Elliptical Excision with Midline Primary Closure Versus Rhomboid Excision with Limberg Flap Reconstruction in Sacrococcygeal Pilonidal Disease: A Prospective, Randomized Study

Abstract

To compare elliptical excision with primary midline closure and rhomboid excision with limberg flap reconstruction techniques for the sacrococcygeal pilonidal sinus. This prospective randomized study of 80 patients of sacrococcygeal pilonidal sinus was performed in SKIMS medical college from 2004 to 2007. After assigning patients randomly to either of the surgical groups, group A patients (40/80) were operated by using rhomboid excision with limberg flap reconstruction whereas group B patients (40/80) were operated by using elliptical excision with primary midline closure. Data was compiled in terms of operative period required, immediate post operative complications, post operative pain (VAS scores), work-off period, hospital stay and recurrences over a follow up of 3 years for the two study groups. Data thereby collected was analyzed by using Microsoft excel. The parameters in which the two techniques were found to differ significantly were work-off period, immediate post operative complications profiles and recurrence rates. Rhomboid excision with limberg flap reconstruction technique surely outscores elliptical excision with primary midline closure in certain important parameters. While facing a patient with uncomplicated sacrococcygeal pilonidal sinus, instead of, which procedure for the patient? Surgeons should pose the question why not rhomboid excision with limberg flaps reconstruction?

A comparison of flap reconstruction vs the laying open technique or excision and direct suture for pilonidal sinus disease: A meta‐analysis of randomised studies

“…Seventeen randomised controlled studies, [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] involving 2215 cases, were included in the systematic review, and their characteristics are shown in Tables 1 and 2. The population in all studies comprised patients presenting with chronic pilonidal sinus. Among them, 1083 patient underwent a flap procedure, 328 patients underwent a laying open procedure, and 804 patients underwent median direct closure.…”

Comparative study between excision with primary closure versus Limberg flap for treatment of primary sacrococcygeal pilonidal sinus

“…This is parallel with other similar studies. 15,16,19 However, group (A) showed significant statistical difference in comparison with group B as regards; time to walk without pain, and time to return to work. These results agree with other related comparative studies.…”

“…The ideal procedure to eradicate the disease should eliminate the natal cleft so as to take off the anatomical predisposition for the recurrence of the sinus. 19 Skin flaps to cover a sacral defect after wide excisions have been described that rhomboid flap technique involves creation of a flap to facilitate primary closure and to obliterate the deep natal cleft. Initially, the rhomboid flap procedure was indicated for complex and recurrent cases, but now it has been recommended as a first line management of chronic sacrococcygeal pilonidal sinuses.…”

“…Many other current studies documented similar reported results. 12,[14][15][16]19 Great number of studies used vacuum drains after rhomboid flap to abolish the dead space and to prevent complications such as hematoma, seroma and recurrence. [14][15][16]22 In our study we used suction drains on both groups.…”

“…These recorded results were close to the incidence of recurrence of other similar related studies. 12,13,16,19,23,26 …”