DOI: http://dx.doi.org/10.18203/2349-2902.isj20195194

A comparative study of excision with primary closure versus Limberg flap in pilonidal sinus

Omesh Kumar Meena, Dheer Singh Kalwaniya, Satya V. Arya, Manikandan Kuppuswami, Jaspreet Singh Bajwa, Ravi S. Pradhan, Akshay Narayan, Ranjith Mahadevan, Mukesh K. Verma

Abstract


Background: The term ‘pilonidal sinus’ describes a condition found in the natal cleft overlying the coccyx which is treated by excision.

Methods: This study is a prospective study held in Department of general surgery, Safdarjung Hospital, New Delhi from October 2014 to April 2016 on 60 patients out of which 30 were controls (excision with primary closure) and 30 were taken as case (Limberg flap). Post-operative follow up was done till 6 months and complications were noted. The data was tabulated and SPSS version 17 was used for statistics.

Results: Pilonidal sinus disease is common in age group 20 years and above and twice more common in males than females. Although operating time in Limberg flap is little more as compared to primary closure but insignificant. The post-operative pain in the long term follow up is less in the Limberg flap procedure, although in the initial post-operative period it is slightly higher as compared to primary closure. In Limberg flap procedure, post-operative complications like stitch line infection, seroma formation, wound dehiscence are low as compared to primary closure. Limberg flap require 2.27±0.52 days hospital stay as compared to 3.57±1.43 days in primary closure due to less post-operative complications. Recurrence rate is 3.33% in Limberg flap as compared to 26.67% in primary closure group.

Conclusions: We recommend the Limberg flap method for primary pilonidal disease with low morbidity rates over primary closure.


Keywords


Limberg flap, Pilonidal sinus, Visual analog scale

Full Text:

PDF

References


Mayo OH. Observations on injuries and disease of the rectum. London: Burgess and Hill; 1833: 45-46.

Schoeller T, Wechselberger G. Definite surgical treatment of complicated recurrent pilonidal disease with a modified fasciocutaneous V-Y advancement flap. Surgery. 1997;121:258-63.

McCallum I, King PM. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev. 2007:CD006213.

Lee HC, Ho YH. Pilonidal disease in Singapore: clinical features and management. Aust N Z J Surg. 2000;70:196-8.

Azad AS, Kamal MS. The rationale of using the rhomboid fasciocutaneous transposition flap for the radical cure of pilonidal sinus. J Dermatol Surg Oncol. 1986;12:1295-9.

Sondenaa K, Nesvik I. Recurrent pilonidal sinus after excision with closed or open treatment: final result of a randomized trial. Eur J Surg. 1996;16:237-40.

Spivak H, Brooks VL. Treatment of chronic pilonidal disease. Dis Colon Rectum. 1996;39:1136-9.

Mentes BB, Leventoglu S. Modified Limberg transposition flap for sacrococcygeal pilonidal sinus. Surg Today. 2004;34:419-23.

Ryilmaz R, Sahin M. Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap. Surgery. 2003;134:745-9.

Sondenaa K, Andersen E. Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis. 1995;10:39-42.

Akca T, Colak T. Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease. Br J Surg. 2005;92:1081-4.

Mahdy T. Surgical treatment of pilonidal disease: primary closure or flap reconstruction after excision. Dis Colon Rectum. 2008;51:1816-22.

Abu Galala KH, Salam IM. Treatment of pilonidal sinus by primary closure with a transposed rhomboid flap compared with deep suturing:a prospective randomized clinical trial. Eur J Surg. 199;165:468-72.

Ertan T, Koc M. Does technique alter quality of life after pilonidal sinus surgery? Am J Surg. 2005;190:388-92.

Petersen S, Koch R. Primary closure techniques in chronic pilonidal sinus: a survey of results of different surgical approaches. Dis Colon Rectum. 2002;45:1458-67.

Daphan C, Tekelioglu MH. Limberg flap repair for pilonidal sinus disease. Dis Colon Rectum. 2004;47:233-7.

Bascom JU. Pilonidal disease: correcting overtreatment and under treatment. Contemporary Surg. 1981;18:13-28.