Abstract

Background: Sacrococcygeal pilonidal sinus is an acquired disease commonly seen in young adults especially males in gluteal cleft and it is known for recurrence and affects the patient’s quality of life. Rhomboid excision of sinus with Limberg rotation gap coverage is a well-known surgical modality for this. This prospective study is carried out to determine the effects of the Limberg gap rotation surgery especially for its feasibility in a General surgical unit for the sacrococcygeal pilonidal sinus patients, their compliance, outcomes of the surgery such as wound infection, postoperative pain relief, recurrence rates, and back to routine duration. Patients and methods: This is a prospective study of 40 Limberg gaps done from 2017 January to 2018 December in general surgical unit by the same surgical team for both primary and recurrent Pilonidal sinuses, and patients who previous incision and drainage had done for the pilonidal abscess. The various demographic, clinical and surgical data are studied and compared to other studies. Results: There were 34 (85%) male patients and 6 (15%) female patients and all patients successfully underwent surgery, with very minimal postoperative pain, stayed in hospital for average 10 days, returned to work after 3 weeks. The operative time, blood loss, hospital stay, surgeon’s performance scale, wound hypothesia, wound cosmoses score, patient satisfaction score, and patient quality of life were studied. The Limberg gap surgery had better clinical results regarding frequency of seroma formation and time to drain removal, pain score and early return to normal works. Out of the 40 patients operated 1 (2.5%) developed superfacial skin necrosis, 2 (5%) developed seroma, and 1(2.5%) type-1 diabetic female developed surgical site infection. Conclusion: In this procedure of Limberg gap there are significant benefits in terms of postoperative pain, infection rates, less hospital stay and early return to work with almost nil recurrences.

• 1.   Hull TL, Wu J. Pilonidal disease. Surg Clin North Am. 2002;82:1169–1185. doi: 10.1016/S0039- 6109(02)00062-2.
• 2.   Mentes O, Bagci M, Bilgin T, Ozgul O, Ozdemir M. Limberg gap procedure for pilonidal sinus disease: results of 353 patients. Langenbecks Arch Surg. 2008;393(2):185-9.
• 3.   Humphries AE, James E. Evaluation and management of pilonidal disease. Surg Clin North Am. 2010;90(1):113–124. doi: 10.1016/j.suc. 2009.09.006.
• 4.   Sondenaa K, Andersen E. Patient characteristics and symptoms of in chronic pilonidal sinus disease. Int J Colorectal Dis. 1995;10(1):39–42.doi: 10.1007/ BF00337585.
• 5.   Clothier PR, Haywood IR. The natural history of the post anal pilonidal sinus. Ann R College Surg England. 1984;66(3):201–203.
• 6.   Brearley R. Pilonidal sinus: a new theory of origin. Br J Surg. 1955;43:62–68. doi: 10.1002/bjs.18004317708.
• 7.   Bascom J. Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery. 1980;87:567–572.
• 8.   Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust NZJ Surg. 1992;62:385–389 doi: 10.1111/j.1445-2197.1992.tb07208.x.
• 9.   Mohamed HA, Kadry I, Adly S. Comparison between three modalities for non-complicated pilonidal sinus disease. Surgeon. 2005;3(2):73-77. doi: 10.1016/S1479-666X(05)80065-4.
• 10.   Berger A, Frileux P. Pilonidal sinus. Ann Chir. 1995;49:889–901.
• 11.   Casetecker J, Mann BD, Castellanes AF, Strauss J (2006) Pilonidal disease. http://emedicine. medscape.com/article192668. Accessed 11 Dec 2011.
• 12.   Solla JA, Rothenberger DA. Chronic pilonidal disease. An assessment of 150 cases. Dis Colon Rectum. 1990 Sep;33(9):758-61.
• 13.   Wolfe SA, Limberg AA, M.D., 1894-1974. Plastic and reconstructive surgery. 1975;56(2):239–240.
• 14.   Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, Westlake L. Validating the SF-36 health survey questionnaire: new outcome measure for pri care. BMJ 1992; 305:160-164.
• 15.   Bascom JU. Pilonidal sinus. Curr Pract Surg 1994; 6:175-180.
• 16.   Lee HC, Ho YH, Seow CF, Eu KW, Nyam D. Pilonidal disease in Singapore: clinical features and Management. Aust N Z J Surg. 2000;70:196-98.
• 17.   Akinci OF, Bozer M, Uzunkoy A, et al. Incidence and aetiological factors in pilonidal sinus among Turkish soldiers. Eur J Surg. 1999;165:339-342.
• 18.   Harlak A, Mentes O, Kilics S, et al. Sacrococcygeal PSD: analysis of previously proposed risk factors. Clinics. 2010;65:125-31.
• 19.   Jensen SL, Harling H. Prognosis after simple incision and drainage for a rst-episode acute pilonidal abscess. Br J Surg. 1988 Jan;75(1):60-1.
• 20.   Akin M, Gokbayir H, Kilic K, Topgul K, Ozdemir E, Ferahkose Z. Rhomboid excision and Limberg gap for managing pilonidal sinus: long-term results in 411 patients. Colorectal Dis. 2008 Nov;10(9):945-8.
• 21.   El-khadrawy OH. The rhomboid gap for recurrent pilonidal disease. Tanta Med Sci J. 2006 Oct;1(4):175-81.
• 22.   Abu Galala KH, Salam IM, Abu Samaan KR, El Ashaal YI, Chandran VP, Sabastian M. Treatment of pilonidal sinus by primary closure with a transposed rhomboid gap compared with deep suturing: a prospective randomised clinical trial. Eur J Surg. 1999 May;165(5):468-72.
• 23.   Katsoulis IE, Hibberts F, Carapeti EA. Outcome of treatment of primary and recurrent pilonidal sinus with Limberg gap. Surgeon. 2006;4(1):7–10.
• 24.   Aslam M, Choudhry A. Use of Limberg gap for pilonidal sinus—a viable option. J Ayub Med Coll Abbottabad. 2009 Oct-Dec;21(4):31-3. [PubMed].
• 25.   Urhan MK, Kucukel F, Topgul K, Ozer I, Sari S. Rhomboid excision and Limberg gap for managing pilonidal sinus: results of 102 cases. Dis Colon Rectum. 2002 May;45(5):656-9.

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