Top

International Journal of Colorectal Disease

Published in:

01-07-2021 | Seroma | Review

Karydakis procedure versus Limberg flap for treatment of pilonidal sinus: an updated meta-analysis of randomized controlled trials

Authors: Sameh Hany Emile, Sualeh Muslim Khan, Samer Hani Barsom, Steven D Wexner

Published in: International Journal of Colorectal Disease | Issue 7/2021

Abstract

Background

The Karydakis procedure (KP) and Limberg flap (LF) are two commonly performed operations for pilonidal sinus disease (PND). The present meta-analysis aimed to review the outcome of randomized trials that compared KP and LF.

Methods

Electronic databases were searched in a systematic manner for randomized trials comparing KP and LF through July 2020. This meta-analysis was reported in line with the PRISMA statement. The main outcome measures were failure of healing of PND, complications, time to healing, time to return to work, and cosmetic satisfaction.

Results

Fifteen randomized controlled trials (1943 patients) were included. KP had a significantly shorter operation time than LF with a weighted mean difference (WMD) of −0.788 (95%CI: −11.55 to −4.21, p < 0.0001). Pain scores, hospital stay, and time to healing were similar. There was no significant difference in overall complications (OR= 1.61, 95%CI: 0.9–2.85, p = 0.11) and failure of healing (OR= 1.22, 95%CI: 0.76–1.95, p = 0.41). KP had higher odds of wound infection (OR= 1.87, 95%CI: 1.15–3.04, p = 0.011) and seroma formation (OR= 2.33, 95%CI: 1.39–3.9, p = 0.001). KP was followed by a shorter time to return to work (WMD= −0.182; 95%CI: −3.58 to −0.066, p = 0.04) and a higher satisfaction score than LF (WMD= 2.81, 95%CI: 0.65–3.77, p = 0.01).

Conclusions

KP and LF were followed by similar rates of complications and failure of healing of PND and comparable stay, pain scores, and time to wound healing. KP was associated with higher rates of seroma and wound infection, shorter time to return to work, and higher cosmetic satisfaction than LF.

Koyfman A. Pilonidal sinus and cyst. Medscape. Available online at https://emedicine.medscape.com/article/788127-overview#a6. Accessed on August 10, 2020.

Hull TL, Wu J (2002) Pilonidal disease. Surg Clin North Am 82(6):1169–1851CrossRef

da Silva JH (2000) Pilonidal cyst: cause and treatment. Dis Colon Rectum 43(8):1146–1156CrossRef

Burnstein M (1993 Aug.) Managing anorectal emergencies. Can Fam Physician 39:1782–1785PubMedPubMedCentral

Stauffer VK, Luedi MM, Kauf P et al (2018) Common surgical procedures in pilonidal sinus disease: a meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep 8(1):3058. Published 2018 Feb 15. https://doi.org/10.1038/s41598-018-20143-4CrossRefPubMedPubMedCentral

Arnous M, Elgendy H, Thabet W, Emile SH, Elbaz SA, Khafagy W (2019) Excision with primary midline closure compared with Limberg flap in the treatment of sacrococcygeal pilonidal disease: a randomised clinical trial. Ann R Coll Surg Engl 101(1):21–29. https://doi.org/10.1308/rcsann.2018.0144CrossRefPubMed

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and metaanalyses of studies that evaluate healthcareinterventions: explanation and elaboration. BMJ. 339:b2700CrossRef

Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA (2011) Cochrane Bias Methods Group, Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 343:d5928

Elhiny AA, Saad D, Farahat M (2020) Effectiveness and feasibility of Limberg and Karydakis flap in recurrent and complicated pilonidal sinus disease. Indian Journal of Surgery 83:55–60. https://doi.org/10.1007/s12262-020-02236-5CrossRef

10.

Destek S, Bektaşoğlu HK, Kunduz E, Akyüz MN (2020) Comparison of postoperative quality of life of Limberg flap and Karydakis flap in pilonidal sinus operations. Turk J Surg 36(1):59–64. https://doi.org/10.5578/turkjsurg.4598CrossRefPubMedPubMedCentral

11.

El Hadidi A, Negm A, Abdelhalim M, Taha A, Noaman N, Dawoud I (2019) Karydakis versus Limberg flap reconstruction for the treatment of recurrent pilonidal disease: a prospective randomized controlled trial. Egypt J Surg 38:369–375CrossRef

12.

Alvandipour M, Zamani MS, Ghorbani M, Charati JY, Karami MY (2019) Comparison of Limberg flap and Karydakis flap surgery for the treatment of patients with pilonidal sinus disease: a single-blinded parallel randomized study [published online ahead of print, 2019 May 22]. Ann Coloproctol 35(6):313–318. https://doi.org/10.3393/ac.2018.09.27CrossRefPubMedCentral

13.

Ahmed Z, Shahid M, Malik MS et al (2017) Comparison of Karydakis technique with Limberg flap procedure for sacrococcygeal pilonidal sinus disease in terms of hospital stay and work loss. Pak Armed Forces Med J 67:141–144

14.

Kohla SM, Alsesy AA, Abd El-Aziz TF, Mohammed MA, Abo Zaid MA (2016) Comparative study between the Karydakis technique and the Limberg flap in pilonidal sinus. Menoufia Med J 29:539–544CrossRef

15.

Khan KJ, Ghaffar A, Choudhry S et al (2016) Comparison of early outcome between modified Limberg and Karydakis flap procedures in patients with sacrococcygeal pilonidal sinus. Pak J Med Health Sci 10:631–634

16.

Sevinç B, Karahan Ö, Okuş A, Ay S, Aksoy N, Şimşek G (2016) Randomized prospective comparison of midline and off-midline closure techniques in pilonidal sinus surgery. Surgery. 159(3):749–754. https://doi.org/10.1016/j.surg.2015.09.024CrossRefPubMed

17.

Tokac M, Dumlu EG, Aydin MS, Yalcın A, Kilic M (2015) Comparison of modified Limberg flap and Karydakis flap operations in pilonidal sinus surgery: prospective randomized study. Int Surg 100:870–877CrossRef

18.

Bali I, Aziret M, Sözen S, Emir S, Erdem H, Çetinkünar S, İrkörücü O (2015) Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease. Clinics (Sao Paulo) 70:350–355CrossRef

19.

Arslan K, Said Kokcam S, Koksal H, Turan E, Atay A, Dogru O (2014) Which flap method should be preferred for the treatment of pilonidal sinus? A prospective randomized study. Tech Coloproctol 18:29–37CrossRef

20.

Bessa SS (2013) Comparison of short-term results between the modified Karydakis flap and the modified Limberg flap in the management of pilonidal sinus disease: a randomised controlled trial. Dis Colon Rectum 56:491–498CrossRef

21.

Ates M, Dirican A, Savac M et al (2011) Short and long-term results of the Karydakis flap versus the Limberg flap for treating pilonidal sinus disease: a prospective randomized study. Am J Surg 202:568–573CrossRef

22.

Can MF, Sevinc MM, Hancerliogullari O, Yilmaz M, Yagci G (2010) Multicentre prospective randomized trial comparing modified Limberg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease. Am J Surg 200:318–327. https://doi.org/10.1016/j.amjsurg.2009.08.042CrossRefPubMed

23.

Ersoy E, Devay AO, Aktimur R, Doganay B, Özdoğan M, Gündoğdu RH (2009) Comparison of the short-term results after Limberg and Karydakis procedures for pilonidal disease: randomized prospective analysis of 100 patients. Color Dis 11:705–710. https://doi.org/10.1111/j.1463-1318.2008.01646.xCrossRef

24.

Duman K, Gırgın M, Harlak A (2017) Prevalence of sacrococcygeal pilonidal disease in Turkey. Asian J Surg 40(6):434–437. https://doi.org/10.1016/j.asjsur.2016.04.001CrossRefPubMed

25.

Doll D, Orlik A, Maier K, Kauf P, Schmid M, Diekmann M, Vogt AP, Stauffer VK, Luedi MM (2019) Impact of geography and surgical approach on recurrence in global pilonidal sinus disease. Sci Rep 9(1):15111. https://doi.org/10.1038/s41598-019-51159-zCrossRefPubMedPubMedCentral

26.

Youssef T, El-Awady S, Farid M (2015) Tension-free primary closure compared with modified Limberg flap for pilonidal sinus disease: a prospective balanced randomized study. Egypt J Surg 34:85–89CrossRef

27.

Erderm E, Sungurtekin U, Nessar M (1998) Are postoperative drains necessary with the Limberg flap for treatment of pilonidal sinus? Dis Colon Rectum 41:1427–1431CrossRef

28.

Kanlioz M, Ekici U (2019) Complications during the recovery period after pilonidal sinus surgery. Cureus 11(4):e4501. Published 2019 Apr 19. https://doi.org/10.7759/cureus.4501CrossRefPubMedPubMedCentral

29.

Almajid FM, Alabdrabalnabi AA, Almulhim KA (2017) The risk of recurrence of Pilonidal disease after surgical management. Saudi Med J 38(1):70–74. https://doi.org/10.15537/smj.2017.1.15892CrossRefPubMedPubMedCentral

30.

Pronk AA, Eppink L, Smakman N, Furnee EJB (2018) The effect of hair removal after surgery for sacrococcygeal pilonidal sinus disease: a systematic review of the literature. Tech Coloproctol 22(1):7–14. https://doi.org/10.1007/s10151-017-1722-9CrossRefPubMed

31.

Abdelnaby M, Emile SH, El-Said M et al (2018) Rotational gluteal flap versus modified Limberg flap in treatment of sacrococcygeal pilonidal disease. J Surg Res 223:174–182. https://doi.org/10.1016/j.jss.2017.11.017CrossRefPubMed

32.

Gavriilidis P, Bota E (2019) Limberg flap versus Karydakis flap for treating pilonidal sinus disease: a systematic review and meta-analysis. Can J Surg 62(2):131–138. https://doi.org/10.1503/cjs.003018CrossRefPubMedPubMedCentral

Title: Karydakis procedure versus Limberg flap for treatment of pilonidal sinus: an updated meta-analysis of randomized controlled trials
Authors: Sameh Hany Emile
Sualeh Muslim Khan
Samer Hani Barsom
Steven D Wexner
Publication date: 01-07-2021
Publisher: Springer Berlin Heidelberg
Keyword: Seroma
Published in: International Journal of Colorectal Disease / Issue 7/2021
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-021-03922-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Karydakis procedure versus Limberg flap for treatment of pilonidal sinus: an updated meta-analysis of randomized controlled trials

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2021

Correction to: Accuracy and inter-observer agreement of the nice and kudo classifications of superficial colonic lesions: a comparative study

Anastomotic leak in patients with acute complicated diverticulitis undergoing primary anastomosis: risk factors and the role of diverting loop ileostomy

Normal inflammatory markers and acute appendicitis: a national multicentre prospective cohort analysis

Interhospital referral of colorectal cancer patients: a Dutch population-based study

Oral antibiotics and mechanical bowel preps: do they have to come together?

Failure of nonoperative management in patients with acute diverticulitis complicated by abscess: a systematic review