DOI: http://dx.doi.org/10.18203/2349-2902.isj20213996

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

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

Abstract


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.


Keywords


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

Full Text:

PDF

References


Norman SW. The anus and anal canal. In: Bailey & Love’s short practice of surgery. 26th ed. India: Arnold Publishers; 2013;73:1244-5.

Kosaka M, Kida M, Mori H, Kamiishi H. Pilonidal cyst of the scalp due to single minor trauma. Dermatologic Surg. 2007;33(4):505-7.

Aslam MN, Shoaib S, Choudhry AM. Use of Limberg flap for pilonidal sinus–a viable option. Journal of Ayub Medical College Abbottabad. 2009;21(4):31-3.

Fatih A, Enis D, Yusuf A, Taner O, Gokhan A, Nuri DO. Comparision of the Limberg flap with the VY flap technique in the treatment of pilonidal disease. Annl Surg Treat Res. 2013;85(2):63-7.

Mentes O, Bagci M, Bilgin T, Ozgul O, Ozdemir M. Limberg flap procedure for pilonidal sinus disease: results of 353 patients. Langenbeck's Arch Surg. 2008;393(2):185-9.

Hodges RB. Limberg flap Suegrey. Med Surg J. 1946;103:485.

Spivak H, Brooks VL, Nussbaum M, Friedman I. Treatment of chronic pilonidal disease. Lancet. 1996; 39(10):1136-9.

Sharma PP. Multiple Z-plasty in pilonidal sinus-a new technique under local anesthesia. World J Surg. 2006;30(12):2261-5.

Muzi MG, Milito G, Cadeddu F, Nigro C, Andreoli F, Amabile D, et al. Randomized comparison of Limberg flap versus modified primary closure for the treatment of pilonidal disease. Am J Surg. 2010; 200(1):9-14.

Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust J Surg. 1992;62(5):385-9.

Anyanwu AC, Hossain S, Williams A, Montgomery AC. Karydakis operation for sacrococcygeal pilonidal sinus disease: experience in a district general hospital. Annl Royal College Surg Eng. 1998;80(3):197.

Akca T, Colak T, Ustunsoy B, Kanik A, Aydin S. Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease. British J Surg. 2005;92(9):1081-4.

Doll D, Krueger CM, Schrank S, Dettmann H, Petersen S, Duesel W. Timeline of recurrence after primary and secondary pilonidal sinus surgery. Dis Colon Rectum. 2007;50(11):1928-34.

Limongelli P, Brusciano L, Di Stazio C, del Genio G, Tolone S, Lucido FS, et al. D-shape asymmetric and symmetric excision with primary closure in the treatment of sacrococcygeal pilonidal disease. Am J Surg. 2014;207(6):882-9.

Ates M, Dirican A, Sarac M, Aslan A, Colak C. Short and long-term results of the Karydakis flap versus the Limberg flap for treating pilonidal sinus disease: a prospective randomized study. Am J Surg. 2011; 202(5):568-73.