Evaluation of single center clinical experience in patients undergoing modified Limberg flap technique in pilonidal sinus disease
Abstract
Aims: Pilonidal sinus disease (PSD) is a chronic inflammatory disease that is seen especially in young men, is often located in the sacrococcygeal region and negatively affects the quality of life and daily life of the person. In this study, we aimed to share our experience with the literature by examining our clinical approach and results in the patient group who underwent Modified Limberg flap technique electively in PSD.
Methods: Patients who underwent elective modified Limberg flap application due to PSD in the general surgery clinic were included in the study. Demographic and clinical parameters of the patients were investigated retrospectively.
Results: The mean age of 76 patients included in the study was 27.5±8.5 years (18-51 years). The median duration of hospitalisation was 2 days. The most commonly preferred prophylactic antibiotic at surgery was cefuroxime + metranidazole combination (60.5%) or cefuroxime alone (32.9%). Drain use was present in approximately 40% of the cases. Subcutaneous tissues were closed with a single layer of polyglactin suture in most cases (94.7%). During the median follow-up period of 12 months, postoperative recurrence was observed in only 6 cases (7.9%).
Conclusions: Modified Limberg flap technique is a well-defined, safe and feasible surgical method. Since it is an effective off-midline technique, its application by experienced surgeons in complicated and recurrent cases in elective PSD surgery and its transfer to junior and resident surgeons will be effective in terms of moving away from midline techniques.
References
- Kanat BH, Sözen S. Disease that should be remembered: sacrococcygeal pilonidal sinus disease and short history. World J Clin Cases. 2015;3(10):876-879. doi: 10.12998/wjcc.v3.i10.876
- Kober MM, Alapati U, Khachemoune A. Treatment options for pilonidal sinus. Cutis. 2018;102(4):E23-E29.
- Kumar M, Clay WH, Lee MJ, Brown SR, Hind D. A mapping review of sacrococcygeal pilonidal sinus disease. Tech Coloproctol. 2021;25(6):675-682. doi: 10.1007/s10151-021-02432-9
- Sarı R, Akbaba S, Gündoğdu RH, Yazıcıoğlu MÖ. Comparison of VY flap and Limberg flap methods in pilonidal sinus surgery. Turk J Colorectal Dis. 2019;29(2):69-74. doi: 10.4274/tjcd.galenos. 2018.10437
- Danilov MA, Saakyan GG, Leontyev AV, Baichorov AB, Abdulatipova ZM. Rezul'taty khirurgicheskogo lecheniya epitelial'nogo kopchikovogo khoda s ispol'zovaniem plastiki po Limbergu [Limberg flap reconstruction for pilonidal sinus]. Khirurgiia (Mosk). 2021;(11):34-38. Russian. doi: 10.17116/hirurgia202111134
- Giuseppe F, Silvia DG, Patrizia R, et al. Pilonidal sinus disease: preliminary case-control study on heat-related wound dehiscence. Ann Med Surg. 2019;48:144-149. doi: 10.1016/j.amsu.2019.07.032
- Bi S, Sun K, Chen S, Gu J. Surgical procedures in the pilonidal sinus disease: a systematic review and network meta-analysis. Sci Rep. 2020;10(1):13720. doi: 10.1038/s41598-020-70641-7
- Collings AT, Rymeski B. Updates on the management of pilonidal disease. Adv Pediatr. 2022;69(1):231-241. doi: 10.1016/j.yapd.2022.03.001
- Gozukucuk A, Cakiroglu B, Yapici S, Cesur IB, Ozcelik Z, Kilic HH. Comparing crystallized phenol and surgical excision treatments in pilonidal sinus disease. J Coll Physicians Surg Pak. 2022;32(5):652-657. doi: 10.29271/jcpsp.2022.05.652
- Lund J, Tou S, Doleman B, Williams JP. Fibrin glue for pilonidal sinus disease. Cochrane Database Syst Rev. 2017;1(1):CD011923. doi: 10.1002/14651858.CD011923.pub2
- Williams MD, Sullivan GA, Nimmagadda N, et al. Laser ablation of pilonidal sinus disease: a pilot study. Dis Colon Rectum. 2023;66(5):e224-e227. doi: 10.1097/DCR.0000000000002745
- Halleran DR, Onwuka AJ, Lawrence AE, Fischer BC, Deans KJ, Minneci PC. Laser hair depilation in the treatment of pilonidal disease: a systematic review. Surg Infect. 2018;19(6):566-572. doi: 10.1089/sur.2018.099
- Bi S, Sun K, Chen S, Gu J. Surgical procedures in the pilonidal sinus disease: a systematic review and network meta-analysis. Sci Rep. 2020;10(1):13720. doi: 10.1038/s41598-020-70641-7
- 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(3):318-327. doi: 10.1016/j.amjsurg.2009.08.042
- Sewefy AM, Hassanen A, Atyia AM, Saleh SK. Karydakis flap with compressing tie-over interrupted sutures without drain versus standard Karydakis for treatment of sacrococcygeal pilonidal sinus disease. Dis Colon Rectum. 2017;60(5):514-520. doi: 10.1097/DCR.0000000000000784
- Sahin A, Simsek G, Arslan K. Unroofing curettage versus modified Limberg flap in pilonidal disease: a retrospective cohort study. Dis Colon Rectum. 2022;65(10):1241-1250. doi: 10.1097/DCR.0000000000002227
- Gavriilidis P, Bota E. Limberg flap versus Karydakis flap for treating pilonidal sinus disease: a systematic review and meta-analysis. Can J Surg. 2019;62(2):131-138. doi: 10.1503/cjs.003018
- Boshnaq M, Phan YC, Martini I, Harilingam M, Akhtar M, Tsavellas G. Limberg flap in management of pilonidal sinus disease: systematic review and a local experience. Acta Chir Belg. 2018;118(2):78-84. doi: 10.1080/00015458.2018.1430218
- Destek S, Bektaşoğlu HK, Kunduz E, Akyüz MN. Comparison of postoperative quality of life of Limberg flap and Karydakis flap in pilonidal sinus operations. Turk J Surg. 2020;36(1):59-64. doi: 10.5578/turkjsurg.4598
- Alvandipour M, Zamani MS, Ghorbani M, Charati JY, Karami MY. Comparison of Limberg flap and Karydakis flap surgery for the treatment of patients with pilonidal sinus disease: a single-blinded parallel randomized study. Ann Coloproctol. 2019;35(6):313-318. doi: 10.3393/ac.2018.09.27
Pilonidal sinus hastalığında Rhomboid eksizyon ve Modifiye Limberg flep uygulanan hastalarda tek merkez klinik deneyiminin değerlendirilmesi
Abstract
Amaç: Pilonidal sinüs hastalığı (PSD), özellikle genç erkeklerde görülen, sıklıkla sakrokoksigeal bölgede yerleşim gösteren ve kişinin yaşam kalitesini ve günlük hayatını olumsuz etkileyen bir kronik inflamatuvar hastalıktır. Bu çalışmada; PSD’de elektif olarak Rhomboid eksizyon ve Modifiye Limberg flep uygulanan hasta grubunda klinik yaklaşımımızı ve sonuçlarımızı inceleyerek deneyimimizi literatürle paylaşmayı amaçladık.
Gereç ve Yöntem: Genel cerrahi kliniğinde PSD nedeniyle elektif olarak rhomboid eksizyon ve modifiye limberg flep uygulaması yapılan hastalar çalışmaya dahil edildi. Hastalara ait demografik ve klinik parametreler retrospektif olarak araştırıldı.
Bulgular: Çalışmaya dahil edilen 76 hastanın yaş ortalaması 27,5 ± 8,5 yıl idi (18-51 yaş). Hastaların median hastanede yatış süresi 2 gün idi. Cerrahide en sık tercih edilen profilaktik antibiyotik sefuroksim+ metranidazol (%60,5) kombinasyonu veya sadece sefuroksim (%32,9) idi. Olguların yaklaşık %40’ında dren kullanımı mevcuttu. Cilt altı dokular olguların çoğunda (%94,7) tek kat poliglaktin sütur ile kapatılmıştı. Median 12 aylık takip süresi içerisinde, postoperatif sadece 6 olguda (%7,9) nüks izlenmişti.
Sonuç: Consequently, Rhomboid eksizyon + Modifiye Limberg flep tekniği iyi tanımlanmış, safe and feasible bir cerrahi metoddur. Etkin bir off-midline teknik olması sebebiyle elektif PSD cerrahisinde komplike, unkomplike ve rekürren vakalarda deneyimli cerrahlar tarafından uygulanması, junior ve resident cerrahlara aktarılması midline tekniklerden uzaklaşılması açısından etkin olacaktır.
References
- Kanat BH, Sözen S. Disease that should be remembered: sacrococcygeal pilonidal sinus disease and short history. World J Clin Cases. 2015;3(10):876-879. doi: 10.12998/wjcc.v3.i10.876
- Kober MM, Alapati U, Khachemoune A. Treatment options for pilonidal sinus. Cutis. 2018;102(4):E23-E29.
- Kumar M, Clay WH, Lee MJ, Brown SR, Hind D. A mapping review of sacrococcygeal pilonidal sinus disease. Tech Coloproctol. 2021;25(6):675-682. doi: 10.1007/s10151-021-02432-9
- Sarı R, Akbaba S, Gündoğdu RH, Yazıcıoğlu MÖ. Comparison of VY flap and Limberg flap methods in pilonidal sinus surgery. Turk J Colorectal Dis. 2019;29(2):69-74. doi: 10.4274/tjcd.galenos. 2018.10437
- Danilov MA, Saakyan GG, Leontyev AV, Baichorov AB, Abdulatipova ZM. Rezul'taty khirurgicheskogo lecheniya epitelial'nogo kopchikovogo khoda s ispol'zovaniem plastiki po Limbergu [Limberg flap reconstruction for pilonidal sinus]. Khirurgiia (Mosk). 2021;(11):34-38. Russian. doi: 10.17116/hirurgia202111134
- Giuseppe F, Silvia DG, Patrizia R, et al. Pilonidal sinus disease: preliminary case-control study on heat-related wound dehiscence. Ann Med Surg. 2019;48:144-149. doi: 10.1016/j.amsu.2019.07.032
- Bi S, Sun K, Chen S, Gu J. Surgical procedures in the pilonidal sinus disease: a systematic review and network meta-analysis. Sci Rep. 2020;10(1):13720. doi: 10.1038/s41598-020-70641-7
- Collings AT, Rymeski B. Updates on the management of pilonidal disease. Adv Pediatr. 2022;69(1):231-241. doi: 10.1016/j.yapd.2022.03.001
- Gozukucuk A, Cakiroglu B, Yapici S, Cesur IB, Ozcelik Z, Kilic HH. Comparing crystallized phenol and surgical excision treatments in pilonidal sinus disease. J Coll Physicians Surg Pak. 2022;32(5):652-657. doi: 10.29271/jcpsp.2022.05.652
- Lund J, Tou S, Doleman B, Williams JP. Fibrin glue for pilonidal sinus disease. Cochrane Database Syst Rev. 2017;1(1):CD011923. doi: 10.1002/14651858.CD011923.pub2
- Williams MD, Sullivan GA, Nimmagadda N, et al. Laser ablation of pilonidal sinus disease: a pilot study. Dis Colon Rectum. 2023;66(5):e224-e227. doi: 10.1097/DCR.0000000000002745
- Halleran DR, Onwuka AJ, Lawrence AE, Fischer BC, Deans KJ, Minneci PC. Laser hair depilation in the treatment of pilonidal disease: a systematic review. Surg Infect. 2018;19(6):566-572. doi: 10.1089/sur.2018.099
- Bi S, Sun K, Chen S, Gu J. Surgical procedures in the pilonidal sinus disease: a systematic review and network meta-analysis. Sci Rep. 2020;10(1):13720. doi: 10.1038/s41598-020-70641-7
- 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(3):318-327. doi: 10.1016/j.amjsurg.2009.08.042
- Sewefy AM, Hassanen A, Atyia AM, Saleh SK. Karydakis flap with compressing tie-over interrupted sutures without drain versus standard Karydakis for treatment of sacrococcygeal pilonidal sinus disease. Dis Colon Rectum. 2017;60(5):514-520. doi: 10.1097/DCR.0000000000000784
- Sahin A, Simsek G, Arslan K. Unroofing curettage versus modified Limberg flap in pilonidal disease: a retrospective cohort study. Dis Colon Rectum. 2022;65(10):1241-1250. doi: 10.1097/DCR.0000000000002227
- Gavriilidis P, Bota E. Limberg flap versus Karydakis flap for treating pilonidal sinus disease: a systematic review and meta-analysis. Can J Surg. 2019;62(2):131-138. doi: 10.1503/cjs.003018
- Boshnaq M, Phan YC, Martini I, Harilingam M, Akhtar M, Tsavellas G. Limberg flap in management of pilonidal sinus disease: systematic review and a local experience. Acta Chir Belg. 2018;118(2):78-84. doi: 10.1080/00015458.2018.1430218
- Destek S, Bektaşoğlu HK, Kunduz E, Akyüz MN. Comparison of postoperative quality of life of Limberg flap and Karydakis flap in pilonidal sinus operations. Turk J Surg. 2020;36(1):59-64. doi: 10.5578/turkjsurg.4598
- Alvandipour M, Zamani MS, Ghorbani M, Charati JY, Karami MY. Comparison of Limberg flap and Karydakis flap surgery for the treatment of patients with pilonidal sinus disease: a single-blinded parallel randomized study. Ann Coloproctol. 2019;35(6):313-318. doi: 10.3393/ac.2018.09.27
Details
| Primary Language | English |
|---|---|
| Subjects | General Surgery |
| Journal Section | Research Articles [en] Araştırma Makaleleri [tr] |
| Authors | |
| Publication Date | December 31, 2023 |
| Submission Date | November 14, 2023 |
| Acceptance Date | December 26, 2023 |
| Published in Issue | Year 2023 Volume: 4 Issue: 6 |
TR DİZİN ULAKBİM and International Indexes (1d)
Interuniversity Board (UAK) Equivalency: Article published in Ulakbim TR Index journal [10 POINTS], and Article published in other (excuding 1a, b, c) international indexed journal (1d) [5 POINTS]
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