The application of the Limberg flap repair technique in the surgical treatment of pilonidal sinus disease

Abstract

Pilonidal sinus disease (PNSD) challenged surgeons for decades. Limberg flap repair (LFR) is a common treatment for PNSD. The purpose of this study was to observe the effect and risk factors of LFR in PNSD. A retrospective study was conducted on the PNSD patients who visited two medical centers and four departments in the People's Liberation Army General Hospital and were taking LFR treatment between 2016 and 2022. The risk factors, the effect of the operation, and complications were observed. The effects of known risk factors on the surgical results were compared. There were 37 PNSD patients: male/female ratio of 35:2, average age: 25.1 ± 7.9 years. Average BMI: 25.2 ± 4.0 kg/m2, average wound healing time: 15.4 ± 3.4 days. 30 patients (81.0%) healed in stage one and 7 (16.3%) had postoperative complications. Only 1 patient (2.7%) had a recurrence while others were healed after dressing‐changing. There was no significant difference in age, BMI, preoperative debridement history, preoperative sinus classification, Wound area, Negative pressure drainage tube, prone time (<3d) and treatment effect. Squat defecate and premature defecation were associated with treatment effect, and they were independent predictors of treatment effect in the multivariate analysis. LFR has a stable therapeutic outcome. Compared with other skin flaps, the therapeutic effect of this flap is not significantly different, but the design is simple and is not affected by the known risk factors before operation. However, it is necessary to avoid the influence of two independent risk factors, squatting defecation and premature defecation, on the therapeutic effect.

Outcomes of pediatric pilonidal disease treatment: excision with off-midline flap reconstruction versus endoscopic pilonidal sinus treatment

“…In comparing the two operative modalities, excision with OMF reconstruction was associated with lower rates of disease recurrence and reoperation at a limited follow-up duration. Our observed recurrence rate after excision with OMF reconstruction was 5.6% which is consistent with previously reported rates ranging from 2.7 to 6.3% after excision with Limberg flap or MLF reconstruction [ 19 , 20 , 31 ]. We found this to be significantly lower than recurrence rates reported after minimally invasive treatment approaches, which have been previously reported at 13.2% at 5-year follow-up in the adult population and up to 38% at 28-month follow-up in the pediatric population [ 32 , 33 ].…”

Outcomes of Limberg flap repair in recurrent pilonidal sinus disease: a study in a district hospital of Bangladesh

“…Similar outcomes were reported in other studies as well. 10,13 In our study, postoperative complications such as seroma (8.5%) and hematoma (6.4%) were observed in more than 5% of participants. Similar complications were also noted by Baz et al 14 Patient feedback indicated that the majority (62%) experienced excellent results, followed by 21% reporting good outcomes and 17% reporting fair outcomes.…”

“…Similar clinical features were also observed by Song et al in their study. 10 Analyzing the outcomes, our study revealed a mean operation duration of 53.4±7.2 minutes, with patients achieving first mobilization at 1.1±0.2 days, experiencing incapacity for work for 7.3±1.5 days, reporting a pain VAS score of 1.7±0.3, achieving complete healing within 21.7±7.9 days, and attaining painless toilet seating in 1.2±0.6 days for all participants. Similar outcomes were reported in other studies as well.…”

“…PSD predominantly affects males after puberty and is more prevalent among individuals of Arab, European, and American descent. 10 Conversely, it is relatively uncommon in East and Southeast Asia, particularly among females. The condition earned the moniker "jeep cyst" due to its frequent occurrence among American soldiers who operated jeeps during World War II.…”

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

“…If it is not treated in time or treated poorly, it will enter a chronic course and affect the patient’s life, work, and interpersonal relationships. The further aggravation of the disease will necessitate more difficult treatment, and consequently the economic burden on patients will also increase 129 , 130 . At present, there are many treatment options for SPS, both non-surgical and surgical, and various new technologies are emerging in an endless stream.…”