Comparison of Primary Midline Closure, Limberg Flap, and Karydakis Flap Techniques in Pilonidal Sinus Surgery

Erkent, Murathan; Şahiner, İbrahim Tayfun; Bala, Mesut; Kendirci, Murat; Yıldırım, Murat; TOPÇU, Ramazan; Bostanoğlu, Settar; Dolapci, Mete

doi:10.12659/msm.913248

Cited by 16 publications

(12 citation statements)

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“…Esthetic appearance of the scar after surgical treatment of PSD represents an important factor influencing the patient’s choice of treatment. In a comparison of different surgical strategies to manage PSD in patients aged ≥14 years, Erkent et al investigated recurrences and SF-36 score cosmetic outcomes [ 38 ]. They noted lower recurrence rates after Limberg flap repair (8%) and Karydakis flap repair (3.1%) when compared to PMC (10.8%).…”

Section: Discussionmentioning

confidence: 99%

“…They noted lower recurrence rates after Limberg flap repair (8%) and Karydakis flap repair (3.1%) when compared to PMC (10.8%). Despite these findings, the authors reported a preference for surgical treatment by excision and PMC among women because of cosmetic considerations [ 38 ]. Similarly, Kalaiselvan et al stated that reconstructive techniques flattening the natal cleft may cause cosmetic issues that are deemed unacceptable by patients [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

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Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

2020

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We aimed to compare the outcome of two different operative methods to correct pilonidal sinus disease (PSD) in children, i.e., excision and open wound care (OW) versus excision and primary transverse closure (PC) of the wound. In this retrospective, observational study, we extracted data from the medical records of 56 patients who underwent surgery for PSD at our institution between 1 January 2006 and 31 December 2016. To test whether the primary variable, i.e., rate of PSD recurrence, differed between the two surgical groups, a logistic regression model was fitted. Secondary explanatory variables were total length of stay (LOS) at the hospital, complications, sex and age of patients, seniority of the surgeon in charge, and volume of excised specimen. Overall, 32 (57%) children and young adults underwent OW, while 24 (43%) patients were treated by PC. Mean age at operation was 15.5 years in either group. PSD recurred in 12 of 32 (37.5%) children in the OW group and in 3 of 24 (12.5%) children in the PC group (ratio: 0.19, 95% confidence interval [95% CI] 0.03–1.07). Thus, treatment of primary PSD by PC proved superior with respect to PSD recurrence. Moreover, our study did not bring to light any high-grade complications in the PC group, and postoperative pain was minimal. Less invasive treatment approaches for chronic PSD are typically performed in an outpatient setting and offer reduced morbidity, low rates of PSD recurrence, and shortened periods of time to return to work or social activities. More radical operations of PSD should be reserved for recurrent PSD where less invasive approaches have failed several times.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

2020

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“…We see that Erkent et al also had similar results in their study. They also reported that they had a lower relapse rate in LFR when they compared the LFR technique with the PC technique [5]. In their meta-analysis, Boshnaq et al reported that the overall relapse was 7.7% at 18 months of follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Following the long-term debates on whether it is acquired or inherited in terms of etiopathogenesis, there is today a consensus that it is acquired [3-4]. However, the debates on its treatment are still ongoing [5].…”

Section: Introductionmentioning

confidence: 99%

Analysis of the Relapse Rates of the Primary Closure and Limberg Flap Techniques in Pilonidal Sinus Surgery

Kanlıöz¹,

Ekici

2019

Cureus

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Background This study aimed to assess the relapse rates at the long-term follow-up of the Limberg flap repair (LFR) and primary closure (PC) methods in the surgical treatment of pilonidal sinus disease (PSD). Methods The records of primary PSDs who underwent LFR and PC due to PSD were retrospectively examined. The study included patients whose surgical intervention was performed at least two years ago. The patients were contacted by phone to obtain information. They were asked whether they had a relapse or not, and their answers were recorded. The recording and analysis were ensured using the SPSS statistical program (IBM Corp, Armonk, NY, US). The groups were compared using the chi-square test. p˂0.05 was considered significant. Results The patients' mean age was 23.68 ± 8.21 years, and their median age was 22 years. The overall follow-up period was 4.38 ± 2.12 years. LFR-treated patients numbered 292; 38 (13.01%) females and 254 (86.99%) males. Of the LFR-treated patients, 23 (7.87%) had a relapse, including five (13.15%) females and 18 (7.08%) males (p˂0.03). PC-treated patients numbered 184; 58 (31.52%) females and 126 (68.48%) males. Of PC-treated patients, 39 (21.19%) had a relapse, including 15 (25.86%) females and 24 (19.04%) males (p˂0.04). The relapse was more than three times higher in PC when compared to LFR (p˂0.01). Conclusion LFR clearly takes precedence over PC. In both methods, the relapse rate is higher in females. We believe that this is due to our tendency to be more limited in resection in women.

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“…We think the lower incidence of this disease due to the structural characteristics of females and females attaching more importance to cosmetics (less scar remaining and less deviation from natural appearance of the region in the postoperative period) caused this result. Erkent et al (13) stated they chose the Karydakis and primary repair methods more often as they primarily considered cosmetic reasons.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Pilonidal Sinus Morphology on Surgical Selection

Gumusoglu¹,

Ertürk²

2019

btd

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ÖZAmaç: Biz bu çalışmamızda, cerrahi tedavi uygulanan pilonidal sinüs tanılı hastalarımızın histo-patolojik verilerinden yola çıkarak, kliniğimizde seçilen cerrahi tekniğin belirlenmesinde göz önüne alınan morfolojik parametreleri retrospektif olarak ortaya çıkarmayı ve ileride uygulanacak olan cerrahi girişimlerin seçiminde kullanılabilir algoritmaların oluşturulması için bir temel oluşturabilmeyi amaçladık.Yöntemler: Bu çalışmada, İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Genel Cerrahi Anabilim Dalı'nda 2007 ile 2011 yılları arasında pilonidal sinüs tanısı ile farklı cerrahlar tarafından opere edilen 594 hastanın histopatoloji raporları retrospektif olarak incelendi. Piyesin boyutu, orifis sayısı ve çapı, eksizyon materyalinin boyutu, cerrahi sınır (fistül ağzının en yakın cerrahi sınıra olan mesafesi) parametreleri elde edildi. Histo-patolojik verilerin yanı sıra, hastaların yaş ve cinsiyetlerinin operasyon seçimine etkisi de araştırıldı.Bulgular: Limberg flebi ile onarım, %68,7'lik oran ile en çok tercih edilen yöntem olarak belirlendi. Limberg grubunda fleb alanı ve cerrahi sınır diğer üç ameliyat grubundan anlamlı olarak yüksek bulunmuştur (p<0,05). Marsupiyalizasyon yönteminin, limberg, karydakis ve primer tamir ameliyatlarına göre, her geçen yıl kendi içinde anlamlı düzeyde daha fazla tercih edildiği gözlenmiştir (p<0,05). Tüm yöntemler incelendiğinde Karydakis ve primer tamir uygulanan kadınların erkek hastalara göre oranı, diğer iki yöntemdeki orandan anlamlı fazla bulunmuştur (p<0,001).Sonuç: Patolojik verilerden yola çıkarak yaptığımız inceleme sonucunda cerrahların pilonidal sinüs tedavi yöntemi tercihinde hastanın cinsiyetine, hastalığın derecesine, iyileşme sürecine, uyguladıkları cerrahi yönteme alışkanlıklarına ve rezeksiyon materyalinin genişliğine göre karar verdikleri görülmektedir. Anahtar Kelimeler: Pilonidal sinüs, limberg, karydakis, primer tamir, marsupiyalizasyonObjective: In this study we aimed to reveal the morphological parameters which are taken into account when determining the surgical technique and to define an algorithm to determine the surgical procedure for future patients, based on the histopathological data of patients who underwent surgical treatment for pilonidal disease, retrospectively. Methods:In this study histopathology reports of 594 patients who were operated by different surgeons between 2007 and 2011 at Istanbul University Cerrahpasa School of Medicine General Surgery Department were evaluated retrospectively. By evaluating the histopathology reports of patients retrospectively, we acquired data on specimen size, number and radius of orifice, size of excision material and surgical margin. Besides histopathological findings, we also researched the effects of patient age and gender on the surgical selection. Results:The Limberg flap was the most preferred method with a ratio of 68.7%. The Limberg flap region and surgical margin were significantly higher than the other three surgical groups (p<0.05). Unlike the limberg, karydakis and primary repair methods; patie...

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Comparison of Primary Midline Closure, Limberg Flap, and Karydakis Flap Techniques in Pilonidal Sinus Surgery

Cited by 16 publications

References 18 publications

Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

Analysis of the Relapse Rates of the Primary Closure and Limberg Flap Techniques in Pilonidal Sinus Surgery

The Effects of Pilonidal Sinus Morphology on Surgical Selection

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