Primary wound closure with a Limberg flap vs. secondary wound healing after excision of a pilonidal sinus: a multicentre randomised controlled study

Käser, Samuel; Zengaffinen, R.; Uhlmann, Michael; Gläser, Christian; Maurer, Christoph A.

doi:10.1007/s00384-014-2057-x

Cited by 51 publications

(33 citation statements)

References 25 publications

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“…Various researchers compared the effectiveness of primary closure and oblique incision (Limberg technique) and found a mean length of hospital stay of 1.44 +/-3 days and 5.51 +/-2.85 days, Mentes et al observed a 5.6% recurrence rate in the 18 months follow up period in their study, while Bali et al did not find any patient with recurrence of a pilonidal sinus. 18,19 In our study we found a 5% recurrence rate with primary closure and length of stay of 4.09 +/-1.96 days. Return to normal functioning is also a significant factor which affects the morbidity and accounts for the success of primary closure, according to a study by Kaser et al they observed a 49% complication rate in primary closure and a complication rate of 12% in the open wound healing group.…”

Section: Discussionsupporting

confidence: 52%

Comparison of primary repair with healing by secondary intention for the treatment of pilonidal sinus, at a Tertiary Care Hospital in Karachi, Pakistan.

Ghayasuddin

Usmani

Sheikh³

et al. 2019

TPMJ

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The aim of our study is to assess the surgical outcome of healing by primary intention and compare it with primary repair for the treatment of pilonidal sinus. Study Design: Randomized controlled trial. Setting: Tertiary Care Center in Karachi Pakistan. Period: Two years from April 2015 to April 2017. Materials and Methods: 60 patients were divided into two groups by utilizing a Random Allocation Software. All the patients involved in the study signed a duly informed consent. The inclusion criteria were patients who presented to us with a pilonidal sinus and agreed to participate in the study. All the procedures were performed by the same team of surgeons. Patient follow up was bi-weekly at the outpatient. Data were collected in a predesigned proforma with various variables such as patient demographics, clinical findings, treatment option used, postoperative results, complications (if any), healing time, length of hospital stay and time for a return to function among others. The data were analyzed using IBM SPSS version 21.0. A p value of less than 0.05 was considered to be statistically significant. Results: N= 60 patients were included in the study. There were n= 51 men (85%) and n= 9 women (15%). The mean age of patients in group A was 26.45 +/- 5.81 years and the mean age of participants in group B was 27.10 +/- 5.75 years. Symptoms lasted for 6.52 +/- 2.03 days, the most common presenting complaint was pain in 51.66% of patients followed by discharge in 40% and swelling in 33.33% respectively. The mean length of stay at the hospital for both the groups was 4.40 +/- 2.11 days (4.09 +/- 1.96 days in group A and 4.85 +/- 2.33 days in group B), mean time to return to normal functioning was 17.88 +/- 8.46 days (14.50 +/- 7.30 days in group A and 23.80 +/- 6.50 days in group B). The mean healing time postoperatively for both the groups was 39.98 +/- 24.46 days (21.90 +/- 10.15 days in group A and 67.30 +/- 9.09 days in group B. Early postoperative infection was found in n=7 (11.66%) patients, wound necrosis was found in n= 2 (3.33%) patients, and recurrence of the pilonidal sinus was found in n= 3 (5%) of the patients respectively. Conclusion: According to the results of our study primary closure technique provides better outcomes in terms of early return to functioning, shorter duration of wound healing and lower rates of wound infection as compared to excision and healing by secondary intention.

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Section: Discussionsupporting

confidence: 52%

Comparison of primary repair with healing by secondary intention for the treatment of pilonidal sinus, at a Tertiary Care Hospital in Karachi, Pakistan.

Ghayasuddin

Usmani

Sheikh³

et al. 2019

TPMJ

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“…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.…”

Section: Characteristics Of the Studies Includedmentioning

confidence: 99%

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

Berthier¹,

Bérard²,

Méresse³

et al. 2019

International Wound Journal

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Many treatments have been described for pilonidal disease, but recurrence cannot be completely eliminated. The aim of this study was to perform a meta‐analysis of randomised, controlled trials comparing flap repair vs the laying open technique and/or excision and direct closure techniques in the treatment of chronic pilonidal sinus disease. The primary outcome measure was the recurrence rate. Secondary outcomes were complete wound‐healing time, duration of the incapacity to work, quality of life and patient satisfaction, postoperative pain, wound infection, bleeding or haematoma, skin wound complications, and duration of hospital stay. Seventeen studies were included. The meta‐analysis demonstrated a lower risk of recurrence, a shorter duration of incapacity to work, a lower risk of wound infections, a lower risk of skin wound complications, and a shorter duration of hospitalisation in favour of flap vs direct closure. A shorter time to complete wound healing and a shorter duration of incapacity to work for flap vs the laying open technique were observed. Superiority of flap repair vs direct closure in pilonidal sinus treatment was demonstrated in this meta‐analysis. These results suggest avoiding primary direct closure in clinical practice. Compared with the laying open technique, flaps result in faster healing and a shorter time to return to activities.

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“…Amir Keshvari в своем рандомизированном исследовании сравнил методику Karydakis (K-flap) и открытое ведение раны (заживление вторичным натяжением). При использовании K-flap отмечается: слабая выраженность болевого синдрома в течение первой недели, меньший период нетрудоспособности ( [34]. Ali Guner в своем рандомизированном исследовании провел сравнение лечения пилонидальной болезни по методике Bascom II и Limberg Flap (пластика по Лимбергу).…”

Section: Discussionunclassified

SURGICAL TREATMENT OF PILONIDAL DESEASE (review)

et al. 2018

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1 ГБОУ ВПО «Рязанский государственный медицинский университет им. акад. И.П.Павлова», кафедра хирургии, акушерства и гинекологии ФДПО, г. Рязань, Россия (зав. кафедрой -д.м.н. Д.А.Хубезов) 2 ГБУ РО «Областная клиническая больница», г. Рязань, Россия Проблема лечения пилонидальной болезни является чрезвычайно актуальной в наши дни. От данной патологии страдает до 5% взрослого трудоспособного населения. Среди колопроктологических заболеваний пилонидальная болезнь занимает четвертое место, уступая лишь геморрою, парапроктиту и анальной трещине. Первое упоминание пилонидальной болезни появилось в научной литературе около двух веков назад. За этот период были сформированы разнообразные взгляды на этиологию и патогенез данного заболевания. Западные ученые являются сторонниками приобретенного генеза заболевания. Им противопоставлены страны бывшего СССР, где пилонидальную болезнь рассматривают с позиции врожденной патологии. Исходя из теорий этиопатогенеза были предложены различные методы хирургического лечения. При рассмотрении пилонидальной болезни с точки зрения врожденной аномалии, применяются методы, направленные на ее устранение (иссечение пилонидальной кисты с пластикой послеоперационной раны и без нее). Если же рассматривать данную нозологическую единицу как приобретенное заболевание, то ее хирургическое лечение будет заключаться в выполнении операций, разрывающих патогенетический механизм. К ним относятся: BascomI, CleftLift, EPSiT и многие другие. Каждый клинический случай трeбует индивидуального подхода для получения положительных результатов Любой из методов хирургического лечения пилонидальной болезни имеет определенные показания и противопоказания к оперативному вмешательству. Цель нашей работы состоит в сравнении основных методик хирургического лечения рассматриваемой нозологической единицы и определении их сильных и слабых сторон. К сожалению, на сегодняшний день отсутствует «золотой стандарт» в лечении пилонидальной болезни. [Ключевые слова: пилонидальная болезнь, пилонидальная киста, эпителиальный копчиковый ход, колопроктология]

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Primary wound closure with a Limberg flap vs. secondary wound healing after excision of a pilonidal sinus: a multicentre randomised controlled study

Abstract: After excision of a pilonidal sinus, primary wound closure with a Limberg flap has no advantage over secondary wound healing. The main reason for this conclusion is the relatively high complication rate of primary wound closure with a Limberg flap.

Cited by 51 publications

References 25 publications

Comparison of primary repair with healing by secondary intention for the treatment of pilonidal sinus, at a Tertiary Care Hospital in Karachi, Pakistan.

Comparison of primary repair with healing by secondary intention for the treatment of pilonidal sinus, at a Tertiary Care Hospital in Karachi, Pakistan.

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

SURGICAL TREATMENT OF PILONIDAL DESEASE (review)

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