Purpose: Pilonidal sinus disease is a common condition, which mostly affects young men. While various surgical techniques have been introduced for treating intergluteal pilonidal disease (IPD), controversies still exist regarding the best surgical approach. The purpose of this study was to compare the efficiency and the short-term outcomes of Limberg flap and Karydakis flap surgeries for the treatments of patients with IPD. Methods: A total of 80 patients with IPD who had underwent either Karydakis flap (KF group: n = 37) or Limberg flap (LF group: n = 27) surgery between January 2015 and January 2016 at Imam Khomeini Hospital of Sari in the North of Iran were recruited for inclusion in this randomized, single-blind study. Results: Compared to the KF group, the LF group showed faster complete wound healing, longer duration of surgery and hospital stay, larger wound size, and shorter period of incapacity for work. The overall patient satisfaction in the LF group was significantly higher than that in the KF group. The visual analogue scale score of pain was lower in the LF group than in the KF group. Also, the overall frequency of postoperative complications was higher in the KF group than in the LF group. Recurrence was reported in one patient from the KF group. Conclusion: Given the lower rate of postoperative complications and greater cosmetic satisfaction of patients, the Limberg flap procedure should be selected, instead of the Karydakis flap procedure, as the standard technique for treating patients with IPD.

Material and MethodsWe conduct Monte Carlo simulation studies to investigate the performance of procedures based on least-squares estimators. The performance of estimators and confidence intervals are evaluated utilizing a simulation study. We report the results in terms of the stopping variables, the ratio of the average stopping variable to the optimal fixed sample size, the root of mean square error (RMSE) of the estimators, and the proportion of risk efficiency functions. Furthermore, real-time series data is considered to illustrate the applicability of the modified two-stage procedure. Results and DiscussionThe simulation results confirm the theoretical results and show the procedure's effectiveness compared to the optimal fixed sample size. Also, the actual data results show the excellent performance of this procedure in practice. ConclusionThe modified two-stage procedure and operational savings are more accessible to implement than the most commonly used purely sequential procedure. It is also more accurate than the two-stage procedure. Also, the procedure performs well and is an excellent candidate for analyzing time series models.