Abstract
Background
The aim of this study was to determine whether the lateralization distance causes differences in the flattening ratio of the natal cleft, early complications, or recurrence rates in patients with sacrococcygeal pilonidal sinus disease undergoing the modified Limberg flap.
Methods
This clinical study was conducted from March 2012 to April 2013. Forty patients with sacrococcygeal pilonidal sinus disease were divided into two groups of 20 patients, each according to the lateralization distance of the lower part of the Limberg flap incision (Group I, 1 cm lateralized; Group II, 2 cm lateralized). Early wound complications, recurrence rates, and the flattening ratio of the natal cleft were evaluated.
Results
No statistically significant differences in operating time (mean 42.2 ± 5.7 and 42.3 ± 6.4 min, respectively; p = 0.855), drain removal time [median 3 (range 2–10) and 4 (range 2–14) days, respectively; p = 0.1], or length of hospitalization [median 1 (range 1–3) and 1 (range 1–4) days, respectively; p = 0.775] were found between the groups. The mean follow-up period was 12.8 ± 3.7 months. Recurrence was observed in only one patient of Group II. There were no statistically significant differences in the flattening ratio of the natal cleft, overall wound complications, or recurrence between the two groups.
Conclusions
No statistically significant differences in early complications or recurrence rates were found between the two different lateralization distances in the modified Limberg flap procedure. Therefore, we conclude that 1-cm lateralization of the lower part of the incision is sufficient.
References
Mayo OH (1833) Observations on injuries and diseases of the rectum. Burgess and Hill, London, pp 45–46
Hodges RM (1880) Pilonidal sinus. Boston Med Surg J 103:485–486
Karydakis GE (1992) Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg 62:385–389
Dufourmentel C, Mouly R, Baruch J, Banzet P (1966) Sacrococcygeal cysts and fistulas. Pathogenic and therapeutic discussion. Ann Chir Plast 11:181–186
Azab AS, Kamal MS, Saad RA, Abou al Atta KA, Ali N (1984) Radical cure of pilonidal sinus by a transposition rhomboid flap. Br J Surg 71:154–155
Monro RS, McDermott FT (1965) The elimination of causal factors in pilonidal sinus treated by z-plasty. Br J Surg 52:177–181
Roth RF, Moorman WL (1977) Treatment of pilonidal sinus and cyst by conservative excision and W-plasty closure. Plast Reconstr Surg 60:412–415
Khatri VP, Espinosa MH, Amin AK (1994) Management of recurrent pilonidal sinus by simple V–Y fasciocutaneous flap. Dis Colon Rectum 37:1232–1235
Perez-Gurri JA, Temple WJ, Ketcham AS (1984) Gluteus maximus myocutaneous flap for the treatment of recalcitrant pilonidal disease. Dis Colon Rectum 27:262–264
Neşşar G, Kayaalp C, Seven C (2004) Elliptical rotation flap for pilonidal sinus. Am J Surg 187:300–303
Ozgültekin R, Ersan Y, Ozcan M et al (1995) Therapy of pilonidal sinus with the Limberg transposition flap. Chirurg 66:192–195
Eryilmaz R, Sahin M, Alimoglu O, Dasiran F (2003) Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap. Surgery 134:745–749
Akca T, Colak T, Ustunsoy B, Kanik A, Aydin S (2005) Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease. Br J Surg 92:1081–1084
Aslam MN, Shoaib S, Choudhry AM (2009) Use of Limberg flap for pilonidal sinus—a viable option. J Ayub Med Coll Abbottabad 21:31–33
Mentes BB, Leventoglu S, Cihan A, Tatlicioglu E, Akin M, Oguz M (2004) Modified Limberg transposition flap for sacrococcygeal pilonidal sinus. Surg Today 34:419–423
Cihan A, Mentes BB, Tatlicioglu E, Ozmen S, Leventoglu S, Ucan BH (2004) Modified Limberg flap reconstruction compares favourably with primary repair for pilonidal sinus surgery. ANZ J Surg 4:238–242
Tekin A (2005) A simple modification with the Limberg flap for chronic pilonidal disease. Surgery 5:951–953
Cihan A, Ucan BH, Comert M, Cesur A, Cakmak GK, Tascilar O (2006) Superiority of asymmetric modified Limberg flap for surgical treatment of pilonidal disease. Dis Colon Rectum 49:244–249
Mahdy T (2008) Surgical treatment of the pilonidal disease: primary closure or flap reconstruction after excision. Dis Colon Rectum 51:1816–1822
Akin M, Leventoglu S, Mentes BB et al (2010) 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 40:757–762
Can MF, Sevinc MM, Hancerliogullari O, Yilmaz M, Yagci G (2010) Multicenter prospective randomized trial comparing modified Limberg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease. Am J Surg 3:318–327
Kicka M, Toporcer T, Radonak J (2011) Pilonidal sinus—a classical plastic procedure according to Limberg (Limberg flap procedure) or its modified version? Rozhl Chir 8:482–487
Karaca T, Yoldaş O, Bilgin BÇ, Ozer S, Yoldaş S, Karaca NG (2012) Comparison of short-term results of modified Karydakis flap and modified Limberg flap for pilonidal sinus surgery. Int J Surg 10:601–606
Kaya B, Eris C, Atalay S et al (2012) Modified Limberg transposition flap in the treatment of pilonidal sinus disease. Tech Coloproctol 1:55–59
Karakas BR (2013) Comparison of Z-plasty, Limberg flap, and asymmetric modified Limberg flap techniques for the pilonidal sinus treatment: review of literature. Acta Chir Iugosl 3:31–37
Bessa SS (2013) 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 56:491–498
Sit M, Aktas G, Yilmaz EE (2013) Comparison of the three surgical flap techniques in pilonidal sinus surgery. Am Surg 12:1263–1268
Arslan K, Said Kokcam S, Koksal H, Turan E, Atay A, Dogru O (2014) Which flap method should be preferred for the treatment of pilonidal sinus? A prospective randomized study. Tech Coloproctol 1:29–37
Akinci OF, Kurt M, Terzi A, Atak I, Subasi IE, Akbilgic O (2009) Natal cleft deeper in patients with pilonidal sinus: implications for choice of surgical procedure. Dis Colon Rectum 5:1000–1002
Marzouk DM, Abou-Zeid AA, Antoniou A, Haji A, Benziger H (2008) Sinus excision, release of coccycutaneous attachments and dermal-subcuticular closure (XRD procedure): a novel technique in flattening the natal cleft in pilonidal sinus treatment. Ann R Coll Surg Engl 5:371–376
Acknowledgments
The authors thank Kemal Hakan Gülkesen, MD, PhD, for advice in statistical analysis.
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Karakaş, B.R., Aslaner, A., Gündüz, U.R. et al. Is the lateralization distance important in terms in patients undergoing the modified Limberg flap procedure for treatment of pilonidal sinus?. Tech Coloproctol 19, 309–316 (2015). https://doi.org/10.1007/s10151-014-1252-7
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DOI: https://doi.org/10.1007/s10151-014-1252-7