Comparison of Modified Limberg Flap and Karydakis Flap Operations in Pilonidal Sinus Surgery: Prospective Randomized Study

The best surgical technique for pilonidal sinus disease (PSD) is still disputed. The objective of this prospective randomized study is to compare the short and long-term results of modified Limberg flap and Karydakis flap surgeries that have been widely used in recent years. Ninety one patients were included in the study. The patients were divided into two groups: modified Limberg flap (MLF; n = 46) and Karydakis flap (KF; n = 45). Preoperative findings of the patients, their surgical findings, and short and long-term postoperative findings were recorded and statistically compared. While no significant difference was discovered between the groups in terms of postoperative analgesic need, hospital stay, postoperative infection rate, drain stay time, painless sitting time, painless toilet-sitting time, and painless walking time, return to work or school time was shorter in the MLF group compared with the KF group (20.61 ± 7.89 days, 23.29 ± 6.42, respectively; P < 0.05). Cosmetically, the visual analog scale (VAS) of the KF group was significantly higher than that of the MLF group (VAS score 7.12 ± 1.28, 5.45 ± 1.77, respectively; P < 0.05). Considering recurrence rates, no statistically significant difference was found between the groups. Our study found out that short and long-term results of the MLF and KF procedures are similar. We believe both methods can be safely used in surgical PSD treatment given that in the MLF procedure, shorter return-to-work time is achieved, while the procedure provides better cosmetic results.Key words: Pilonidal sinus, Limberg flap, Karydakis flap, Surgical techniquesPilonidal sinus disease (PSD) is a chronic inflammation and infection of the sacrococcygeal region. It often affects young adult males and produces clinic findings with abscess and discharge in sacrococcygeal region or painful sinus tract in the natal cleft.^1,2 Its incidence rate is predicted to be minimum 26 and maximum 700 in 100,000, and its incidence rate among Turkish servicemen is reported to be 8.8% in a study.^3,4Discussion as to whether PSD is a congenital disease continued until a few decades ago, and many authors are now convinced that it is an acquired disease. Although theories of Karydakis and Bascom provide the best explanation about the pathogeny of the disease, there is no definite etiology and pathogenesis.^5,6 Male sex, obesity, sedentary lifestyle, jobs that require sitting for long hours, family history, hirsute body habitus, trauma or irritation of the natal cleft, and poor hygienic conditions are among the listed risk factors.^7,8Several methods were defined in order to determine the ideal treatment of PSD. The expectations from an ideal treatment can be listed as simplicity and convenience, good postoperative patient comfort, low complication rate, early return-to-work time and low recurrence rate.⁹ Although several medical and surgical methods exist, ranging from phenol application to complex advancement flaps, no optimal treatment method has been defined yet due to high complication and recurrence rates.^10,11 Recently, lateralization of the natal cleft has gained significance in surgical PSD treatment. The purpose with this method is to prevent recurrence on the midline by removing the cavity in the natal cleft. While this is achieved with the Karydakis flap (KF) by moving the suture laterally, it is achieved in the modified Limberg flap (MLF) operation by flattening the natal cleft with a full-thickness flap.^6,12Our objective is to compare short- and long-term results of Karydakis flap and Modified Limberg flap operations, which have been widely preferred in recent years in surgical treatment of PSD, by conducting a prospective randomized study.