Prospective randomized study of surgical treatment of pilonidal sinus; primary midline closure after elliptical excision versus rhomboid excision with limberg flap reconstruction versus open excision and healing by secondary intention

Kumar, Rajneesh; Hastir, Ankur; Walia, Ramandeep; Goyal, Subhash; Kaur, Amandeep

doi:10.18203/2349-2902.isj20174879

Cited by 5 publications

(8 citation statements)

References 18 publications

(22 reference statements)

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“…The patients who received Limberg flap repair could return to their work after suture removal, however, patients with wide local excision resisted resuming their work due to significant anxiety about the wound and the requirement of daily dressing. In the study done by Kumar et al, the mean healing time for group II (rhomboid excision with Limberg flap reconstruction) was 17.0±8.0 days and for group III (open excision and healing by secondary intention) was 60±9.6 days which is in accordance with our findings [9]. In the present study, no recurrence was reported in either group.…”

Section: Discussionsupporting

confidence: 92%

“…In the present study, no recurrence was reported in either group. Similar results were reported by Kumar et al where none of the study participants of either group reported recurrence [ 9 ]. On contrary, Singh et al reported 16% recurrence in the wide excision group [ 17 ].…”

Section: Discussionsupporting

confidence: 90%

“…PNS disease can be asymptomatic, acute, chronic, or recurrent. The common presenting symptoms are pain (84%), discharge (78%), and localized edema [ 9 ]. However, to rule out other differential diagnoses such as perirectal abscess, anal fistula, hidradenitis suppurativa, and pyoderma gangrenosum; a thorough clinical examination, history taking, and radiological investigations like MRI may be necessary.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Study of Limberg Flap Reconstruction With Wide-Open Excision and Healing by Secondary Intention in the Management of Pilonidal Sinus: Our Experience at a Tertiary Care Center in India

Chopde¹,

Adhikari²

2022

Cureus

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IntroductionA pilonidal sinus (PNS) is a small passageway in the subcutaneous tissue which develops most frequently in the sacrococcygeal area. In terms of postoperative outcomes, the decision on the best surgical treatment for PNS is still a challenge for a surgeon. Prevention of the disease recurrence and improving quality of the life can be considered primary goals of the treatment. The current study intends to compare two commonly practiced surgical treatments for PNSes-Rhomboid excision with Limberg flap repair against wide-open excision with healing by secondary intention. MethodsIn a prospective randomized study, 50 patients with sacrococcygeal PNS were divided into two groups. Group A was operated by rhomboid excision with Limberg flap reconstruction and Group B was operated by wide-open excision and healing by secondary intention. Data were collected on a specially designed structured proforma and consisted of patient demographics, medical history, presentation, and postoperative complications assessed for a period of 6 months. Comparative outcomes of interest were postoperative pain, postoperative anxiety, duration of wound healing, duration of work loss, presence of wound infection, and recurrence. ResultsMean age of 28 years was observed across the study with a male preponderance (76%). The mean visual analog scale (VAS) score for pain was greater in Group A during the early postoperative period, i.e., days 1, 3, and 7. However, patients in Group B reported a mean VAS score of 3 ± 0 and 1 ± 0 at one month and 2 months, respectively indicating a longer duration of postoperative pain overall. Patients in Group B also reported a significantly higher VAS for anxiety (VAS-A) score for postoperative anxiety/stress in all the follow-up visits. The mean healing time was 20 ± 2 days in Group A and 57 ± 11 days in Group B showing a significant difference. Duration of work loss was also significantly higher in Group B (31 days). Five patients in Group B developed wound infections. No recurrence was observed across both the groups in this study. ConclusionAccording to the findings of this study, the Limberg flap method outperforms the wide-open excision approach in terms of healing duration, work loss days, postoperative pain, anxiety, and wound infection. Both the techniques, however, are comparable in terms of recurrence.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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Comparative Study of Limberg Flap Reconstruction With Wide-Open Excision and Healing by Secondary Intention in the Management of Pilonidal Sinus: Our Experience at a Tertiary Care Center in India

Chopde¹,

Adhikari²

2022

Cureus

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“… 10 However, challenges to incision healing include lateral tension and the potential for contamination. Although primary midline closures require less technical training and have shorter operative times, 26 – 28 they have also been associated with higher lateral tension and postoperative complications. 29 Data from this study suggest that the use of ciNPT may promote favorable outcomes (eg, decrease in the length of hospital stay, postoperative pain, and time-to-healing) after excision when used over closed, primary midline incisions in the intergluteal groove.…”

Section: Discussionmentioning

confidence: 99%

Pilonidal Cyst Excision: Primary Midline Closure with versus without Closed Incision Negative Pressure Therapy

Gabor¹,

Fávaro

Pedroso³

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Pilonidal cysts are a painful condition that primarily affect young adult men. In the literature, numerous operative techniques for resolving pilonidal cysts are described, with variable outcomes. The objective of this study was to compare primarily closed midline incisions managed with or without the use of closed incision negative pressure therapy after pilonidal cyst excision. Methods: Twenty-one patients underwent excision and midline primary closure. Postoperative care composed of closed incisional negative pressure therapy (study group; n = 10) or gauze dressings (control group; n = 11). In both groups, the sutures were partially removed on day 14 and completely removed on day 21. Compared outcomes included the duration of hospitalization, pain on the day of surgical procedure, and on postoperative day 7, and time-to-healing. Results: The median hospital stay was about 9 hours and 23 hours in the study and control groups, respectively ( P < 0.05). The median pain scores on the day of operation were 1.20/10 in the study group and 3.36/10 in the control group ( P < 0.05). On day 7, study group showed median pain score 0.9/10 and control group showed 2.63/10 ( P < 0.05). The mean healing time was 23.8 and 57.9 days in the ciNPT group and gauze group, respectively ( P < 0.05). Conclusion: These outcomes supported the incorporation of closed incision negative pressure therapy into our surgical treatment protocol for pilonidal cysts.

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“…The minimally invasive approach has been named endoscopic pilonidal sinus treatment (EPSiT), adding a possible effective tool for this disease. 8,9 Despite the huge morbidity associated with pilonidal sinus disease, there is still an open debate on the optimal treatment and management associated with the best patient outcome. Hence, this study was undertaken in order to study the possible benefits and disadvantages of the EPSiT.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Pilonidal Sinus Treatment (EPSIT) Vs Total Excision with Primary Closure (EPC) for Pilonidal Sinus Disease in Combined Military Hospital Rawalpindi

Muazzam

Hussain

Quraishi

2022

PAFMJ

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Objective: To compare endoscopic pilonidal sinus treatment (EPSIT) vs total excision with primary closure (EPC) for pilonidal sinus disease in Combined Military Hospital Rawalpindi regarding intra and post-operative outcomes. Study Design: Comparative cross-sectional. Place and Duration of Study: Department of Surgery, Combined Military Hospital Rawalpindi, from Sep 2017 to Aug 2018. Methodology: A total of 94 patients, all male patients were included. All 94 have primary pilonidal sinus; Patient were randomized in a double-blind study to undergo EPSiT or EPC by non-probability, consecutive sampling into two equal groups. Results: The mean ± age SD of patients was 28 years ± 2.6 years. All patients completed the follow-up. All 94 patients divided equally for EPSiT and EPC. The patients completed the follow-up. All 94 patients divided equally for EPSiT and EPC. Surgery duration of EPSiT with a median duration of 34.5 minutes (IQR 30-39) and EPC 40.5 minutes (IQR 35-46); The median hospital stay was 8.5 hours (IQR 4-14) in EPSIT and 21.5 hours (IQR 15-28) in EPC. Complete wound healing in EPSiT was 93.6% and EPC was 81%. Wound complication rate was lower for EPSiT 3 (6.3%) and 8 (17%) or EPC (p-value 0.108). One case of wound dehiscence reported in EPC. Recurrence occurred in EPSiT was 3(6.3%) and EPC 9(19.1%). Conclusions: In our experience, EPSiT was viable as EPC in the treatment of pilonidal sinus.

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Prospective randomized study of surgical treatment of pilonidal sinus; primary midline closure after elliptical excision versus rhomboid excision with limberg flap reconstruction versus open excision and healing by secondary intention

Cited by 5 publications

References 18 publications

Comparative Study of Limberg Flap Reconstruction With Wide-Open Excision and Healing by Secondary Intention in the Management of Pilonidal Sinus: Our Experience at a Tertiary Care Center in India

Comparative Study of Limberg Flap Reconstruction With Wide-Open Excision and Healing by Secondary Intention in the Management of Pilonidal Sinus: Our Experience at a Tertiary Care Center in India

Pilonidal Cyst Excision: Primary Midline Closure with versus without Closed Incision Negative Pressure Therapy

Endoscopic Pilonidal Sinus Treatment (EPSIT) Vs Total Excision with Primary Closure (EPC) for Pilonidal Sinus Disease in Combined Military Hospital Rawalpindi

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