Comparison between Limberg Flap and Simple Closure Methods for the Treatment of Sacrococcygeal Pilonidal Sinus

Abstract

Background and Aim: Pilonidal sinus is a common disease in young adults that accounts for high postoperative morbidity and patient discomfort. Implementation of comparative studies on the effectiveness of different techniques for the treatment of sacrococcygeal pilonidal disease can help resolve the ongoing controversies regarding the standard surgical approaches for the disease. Regarding this, the present study aimed to compare Limberg flap and simple closure methods in the treatment of patients with sacrococcygeal pilonidal disease. Materials and Methods: This randomized clinical trial was performed on 148 patients with pilonidal sinus referring to Besat Hospital, Hamadan, Iran, during 2015-2017. The study population was divided into two groups of simple closure and Limberg flap (n=74 in each group). The pain severity was measured by means of visual analogue scale (VAS) in two stages, namely 1, 7 days after the surgery. The two groups were compared in terms of infection and recurrence rates, length of hospital stay and time to return to work. Results: The mean age of the participants was obtained at 23.8±8.1 years and 70.3% of them were male. The mean length of hospital stay was 40.18±15.62 h (range: 10.75-80.75 h). The results revealed no significant difference between the two groups considering the length of hospital stay (P=0.105). The comparison of two groups in terms of VAS score (P=0.001) and time to return to work (P=0.007) showed a significant difference between them a day after the operation. Recurrence was observed in 8.1% and 5.4% of the patients undergoing simple closure and Limberg flap, respectively. There was no significant difference between the two groups in terms of the rates of recurrence (P=0.79) and postoperative infection (P=0.42). Conclusion: As the findings indicated, the patients undergoing the Limberg flap approach had a shorter length of hospital stay and time to return to work in comparison to those managed with the simple closure technique. Consequently, Limberg flap method can be preferred over the simple closure, especially with regard to its fewer complications.