Pilonidal sinus- limberg versus karidakis flap our experience at SIMS, Shivamogga

Abstract

INTRODUCTIONThe term pilonidal sinus originates from-pilus; latin for hair (pleural-pilli), nest from nidus. Sinus is a blind tract from an epithelial surface, lined by granulation tissue. The etiology and pathogenesis of sacro-coccygeal pilonidal sinus are not clear.1,2 The pathogenesis of the disease is hypothesized to be related to the accumulation of weak and lifeless hair in the intergluteal region, which over time gives rise to foreign body reaction, causing abscess and sinus formation. 3,4 A deep natal cleft with one of favourable factors enhance sacro-coccygeal pilonidal sinus, e.g., sweating, maceration, bacterial contamination and penetration of hairs. Obesity, trauma, local irritation and a sedentary lifestyle are usually associated with PS. 5,6 Although, pilonidal sinus can be treated using various conservative ABSTRACT Background: The etiology and pathogenesis of sacro-coccygeal pilonidal sinus are not clear. The pathogenesis of the disease is hypothesized to be related to the accumulation of weak and lifeless hair in the intergluteal region, which over time gives rise to foreign body reaction, causing abscess and sinus formation. A deep natal cleft with one of favourable factors enhance sacro-coccygeal pilonidal sinus, e.g., sweating, maceration, bacterial contamination and penetration of hairs. Obesity, trauma, local irritation and a sedentary lifestyle are usually associated with PS. Although pilonidal sinus can be treated using various conservative and surgical methods, recurrence rate remains high. Complete surgical removal of the pilonidal sinus or sinuses and appropriate reconstruction can lead to successful recovery. However, collection of the lifeless hair depends on the anatomy of the intergluteal area, and accompanying risk factors can lead to subsequent recurrence. Methods: The objective of this study is to compare the immediate post-operative and long-term results of Limberg flap and Karydakis flap, which are being widely used now to treat pilonidal sinus disease. It was a retrospective observational study where the patients (total number of patients-30) who underwent both the procedures were compared, Limberg flap (LF; n = 13) and Karydakis flap (KF; n = 17). Results: Present study found out that short and long-term results of the LF and KF procedures are similar. In present study we also noted that all patients with pilonidal sinus disease were men, and most of them had jobs which involved sitting for long durations. Poor hygiene and hirsutism however was not noted in most of the patients, and was not objectively assessed. Conclusions: Both the techniques can be used safely and effectively in sacro coccygeal pilonidal sinus disease.