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CC BY-NC-ND 4.0 · Journal of Coloproctology 2022; 42(04): 335-339
DOI: 10.1055/s-0042-1759740
Original Article

Surgical Outcome of Modified Karydakis Flap and Modified Limberg Flab in the Management of Sacroccygeal Pilonidal Disease: A Comparative Study

Yasser Baz 
1   Surgery Department, Helwan University, Helwan, Egypt
,
Yasser Ali Orban 
2   Surgery Department, Zagazig University, Zagazig, Egypt
,
Mohamed Mahmoud Ezzat 
1   Surgery Department, Helwan University, Helwan, Egypt
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Abstract

Introduction Sacrococcygeal pilonidal disease (SPD) is a chronic suppurative condition of the sacrococcygeal region causing chronic sinus tract or cyst. It is an acquired complex disease more common in young adult males, causing considerable morbidity and long periods of interruption in work or education. From simple conservative techniques to complex flap reconstruction, many debatable treatment options are offered; however clear dynamics toward the widespread use of minimally invasive methods and off-midline flap reconstruction are suggested in all guidelines, which recommend the Karydakis and Limberg flap modification. The plethora of literature compares procedures for identification of a single best treatment approach, which has proven to be difficult. The surgical outcome of both techniques is compared in the present study.

Objective To compare the surgical outcomes of the modified Karydakis flap (MKF) versus the modified Limberg flap (MLF) in SPD.

Materials and Methods The present study was conducted at the general surgery department on SPD patients who were ≥18 years old. A total of 67 participants were included after obtaining the informed consent, with group A comprising 33 patients undergoing the MLF procedure and group B comprising 34 patients undergoing the MKF procedure.

Results The mean patient age was 28.85 (range, 18–44) years old. For the MKF and MLF methods, the average operating duration was 32.5 (range, 25–40) and 54.5 (range, 45–65) minutes, respectively. The MKF approach was found to significantly improve pain score, mean sitting painless time, return to normal activity, wound healing time, and patient satisfaction.

Conclusion Comparative outcomes were seen between both MKF and MLF; however, our findings show that MKF is a more favourable method than MLF with superior outcomes.

Keywords

modified karydakis - limberg flap - pilonidal sinus


Publication History

Received: 11 August 2022

Accepted: 25 October 2022

Article published online:
22 December 2022

© 2022. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Zou Q, Zhang D, Xian Z. et al. Prognostic factors of flap techniques for pilonidal disease based on magnetic resonance imaging and clinical parameters. Asian J Surg 2022; 45 (01) 284-290
    CrossrefPubMedSearch in Google Scholar
  • 2 Ahmad N, Prakash P, Pawar SS, Baitha KS. Comparative study of limberg's rotation flap versus karydakis procedure in pilonidal sinus surgery. Int J Health Clin Res 2022; 5 (01) 365-369
    Search in Google Scholar
  • 3 Antony AM, Ilango SP, Kiranraj R, Nathan S, Madhivanan S. Surgical outcome between Karydakis flap and Limberg flab in pilonidal sinus: A comparative study. International Journal of Surgery 2022; 6 (01) 13-7
    Search in Google Scholar
  • 4 Orban YA, Habib FM, Sallam AM, Sarhan A, Mansour MI. Limberg versus modified Limberg flap in the management of pilonidal sinus. The Egyptian Journal of Surgery 2021 Oct 1; 40 (04) 1379-83
  • 5 Ali MA, Abd El Monaem AA, Nassar MS. Modified Sinotomy versus Modified Limberg flap in Treatment of Pilonidal Sinus. Al-Azhar International Medical Journal 2022 Feb 21; 2: 93-99
  • 6 Jabbar MS, Bhutta MM, Puri N. Comparison between primary closure with Limberg Flap versus open procedure in treatment of pilonidal sinus, in terms of frequency of post-operative wound infection. Pak J Med Sci 2018; 34 (01) 49-53
    CrossrefPubMedSearch in Google Scholar
  • 7 Elhiny AA, Saad DA, Farahat MS. Effectiveness and feasibility of Limberg and Karydakis flap in recurrent and complicated pilonidal sinus disease. Indian Journal of Surgery 2021 Feb; 83 (01) 55-60
    Crossref
  • 8 Dogra V, Mushtaq U, Gilkar IA, Peer JA. Pilonidal sinus and use of Limberg flap: a three years' experience from two tertiary care centres of Northern India. International Surgery Journal 2022 Jan 29; 9 (02) 444-8
    Crossref
  • 9 Bhama AR, Davis BR. Pilonidal Disease and Hidradenitis Suppurativa. In The ASCRS Textbook of Colon and Rectal Surgery 2022 (pp. 293-310). Springer, Cham.
  • 10 Iesalnieks I, Ommer A, Herold A, Doll D. German National Guideline on the management of pilonidal disease: update 2020. Langenbecks Arch Surg 2021; 406 (08) 2569-2580
    CrossrefPubMedSearch in Google Scholar
  • 11 Guner A, Cekic AB, Boz A, Turkyilmaz S, Kucuktulu U. A proposed staging system for chronic symptomatic pilonidal sinus disease and results in patients treated with stage-based approach. BMC Surg 2016; 16 (01) 18
    CrossrefPubMedSearch in Google Scholar
  • 12 Ekici U, Kanlıöz M, Ferhatoğlu MF, Kartal A. A comparative analysis of four different surgical methods for treatment of sacrococcygeal pilonidal sinus. Asian J Surg 2019; 42 (10) 907-913
    CrossrefPubMedSearch in Google Scholar
  • 13 Prassas D, Rolfs TM, Schumacher FJ, Krieg A. Karydakis flap reconstruction versus Limberg flap transposition for pilonidal sinus disease: a meta-analysis of randomized controlled trials. Langenbecks Arch Surg 2018; 403 (05) 547-554
    CrossrefPubMedSearch in Google Scholar
  • 14 Tokac M, Dumlu EG, Aydin MS, Yalcın A, Kilic M. Comparison of modified Limberg flap and Karydakis flap operations in pilonidal sinus surgery: prospective randomized study. Int Surg 2015; 100 (05) 870-877
    CrossrefPubMedSearch in Google Scholar
  • 15 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 (04) 491-498
    CrossrefPubMedSearch in Google Scholar
  • 16 Karaca T, Yoldaş O, Bilgin BÇ, Özer S, Yoldaş S, Karaca NG. Comparison of short-term results of modified Karydakis flap and modified Limberg flap for pilonidal sinus surgery. Int J Surg 2012; 10 (10) 601-606
    CrossrefPubMedSearch in Google Scholar
  • 17 Turan U. Modified Limberg flap versus modified Karydakis flap in pilonidal sinus disease: single surgeon experience. Int Surg J 2019; 6 (09) 3069-3073
    CrossrefSearch in Google Scholar
  • 18 Caliskan M, Kosmaz K, Subasi IE. et al. Comparison of common surgical procedures in non-complicated pilonidal sinus disease, a 7-year follow-up trial. World J Surg 2020; 44 (04) 1091-1098
    CrossrefPubMedSearch in Google Scholar
  • 19 Khan KJ, Ghaffar AA, Choudhry S, Irshad K. Comparison of early outcome between modified Limberg and Karydakis flap procedures in patients with sacrococcygeal pilonidal sinus. Pak J Med Health Sci 2016; 10 (02) 631-634
    Search in Google Scholar
  • 20 Alam F, Farooq D, Theofilis A, Wooler H, Payne R. 269 Outcomes of Modified Karydakis Flap in The Surgical Management of Sacrococcygeal Pilonidal Disease: A Single Surgeon's Experience. Br J Surg 2021; 108 (Suppl. 06) znab259-408
    Search in Google Scholar