Is limberg flap better than excision and primary closure for treatment of sacrococcygeal pilonidal sinus: a prospective randomised study of 30 cases

Nida Khan, Pragati Singhal, Shantanu Chandrashekhar, Dipesh Goel, Khyati Patel, Nandini Deshpande


Sacrococcygeal pilonidal sinus is a common presentation to the office of both the General Surgeon and Coloproctologist. Over time various treatment modalities have evolved for the same. Older methods such as excision with or without closure have been associated with higher complications in the post-operative period, recurrence rates and hospital stay. Flap procedures have a longer operative period and a steep learning curve but a better overall post-operative course and lower recurrence rates. Our study was done to compare the outcomes of primary excision and closure to a Limberg flap for treatment of sacrococcygeal pilonidal sinus. The objective of the study was to determine whether Limberg flap was superior to excision and primary closure for treatment of pilonidal sinus. 30 patients presenting with chronic pilonidal sinus where randomly assigned to two groups of 15 patients each. Both the groups were compared in terms of age of presentation, sex prediliction, duration of surgery, post-operative resumption of work, complications and recurrence. We concluded that Limberg flap is superior to excision and primary closure for treatment of pilonidal sinus.  


Pilonidal sinus, Sacrococcygeal pilonidal sinus, Limberg flap, Bascom procedure, Karyadakis procedure

Full Text:



Varnalidis I, Ioannidis O, Paraskevas G, et al. Pilonidal sinus: a comparative study of treatment methods. J Med Life. 2014;7(1):27-30.

Sondenaa K. Patient characteristics and symptoms in chronic pilonidal sinus disease." International journal of colorectal disease. (1995);10:39-42.

Søndenaa K, Andersen E, Nesvik I, Søreide JA. Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis. 1995;10(1):39-42.

Buie LA. Classic articles in colonic and rectal surgery. M.D. 1890-1975: Jeep disease (pilonidal disease of mechanized warfare). Dis Colon Rectum. 1982;25(4):384-90.

Kaymakcioglu N. Treatment of pilonidal sinus by phenol application and factors affecting the recurrence. Techniq Coloproctol. 2005;9:21-4.

Wadhawan, Gaurav, Sharma D, Vyas KC. A comparative study of different treatment outcomes in cases of pilonidal disease. Int J Surg. 2020;4.3:292-7.

Anderson AW. Hair extracted from an ulcer." Boston Med Surg J. 36(1847):74.

Mason WJ. Abscess, containing hair, on the nates. Amer J Med Sci. 1854;28:113.

Brearley, Roger. Pilonidal sinus a new theory of origin. Brit J Surg. 1955;43.177:62-8.

Yildiz, Aybala. Karydakis Flap Reconstruction for Pilonidal Disease. BAiley

Abboud, Bassam, Ingea H. Recurrent squamous-cell carcinoma arising in sacrococcygeal pilonidal sinus tract. Diseas Colo Rect. 1999;2.4: 525-528.

Chintapatla, Srinivas. Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. Techniq Coloproctol. 2003;7.1:3-8.

Mentes, Oner. Management of pilonidal sinus disease with oblique excision and primary closure: results of 493 patients. Diseas Colon Rect. 2006;49.1:104-8.

Rushfeldt C, Bernstein A, Norderval S, Revhaug A. Introducing an asymmetric cleft lift technique as a uniform procedure for pilonidal sinus surgery. Scandinav J Surg. 2008;97(1):77-81.

George, Thomas, Mathew J. Modified Karydakis procedure for uncomplicated pilonidal sinus. Int Surg J. 2020;7.8:2568-72.

Mentes, Bülent B. Modified Limberg transposition flap for sacrococcygeal pilonidal sinus. Surg Tod. 2004;34.5:419-23.

Chasmar, Leslie R. The versatile rhomboid (Limberg) flap. Canad J Plast Surg. 2007;5.2:67-71.

Khan N. Limberg flap for reconstruction after excision of multiple conglomerate epidermoid cysts. Int J Res Medic Sci. 2020;8.1:371.

Clyde SE. Removal of large inclusion cysts with minimal incisional scars. Plast Reconstruct Surg. 2007;119.4:1395.

Clyde SE. Removal of large inclusion cysts with minimal incisional scars. Plast Reconstruct Surg. 2007;119.4:1395.

Eryilmaz, Ramazan. Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap. Surgery. 2003;134.5:745-9.

Gavriilidis P, Bota E. Limberg flap versus Karydakis flap for treating pilonidal sinus disease: a systematic review and meta-analysis. Can J Surg. 2019;62(2):131-8.

Ersoy E, Devay AO, Aktimur R, et al. Comparison of the short-term results after Limberg and Karydakis procedures for pilonidal disease: randomized prospective analysis of 100 patients. Colorectal Dis. 2009;11:705–10.

Arslan, K. Which flap method should be preferred for the treatment of pilonidal sinus? A prospective randomized study. Techniq Coloproctol. 2014;18.1: 29-37.

Can, Fatih M. Multicenter prospective randomized trial comparing modified Limberg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease. Am J Surg. 2010;200.3:318-27.

Meinero PL. Mori, Gasloli G. Endoscopic pilonidal sinus treatment (EP Si. T.). Techniq Coloproctol. 2014;18.4:389-92.

Muzi MG, Milito G, Cadeddu F, Nigro C, Andreoli F, Amabile D, et al. Randomized comparison of Limberg flap versus modified primary closure for the treatment of pilonidal disease. Am J Surg. 2010;200(1):9-14.

Akca T, Colak T, Ustunsoy B, Kanik A, Aydin S. Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease. Brit J Surg. 2005;92(9):1081-4.