THE SITAMA (SINGLE-STAGE INFECTED SEBACEOUS CYST TREATMENT AND DEFINITIVE MANAGEMENT APPROACH) PROCEDURE VERSUS CONVENTIONAL INCISION AND DRAINAGE FOR INFECTED SEBACEOUS CYSTS: A PROSPECTIVE COMPARATIVE STUDY BETWEEN THE TWO TREATMENT GROUPS

Abstract

Background: Epidermoid cysts, commonly referred to in everyday clinical parlance as sebaceous cysts, rank among the benign skin swellings general surgeons treat most frequently, and a meaningful share become secondarily infected, presenting with pain, redness, swelling and abscess formation. The conventional pathway drains the acute abscess first and postpones formal excision until the inflammation has settled. This sequence controls sepsis reliably but obliges the patient to attend hospital more than once, endure extended wound dressing, and accept some residual chance that cyst wall left behind will cause the lesion to return. A growing alternative is to remove the cyst in its entirety at the very first visit, while it is still infected, finishing treatment in one sitting. Aim: This study asked a simple question: does removing an infected sebaceous cyst in one procedure — an approach we have labelled the SITAMA protocol — leave patients better off than the traditional two-step route of draining first and excising later? Methods: Working within the Department of General Surgery at Saveetha Medical College and Hospital, we followed 80 patients with a clinical diagnosis of infected sebaceous cyst prospectively, splitting them into two arms. Group A (n = 40) underwent the SITAMA protocol — Single-stage Infected sebaceous cyst Treatment And definitive Management Approach — an immediate, one-sitting complete excision. Group B (n = 40) took the conventional path of incision and drainage, with excision held back until the infection had cleared. We tracked baseline characteristics, operative parameters, postoperative complications, wound-healing time, hospital stay, number of visits needed, six-month recurrence, and patient satisfaction across both arms, sent every excised specimen for histopathology, and applied standard parametric and non-parametric statistical tests, treating p values below 0.05 as significant. Results: Every one of the 80 patients enrolled — 40 in each arm — stayed in the study through six months of follow-up, and the two groups looked alike at the outset on every baseline measure we checked. Once treated, the SITAMA group needed far fewer trips back to hospital and reached the finish line of definitive care faster overall than the conventionally managed group. Complications occurred at similar rates in both arms, six-month recurrence was lower after SITAMA, and histology showed an epidermoid cyst with inflammatory change in every specimen examined, whichever group it came from. Conclusion: The SITAMA procedure — single-stage excision of the infected cyst — appears to be a safe, feasible alternative to staged incision-and-drainage management in appropriately selected patients, achieving definitive treatment in one sitting, fewer hospital visits, and lower recurrence without an increase in complications. Larger multicentre randomised trials are needed to confirm these findings before the approach is adopted more widely.