LIMBERG FLAP TECHNIQUE FOR PILONIDAL SINUS DISEASE TREATMENT: AN EXPERIENCE OF HAMDARD UNIVERSITY HOSPITAL

Authors

  • Rabbia Zubair Department of Surgery, Hamdard University Hospital, Karachi-Pakistan
  • Muhammad Ali Channa Hamdard University Hospital, Karachi-Pakistan

DOI:

https://doi.org/10.55519/JAMC-02-9371

Keywords:

pilonidal sinus disease, Limberg’s flap, natal cleft, recurrence

Abstract

Background: Pilonidal sinus disease (PNSD) is considered as the challenging disease for surgeons since decades. The term pilo-nidal is derived from Latin meaning “nest of hair”. It is a commonly occurring disease usually involved young male adults.  It is considered as an acquired condition with unidentified aetiology and pathogenesis. The objective was to observe the results of Limberg’s flap operation in patients with Pilonidal sinus disease. Methods: We performed an observational study at Hamdard University Hospital from 1st January 2016 to 31st December 2019 on patients who came to the outpatient department for the treatment of pilonidal sinus diseases and underwent surgery (Limberg’s flap) after consent. The patient’s presentation varied from single sinus and dry, multiple sinuses and dry, single sinus with serous discharge, single sinus with pus discharge, and pilonidal abscess. Forty-six patients were selected after applying inclusion and exclusion criteria and operated by Limberg’s flap technique. Result: Results were observed for postoperative seroma, hematoma, wound infection, persistent pain, and recurrence. Out of 46 patients, 30 (65.21%) were male and 16 (34.7%) were female. 28 patients (60.8%) were between 31–40 years of age and 12 patients (26.08%) were between 41–50 years of age. After performing Limberg’s flap procedure, 35 patients (76%) had no complications at all. 2 patients (4.3%) had seroma formation. 4 patients had Hematoma formation (8.6%). Two patients (4.3%) patients developed superficial wound infection. 2 patients (4.3%) had persistent pain after 3 months of the procedure. One patient (2.1%) had recurrence during the follow-up period of 12 months. Conclusion: Limberg’s flap operation is associated with low recurrence as well as a low rate of other complications such as seroma or hematoma formation, wound infection, and persistent pain irrespective of the presentation of the pilonidal sinus.

Author Biography

Muhammad Ali Channa, Hamdard University Hospital, Karachi-Pakistan

Professor Department of Surgery

References

Patel MR, Bassini L, Nashad R, Anselmo MT. Barber's interdigital pilonidal sinus of the hand: a foreign body hair granuloma. J Hand Surg 1990;15(4):652–5.

Miller D, Harding K. Pilonidal sinus disease. World Wide Wounds 2003.

Doll D, Friederichs J, Dettmann H, Boulesteix AL, Duesel W, Petersen S. Time and rate of sinus formation in pilonidal sinus disease. Int J Colorectal Dis 2008;23(4):359–64.

Papaconstantinou HT, Thomas JS. Pilonidal disease and hidradenitis suppurativa. InThe ASCRS Textbook of Colon and Rectal Surgery. Springer, New York, NY. 2011; p.261–75.

Varnalidis I, Ioannidis O, Paraskevas G, Papapostolou D, Malakozis SG, Gatzos S, et al. Pilonidal sinus: a comparative study of treatment methods. J Med Life 2014;7(1):27–30.

Mentes BB, Leventoglu S, Cihan A, Tatlicioglu E, Akin M, Oguz M. Modified Limberg transposition flap for sacrococcygeal pilonidal sinus. Surg Today 2004;34(5):419–23.

Khan PS, Hayat H, Hayat G. Limberg flap versus primary closure in the treatment of primary sacrococcygeal pilonidal disease; a randomized clinical trial. Indian J Surg 2013;75(3):192–4.

Al-Khamis A, McCallum I, King PM, Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev 2010;2010(1):CD006213.

Aithal SK, Rajan CS, Reddy N. Limberg flap for sacrococcygeal pilonidal sinus a safe and sound procedure. Indian J Surg 2013;75(4):298–301.

Søndena K, Andersen E, Nesvik I, Søreide JA. Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 1995;10(1):39–42.

Bernier GV, Johnson EK, Maykel JA, Steele SR. Reoperative surgery for pilonidal disease. InSeminars in Colon and Rectal Surgery, 2015; p.211–7.

Edmondson M. Determining the effectiveness of prophylactic topical silver dressings in the treatment of sacrococcygeal pilonidal sinus wounds healing by secondary intention (Doctoral dissertation, Curtin University). 2013.

Enriquez-Navascues JM, Emparanza JI, Alkorta M, Placer C. Meta-analysis of randomized controlled trials comparing different techniques with primary closure for chronic pilonidal sinus. Tech Coloproctol 2014;18(10):863–72.

Chatzoulis GA, Pharmakis D, Milias K, Ioannidis K, Tzikos G, Delligianidis D, et al. “Jeep Disease” and Optimal Treatment Strategy for Sacrococcygeal Pilonidal Sinus in a High Volume Tertiary Military Medical Center. Hell J Surg 2019;91(1):14–21.

Aslam MN, Shoaib S, Choudhry AM. Use of Limberg flap for pilonidal sinus–a viable option. J Ayub Med Coll Abbottabad 2009;21(4):31–3.

Daphan C, Tekelioglu MH, Sayilgan C. Limberg flap repair for pilonidal sinus disease. Dis Colon Rectum 2004;47(2):233–7.

Singh M, Dalal S, Raman S. Management of pilonidal sinus disease with Limberg flap: our experience. Int Surg J 2020;7(5):1575–9.

Rahoma AH. Pilonidal sinus: Why does It recur. Malays J Med Health Sci 2009;5:69–77.

Can MF, Sevinc MM, Yilmaz M. Comparison of Karydakis flap reconstruction versus primary midline closure in sacrococcygeal pilonidal disease: results of 200 military service members. Surg Today 2009;39(7):580–6.

Hussain MA, Malik NA. Complications in Pilonidal Sinus after Excision and Primary Closure. J Univ Med Dent Coll 2017;8(3):18–23.

Yoldas T, Karaca C, Unalp O, Uguz A, Caliskan C, Akgun E, et al. Recurrent pilonidal sinus: lay open or flap closure, does it differ? Int Surg 2013;98(4):319–23.

Afridi Z, Ahmad M, Ahmad M, Haleem A, Ahmad R, Ahmad I. Pilonidal sinus: An experience with Bascom procedure. Pak J Surg 2018;34(2):125–30.

Yildiz T, Ilce Z, Kücük A. Modified Limberg flap technique in the treatment of pilonidal sinus disease in teenagers. J Pediatr Surg 2014;49(11):1610–3.

Yogishwarappa CN, Vijayakumar A. Limberg Flap Reconstruction for Pilonidal Sinus. Int J Biom Adv Res 2016;7(4):165–8.

Published

2022-03-03

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