A modified surgical approach to sacrococcygeal pilonidal disease:our experience
DOI:
https://doi.org/10.18203/2349-2902.isj20162884Keywords:
Pilonidal disease, Recurrence, Rhomboid excision, Modified Limberg flap reconstruction, EpilationAbstract
Background: Pilonidal disease is a fairly common condition encountered in clinical practice with recurrent follicular infection being the causative factor. Inspite of many surgical options available, controversy still exists for the best procedure. Pilonidal disease has been treated for a long time with the conventional open excision technique. Limberg procedure is a safe and reliable technique in the treatment of sacrococcygeal pilonidal disease, with low complications and recurrence rates if performed according to appropriate surgical principles. Epilation is a very useful adjunct to the surgery for Pilonidal disease to prevent recurrence, which is almost a rule.
Methods: In our study we recruited 27 patients of pilonidal disease who underwent modified Limberg flap procedure and were followed up for two years post-surgery. All the patients were subjected to epilation in preoperative period and post operatively for 6 months.
Results: During our study period (2011-2016) 27 patients were enrolled with a median age of 25 years and were followed up 2 years post-surgery. 22 patients were males while 5 were females, 13 were recurrent cases with previous history of one or more surgeries, 11 cases had a sinus without any surgical intervention in the past and 3 had an abscess. There was no recurrence noted for a follow up period of 2 years and there was no flap failure as well.
Conclusions: Modified Limberg flap with epilation for pilonidal disease is safe and easy to perform with minimal morbidity, early recovery and no recurrence.
References
Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust NZ J Surg. 1992;62(62):385-9.
Notaras MJ. A review of three popular methods of treatment of postanal (pilonidal) sinus disease. Br J Surg. 1970;57(12):886-90.
Sahin M, Alimoglu O, Dasiran F. Surgical treatment of pilonidal sinus with the Limberg transposition flap. Surgery. 2003;(134):745-9.
Cheidozi LC, Al RFA, Salem MM, Al HFH, Al BAA. Management of pilonidal sinus. Saudi Med J. 2002;23:786-8.
Solla JA, Rothenberger DA. Chronic pilonidal disease: an assessment of 150 cases. Dis Colon Rectum. 1990;33(9):758-61.
Kapan M, Kapan S, Pekmezci S, Durgun V. Sacrococcygeal pilonidal sinus disease with limberg flap repair. Tech Coloproctol. 2002;6(1):27-32.
Benedetto AV, Lewis AT. Pilonidal sinus disease treated by depilation using 800 nm diode laser and review of the literature. Dermatol Surg. 2005;31:587-91.
Lavelle M, Jafri Z, Town G. Recurrent Pilonidal sinus treated with epilation using a ruby laser. J Cosmet Laser Ther. 2002;4:45-7.
Conroy FJ, Kandamany N, Mahaffey PJ. Laser depilation and hygeine: preventing recurrent pilonidal sinus disease. J Plast reconstr Aesthet Surg. 2008;61:1069-72.
Schulze SM, Patel N, Hertzog D, Fares LG. Treatment of pilonidal disease with laser epilation. Am Surg. 2006;72:534-7.
Sadick NS, Yee LJ. Laser and light treatments for pilonidal cysts. Cutis. 2006;78:125-8.
Downs AMR, Palmer J. Laser hair removal for pilonidal sinus disease. J Cosmet Laser Ther. 2002;4:91
Landa N, Aller O, Landa GN. Successful treatment of recurrent pilonidal sinus with laser epilation. Dermatol Surg. 2005;31:726-8.
Petersen S, Weitelmann K, Evers T, Huser N, Matevossian E, Doll D. Long term effects of post-operative laser epilation in pilonidal sinus. Dis Colon Rectum. 2009;52:131-4.
Davis KA, Mock CN, Versaci A, Lentrichia P. Malignant degeneration of pilonidal cysts. Am Surg. 1994;60:200-4.
Velitchkov N, Djedjev M, Kirov G, Losanoff J, Kjossev K, Losanoff H. Toxic shock syndrome and necrotising fasciitis complicating neglected sacrococcygeal pilonidal sinus disease. Report of a case. Dis Colon Rectum. 1997;40:1386-90.
Jenson SL, Harling H. Prognosis after simple incision and drainage for a first-episode acute pilonidal abscess. Br J Surg. 1988;75(1):60-1.
Sabet Am, El Shaer WMH, El Amary MK. Definitive treatment of recurrent pilonidal sinus disease using rhomboid excision and limberg flap. Egypt J Surg. 2004;23(4):324-7.
Akin M, Gokbayir H, Kilic K, Topgul K, Ozdemir E, Ferahkose Z. Rhomboid excision and limberg flap for managing pilonidal sinus: long-term results in 411 patients. Colorectal Dis. 2008;10(9):945-8.
El KOH. The rhomboid flap for recurrent pilonidal disease. Tanta Med Sci J. 2006;1(4):175-81.
Chasmer LR. The versatile rhomboid (limberg) flap. Can J Plast Surg. 2007;15(2):67-71.
Urhan MK, Kucukel F, Topgul K, Ozer I, Sari S. Rhomboid excision and Limberg flap for managing pilonidal sinus: results of 102 cases. Dis Colon Rectum. 2002;45:656-9.
Hull TL, Wu J. Pilonidal disease. Surg Clin North Am. 2002;82:1169-85.
Jamal A, Shamim M, Hashmi F, Qureshi MI. Open excision with secondary healing versus rhomboid excision with Limberg transposition flap in the management of sacrococcygeal pilonidal disease. J Pak Med Assoc. 2009;59:157-60.
