Comparison of Primary Closure, Secondary Closure, and Limberg Flap in the Surgical Treatment of Pilonidal Cysts

Maghsudi, Hemmat; Almasi, Hojjat; Toomatari, Seyed Ehsan Mousavai; Fasihi, Masoud; Salamat, Sara Akhavan; Toomatari, Seyed Babak Mousavi; Hemmati, Mehdi

doi:10.1097/psn.0000000000000297

Cited by 6 publications

(7 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The advantages of the LF technique were also verified in a cross-sectional study using this technique in the same year 73 . A randomized group study by Maghsudi et al 74 further verified that the LF technique was superior to the simple primary suture and secondary healing techniques in many aspects; however, the LF technique took longer to perform. In 2022, Zubair et al 75 conducted an observational study on 46 patients with different clinical manifestations (single sinus, abscess, or ulceration) after LF surgery.…”

Section: Discussionmentioning

confidence: 97%

Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review

Zhang

Wang

2023

International Journal of Surgery

View full text Add to dashboard Cite

Background: A pilonidal sinus (PS) is an acquired disease resulting from recurrent infections and chronic inflammation. A PS involving the sacrococcyx is referred to as a sacrococcygeal PS (SPS). An SPS is a rare chronic infectious disease for which surgery is a good choice. The incidence of SPS has gradually increased worldwide in recent years. However, surgeons have not reached a consensus on the preferred surgical approach for SPS. The authors performed a systematic review and meta-analysis to analyze differences in the efficacy of different surgical approaches for the treatment of SPS. Methods: A systematic search was conducted in the PubMed database covering the period from 1 January 2003, to 28 February 2023. The primary outcome parameters were recurrence and infection. Finally, statistical analysis (meta-analysis) was carried out using RevMan 5.4.1 software. In addition, we systematically reviewed the latest progress in the surgical treatment of SPS over the past 20 years, especially as reported in the past 3 years. Results: Twenty-seven articles, 54 studies, and 3612 participants were included in this meta-analysis. The recurrence rate following the midline closure (MC) technique was much higher than that of other techniques. Among the techniques analyzed, the differences between MC and Limberg flap (LF), and between MC and marsupialization were statistically significant [P=0.0002, risk ratio (RR)=6.15, 95% CI 2.40, 15.80; P=0.01, RR=12.70, 95% CI 1.70, 95.06]. The recurrence rate of open healing was higher than that of the Karydakis flap (KF) technique, and the difference was statistically significant (P=0.02, RR=6.04, 95% CI 1.37, 26.55). Most of the results comparing MC with other techniques suggested that the former had a higher infection rate, and the difference between MC and LF was statistically significant (P=0.0005, RR=4.14, 95% CI 1.86, 9.23). Comparison between KF and LF, modified LF and KF showed that the differences were not statistically significant in terms of recurrence and infection (P≥0.05). Conclusions: There are various surgical treatment options for SPS, including incision and drainage, excision of diseased tissue with primary closure and secondary healing, and minimally invasive surgery. It is still not possible to determine which surgical technique should be considered the gold standard for treatment, as even the results of different researchers using the same operation method are conflicting. But what is certain is that the midline closure technique has a much higher incidence of postoperative recurrence and infection than other techniques. Therefore, the anorectal surgeon should formulate the most suitable individualized plan for the patient based on a comprehensive evaluation of the patient’s wishes, appearance of the SPS, and the professional ability of the surgeon.

show abstract

Section: Discussionmentioning

confidence: 97%

Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review

Zhang

Wang

2023

International Journal of Surgery

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 98%

“…In line with our results, previous studies made similar conclusions. Maghsudi et al [ 14 ], described the operation time of secondary closure to be 13.8 ± 2.4 min, which compared with the Limberg flap (mean duration: 40 ± 3.2 min) was significantly shorter. Unfortunately, this short-duration feature of secondary closure has few drawbacks.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to the literature [ 18 ], our data supported that slide-swing procedure compared with secondary closure, shortens the duration of incapacity for work and improved patients’ life style significantly. Maghsudi et al concluded that secondary closure of PSD has the worst outcome in terms of healing time, and incapacity for work compared with primary closure with/without Limberg flap [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…A thorough look at these two surgical techniques complications, we found that despite administration of pre/post-operation antibiotic, wound infection still occurred in both groups which was in accordance with the literature. Previous studies reported the rate of wound infection of 6%-20% after PSD surgeries [ 14 ]. Although some studies reported a significant difference regarding wound infection between different surgical techniques [ 25 ], the majority of published articles found insignificant difference on the matter [ 26 - 28 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Primary Closure of Pilonidal Sinus With Slide-Swing Skin Flap Compared With the Secondary Closure: A Single-Blinded Randomized Controlled Trial

Mahmoudvand¹,

Nadri²,

Shekouhi³

et al. 2022

Cureus

View full text Add to dashboard Cite

Introduction: There are many surgical approaches for sacrococcygeal pilonidal sinus disease (PSD) therapy, ranging from wide excision repair to less morbid excisions with primary/flap closure. The off-midline flaps, which shift the incision line away from the midline natal cleft, have been associated with lower recurrence rates than the conventional mid-line closure techniques. This single-blinded randomized controlled trial aims to compare the short/long-term efficacy and outcome of the slide-swing flap technique with the conventional secondary wound closure.Method and materials: This study was a prospective randomized controlled trial conducted on patients with PSD. Patients were assigned into two groups: secondary closure (control) and slide-swing flap (trial). Patients were advised to visit the surgical clinic two times weekly for the two weeks after the operation for at least six months.Results: In this study, 100 patients were enrolled. They were assigned into two groups of control, and trial. The mean age of all participants was 29.15 ± 8.36 years old (age range: 18-62 years old). The mean operation time was 39.65 ± 12.63 for both groups, with the control group being 29.70 ± 7.71 and the swing flap group 46.90 ± 7.81. Patient visual analog scale (VAS) scores in both groups revealed that the trial group was associated with lower VAS scores compared with patients who underwent secondary closure (p-value = 0.006). Also, the trial group demonstrated a higher rate of healing, better cosmetic outcomes, and quicker recovery time compared with the controls. Conclusion: Compared with secondary closure, the slide-swing flap was associated with excellent cosmetic outcomes, disease recurrence, and recovery time. Also, the post-operative complications were significantly lower compared with the traditional method.

show abstract

Midline and off-midline wound closure methods after surgical treatment for pilonidal sinus

Cai,

Zhao,

et al. 2024

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Comparison of Primary Closure, Secondary Closure, and Limberg Flap in the Surgical Treatment of Pilonidal Cysts

Cited by 6 publications

References 20 publications

Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review

Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review

Primary Closure of Pilonidal Sinus With Slide-Swing Skin Flap Compared With the Secondary Closure: A Single-Blinded Randomized Controlled Trial

Midline and off-midline wound closure methods after surgical treatment for pilonidal sinus

Contact Info

Product

Resources

About