Original Article

Tension-free Primary Closure, Secondary Intention, and Limberg Flap, Which Is More Effective in Treatment of Uncomplicated Pilonidal Sinus Disease?

Abstract

Background: This study was performed to compare the efficacy and long-term outcomes of three surgical treatments for uncomplicated pilonidal sinus disease, tension-free primary closure, Limberg flap, and secondary intention (wide excision and packing).
Methods: In this randomized clinical trial study, 66 patients with uncomplicated pilonidal sinus disease were randomly assigned to be surgically treated using tension-free primary closure, Limberg flap, or secondary intention methods. The outcomes including pain, healing time, recurrence, complications, disability, reoperation, and patient satisfaction were compared between three groups after two years of follow-up.
Findings: In Limberg flap group, the healing time and disability were significantly less than the two other groups; besides, the pain was significantly less than secondary intention group and more than the primary closure group (P < 0.0001 for all). There were no significant differences between the groups regarding recurrence, complications, reoperation, and patient satisfaction (P > 0.05 for all).
Conclusions: Totally, according to our findings and comparison with other studies, it may be concluded that Limberg flap is relatively better than primary and secondary intention in patients with uncomplicated pilonidal sinus disease.

1. 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(4): 228-31.
2. Hull TL, Wu J. Pilonidal disease. Surg Clin North Am 2002; 82(6): 1169-85.
3. da Silva JH. Pilonidal cyst: Cause and treatment. Dis Colon Rectum 2000; 43(8): 1146-56.
4. Ghnnam WM, Hafez DM. Laser hair removal as adjunct to surgery for pilonidal sinus: our initial experience. J Cutan Aesthet Surg 2011; 4(3): 192-5.
5. von Laffert M, Stadie V, Ulrich J, Marsch WC, Wohlrab J. Morphology of pilonidal sinus disease: some evidence of its being a unilocalized type of hidradenitis suppurativa. Dermatology 2011; 223(4): 349-55.
6. Doll D, Friederichs J, Boulesteix AL, Dusel W, Fend F, Petersen S. Surgery for asymptomatic pilonidal sinus disease. Int J Colorectal Dis 2008; 23(9): 839-44.
7. McCallum I, King PM, Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev 2007; (4): CD006213.
8. 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(4): 491-4.
9. Bessa SS. Comparison of short-term results between the modified Karydakis flap and the modified Limberg flap in the management of pilonidal sinus disease: a randomized controlled study. Dis Colon Rectum 2013; 56(4): 491-8.
10. 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.
11. Abbasi HR, Boland Parvaz SH, Hosseini SV, Yarmohammadi H. Comparison between two methods of excision and primary closure of pilonidal sinus. Iran Red Crescent Med J 2007; 9(3): 143-6.
12. el-Khadrawy O, Hashish M, Ismail K, Shalaby H. Outcome of the rhomboid flap for recurrent pilonidal disease. World J Surg 2009; 33(5): 1064-8.
13. Ekci B, Gokce O. A new flap technique to treat pilonidal sinus. Tech Coloproctol 2009; 13(3): 205-9.
14. 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(2): 143-51.
15. Muller K, Marti L, Tarantino I, Jayne DG, Wolff K, Hetzer FH. Prospective analysis of cosmesis, morbidity, and patient satisfaction following Limberg flap for the treatment of sacrococcygeal pilonidal sinus. Dis Colon Rectum 2011; 54(4): 487-94.
Files
IssueVol 3 No 3-4 (2016) QRcode
SectionOriginal Article(s)
Keywords
Surgical flaps Wound closure techniques Pilonidal sinus Postoperative complications
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Sabet B, Javaherzadeh M, Rajabian SS, Elyasian S, Shekarchizadeh A. Tension-free Primary Closure, Secondary Intention, and Limberg Flap, Which Is More Effective in Treatment of Uncomplicated Pilonidal Sinus Disease?. AJS. 2017;3(3-4):46-49.