Different Surgical Approaches for Pilonidal Sinus – Our Experience in a Peripherally Located Tertiary Care Hospital

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Sachin Murukanahalli Basavaraju ◽  
Sachin K ◽  
Hanumantha Basappa Vaggara
Keyword(s):  
Pilonidal Sinus ◽  
Primary Closure ◽  
Pilonidal Disease ◽  
Tertiary Care ◽  
Purulent Discharge ◽  
Pilonidal Sinus Disease ◽  
Inflammatory Disorder ◽  
Limberg Flap ◽  
Care Hospital ◽  
The Mean

Introduction: Pilonidal disease in sacrococcygeal or intergluteal region is an acquired chronic inflammatory disorder with superimposed infection. It is commonly seen in young hairy individuals and usually presents as an abscess or a painful sinus tract in the natal deft with sero/purulent discharge. Aims and Objectives : The objectives of the study were to assess and compare different surgical techniques in the management of pilonidal sinus disease. Materials and Methods This retrospective study was conducted in the Department of General Surgery, Adichunchanagiri Institute of Medical Sciences, B. G. Nagara, Mandya (D), from August 2018 to January 2020. Results During the study period, 30 patients were enrolled, 22 patients were male and 8 were female, with a mean age of 24.3 years. The mean operative time for primary closure was 61 min and flap reconstructions were 70 min with mean hospital stay of 8 and 6 days, respectively. The mean time to walk without pain is 30 and 12 days, respectively. Wound dehiscence was noted in a patient with primary closure. No recurrence was noted for a mean follow-up period of 6 months in any patients. Conclusions: Flap reconstructions were superior to primary closure after excision of pilonidal sinus and that modified Limberg flap was superior with regard to wound infection and recurrence for pilonidal disease.

scholarly journals Management of pilonidal sinus disease with Limberg flap: our experience

2020 ◽  
Vol 7 (5) ◽  
pp. 1575
Author(s):  
Mahavir Singh ◽  
Saish Dalal ◽  
Baleshwar . ◽  
Sethu Raman
Keyword(s):  
Pilonidal Sinus ◽  
Pilonidal Disease ◽  
Tertiary Care ◽  
Pilonidal Sinus Disease ◽  
Common Disease ◽  
Main Concern ◽  
Limberg Flap ◽  
Sinus Disease ◽  
Minimal Scarring ◽  
Early Return

Background: Pilonidal sinus disease is a common disease of young adults. The management of the sacrococcygeal pilonidal sinus varies from conservative measures to various surgical procedures. The main concern for the treatment to the patient is the recurrence. Although several methods have been described all have been associated with high recurrence rates. This study was carried out to evaluate the advantages, results of rhomboid excision and limberg flap reconstruction in the management of pilonidal sinus disease.Methods: This prospective study was conducted in General Surgery department of a tertiary care centre of Haryana. It includes 29 patients who were treated for pilonidal sinus disease by Limberg flap surgery from January 2015 to January 2019.  Results: All patients were successfully treated with minimal postoperative discomfort. Only two patients developed seroma which was managed conservatively and in two patients there was slight flap tip necrosis which was also managed conservatively. Rest all other patients wound healed nicely with minimal scarring, with very less postoperative pain, with no recurrence so far.Conclusions:Limberg flap is very effective treatment for pilonidal disease. It has many advantages as it is easy to perform and design, and it flattens the natal cleft with large vascularized pedicle, sutured without tension. This in turn maintains good hygiene, reducing the friction, preventing maceration, and avoiding scar in the midline. The technique is easy to perform in quick time, useful in both primary and recurrent diseases, with very low complication and recurrence rate. Other advantages are quick healing time, short hospital stay, and early return to daily life.  

scholarly journals Limberg flap for pilonidal sinus: an institutional study

2017 ◽  
Vol 4 (2) ◽  
pp. 496
Author(s):  
Sameer Ahmed Mulla ◽  
Srinivas Pai ◽  
Prakash Mahalingashetty
Keyword(s):  
Pilonidal Sinus ◽  
Pilonidal Disease ◽  
Pilonidal Sinus Disease ◽  
Limberg Flap ◽  
Recurrence Rates ◽  
Duration Of Symptoms ◽  
Surgical Data ◽  
The Mean ◽  
Surgical Modality ◽  
A Prospective Study

Background: Pilonidal sinus disease is a common disorder affecting the gluteal cleft and it is notoriously recurrent. Limberg flap is a well-known surgical modality for the treatment of pilonidal sinus. This study aims at studying the surgery in a single institution.Methods: This is a prospective study of 17 limberg flaps done from 2013 to 2016. The various demographic, clinical and surgical data are studied and compared to other studies.Results: In this study, 17 patients of sacrococcygeal pilonidal disease underwent rhomboid excision and limberg flap reconstruction. The mean duration of symptoms was 6.52 months (2-13 months), and the mean operative time was 67.05 min with a range from 60 to 90 min. The mean post-operative stay was 6.05 days (3 to 10 days).Conclusions: Recurrence is known and hence surgery with flap coverage not only decreases the recurrence rates, but it also makes the stay short by eliminating daily dressing. Limberg flap is an easy and efficient way with less and manageable complication.

scholarly journals A comparative study of excision with primary closure versus Limberg flap in pilonidal sinus

2019 ◽  
Vol 6 (12) ◽  
pp. 4282
Author(s):  
Omesh Kumar Meena ◽  
Dheer Singh Kalwaniya ◽  
Satya V. Arya ◽  
Manikandan Kuppuswami ◽  
Jaspreet Singh Bajwa ◽  
...  
Keyword(s):  
Pilonidal Sinus ◽  
Primary Closure ◽  
Pilonidal Disease ◽  
Operating Time ◽  
Pilonidal Sinus Disease ◽  
Limberg Flap ◽  
Flap Procedure ◽  
Operative Complications ◽  
Post Operative Complications

Background: The term ‘pilonidal sinus’ describes a condition found in the natal cleft overlying the coccyx which is treated by excision.Methods: This study is a prospective study held in Department of general surgery, Safdarjung Hospital, New Delhi from October 2014 to April 2016 on 60 patients out of which 30 were controls (excision with primary closure) and 30 were taken as case (Limberg flap). Post-operative follow up was done till 6 months and complications were noted. The data was tabulated and SPSS version 17 was used for statistics.Results: Pilonidal sinus disease is common in age group 20 years and above and twice more common in males than females. Although operating time in Limberg flap is little more as compared to primary closure but insignificant. The post-operative pain in the long term follow up is less in the Limberg flap procedure, although in the initial post-operative period it is slightly higher as compared to primary closure. In Limberg flap procedure, post-operative complications like stitch line infection, seroma formation, wound dehiscence are low as compared to primary closure. Limberg flap require 2.27±0.52 days hospital stay as compared to 3.57±1.43 days in primary closure due to less post-operative complications. Recurrence rate is 3.33% in Limberg flap as compared to 26.67% in primary closure group.Conclusions: We recommend the Limberg flap method for primary pilonidal disease with low morbidity rates over primary closure.

scholarly journals A Prospective Study of the Clinical Profile of Pilonidal Sinus Disease at a Tertiary Care Centre in North India - Comparison of Limberg Flap Closure and Z-Plasty in Treatment

2021 ◽  
Vol 8 (28) ◽  
pp. 2532-2537
Author(s):  
Gulab Dhar Yadav ◽  
Ashish Varshney ◽  
Adiveeth Deb
Keyword(s):  
Wound Healing ◽  
Pilonidal Sinus ◽  
Tertiary Care ◽  
Wound Dehiscence ◽  
Pilonidal Sinus Disease ◽  
Limberg Flap ◽  
Sinus Disease ◽  
The Mean ◽  
A Prospective Study ◽  
Flap Closure

BACKGROUND Sacrococcygeal pilonidal sinus disease is defined as a hair-filled cavity in the subcutaneous fat of the natal cleft (postsacral intergluteal region). This study was done to investigate the prevalence, clinical presentation, body mass index (BMI) as a risk factor; and complications of Limberg flap and Z-plasty, for the reconstruction of defects after excision of sacrococcygeal pilonidal sinus in terms of the incidence of seroma, wound infection, wound dehiscence, flap necrosis, recurrence, duration of hospital stay and time taken for complete wound healing after the procedure. METHODS This was a prospective study done on 50 patients from January 2018 to October 2020 at a tertiary care hospital in 15 to 50 years of age group presenting with pilonidal sinus disease. Statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 15.0 statistical analysis software. Significance was assessed at 5 %. RESULTS The mean age of presentation was 25 years with chief complains of swelling, discharge and pain, the mean BMI was 24.39 kg/m2 . Anaerobic infection is more common in the sinus (40 %), and among aerobic organisms, Staphylococcus was the most common organism (19 %). In Limberg flap closure, only one 1 developed wound infection and this same patient had partial wound dehiscence, while in Zplasty group, 3 developed seroma, 2 wound infections and 2 partial flap ischemia. CONCLUSIONS The goals of management of pilonidal sinus diseases include conservative management along with definitive surgical treatment of the disease. Pilonidal abscess is managed by incision and drainage and is followed by definitive treatment, later on. Flap procedures are effective ways to treat the disease, of which Limberg flap is the most reliable flap with minimum complications, lesser hospital stay and faster wound healing. KEYWORDS Pilonidal Sinus, Limberg Flap, Z-Plasty

scholarly journals Pilonidal Sinus Disease: Risk Factors for Postoperative Complications and Recurrence

2012 ◽  
Vol 97 (3) ◽  
pp. 224-229 ◽  
Author(s):  
Akin Onder ◽  
Sadullah Girgin ◽  
Murat Kapan ◽  
Mehmet Toker ◽  
Zulfu Arikanoglu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Disease Risk ◽  
Pilonidal Sinus Disease ◽  
Limberg Flap ◽  
Sinus Disease ◽  
Faculty Department ◽  
Closure Method

Abstract The aim of this study is to analyze the risk factors for complications and recurrence in pilonidal sinus disease. The prospective study consisted of 144 patients with pilonidal sinus disease who were operated on at Dicle University Medical Faculty, Department of General Surgery, between February 2008 and December 2010. Patients receiving the Limberg flap totaled 106 (73.6%), while 38 (26.4%) had primary closure. Postoperative complications developed in 42 subjects (29.2%), and recurrence occurred in 19 (13.2%). The Limberg flap method was statistically considered as a risk factor for postoperative complications (P  =  0.039). Regarding recurrence, family tendency (P  =  0.011), sinus number (P  =  0.005), cavity diameter (P  =  0.002), and primary closure (P  =  0.001) were found to be risk factors. Postoperative complication rate is higher in the Limberg flap method than primary closure method. The risk of recurrence is related to family tendency, sinus number, cavity diameter and anesthesia type and is also higher in primary closure.

Compare outcome of simple excision with primary closure vs rhomboid excision with limberg flap for pilonidal sinus

2021 ◽  
pp. 2920-2922
Author(s):  
M. Kaleem ◽  
F. Mubarik ◽  
M. U. Afzal ◽  
A. Zahid ◽  
W. I. Andrabi ◽  
...  
Keyword(s):  
Pilonidal Sinus ◽  
Primary Closure ◽  
Advancement Flap ◽  
Pilonidal Sinus Disease ◽  
P Value ◽  
Limberg Flap ◽  
Simple Excision ◽  
Group A ◽  
Group B ◽  
Rhomboid Excision

Background: Sacrococcygeal pilonidal sinus is a common condition usually affecting young-to-middle-aged men. For managing sacrococcygeal pilonidal illness, a variety of lateralizing surgical flap procedures based on this principle have been published, including the Karydakis flap, Limberg flap, modified Limberg flap, Z-plasty, and Y-V advancement flap. Aim: To compare the outcome of simple excision with primary closure versus rhomboid excision with limberg flap for sacrococcygeal pilonidal sinus. Methodology: Randomized control study conducted in Surgery Department, Ghurki Trust Hospital, Lahore. 90 patients fulfilling the inclusion criteria were selected from wards and were randomly divided in two equal groups. In group A, patients underwent rhomboid excision with limberg flap. In group B, patients underwent simple excision with primary closure. The operation was performed under spinal anesthesia. After surgery, patients were evaluated every 24 hours if they are able to move on their own then they were discharged and hospital stay was noted. Then after 10 days, patients will be called in OPD for assessment of wound healing. If wound did heal and patient complained of pain (VAS>4) and cannot sit and have fever (temp>100oF) Results: The average age in group A was 44.37±15.42 years while that in group B was 45.24±14.50 years. In group A there were 23(51.1%) males and 22 (48.9%) females whereas in group B there were 25(55.6%) males and 20(44.4%) females. There was difference significant in the mean stay in hospital in both groups (p-value=0.002). Conclusion: The conclusion of the study, that primary sacrococcygeal pilonidal sinus disease and rhomboid excision with Limberg's flap is an effective treatment. Keywords: Simple Excision with Primary Closure, Rhomboid Excision, Limberg Flap, Sacrococcygeal Pilonidal Sinus

scholarly journals Limberg flap versus primary closure in the treatment of pilonidal sinus: a randomised clinical study

2021 ◽  
Vol 8 (8) ◽  
pp. 2388
Author(s):  
Devaprashanth M. ◽  
Srinivas N. M. ◽  
Akhihlandeshwari N.
Keyword(s):  
Clinical Study ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Wound Dehiscence ◽  
Pilonidal Sinus Disease ◽  
Limberg Flap ◽  
Randomized Clinical Study ◽  
Routine Work ◽  
Group A ◽  
Group B

Background: Pilonidal sinus is a chronic disease usually involving the sacrococcygeal area. Various treatment modalities exist, yet few comparison studies exist to compare the efficacy of one modality over the other. Hence this randomized clinical study was undertaken as an attempt to compare the outcomes of pilonidal sinus following Limberg flap procedure and primary closure.Methods: 60 patients undergoing surgery for pilonidal sinus disease were considered for the study. 30 patients underwent excision and primary closure and 30 patients underwent Limberg flap repair. They were followed up for 1 year. Duration of hospital stay, duration of inability to work, postoperative infection, wound dehiscence, and postoperative recurrence in a follow up period were recorded. Descriptive statistics, chi- square tests and independent t-test are the statistical tools employed.Results: Mean age was 29.83±4.99 years. Male:female ratio was 5.66:1. The mean duration of hospitalization in group A was significantly less (p<0.05) than group B. The patients in group B returned early to routine work (21.56±3.92 days) as compared to 30.5±5.92 days in group A (p<0.05). 5 of 30 patients in group A and 2 of 30 in group B developed surgical site infection. (p>0.05. 4 patients developed wound dehiscence in group A only which was found to be statistically significant.Conclusions: Limberg flap in treatment of pilonidal sinus is associated with shorter hospitalization, early return to routine work and less wound dehiscence as compared with excision and primary closure. Wound infections are comparable with both the modalities.

scholarly journals Kshar sutra in Pilonidal sinus: a minimal invasive modality of management

2017 ◽  
Vol 4 (2) ◽  
pp. 834
Author(s):  
Murtaza Akhtar ◽  
Himanshu Gupta ◽  
Sunil Mishra ◽  
Murtuza Rangwala ◽  
Anil Kad
Keyword(s):  
Pilonidal Sinus ◽  
Pilonidal Disease ◽  
Tertiary Care ◽  
Case Series ◽  
Minimal Invasive ◽  
Care Hospital ◽  
Duration Of Treatment ◽  
Entire Treatment Period ◽  
Natal Cleft ◽  
Septic Focus

Pilonidal sinus is an infective condition between the natal cleft in young males. Chronic Pilonidal disease normally needs a surgical treatment for eradication of septic focus, which ranges from cutting of the tract to complex rotation flap. Kshar sutra is an age old treatment modality practiced since times of Sushruta. Lack of established evidence in the evidence based scenario is the rationale for current study. It is a tertiary care hospital based case series with inclusion criteria of pain and discharge in and around the natal cleft. Clinically diagnosed as Pilonidal sinus with two openings one in natal cleft and other outside the natal cleft. The patients with multiple sinuses, previous treatment and co-morbid conditions are excluded. The study factor was of Kshar sutra threading of Pilonidal Sinus done under local infiltration of anaesthesia around the tract and changed 2-3 times during entire treatment period on clinical judgement. The outcome factors were duration of cutting open of tract and duration for total healing, number of times Kshar sutra was changed and local complications. A total of 5 cases, all males with median age of 21 years and median presentation duration of 8 months were recruited. The median cutting duration of the tract was 23 days and total tract healing time was 29 days. Kshar sutra was changed 2-3 times during the entire duration of treatment. There was no post-operative complication and recurrence after 20.4 months of follow up. Kshar sutra is a minimal invasive procedure in Pilonidal sinus which has encouraging results but need large sample and an RCT to provide quality evidence.

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