Comparative Study of Limberg Flap Reconstruction With Wide-Open Excision and Healing by Secondary Intention in the Management of Pilonidal Sinus: Our Experience at a Tertiary Care Center in India

Introduction A pilonidal sinus (PNS) is a small passageway in the subcutaneous tissue which develops most frequently in the sacrococcygeal area. In terms of postoperative outcomes, the decision on the best surgical treatment for PNS is still a challenge for a surgeon. Prevention of the disease recurrence and improving quality of the life can be considered primary goals of the treatment. The current study intends to compare two commonly practiced surgical treatments for PNSes-Rhomboid excision with Limberg flap repair against wide-open excision with healing by secondary intention. Methods In a prospective randomized study, 50 patients with sacrococcygeal PNS were divided into two groups. Group A was operated by rhomboid excision with Limberg flap reconstruction and Group B was operated by wide-open excision and healing by secondary intention. Data were collected on a specially designed structured proforma and consisted of patient demographics, medical history, presentation, and postoperative complications assessed for a period of 6 months. Comparative outcomes of interest were postoperative pain, postoperative anxiety, duration of wound healing, duration of work loss, presence of wound infection, and recurrence. Results Mean age of 28 years was observed across the study with a male preponderance (76%). The mean visual analog scale (VAS) score for pain was greater in Group A during the early postoperative period, i.e., days 1, 3, and 7. However, patients in Group B reported a mean VAS score of 3 ± 0 and 1 ± 0 at one month and 2 months, respectively indicating a longer duration of postoperative pain overall. Patients in Group B also reported a significantly higher VAS for anxiety (VAS-A) score for postoperative anxiety/stress in all the follow-up visits. The mean healing time was 20 ± 2 days in Group A and 57 ± 11 days in Group B showing a significant difference. Duration of work loss was also significantly higher in Group B (31 days). Five patients in Group B developed wound infections. No recurrence was observed across both the groups in this study. Conclusion According to the findings of this study, the Limberg flap method outperforms the wide-open excision approach in terms of healing duration, work loss days, postoperative pain, anxiety, and wound infection. Both the techniques, however, are comparable in terms of recurrence.