Rhomboid excision with ModifiedLimberg Flap; a novel treatment for Pilonidal Sinus Disease

Background: Pilonidal sinus is a disease of young adults having single or multiple blind tracks lined by granulation tissue containing tuft of shed hair. Natal cleft is the commonest site; rarely involves umbilicus, axilla and inter-digital cleft. It has various methods of its treatment. The modalities of treatment vary from conservative medical management to complex surgical procedures. Aim:To study the outcome of Rhomboid excision and Limberg’s flap closure for the treatment of sacrococcygeal pilonidal sinus. Study Design: Prospective study. Place & duration of study: Department of General Surgery, Khawaja Muhammad Safdar Medical College, Sialkot from January 2015 to December 2016. Methods: A total of 120 patients were included in the study. GroupA included 60 patients for primary excision while Group B included 60 patients of pilonidal sinuses were selected for modified limberg’s flap in this study. After initial workup, they were operated under general anesthesia in prone position by Rhomboid excision and Limberg’s flap technique with a closed suction drain and were followed up for the next twelve months after one week, two weeks, six months and twelve months) for surgical complications of the treatment (like flap edema, postoperative infection, wound dehiscence) and duration of hospital stay. Results: The infection rates were observed to be 10% in Limberg’s flap and 26.6 % in primary closure group. Whereas the recurrence rate were only 3.3% in Limberg’s flap as compared to 13.3 in primary closure group. Because of its low complication rate and acceptable long term results, rhomboid excision and the Limberg’s flap procedure is preferable to simple excision and primary closure in the treatment of sacrococcygeal pilonidal disease. Conclusion: The modified limberg’s flap procedure is an easy and effective technique. Patient comfort, quick healing time, short hospital stay, early return to full activity, and low complication and recurrence rates are the important advantages of this procedure.