Comparison of Limberg Flap and Karydakis Flap Surgery for the Treatment of Patients With Pilonidal Sinus Disease: A Single-Blinded Parallel Randomized Study

Abstract

Purpose: Pilonidal sinus disease is a common condition, which mostly affects young men. While various surgical techniques have been introduced for treating intergluteal pilonidal disease (IPD), controversies still exist regarding the best surgical approach. The purpose of this study was to compare the efficiency and the short-term outcomes of Limberg flap and Karydakis flap surgeries for the treatments of patients with IPD. Methods: A total of 80 patients with IPD who had underwent either Karydakis flap (KF group: n = 37) or Limberg flap (LF group: n = 27) surgery between January 2015 and January 2016 at Imam Khomeini Hospital of Sari in the North of Iran were recruited for inclusion in this randomized, single-blind study. Results: Compared to the KF group, the LF group showed faster complete wound healing, longer duration of surgery and hospital stay, larger wound size, and shorter period of incapacity for work. The overall patient satisfaction in the LF group was significantly higher than that in the KF group. The visual analogue scale score of pain was lower in the LF group than in the KF group. Also, the overall frequency of postoperative complications was higher in the KF group than in the LF group. Recurrence was reported in one patient from the KF group. Conclusion: Given the lower rate of postoperative complications and greater cosmetic satisfaction of patients, the Limberg flap procedure should be selected, instead of the Karydakis flap procedure, as the standard technique for treating patients with IPD.

Pilonidal sinüs cerrahisinde etkin minimal invaziv bir yöntem: Sinüsotomi

“…Although, it is more common especially in people who sit long time. It is mentioned as driver's disease, not only in our country but also in other countries [3]. SPS usually seems in the young population.…”

“…The mean operation time in the primary closure group was 26.9 minutes and the mean hospital stay was 1.7 days [4]. Comparing Limberg flap and Karydakis flap techniques, Alvandipour et al [3] found that mean operative time was 29.1 and 23 minutes, and mean hospitalization time was 1.4 days. Karaca et al [5] likewise compared the flap methods and found that the mean length of hospital stay was 1.1 days.…”

“…In the study of Oliveira et al [6], when the primary closure and MIT were compared, the number of painful days after MIT was zero. In the Alvandipour et al [3] study, pain with sitting after Limberg and Karydakis flap operations was questioned and VAS score was 4 and 4.1, respectively. In this study, pain was questioned on postoperative 2nd day and the mean VAS score was 0.6.…”

Comparison of postoperative quality of life of Limberg flap and Karydakis flap in pilonidal sinus operations

“…In the LF group, 3 (5.9%) developed seroma in the wound site, 1 (2%) hematoma in the wound site, 1 (2%) wound site infection and 1 (2%) dehiscence of incision when skin sutures were removed. During follow up, recurrence was found as 5.9% (n= 3) in the LF group with a mean duration to recurrence as 22 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24) months. Duration to recurrence was statistically shorter in the KF group compared to the LF group (p= 0.001).…”

“…Flap methods providing removal of the intergluteal sulcus enable excision of more pilonidal sinus tissue and decrease the tension in the incision site (16,17). Although currently the most commonly performed extra midline closure methods are KF and LF, still an extra midline closure flap technique that would be most practical could not be determined (17,18).…”