Clinical Science
Comparison of modified Limberg flap transposition and lateral advancement flap transposition with Burow’s triangle in the treatment of pilonidal sinus disease

https://doi.org/10.1016/j.amjsurg.2015.03.031Get rights and content

Highlights

  • We compare 2 flap transposition techniques used in pilonidal sinus disease surgical treatment.

  • This study was planned as a prospective randomized clinical trial.

  • We examine Visual Analog Scale scores, recurrence, postoperative complications, and surgical site infections in the first 12 months postoperatively.

  • No statistically significant differences were found between the groups (P > .05)

  • We recommend lateral advancement flap transposition with Burow’s triangle, especially in cases in which the pilonidal sinuses settle on the upper segment and do not have a very deep natal cleft. We recommend the modified Limberg flap transposition technique in cases in which the sinuses settle close to the anal region according to our clinical experiences.

Abstract

Background

Although many options exist for surgical treatment of pilonidal sinus disease (PSD), consensus has not yet been achieved, as all surgical methods have various rates of complications, postoperative infection, and recurrence.

Methods

This study was a prospective, randomized, clinical trial, and was conducted with consecutive 100 patients admitted to Ankara Military Hospital General Surgery Service for treatment of PSD from May 2013 to August 2013. This study compared two surgical treatments for PSD: modified Limberg flap transposition and lateral advancement flap transposition with Burow's triangle.

The patients received surgical treatment with either modified Limberg flap transposition (n = 50) or lateral advancement flap transposition with Burow’s triangle (n = 50).

Clinical healing period, length of hospital stay, operative time, postoperative complications including recurrence, wound dehiscence, and surgical site infection, as noted during postoperative follow-up period; Visual Analog Scale scores for pain.

Results

The mean follow-up period was 12 months. No significant differences were observed between the 2 groups in length of hospital stay (P = .515), operative time (P = .175), wound dehiscence (P = .645), and Visual Analog Scale pain scores (P = .112). The mean operative times were 42.5 minutes in the modified Limberg group and 40.0 minutes in the lateral advancement group.

Conclusions

Although lateral advancement flap transposition with Burow’s triangle is used less often than modified Limberg flap transposition, we could not determine a parameter that was statistically different such as operative time, postoperative complication, or the length of hospital stay. Hence, the lateral advancement flap is as viable an option as other more preferable techniques in the treatment of PSD, which particularly settled on the upper segment without a deep natal cleft.

Section snippets

Study design

This study was planned as a prospective randomized clinical trial. The study subjects were 100 consecutive patients with PSD admitted to Ankara Mevki Military Hospital General Surgery Service between May 2013 and August 2013. The study protocol was approved by the Gulhane Military Medical Academy Local Ethics Council (number 001642), and was registered at ClinicalTrials.gov (NCT number 02116738). All patients in the study received detailed preoperative information about the study, and confirmed

Results

The study subjects consisted of 100 men (100%). The median age of the individuals was 23 (19 to 34) years. The operative time was determined as follows: minimum: 35 minutes and maximum: 90 minutes. The average BMI was moderate (25.4 ± 2.7) (Table 1).

No statistically significant differences were found in age, BMI, operative time, and hospital length of stay between the groups (P > .05) (Table 1).

The VAS scores were similar between groups (z = 1.590, P = .112). In the patients who underwent the

Comments

There is no consensus on the treatment of PSD, with many debates ongoing regarding the best treatment. A study conducted in Turkey showed that 83% of the surgeons prefer surgical methods in the treatment of PSD.7 The optimal surgical procedures for PSD should result in minimal length of hospital stay, satisfactory VAS scores, low disease recurrence, low complication rates, as much esthetic satisfaction as possible, and allow patients to return quickly to work.8, 9

Complications and recurrence

Conclusion

In conclusion, all the flap techniques have some advantages or disadvantages. The results of this study did not reveal a statistically significant difference between the 2 flap techniques in terms of recurrence rate, VAS pain scores, length of hospital stay, wound dehiscence, SSI, or mean operative time. In addition, beside our clinical experiences, we found approximate equivalence in both procedures. On this subject, further randomized controlled studies with a large number of patients and

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  • There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs.

    The authors declare no conflicts of interest.

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