Comparative Evaluation of Postoperative Complications Following Karydakis Versus Limberg Flap Procedures for Pilonidal Sinus Disease: A Retrospective Study
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Abstract
Background: Pilonidal sinus disease is a chronic inflammatory condition of the sacrococcygeal region that frequently requires surgical treatment. Although Karydakis and Limberg procedures are widely used, the optimal technique remains debated because postoperative recovery and wound complication profiles vary across settings. Objective: To compare postoperative complications and recovery outcomes following Karydakis and Limberg procedures for pilonidal sinus disease. Methods: This retrospective comparative observational study included 78 patients who underwent pilonidal sinus surgery at Chaudhry Hospital, Lahore. Patients were categorized according to surgical procedure: Karydakis procedure (n=43) or Limberg flap procedure (n=35). Baseline characteristics, recovery outcomes, and postoperative complications were extracted from medical records and operative notes. Categorical variables were compared using appropriate statistical tests, with p≤0.05 considered statistically significant. Results: The Karydakis group had significantly shorter hospital stay (p=0.039), earlier drain removal (p<0.001), and earlier return to daily activities (p=0.018). However, wound infection was higher after Karydakis surgery than after Limberg flap surgery (41.9% vs 17.1%; OR=3.48, 95% CI 1.20–10.12; p=0.019), as were wound dehiscence (34.9% vs 5.7%; OR=8.84, 95% CI 1.86–42.02; p=0.002) and edema (41.9% vs 20.0%; OR=2.88, 95% CI 1.03–8.04; p=0.040). Hematoma and pain were not significantly different. Conclusion: Karydakis surgery showed faster recovery, whereas Limberg flap surgery demonstrated fewer wound-related complications.
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1. Demiryas S, Donmez T. Could early postoperative complications be considered as risk factor for recurrence after pilonidal sinus surgery. Chirurgia. 2019;114(4):475-486.
2. Onder A, Girgin S, Kapan M, Toker M, Arikanoglu Z, Palanci Y, et al. Pilonidal sinus disease: risk factors for postoperative complications and recurrence. Int Surg. 2012;97(3):224-229.
3. Brown SR, Hind D, Strong E, Bradburn M, Din F, Lee E, et al. Real-world practice and outcomes in pilonidal surgery: Pilonidal Sinus Treatment Studying The Options (PITSTOP) cohort. Br J Surg. 2024;111(3):znae009.
4. Kanlioz M, Ekici U. Complications during the recovery period after pilonidal sinus surgery. Cureus. 2019;11(4).
5. de Kort J, Pronk AA, Vriens MR, Smakman N, Furnee EJ. Long-term follow-up of sacrococcygeal pilonidal sinus disease after previous abscess drainage: a retrospective cohort study. J Gastrointest Surg. 2025;29(2):101892.
6. Kaba M. New factors affecting wound healing and recurrence after pilonidal sinus surgery in adolescents; seborrheic dermatitis and psychiatric co-occurring conditions. Int Wound J. 2024;21(1):e14404.
7. Spyridakis M, Christodoulidis G, Chatzitheofilou C, Symeonidis D, Tepetes K. The role of platelet-rich plasma in accelerating the wound-healing process and recovery in patients being operated for pilonidal sinus disease: preliminary results. World J Surg. 2009;33(8):1764-1769.
8. Zubair R, Channa MA. Limberg flap technique for pilonidal sinus disease treatment: an experience of Hamdard University Hospital. J Ayub Med Coll Abbottabad. 2022;34(2):230-234.
9. Al-Khayat H, Al-Khayat H, Sadeq A, Groof A, Haider HH, Hayati H, et al. Risk factors for wound complication in pilonidal sinus procedures. J Am Coll Surg. 2007;205(3):439-444.
10. Milone M, Velotti N, Manigrasso M, Anoldo P, Milone F, De Palma GD. Long-term follow-up for pilonidal sinus surgery: a review of literature with metanalysis. Surgeon. 2018;16(5):315-320.
11. Kartal A, Aydın HO, Oduncu M, Ferhatoğlu MF, Kıvılcım T, Filiz Aİ. Comparison of three surgical techniques in pilonidal sinus surgery. Prague Med Rep. 2019;119(4):148-155.
12. Unalp HR, Derici H, Kamer E, Nazli O, Onal MA. Lower recurrence rate for Limberg vs VY flap for pilonidal sinus. Dis Colon Rectum. 2007;50(9):1436-1444.
13. Breidung D, Billner M, Buben P, Grieb G, Sievers R, Reichert B, et al. Evaluation of clinical outcomes and quality of life following the Karydakis flap procedure for pilonidal sinus treatment. Adv Skin Wound Care. 2024;37(11-12):1-6.
14. Ali MA. To study the surgical outcome of Z plasty versus Limberg flap in the management of pilonidal sinus disease [master’s thesis]. Rajiv Gandhi University of Health Sciences; 2019.