Ann Surg Treat Res.  2017 Aug;93(2):82-87. 10.4174/astr.2017.93.2.82.

Comparative analysis of the same technique-the same surgeon approach in the surgical treatment of pilonidal sinus disease: a retrospective cohort study

• Kose E
• Hasbahceci M
• Tonyali H
• Karagulle

• KMID: 2387338
• DOI: http://doi.org/10.4174/astr.2017.93.2.82

Abstract

PURPOSE
Although there are several surgical methods for treatment of sacrococcygeal pilonidal sinus, there is no widespread consensus. In this study, we aimed to compare primary closure, Limberg, and modified Limberg flap techniques, with each performed by each of 3 surgeons.
METHODS
A total of 802 patients who were operated on for pilonidal sinus disease were included in this retrospective cohort study. Patients were evaluated in 3 groups: group 1 (limited excision + primary closure), group 2 (large excision + Limberg flap technique), and group 3 (large excision + modified Limberg technique). Development of early or late period complications was accepted as primary outcome.
RESULTS
Mean patient age was 28.1 ± 6.7 years. Operation time in group 1 was 44.0 ± 14.5 minutes, and was shorter in comparison to other 2 groups (P < 0.001). One or more complications developed in 171 patients (21.3%) within study group. Highest complication rate was in group 1, with a rate of 30.7% (P < 0.001). Rate of wound dehiscence and recurrence in group 1 were differed significantly from other groups (P < 0.001 and P = 0.001, respectively).
CONCLUSION
Based on the same technique-the same surgeon approach, comparison of surgical methods for treatment of pilonidal sinus showed that modified Limberg and Limberg techniques are superior to primary closure technique in terms of general complication, wound dehiscence, and recurrence rates.

Keyword

Pilonidal sinus; Surgery; Surgical flap; Postoperative complication

MeSH Terms

Cohort Studies*
Consensus
Humans
Pilonidal Sinus*
Postoperative Complications
Recurrence
Retrospective Studies*
Surgeons
Surgical Flaps
Wounds and Injuries

Reference

1. Tavassoli A, Noorshafiee S, Nazarzadeh R. Comparison of excision with primary repair versus Limberg flap. Int J Surg. 2011; 9:343–346. PMID: 21354343.

2. Osmanoglu G, Yetisir F. Limberg flap is better for the surgical treatment of pilonidal sinus. Results of a 767 patients series with an at least five years follow-up period. Chirurgia (Bucur). 2011; 106:491–494. PMID: 21991875.

3. 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. Br J Surg. 2005; 92:1081–1084. PMID: 16078300.

4. Akin M, Leventoglu S, Mentes BB, Bostanci H, Gokbayir H, Kilic K, et al. Comparison of the classic Limberg flap and modified Limberg flap in the treatment of pilonidal sinus disease: a retrospective analysis of 416 patients. Surg Today. 2010; 40:757–762. PMID: 20676861.

5. Khan PS, Hayat H, Hayat G. Limberg flap versus primary closure in the treatment of primary sacrococcygeal pilonidal disease; a randomized clinical trial. Indian J Surg. 2013; 75:192–194.

6. Horwood J, Hanratty D, Chandran P, Billings P. Primary closure or rhomboid excision and Limberg flap for the management of primary sacrococcygeal pilonidal disease? A meta-analysis of randomized controlled trials. Colorectal Dis. 2012; 14:143–151. PMID: 20969718.

7. Akin M, Gokbayir H, Kilic K, Topgul K, Ozdemir E, Ferahkose Z. Rhomboid excision and Limberg flap for managing pilonidal sinus: long-term results in 411 patients. Colorectal Dis. 2008; 10:945–948. PMID: 18462233.

8. Ozer S, Karaca T, Bilgin BC, Demir A, Ozer H, Ertas E. Comparison of recurrence between marsupialization, primary repair, limberg flap methods for pilonidal sinus disease. Turk J Colorectal Dis. 2012; 22:10–16.

9. Mentes O, Bagci M, Bilgin T, Coskun I, Ozgul O, Ozdemir M. Management of pilonidal sinus disease with oblique excision and primary closure: results of 493 patients. Dis Colon Rectum. 2006; 49:104–108. PMID: 16283563.

10. Enshaei A, Motearefi S. Comparison of two surgical methods, primary closure and rotational flap, in patients with chronic pilonidal sinus. Glob J Health Sci. 2014; 6(7 Spec No):18–22. PMID: 25363174.

11. Hosseini SV, Bananzadeh AM, Rivaz M, Sabet B, Mosallae M, Pourahmad S, et al. The comparison between drainage, delayed excision and primary closure with excision and secondary healing in management of pilonidal abscess. Int J Surg. 2006; 4:228–231. PMID: 17462356.

12. McCallum IJ, King PM, Bruce J. Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis. BMJ. 2008; 336:868–871. PMID: 18390914.

13. Karaca AS, Ali R, Capar M, Karaca S. Comparison of Limberg flap and excision and primary closure of pilonidal sinus disease, in terms of quality of life and complications. J Korean Surg Soc. 2013; 85:236–239. PMID: 24266015.

14. Shabbir F, Ayyaz M, Farooka MW, Toor AA, Sarwar H, Malik AA. Modified Limberg's flap versus primary closure for treatment of pilonidal sinus disease: a comparative study. J Pak Med Assoc. 2014; 64:1270–1273. PMID: 25831644.

15. 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; 200:9–14. PMID: 20637332.

16. Dass TA, Zaz M, Rather A, Bari S. Elliptical excision with midline primary closure versus rhomboid excision with limberg flap reconstruction in sacrococcygeal pilonidal disease: a prospective, randomized study. Indian J Surg. 2012; 74:305–308. PMID: 23904719.

17. Ersoy OF, Karaca S, Kayaoglu HA, Ozkan N, Celik A, Ozum T. Comparison of different surgical options in the treatment of pilonidal disease: retrospective analysis of 175 patients. Kaohsiung J Med Sci. 2007; 23:67–70. PMID: 17339168.

18. Kaya B, Eris C, Atalay S, Bat O, Bulut NE, Mantoglu B, et al. Modified Limberg transposition flap in the treatment of pilonidal sinus disease. Tech Coloproctol. 2012; 16:55–59. PMID: 22170253.

19. Zorlu M, Sahiner IT, Zobaci E, Kocak C, Yasti AC, Dolapci M. Early results with the Mutaf technique: a novel off-midline approach in pilonidal sinus surgery. Ann Surg Treat Res. 2016; 90:265–271. PMID: 27186571.

20. Colak T, Turkmenoglu O, Dag A, Akca T, Aydin S. A randomized clinical study evaluating the need for drainage after Limberg flap for pilonidal sinus. J Surg Res. 2010; 158:127–131. PMID: 19394643.

21. Mentes BB, Leventoglu S, Cihan A, Tatlicioglu E, Akin M, Oguz M. Modified Limberg transposition flap for sacrococcygeal pilonidal sinus. Surg Today. 2004; 34:419–423. PMID: 15108080.

22. Erdem E, Sungurtekin U, Nessar M. Are postoperative drains necessary with the Limberg flap for treatment of pilonidal sinus? Dis Colon Rectum. 1998; 41:1427–1431. PMID: 9823811.

23. Tocchi A, Mazzoni G, Bononi M, Fornasari V, Miccini M, Drumo A, et al. Outcome of chronic pilonidal disease treatment after ambulatory plain midline excision and primary suture. Am J Surg. 2008; 196:28–33. PMID: 18565338.

24. el-Khadrawy O, Hashish M, Ismail K, Shalaby H. Outcome of the rhomboid flap for recurrent pilonidal disease. World J Surg. 2009; 33:1064–1068. PMID: 19198934.

25. Eryilmaz R, Sahin M, Alimoglu O, Dasiran F. Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap. Surgery. 2003; 134:745–749. PMID: 14639351.