Surgical excision with secondary healing versus Limberg transposition flap in the management of Sacrococcygeal Pilonidal Disease

Abstract

Objective: To compare the outcome of Open excision and secondary healing with rhomboid
excision and Limberg flap in the management of sacrococcygeal pilonidal sinus disease.
Methods: A comparative study using randomized controlled trial (RCT) was conducted at
Nishtar Hospital Multan & Ghazi Khan teaching Hospital DG khan from November 2012 to July
2016. In total 49 patients, who either underwent open excision and secondary healing (group A:
25 patients out of which 4 patients did not reported during follow up so actual figure of 21 was
included in this group) or rhomboid excision and Limberg flap (group B: 24 patients), were
enrolled in the study. Duration of operation, postoperative pain, duration of hospital stay,
postoperative complications, and time to recurrence were noted. The inclusion criteria were all
patients with primary or recurrent Disease. Diabetics, patients with other co morbid condition,
patients with poor follow up and patients with incomplete record were excluded from study.
Results: Duration of operation was longer in group B patients (p=0.004) but pain perception was
markedly reduced in this group (p=0.003). Total hospitalization period was shorter in patients in
group B (p=0.002) and so was the time for complete healing of the wound (p=0.002). The
recurrence rate was also significantly lower in patients who underwent Limberg rotation flap
(p=0.005).
Conclusion: Limberg flap is advantageous over simple excision and secondary healing in the
management of pilonidal disease