Comparative Clinical Evaluation Of Ksharasutra (Indian Seton 800 BCE) With Surgical Excision In The Management Of Pilonidal Sinus - A Review

Introduction: Pilonidal sinus is a common disease that mostly affects young people. Although various surgical techniques have been described for treating sacrococcygeal pilonidal disease (SPD), controversy still exists as to the best surgical technique. The purpose of this study was to compare the efficiency and short-term and long-term results of the Ksharasutra technique (Indian seton 800 BCE) with that of surgical excision.Methods: In this prospective randomized study, 69 patients with SPD were recruited to undergo either the Ksharasutra (Indian seton) (n = 39) or surgical excision (n = 30) between September 2010 and September 2016.Surgical excision. The operation was carried out with patients in the prone position. Shaving of the operative area was performed just before the operation, and the skin was cleaned with an antiseptic solution. Local anaesthesia was applied in the subcutaneous skin around the orifices using 2% lidocaine solution with adrenaline. Entrance to the sinus opening was made with a small incision. The incision technique was preferred to ensure better communication of the openings. Minimal bleeding was stopped using compression. Curettage was used for cleaning all cavities and tracts from hair, debris, and granulation tissue. The cavity was packed with a sterile dressing.Ksharasutra (Indian seton) application: with the above asceptic procedure, the pilonidal sinus track was probed from the external opening to the weak point of the track near by anal canal and thus was tied with ksharasutra (Indian seton). Every week the thread was changed until the sinus healed.Results: The cutting time in Ksharasutra (Indian seton), the visual analogue scale score for postoperative pain, discharge and wound healing were assessed and subjected for statistical evaluation. This showed Ksharasutra (Indian seton) was superior to surgical excision with p < 0.01.Conclusion: This clinical trial showed the Ksharasutra (Indian seton 800 BCE) to be superior to surgical excision. The statistical evaluation also confirmed the same with the p value of 0.01 in all parameters