Amir Keshvari1, Mohammad Reza Keramati2, Mohammad Sadegh Fazeli1, Alireza Kazemeini1, Alipasha Meysamie3, Mohammad Kazem Nouritaromlou1. 1. Department of Surgery, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2. Department of Surgery, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: dr_morezak@yahoo.com. 3. Department of Community and Preventive Medicine, Medical Faculty, Tehran University of Medical Sciences, Tehran, Iran.
Abstract
BACKGROUND:Karydakis flap (K-flap) and excision with healing by secondary intention (EHSI) are currently accepted methods for surgical management of sacrococcygeal pilonidal disease. This clinical trial study aimed to compare early and late outcomes of these two surgical techniques. MATERIALS AND METHODS: In this controlled, prospective, randomized clinical trial, patients diagnosed with sacrococcygeal pilonidal disease were randomly allocated to two groups. Patients in the first group underwent Karydakis procedure, whereas EHSI was the surgical management in the second group. The two techniques were compared based on their overall time of wound healing, return to work, rate of complications, and recurrence. RESULTS: A total of 321 patients including 161 in the K-flap group and 160 in the EHSI group were included in the study. The median follow-up duration was 49 mo. The mean time of wound healing (16.44 versus 80.01 d, P < 0.001), return to work (14.44 versus 24.19, P < 0.001), rate of wound complications (18.7% versus 31.2%, P = 0.006), and recurrence (1.2% versus 7.5%, P = 0.005) were all significantly lower in the K-flap group. The mean operation time was significantly shorter in the EHSI group (15.87 versus 55.17 min, P < 0.001). The K-flap group showed significantly higher pain on their first postoperative day and significantly less pain after 1 wk (P < 0.001). CONCLUSIONS: Although both techniques are safe, the K-flap is associated with significantly lower rates of complications and recurrence and significantly shorter time of wound healing and return to work.
RCT Entities:
BACKGROUND: Karydakis flap (K-flap) and excision with healing by secondary intention (EHSI) are currently accepted methods for surgical management of sacrococcygeal pilonidal disease. This clinical trial study aimed to compare early and late outcomes of these two surgical techniques. MATERIALS AND METHODS: In this controlled, prospective, randomized clinical trial, patients diagnosed with sacrococcygeal pilonidal disease were randomly allocated to two groups. Patients in the first group underwent Karydakis procedure, whereas EHSI was the surgical management in the second group. The two techniques were compared based on their overall time of wound healing, return to work, rate of complications, and recurrence. RESULTS: A total of 321 patients including 161 in the K-flap group and 160 in the EHSI group were included in the study. The median follow-up duration was 49 mo. The mean time of wound healing (16.44 versus 80.01 d, P < 0.001), return to work (14.44 versus 24.19, P < 0.001), rate of wound complications (18.7% versus 31.2%, P = 0.006), and recurrence (1.2% versus 7.5%, P = 0.005) were all significantly lower in the K-flap group. The mean operation time was significantly shorter in the EHSI group (15.87 versus 55.17 min, P < 0.001). The K-flap group showed significantly higher pain on their first postoperative day and significantly less pain after 1 wk (P < 0.001). CONCLUSIONS: Although both techniques are safe, the K-flap is associated with significantly lower rates of complications and recurrence and significantly shorter time of wound healing and return to work.
Authors: V K Stauffer; M M Luedi; P Kauf; M Schmid; M Diekmann; K Wieferich; B Schnüriger; D Doll Journal: Sci Rep Date: 2018-02-15 Impact factor: 4.379
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Authors: R Perinotti; G Gallo; M Milone; L Basso; M Manigrasso; R Pietroletti; A Bondurri; M La Torre; G Milito; M Pozzo; D Segre Journal: Tech Coloproctol Date: 2021-06-27 Impact factor: 3.781