Off-midline closure errors as a recurrence factor in Limberg flap surgery in sacrococcygeal pilonidal sinus: a multicenter, case-control study

Abstract Background The Limberg flap (LF) procedure widely performed for the treatment of sacrococcygeal pilonidal sinus (SPS); however, recurrences continue to be observed. The aim of this study was to assess the relationship between LF designs to the risk of SPS recurrence. Methods Sixty-one cases...

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Bibliographic Details
Published in:The American journal of surgery 2017
Main Authors: Kaplan, Mehmet, M.D, Ozcan, Onder, M.D, Bilgic, Ethem, M.D, Kaplan, Elif Tugce, M.S, Kaplan, Tugba, MS, Kaplan, Fatma Cigdem, M.D
Format: Article
Language:English
Subjects:
Surgery
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Summary:Abstract Background The Limberg flap (LF) procedure widely performed for the treatment of sacrococcygeal pilonidal sinus (SPS); however, recurrences continue to be observed. The aim of this study was to assess the relationship between LF designs to the risk of SPS recurrence. Methods Sixty-one cases with recurrent disease (study group, SG) and 194 controls, with a minimum of 5 recurrence-free years following surgery (control group, CG), were included in the study. LF reconstructions in each group were classified into off-midline closure (OMC) and non-OMC types. Subsequently, the 2 groups were analyzed. Results After adjusted for all variables, non-OMC types showed the most prominent correlation with recurrence, followed by interrupted suturing type, family history of SPS, smoking, prolonged healing time and younger age. The best cut-off value for critical distance from the midline was found to be 11 mm, with 72% sensitivity and 95% specificity for recurrence. Conclusions We recommend OMC modifications, with the flap tailored to create a safe margin of at least 2 cm between the flap borders and the midline.
ISSN:0002-9610
DOI:10.1016/j.amjsurg.2017.02.008