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World Journal of Surgery

Published in:

01-05-2013

Karydakis Flap for Recurrent Pilonidal Disease

Authors: Igors Iesalnieks, Sina Deimel, Hans J. Schlitt

Published in: World Journal of Surgery | Issue 5/2013

Abstract

Background

Patients undergoing surgery for recurrent pilonidal disease are at high risk of developing re-recurrence. The present retrospective analysis was performed to compare long-term results in patients with recurrent disease undergoing midline excision surgery compared to patients undergoing the Karydakis flap procedure.

Methods

Only patients with previous excision surgery apart from simple abscess incision were included. Disease recurrence was defined as the need for repeat surgery.

Results

A total of 124 patients underwent surgery for recurrent pilonidal disease. Group 1 consisted of 37 patients (25 excision + midline closure, 12 excision + lay-open). Group 2 consisted of 87 patients (Karydakis flap). There were no statistically significant differences between the groups with regard to patient’s age, duration of disease, body mass index, or sex. The average number of previous surgeries was significantly higher in group 1 patients (2.1 vs. 1.8, p = 0.019). The overall 1-year recurrence rate was 43 % in group 1 and 3 % in group 2 (p < 0.0001). The wound dehiscence rate after the Karydakis flap procedure was as high as 43 % between years 2005 and 2009, but it fell to 10 % thereafter (p = 0.02).

Conclusions

Karydakis flap procedure is superior to midline excision surgery in patients presenting with recurrent pilonidal disease.

Kooistra HP (1942) Pilonidal sinuses: review of the literature and report of 350 cases. Am J Surg 55:3–17CrossRef

Kronborg O, Christensen K, Zimmermann-Nielsen C (1985) Chronic pilonidal disease: a randomized trial with a complete 3-year follow-up. Br J Surg 72:303–304PubMedCrossRef

Tejirian T, Lee JJ, Abbas MA (2007) Is wide local excision for pilonidal disease still justified? Am Surg 73:1075–1078PubMed

Khaira HS, Brown JH (1995) Excision and primary suture of pilonidal sinus. Ann R Coll Surg Engl 77:242–244PubMed

Karydakis GE (1973) New approach to the problem of pilonidal sinus. Lancet 2:1414–1415PubMedCrossRef

Bascom J, Bascom T (2002) Failed pilonidal surgery: new paradigm and new operation leading to cures. Arch Surg 137:1146–1150PubMedCrossRef

Bozkurt MK, Tezel E (1998) Management of pilonidal sinus with the Limberg flap. Dis Colon Rectum 41:775–777PubMedCrossRef

Jonas J, Blaich S, Bahr R (2000) Der Transpositionslappen nach Limberg in der operativen Therapie des chronischen Sinus pilonidalis. Zentralbl Chir 125:976PubMedCrossRef

Petersen S, Koch R, Stelzner S et al (2002) Primary closure techniques in chronic pilonidal sinus: a survey of the results of different surgical approaches. Dis Colon Rectum 45:1448–1467CrossRef

10.

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 (1). doi:10.1002/14651858.CD006213.pub3

11.

Tocchi A, Mazzoni G, Bononi M et al (2008) Outcome of chronic pilonidal disease treatment after ambulatory plain midline excision and primary suture. Am J Surg 196:28–33PubMedCrossRef

12.

Rao MM, Zawislak W, Kennedy R et al (2010) A prospective randomised study comparing two treatment modalities for chronic pilonidal sinus with a 5-year follow-up. Int J Colorectal Dis 25:395–400PubMedCrossRef

13.

Karakayali F, Karagulle E, Karabulut Z et al (2009) Unroofing and marsupialization versus rhomboid excision and Limberg flap in pilonidal disease: a prospective, randomized, clinical trial. Dis Colon Rectum 52:496–502PubMedCrossRef

14.

Solla JA, Rothenberger DA (1990) Chronic pilonidal disease: an assessment of 150 cases. Dis Colon Rectum 33:758–761PubMedCrossRef

15.

Al-Jaberi TM (2001) Excision and simple primary closure of chronic pilonidal sinus. Eur J Surg 167:133–165PubMedCrossRef

16.

Søndenaa K, Andersen E, Søreide JA (1992) Morbidity and short term results in a randomised trial of open compared with closed treatment of chronic pilonidal sinus. Eur J Surg 158:351–355PubMed

17.

Iesalnieks I, Fürst A, Rentsch M et al (2003) Primary midline closure after excision of a pilonidal sinus is associated with a high recurrence rate. Chirurg 74:461–468PubMedCrossRef

18.

Kitchen PR (1996) Pilonidal sinus: experience with the Karydakis flap. Br J Surg 83:1452–1455PubMedCrossRef

19.

Iesalnieks I, Deimel S, Kienle K et al (2011) Pit-picking surgery for pilonidal disease. Chirurg 82:927–931PubMedCrossRef

20.

Bascom J (1980) Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 87:567–572PubMed

21.

Akinci OF, Coskun A, Uzunkoy A (2000) Simple and effective surgical treatment of pilonidal sinus: asymmetric excision and primary closure using suction drain and subcuticular skin closure. Dis Colon Rectum 43:701–707PubMedCrossRef

22.

Ozgültekin R, Ersan Y, Ozcan M et al (1995) Die Therapie des Sinus pilonidalis mit dem Transpositionslappen nach Limberg. Chirurg 66:192–195PubMed

23.

Abu Galala KH, Salam IM, Abu Samaan KR et al (1999) Treatment of pilonidal sinus by primary closure with a transposed rhomboid flap compared with deep suturing: a prospective randomised clinical trial. Eur J Surg 165:468–472PubMedCrossRef

24.

Schoeller T, Wechselberger G, Otto A et al (1997) Definite surgical treatment of complicated recurrent pilonidal disease with a modified fasciocutaneous V-Y advancement flap. Surgery 121:258–263PubMedCrossRef

25.

Bascom J, Bascom T (2007) Utility of the cleft lift procedure in refractory pilonidal disease. Am J Surg 193:606–609PubMedCrossRef

26.

Madbouly KM (2010) Day-case Limberg flap for recurrent pilonidal sinus: Does obesity complicate the issue? Am Surg 76:995–999PubMed

27.

Ersoy E, Devay AO, Aktimur R et al (2009) Comparison of the short-term results after Limberg and Karydakis procedures for pilonidal disease: randomized prospective analysis of 100 patients. Colorectal Dis 11:705–710PubMedCrossRef

28.

Can MF, Sevinc MM, Hancerliogullari O et al (2010) Multicenter prospective randomized trial comparing modified Limberg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease. Am J Surg 200:318–327PubMedCrossRef

29.

Sondenaa K, Andersen E, Nesvik I et al (1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 10:39–42PubMedCrossRef

Title: Karydakis Flap for Recurrent Pilonidal Disease
Authors: Igors Iesalnieks
Sina Deimel
Hans J. Schlitt
Publication date: 01-05-2013
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 5/2013
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-013-1950-8

At a glance: The STEP trials

Springer Medicine

Karydakis Flap for Recurrent Pilonidal Disease

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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