Comparison between Limberg Flap and Simple Closure Methods for the Treatment of Sacrococcygeal Pilonidal Sinus

Main Article Content

Hosein Kimiaei Asadi
Seyed Mohammadreza Javadi
Abdollah Boostan Afrooz
Mohammad Ali Seifrabiei

Abstract

Background and Aim: Pilonidal sinus is a common disease in young adults that accounts for high postoperative morbidity and patient discomfort. Implementation of comparative studies on the effectiveness of different techniques for the treatment of sacrococcygeal pilonidal disease can help resolve the ongoing controversies regarding the standard surgical approaches for the disease. Regarding this, the present study aimed to compare Limberg flap and simple closure methods in the treatment of patients with sacrococcygeal pilonidal disease.

Materials and Methods: This randomized clinical trial was performed on 148 patients with pilonidal sinus referring to Besat Hospital, Hamadan, Iran, during 2015-2017. The study population was divided into two groups of simple closure and Limberg flap (n=74 in each group). The pain severity was measured by means of visual analogue scale (VAS) in two stages, namely 1, 7 days after the surgery. The two groups were compared in terms of infection and recurrence rates, length of hospital stay and time to return to work.

Results: The mean age of the participants was obtained at 23.8±8.1 years and 70.3% of them were male. The mean length of hospital stay was 40.18±15.62 h (range: 10.75-80.75 h). The results revealed no significant difference between the two groups considering the length of hospital stay (P=0.105). The comparison of two groups in terms of VAS score (P=0.001) and time to return to work (P=0.007) showed a significant difference between them a day after the operation. Recurrence was observed in 8.1% and 5.4% of the patients undergoing simple closure and Limberg flap, respectively. There was no significant difference between the two groups in terms of the rates of recurrence (P=0.79) and postoperative infection (P=0.42).

Conclusion: As the findings indicated, the patients undergoing the Limberg flap approach had a shorter length of hospital stay and time to return to work in comparison to those managed with the simple closure technique. Consequently, Limberg flap method can be preferred over the simple closure, especially with regard to its fewer complications.

Keywords:
Pilonidal sinus, simple closure, limberg flap, recurrence rate.

Article Details

How to Cite
Asadi, H. K., Javadi, S. M., Afrooz, A. B., & Seifrabiei, M. A. (2020). Comparison between Limberg Flap and Simple Closure Methods for the Treatment of Sacrococcygeal Pilonidal Sinus. Asian Journal of Research in Surgery, 4(2), 1-7. Retrieved from https://journalajrs.com/index.php/AJRS/article/view/30127
Section
Original Research Article

References

Bronshtein M, Solt I, Arad A, Blumenfeld Z. Pilonidal sinus—The tale of the fetal tail. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2005;119(2):255-6.

El-Khadrawy O, Hashish M, Ismail K, Shalaby H. Outcome of the rhomboid flap for recurrent pilonidal disease. World Journal of Surgery. 2009;33(5):1064-8.

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 Journal of Surgery. 2012;74(4):305-8.

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 Disease. 2012;14(2):143-51.

Abdelraheem O, Khalil M. Comparative study between excision with primary closure versus Limberg flap for treatment of primary sacrococcygeal pilonidal sinus. International Surgery Journal. 2017;4(11): 3581-5.

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. Infection. 2014;2(6.6):8.

Ahmed AK, McCallum I, King PM, Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database of Systematic Reviews. 2010;1.

Petersen S, Koch R, Stelzner S, Wendlandt TP, Ludwig K. Primary closure techniques in chronic pilonidal sinus. Diseases of the Colon & Rectum. 2002;45(11):1458-67.

Eryilmaz R, Sahin M, Alimoglu O, Dasiran F. Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap. Surgery. 2003;134(5): 745-9.

Nursal TZ, Ezer A, Çalışkan K, Törer N, Belli S, Moray G. Prospective randomized controlled trial comparing V–Y advancement flap with primary suture methods in pilonidal disease. The American Journal of Surgery. 2010;199(2): 170-7.

Seleem M, Al‐Hashemy A. Management of pilonidal sinus using fibrin glue: A new concept and preliminary experience. Colorectal Disease. 2005;7(4):319-22.

Al-Khayat H, Al-Khayat H, Sadeq A, Groof A, Haider HH, Hayati H, et al. Risk factors for wound complication in pilonidal sinus procedures. Journal of the American College of Surgeons. 2007;205(3):439-44.

Khan PS, Hayat H, Hayat G. Limberg flap versus primary closure in the treatment of primary sacrococcygeal pilonidal disease; A randomized clinical trial. Indian Journal of Surgery. 2013;75(3):192-4.

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. Surgery Today. 2010;40(8):757-62.

Mentes BB, Leventoglu S, Cihan A, Tatlicioglu E, Akin M, Oguz M. Modified Limberg transposition flap for sacrococcygeal pilonidal sinus. Surgery Today. 2004;34(5):419-23.

Topgül K, Özdemir E, Kiliç K, Gökbayir H, Ferahköşe Z. Long-term results of Limberg flap procedure for treatment of pilonidal sinus. Diseases of the Colon & Rectum. 2003;46(11):1545-8.

Cihan A, Mentes B, Tatlicioglu E, Ozmen S, Leventoglu S, Ucan B. Modified Limberg flap reconstruction compares favourably with primary repair for pilonidal sinus surgery. ANZ Journal of Surgery. 2004;74(4):238-42.

Chintapatla S, Safarani N, Kumar S, Haboubi N. Sacrococcygeal pilonidal sinus: Historical review, pathological insight and surgical options. Techniques in Coloproctology. 2003;7(1):3-8.

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 Journal of Surgery. 2005;92(9):1081-4.

Lee H, Ho YH, Seow C, Eu KW, Nyam D. Pilonidal disease in Singapore: Clinical features and management. Australian and New Zealand Journal of Surgery. 2000;70(3):196-8.

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

Urhan MK, Kücükel F, Topgul K, Özer İ, Sari S. Rhomboid excision and Limberg flap for managing pilonidal sinus. Diseases of the Colon & Rectum. 2002;45(5):656-9.

Abu Galala KH, Salam IM, Abu Samaan KR, El Ashaal YI, Chandran VP, Sabastian M, et al. Treatment of pilonidal sinus by primary closure with a transposed rhomboid flap compared with deep suturing: A prospective randomised clinical trial. The European Journal of Surgery. 1999;165(5):468-72.

Khaira H, Brown J. Excision and primary suture of pilonidal sinus. Annals of the Royal College of Surgeons of England. 1995;77(4):242.