Long‐term results of endoscopic pilonidal sinus treatment vs Limberg flap for treatment of difficult cases of complicated pilonidal disease: a prospective, nonrandomized study

• DOI: 10.1111/codi.14857
• Publication Date: 2019-09-18T18:40:00Z
• Authors: M. Romaniszyn; J. S. Swirta; P. J. Walega
• Keywords: 03 medical and health sciences; Pilonidal Sinus; Postoperative Complications; Treatment Outcome; 0302 clinical medicine; Recurrence; Humans; Prospective Studies; Neoplasm Recurrence, Local; Surgical Flaps; 3. Good health

AbstractAimTo present the results of a prospective, nonrandomized comparative study on the treatment of complicated pilonidal sinus by endoscopic pilonidal sinus treatment (EPSiT) compared with Limberg flap surgery, based on experience of a single surgical centre.MethodA prospective, nonrandomized comparative study. Long‐term follow‐up of 62 patients with complicated pilonidal disease was analysed (36 operated on using the Limberg flap technique and 26 using the EPSiT method). The median follow‐up was 27 months (12–44).ResultsThe median operating time in the EPSiT group was 60 min (25–80 min) and in the Limberg group 67 min (35–95 min). In the EPSiT group, primary healing was achieved in 22 out of 26 patients (84.6%) in a median of 42 days with a total complication rate of 11.5%. There were seven recurrences after initial healing. The total success rate of the EPSiT procedure with long‐term follow‐up was 57.7%. In the Limberg flap group, all patients healed (100%) in a median of 21 days. The complication rate in this group was 26.5%, and there were two recurrences in this group. The total success rate of the Limberg flap procedure was 94.1%.ConclusionFor patients with complicated pilonidal sinus, the endoscopic procedure has a significantly lower success rate than the Limberg flap procedure, but a lower risk of complications. Such patients should be offered a choice between a safer, minimally invasive procedure with a higher risk of recurrence or flap surgery, which is more effective, but with a higher risk of complications.