Abstract
Purpose: Pilonidal sinus is a common chronic disease relating sacrococcygeal region. Although several surgical treatment methods were determined relating pilonidal sinus, no optimal treatment method is available because of its high recurrence rates. This study was designed to compare Limberg and Dufourmentel flap methods that are currently used.
Patients and Methods: This study is a clinical study including patients admitted to our hospital and diagnosed as chronic pilonidal sinus disease between 2004 to 2007.
Patients were divided into two groups. Romboid sinus excision with Limberg flap method was performed to first group named as group L included 50 patients.
Romboid sinus excision with Dufourmentel flap method was performed to second group named as group D included 50 patients. Patients had complicated or recurrent pilonidal sinus and patients with infection were excluded.
Results: When parameters related to early term complication were taken into account, there were no differences between the groups regarding seroma and wound dehiscence, although infection and hematoma were significantly less in group D patients. When parameters related to late term complication were taken into account no significant differences were detected between groups regarding sensory loss, pain, itching, and cosmetic worry. Two patients in group D and three patients in group L had recurrent pilonidal sinus in present study. However, no satistical significance was found between groups in term of recurrence.
Conclusion: There are very different surgical and non-surgical treatment choices for treatment of pilonidal sinus. Not any treatment method absolutely prevent recurrence. The lowest recurrence rates were reported with primary excision and Romboid flap method in current literature. We suggest that Dufourmentel flap method could be used as an alternative to Limberg flap method in treatment of pilonidal sinus because of its lower infection and hematoma rates, although time of hospitalisation, late complications and recurrence rates are similar compared to Limberg flap method.
Keywords:
Pilonidal sinus, Limberg flap, Dufourmentel flap
References
1Bailey HR, Ford DB. Pilonidal Disease. ed: Zuidema GD, Yeo JC. Shackelford's Surgery of the Alimentary Tract 5th Ed.Vol:4, Philadelphia: Saunders 2002;480- 484.
2Urhan MK, Kücükel F, Topgul K et al. Rhomboid excision and Limberg flap for managing pilonidal sinus: results of 102 cases. Dis Colon Rectum 2002;45:656-659.
3Bozkurt MK, Tezel E. Management of pilonidal sinus with the Limberg flap. Dis Colon Rectum 1998; 41: 775-777. [DOI:10.1007/BF02236268]
4Aslam MN, Shoaib S, Choudhry AM. Use of Limberg flap for pilonidal sinus--a viable option. J Ayub Med Coll Abbottabad 2009;21:31-33.
5Mahdy T. Surgical treatment of the pilonidal disease: primary closure or flap reconstruction after excision. Dis Colon Rectum 2008;51:1816-1822. [DOI:10.1007/s10350- 008-9436-8]
6Keighley MR. Pilonidal sinus in: Keighley MRB, Williams NS eds. Surgery of the Anus, Rectum & Colon. 2nd ed.WB Saunders Company, London; 1999. p.539-563.
7Lee PJ, Raniga S, Biyani DK, Watson AJ, Faragher IG, Frizelle FA. Sacrococcygeal pilonidal disease. Colorectal Dis 2008;10:639-650.
8Hamaloğlu E, Yorgancı K. Pilonidal sinüs. Temel cerrahi'de. ed: Sayek İ. Ankara: Güneş Kitapevi 2004:126;1273.
9Ertan T, Koc M, Gocmen E, Aslar AK, Keskek M, Kilic M. Does technique alter quality of life after pilonidal sinus surgery? Am J Surg 2005;190:388-392.
10Sondenaa K, Nesvik I. Recurrent pilonidal sinus after excision with closed or open treatment: final result of a randomized trial. Eur J Surg 1996;162:237-240.
11Humphries AE, Duncan JE. Evaluation and management of pilonidal disease. Surg Clin Nort Am 2010;90:113-124.
12Azab AS, Kamal MS, Saad RA, Abou al Ata KA, Ali NA. Radical cure of pilonidal sinus by a transposition flap. Br J Surg 1984;71:154-155.
13Lieto E, Castellano P, Pinto M, Zamboli A, Pignatelli C, Galizia G. Dufourmentel rhomboid flap in the radical treatment of primary and recurrent sacrococcygeal pilonidal disease. Dis Colon Rectum. 2010;53:1061-1068.
14Mentes O, Bagci M, Bilgin T, Ozgul O, Ozdemir M. Limberg flap procedure for pilonidal sinus disease: results of 353 patients. Langenbecks Arch Surg 2008;393;185-189.
15Akin 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 Disease 2008;10:945-948.
16Bascom J. Pilonidal sinus: long-term results of follicle removal. Dis Colon Rectum 1983;26:800-807.
17Hull TL, Wu J. Pilonidal disease. Surg Clin North Am 2002;82:1169-1185.
18Da Silva JH. Pilonidal cyst, cause and treatment. Dis Colon Rectum 2000;42:1146– 1156.
19Cihan A, Mentes BB, Tatlicioglu E, Ozmen S, Leventoglu S, Ucan BH. Modified Limberg flap reconstruction compares favourably with primary repair for pilonidal sinus, surgery. Aust N Z Surg 2004; 74: 238-242. [DOI:10.1111/j.1445- 2197.2004.02951.x]
20Sözen S, Topuz O, Donder Y, Emir S, Ozdemir CS, Keceli M, Baktir HA, Saricik B. Sakrokoksigeal pilonidal sinüsün cerrahi tedavisinde Karydakis flep ile Limberg flep ameliyatlarının karşılaştırılması (erken dönem sonuçları). Ulusal Cerrahi Dergisi 2010;3:153-156.
21Erdem E. Sungurtekin U, Nessar M. Are postoperative drains neccessary with the Limberg flep for treatment of pilonidal sinus? Dis Colon Rectum 1998;41:1427– 1431.
22Larrabee WF Jr, Trachy R, Sutton D, Cox K. Rhomboid flap dynamics. Arch Otolaryngol 1981;107:755-757.
23Lister GD, Gibson T. Closure of Romboid skin defects: the flaps of Limberg and Dufourmentel. Br J Plast Surg 1972;25:300-314.