Clinical Report: Seagull Technique for Pilonidal Sinus Surgical Management

Overview

The seagull excision technique for pilonidal sinus disease demonstrated significantly lower surgical site infection and wound complication rates compared to the Bascom cleft lift, with comparable recurrence, pain, and cosmetic outcomes. This advancement flap method offers a tension-free, off-midline closure with enhanced tissue mobilization.

Background

Pilonidal sinus disease is a chronic infection affecting the natal cleft, predominantly in young men, causing pain, swelling, and discharge. Surgical management aims to excise diseased tissue and minimize recurrence and complications. Off-midline closure techniques like Bascom’s cleft lift and Karydakis procedures have improved outcomes by flattening the natal cleft and reducing wound tension. The seagull technique is a novel advancement flap method designed to further lateralize the incision and reduce local complications.

Data Highlights

Key Findings

• The seagull technique significantly reduced surgical site infection rates to 2% compared to the cleft lift.
• Overall wound complications were significantly lower with the seagull excision (12%).
• Recurrence rates were low and comparable between seagull (4%) and cleft lift (6%) groups.
• Postoperative pain and cosmetic satisfaction scores did not differ significantly between techniques.
• The seagull technique allows for greater lateralization of the incision, reducing tension and displacement from the intergluteal sulcus and anal verge.
• Surgeons experienced in advancement flap procedures can achieve proficiency with the seagull technique after approximately 7–8 cases.

Clinical Implications

The seagull excision technique offers a safe and effective surgical option for pilonidal sinus disease, particularly in recurrent or complex cases. Its design facilitates tension-free, off-midline closure that reduces infection and wound complications without compromising recurrence or cosmetic outcomes. Surgeons familiar with flap procedures can adopt this technique to potentially improve patient recovery and reduce postoperative morbidity.

Conclusion

The seagull technique is a promising advancement flap method for pilonidal sinus surgery, demonstrating lower complication rates while maintaining comparable recurrence and patient satisfaction to established cleft lift procedures. It represents a valuable addition to the surgical armamentarium for managing this challenging condition.

References

1. Tezel et al. 2024 -- The Seagull Technique for Surgical Management of Pilonidal Sinus Disease