Rhomboid Excision and Limberg Flap for Pilonidal Sinus Disease: A Clinical Study

Title: Rhomboid Excision and Limberg Flap for Pilonidal Sinus Disease: A Clinical Study

Author: Dr TRV Wilkinson, Dr Mahendra K. Chauhan, Dr Rama Fanandrakumar

DOI: https://dx.doi.org/10.18535/jmscr/v5i2.13

Abstract

Introduction: Pilonidal sinus is an acquired disease of young adults especially males in the age group of 15 to 40 years. The multiplicity of treatments available for this condition (surgical /non surgical) are testimony to the lack of satisfaction found with each.

Objectives: To study the advantages of rhomboid excision and Limberg flap in pilonidal sinus disease

Material and Methods: It was the prospective study of 25 patients who were diagnosed to have pilonidal sinus (primary or recurrent). All the patients included in the study underwent rhomboid excision and Limberg flap by the same team. The post operative course of each patient was studied. Immediate complications of the procedure like wound infection, seroma, post operative pain and hospitalization time were recorded. Patients were followed up to 6 months for recurrence.

Result: Males were predominantly affected and female to male ratio 1:7. Mean age of the patient were 32.4 yrs. Most of the patients involved in work pertaining to prolonged sitting. Out of 25 patients, 4 patient developed wound infection. Flap tip necrosis was observed in one patient and prolonged drainage was present in 3 patients (average 18 days).We encounter one recurrence in 6^th month follow up.

Conclusion: Primary and recurrent pilonidal sinus is very effectively managed by this procedure with minimum complications and very low recurrence rate.

Keywords: Pilonidal sinus, Rhomboid excision, Limberg flap, wound infection.

References

1. Anderson AW. Hair extracted from an ulcer; Boston Medical and Surgical Journal 1847; 36:74.

2. Sondenaa K, Andersen E, Nesvik I, Soreide JA. Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 1995 Feb;10(1):39-42.

3. Solla JA, Rothenberger DA. Chronic pilonidal disease. An assessment of 150 cases. Dis Colon Rectum 1990 Sep;33 (9):758-61.

4. W. H. Palmer “Pilonidal disease A new concept of pathogenesis” Diseases of the Colon and Rectum. 1959; Vol.-2; No.-3: Pg. 303-307.

5. Davage “The origin of sacrococcygeal pilonidal sinuses:based on an analysis of four hundred sixty–three cases” American Journal of Pathology. 1954; Vol.- 30:Pg.1191–1205.

6. Brearly. R. “Pilonidal sinus:a new theory of origin.” British Journal of Surgery. 1955; Vol.–43:Pg.62–68.

7. Hull T.L. et al.“Pilonidal disease.” Surgery Clinics of North America. 2002; Vol.82: Pg.1169-85.

8. Koray Topgül, et al. “Long-term results of limberg flap procedure for treatment of pilonidal sinus: a report of 200 cases.” Diseases of the Colon and Rectum. November 2003; Vol.-46 (11): Pg.1545-1548.May 2004;Vol.34; No.5: Pg.419-423.

9. Omer Mentes, et al. “Limberg Flap Procedure for Pilonidal Sinus Disease- Results of 353 Patients” Langenbecks Archives of Surgery. March 2008; Vol.- 393; No.2.: Pg. 185-189.

10. Murat Akin, et al. “Rhomboid Excision and Limberg Flap in the Management of Pilonidal Sinus-Long Term Results of 411 cases” Colorectal Disease Vol.9999 Issue 999A May 2008.

11. Srikanth K. Aithal C. S. Rajan, and Narender Reddy Limberg Flap for Sacrococcygeal Pilonidal Sinus a Safe and Sound Procedure Indian J Surg. 2013 Aug; 75(4): 298– 301.

12. Akca T, Colak T. Primary closure with Limberg flap in treatment of pilonidal sinus-randomized clinical trial. BJS. 2005;5074:1081–1084.

doi: 10.1002/bjs.5074

13. Azab AS, Kamal MS, Saad RA, Abount AL, Atta KA, Ali NA. Radical cure of pilonidal sinus by a transposition rhomboid flap. BJS. 1984;71(2):154–155. doi: 10.1002/bjs.1800710227

14. Chiedozi L C, Al-rayyes F A, Saleem M Mand Al-Hadi F H (2002), “Management of Pilonidal sinus”, Saudi Med J, Vol. 23, pp. 786-788.

15. Armstrong J H and Barcia P J (1994),“Pilonidal Sinus Disease (The conservative approach)”, Arch Surg, Vol. 129, pp. 914-917.

16. Surrell J A (1994), “Pilonidal Disease”, SurgClin North Am, Vol. 74, pp. 1309-1315.

17. da Silva J H (2000), “Pilonidal Cyst: Cause and Treatment”, Dis Colon Rectum., Vol. 43,pp. 1146-1156.

18. Allen-Mersh T G (1990), “Pilonidal Sinus:Finding the Right Track for Treatment”, Br JSurg, Vol 77, pp 123-132.

19. Karydakis G E (1992), “Easy andSuccessful Treatment of Pilonidal Sinus After Explanation of Its Causative Process”,Aust N Z J Surg , Vol. 62, pp. 385-389.

20. Petersen S, Koch R, Stelzner S et al. (2002),“Primary Closure Techniques in Chronic Pilonidal Sinus: A Survey of the Result ofDifferent Surgical Approaches”, Dis Colon Rectum, Vol. 45, pp. 1458-1462.

21. Al-Khamis A, McCallum I, King PM, et al.(2010), “Healing by Primary Versus Secondary Intention After Surgical Treatment For Pilonidal Sinus”, Cochrane Database Syst Rev, Vol. 20, p. 1.

22. Walid G E and Kaled S (2012), “Clinical TrialComparing Open Excision and Primary Closure With Modified Limberg Flap inTreatment of Uncomplicated SPD”, AJM , Vol. 48, pp. 13-18.

23. Can M F, Sevinc M M, Hancerliogullari O, etal. (2013), “Multicenter Prospective Randomized Trial Comparing Modified Limberg Flap Transposition and Karydakis Flap Reconstruction In Patients WithSacrococcygeal Pilonidal Disease”, Am J Surg , Vol. 200, pp. 318-327.

24. Jethwani U, Singh G, Mohil RS, Kandwal V, Chouhan J, Saroha R, et al. Limberg flap for pilonidal sinus disease: our experience. OA Case Reports 2013 Aug 08;2(7):69.

25. Shreeraz Shakoor et al. “Pilonidal sinus: Floowing the Aristotelian middle”Pakistan Journal Of Medical Sciences October – December 2008. Part II. Vol.-24: No.-6; Pg.845-846.

26. Akmal Jamal et al. “Open excision with secondary healing versus rhomboid excision with Limberg transposition flap in the management of sacro coccygeal pilonidal disease” Journal of Pakistan Medical Association. March2009. Vol.-59 (3); Pg.- 157-160.

Abstract

References

Corresponding Author

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles

Search

Abstract

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles