D-shape asymmetric excision with primary closure versus limberg flap surgery for sacrococcygeal pilonidal sinus

Naveen Rajendra, Venugopal Karigowda, Girish Honnavara Raju, Nitish Suresh


Background: Treatment of sacrococcygeal pilonidal disease with off-midline closure after excision has been suggested to improve surgical outcomes. The aim of this study was to compare the short-term outcomes in patients with sacrococcygeal pilonidal disease, who underwent D shaped asymmetrical excision with flap reconstruction and Limberg flap reconstruction.

Methods: An analysis of 50 patients was done; 25 were treated with D shaped asymmetrical excision with flap reconstruction and 25 with Limberg flap reconstruction procedure from September 2015 to Feb 2017 and were followed up for six months to 1 year.

Results: There were significant difference between group 1 and group 2 with respect to operation time (mean: 40.20±3.19 min and 49.24±3.76 min, p<0.001), blood loss (mean: 45.64±2.93 mland 61.04±3.34 ml, p<0.001). Visual analog scale score was evaluated on postoperative day 15 and 30. On postoperative day 15, VAS score was 2.52±0.77 in group 1 and 3.12±0.97 in group 2. On day 30, VAS score was 1.56±0.77 in group 1 and 2.16±0.94 in group 2, and the differences were statistically significant. The complications were lesser I patients with D shaped asymmetric excision when compared to Limberg flap.

Conclusions: The D-shape procedure is an easier and safer treatment option when compared to Limberg flap for the surgical treatment of sacrococcygeal pilonidal sinus disease owing to the associated low complication rate, short duration to return to normal activity, faster healing, and a high patient satisfaction rate and an easier learning curve.


Sacrococcygeal pilonidal disease, D-shaped asymmetric excision, Limberg flap

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