Gastrointestinal surgery: pilonidal sinus: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Gastrointestinal surgery: pilonidal sinus

Sample item

A young hirsute man has recurrent discharge from midline pits in the natal cleft. Which is the best surgical principle for chronic disease?

AAntibiotics alone for recurrent diseaseBMidline primary closure after wide excisionCAnal sphincterotomyDExcision with off-midline flap closure such as Limberg or Karydakis

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Excision with off-midline flap closure such as Limberg or Karydakis

Midline wounds in the natal cleft heal poorly, so flattening the cleft with an off-midline flap lowers recurrence. Acute abscesses are drained first. Hair removal helps prevent relapse.

Option by option

A. Antibiotics alone for recurrent disease
Antibiotics do not remove the sinus tracts.
B. Midline primary closure after wide excision
Midline closure often breaks down.
C. Anal sphincterotomy
Sphincterotomy is for fissure.
D. Excision with off-midline flap closure such as Limberg or Karydakis (correct)
Correct. Off-midline flaps reduce recurrence.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Excision with off-midline flap closure such as Limberg or Karydakis. Midline wounds in the natal cleft heal poorly, so flattening the cleft with an off-midline flap lowers recurrence.

Why is "Antibiotics alone for recurrent disease" not the answer?

Antibiotics do not remove the sinus tracts.

Why is "Midline primary closure after wide excision" not the answer?

Midline closure often breaks down.

Why is "Anal sphincterotomy" not the answer?

Sphincterotomy is for fissure.

What concept does this question test?

It tests Gastrointestinal surgery: pilonidal sinus in General Surgery. Acute abscesses are drained first. Hair removal helps prevent relapse.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastrointestinal surgery: pilonidal sinus?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.