Abstract
Purpose: Pilonidal sinus, especially seen in young men, is known to be a distressed condition both in preoperative and postoperative period. Many surgical methods are defined to have advantages against each other, in many different publications in the medical literature. In this study, we aimed to compare two different methods in terms of postoperative complications, recurrence and patients' quality of life. Patients and Methods: A total of 98 patients who have undergone surgical treatment for pilonidal sinus between February 2002 and August 2010 were included in this study. Patients were divided into two groups: Group I was treated by excision and primary repair and Group II was treated by Limberg flap. Results: When evaluated according to the characteristics of patients included in the study, there were no differences in mean age and gender between Group I and II (p=0.496, p=0.382). The duration of surgery was lower in Group I (p<0.001). Postoperat ive hospital stay, minor complications and the rate of recurrence did not differ between groups (p=0.712, p=1.000, p=1.000). The periods until walking without pain, sitting on toilet without pain and returning to work were lower in Group II, and the difference was statistically significant (p<0.001, p<0.001, p<0.001). However, the patients in Group I have expressed that they are more satisfied with the cosmetic results (p<0.001). Conclusion: We found that these two methods did not differ in terms of postoperative minor complications and the rate of recurrence. We observed that the patients were more satisfied with excision and primary repair, in cosmetic point of view. Therefore, we believe that it would be more appropriate to consider the patient's postoperative life and satisfaction as much as we consider the rate of recurrence while deciding the type of surgical method for pilonidal sinus.
Keywords: Pilonidal sinus, excision, Limberg flap, complications, patient satisfaction
References
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.
Hull TL, Wu J. Pilonidal disease. Surg Clin North Am 2002;82:1169-1185.
Tocchi A, Mazzoni G, Bononi M, Fornasari V, Miccini M, Drumo A, Colace L. Outcome of chronic pilonidal disease treatment after ambulatory plain midline excision and primary suture. Am J Surg 2008;196: 28–33.
Polat C, Gungor B, Karagul S, Buyukakıncak S, Topgul K, Erzurumlu K. Is oval flap reconstruction a good modification for treating pilonidal sinuses? Am J Surg 2011; 201: 192–196. DOI:10.1016/j.amjsurg.2010.01.025
Muzi MG, Milito G, Cadeddu F, Nigro C, Andreoli F, Amabile D, Farinon AM. Randomized comparison of Limberg flap versus modified primary closure for the treatment of pilonidal disease. Am J Surg 2010;200:9-14.
Al-Khayat H, Al-Khayat H, Sadeq A, Groof A, Haider HH, Hayati H, Shamsah A , Zarka ZA, Al Haji H, Al- Momen A. Risk factors for wound complication in pilonidal sinus procedures. J Am Coll Surg 2007;205:439-444.
Unalp HR, Derici H, Kamer E et al. Lower recurrence rate for Limberg vs. V-Y flap for pilonidal sinus. Dis Colon Rectum 2007;50:1436-1444.
Hølmebakk T, Nesbakken A. Surgery for pilonidal disease. Scand J Surg 2005;94: 43–46.
Ertan T, Koc M, Gocmen E, et al. Does technique alter quality of life after pilonidal sinus surgery? Am J Surg 2005;190:388–392.
Akca T, Colak T, Ustunsoy B, et al. 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.
Katsoulis IE, Hibberts F, Carapeti EA. Outcome of treatment of primary and recurrent pilonidal sinuses with the Limberg flap. Surgeon 2006;4:7-10.
Eryilmaz R, Sahin M, Alimoglu O, Dasiran F. Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap. Surgery 2003;134:745-749.
Franklin P. Bendewald, Pilonidal disease. Clin Colon Rectal Surg 2007; 20:86-95. DOI:10.1055/s-2007-977486
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. Am J Surg 2010;199: 170–177.
Can MF, Sevinc MM, Hancerliogullari O, Yilmaz M, Yagci G. Multicenter prospective randomized trial comparing modified Limberg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease. Am J Surg 2010;200: 318–327.
Ersoy OF, Karaca S, Kayaoglu HA, Ozkan N, Celik A, Ozum T. Comparison of different surgical options in the treatment of pilonidal sidease: Retrospective analysis of 175 patients. Kaohsiung J Med Sci 2007;23:67-70.
Sözen S, Topuz Ö, Dönder Y, Emir S, Özdemir CŞ, Keçelin M, Baktır HA, Sarıcık B. Sakrokoksigeal pilonidal sinüsün cerrahi tedavisinde Karydakis flep ile Limberg flep ameliyatlarının karşılaştırılması (erken dönem sonuçları). Ulusal Cerrahi Dergisi 2010; 26: 153-156.
Leventoğlu S, Özdemir S, Özçay N et al. Comparison of primary closure with Limberg flap in the treatment of pilonidal disease. Kolon Rektum Hast Derg 2008;19: 90-92.


