the excised area were also recorded.

Results: Twenty patients (Female =3, Male =17) were included in the study with a mean age of 25.7 years (range=16-42 years), The average amount of blood loss was 168g +/-48.3 g (95% CI). Patient factors associated with a greater operative blood loss included the presence of 4 or more pilonidal sinuses (mean blood loss in ≤ 3 sinuses 136g +/- 52g vs ≥ 4 sinuses 217g +/- 95g, 95% CI, p value 0.08), gender (mean blood loss in males 184g +/- 53g vs females 80g +/- 78g, 95% CI, p value 0.11), and secondary fistula formation (mean blood loss with secondary fistulas 188g +/- 69g vs without 109g +/-55g, 95% CI, p value 0.15).

Conclusion: Gender (males), the presence of more than 3 primary sinuses, and secondary fistula formation may predict a higher operative blood loss. This may have implications for staging the disease. Thinner patients with less excised tissue might bleed more.  The reasons for these observations are unclear.