Samer S Bessa1. 1. Department of General Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt. samerbessa@gmail.com
Abstract
BACKGROUND: The modified Karydakis flap and the modified Limberg flap are commonly used in the surgical management of sacrococcygeal pilonidal sinus disease. OBJECTIVE: The study aimed to compare short- term results of these techniques. DESIGN: The modified Karydakis flap and the modified Limberg flap were compared in a randomized controlled trial. SETTINGS: The study was conducted in the day-case surgery department of a large academic teaching hospital in Alexandria, Egypt, from February 2009 through September 2011. PATIENTS: Patients undergoing surgery for chronic sacrococcygeal pilonidal sinus disease were eligible for the study. Patients with sepsis were eligible only after aggressive treatment to eliminate sepsis. INTERVENTIONS: Patients were randomly allocated to undergo surgery with either the modified Karydakis flap or the modified Limberg flap. MAIN OUTCOME MEASURES: The primary end point was operative time. Secondary endpoints included proportion of patients with postoperative complications, proportion of patients who were satisfied with the cosmetic results, and the rate of recurrence. LIMITATIONS: Follow-up times were not sufficient to evaluate long-term recurrence rates. RESULTS: Of 154 patients screened, 125 were enrolled, and 120 patients completed the study. The median operative time was significantly shorter in patients with the modified Karydakis flap than in those with the modified Limberg flap: 33 (range, 28-40) min vs 52 (range, 48-62) min; p < 0.001). No significant differences were found between study groups regarding overall complication rate (23% vs 40%, p = 0.08), wound infection (3% vs 5%, p > 0.99), subcutaneous fluid collection (5% vs 0%, p = 0.24), or hypoesthesia (10% vs 23%, p = 0.09). Full-thickness wound disruption was encountered in 9 patients (15%) in the modified Limberg group vs no patient in the modified Karydakis group (p = 0.003). The median follow-up duration was 20.5 months in each study group. One patient (2%) in the modified Karydakis group developed recurrent disease vs 2 patients (3%) in the modified Limberg group (p > 0.99). In the modified Karydakis group, 58 patients (97%) were satisfied with the cosmetic outcome and were willing to recommend the operation to others vs 43 patients (72%) in the modified Limberg group (p < 0.001). CONCLUSIONS: Both techniques provide effective treatment for pilonidal sinus disease and can be performed safely as day-case surgery. The modified Karydakis flap is associated with significantly shorter operative time, a lower full-thickness wound disruption rate, and a higher patient satisfaction rate.
RCT Entities:
BACKGROUND: The modified Karydakis flap and the modified Limberg flap are commonly used in the surgical management of sacrococcygeal pilonidal sinus disease. OBJECTIVE: The study aimed to compare short- term results of these techniques. DESIGN: The modified Karydakis flap and the modified Limberg flap were compared in a randomized controlled trial. SETTINGS: The study was conducted in the day-case surgery department of a large academic teaching hospital in Alexandria, Egypt, from February 2009 through September 2011. PATIENTS: Patients undergoing surgery for chronic sacrococcygeal pilonidal sinus disease were eligible for the study. Patients with sepsis were eligible only after aggressive treatment to eliminate sepsis. INTERVENTIONS:Patients were randomly allocated to undergo surgery with either the modified Karydakis flap or the modified Limberg flap. MAIN OUTCOME MEASURES: The primary end point was operative time. Secondary endpoints included proportion of patients with postoperative complications, proportion of patients who were satisfied with the cosmetic results, and the rate of recurrence. LIMITATIONS: Follow-up times were not sufficient to evaluate long-term recurrence rates. RESULTS: Of 154 patients screened, 125 were enrolled, and 120 patients completed the study. The median operative time was significantly shorter in patients with the modified Karydakis flap than in those with the modified Limberg flap: 33 (range, 28-40) min vs 52 (range, 48-62) min; p < 0.001). No significant differences were found between study groups regarding overall complication rate (23% vs 40%, p = 0.08), wound infection (3% vs 5%, p > 0.99), subcutaneous fluid collection (5% vs 0%, p = 0.24), or hypoesthesia (10% vs 23%, p = 0.09). Full-thickness wound disruption was encountered in 9 patients (15%) in the modified Limberg group vs no patient in the modified Karydakis group (p = 0.003). The median follow-up duration was 20.5 months in each study group. One patient (2%) in the modified Karydakis group developed recurrent disease vs 2 patients (3%) in the modified Limberg group (p > 0.99). In the modified Karydakis group, 58 patients (97%) were satisfied with the cosmetic outcome and were willing to recommend the operation to others vs 43 patients (72%) in the modified Limberg group (p < 0.001). CONCLUSIONS: Both techniques provide effective treatment for pilonidal sinus disease and can be performed safely as day-case surgery. The modified Karydakis flap is associated with significantly shorter operative time, a lower full-thickness wound disruption rate, and a higher patient satisfaction rate.