PİLONİDAL SİNÜS’ÜN CERRAHİ TEDAVİSİNDE LİMBERG FLEP İLE KARYDAKİS FLEP KARŞILAŞTIRMASI

Abstract

Giriş: Pilonidal sinüs en sık sakrokoksigeal bölgede rastlanan ve günlük aktivite ve yaşam konforunu etkileyen bir hastalıktır. Bu hastalığın tedavisinde çok sayıda cerrahi teknik ve tıbbi metot tanımlanmıştır. Modifiye Karydakis flebi ve modifiye Limberg flebi sakrokoksigeal pilonidal sinüs hastalığının cerrahi tedavisinde yaygın olarak kullanılmaktadır. Bu retrospektif çalışmanın amacı, KAR prosedürünün ve Limberg flebinin etkinliğini değerlendirmektir. Materyal ve Metot: Bu çalışma, Ekim 2011 – Eylül 2012 yılları arasında genel cerrahi polikliniğine başvuran ve kronik pilonidal sinüs hastalığı tanısı konulup Genel Cerrahi kliniğinde pilonidal sinüs eksizyonu ile Karydakis flep uygulanan 31 olgu ile pilonidal sinüs eksizyonu ve Limberg flep yöntemi uygulanan 32 olgu değerlendirmeye alındı ve sonuçlar karşılaştırıldı. Tartışma: Pilonidal sinüs toplumda en sık genç erkeklerde görülen bir hastalıktır. Bugüne kadar tanımlanmış birçok farklı tedavi yöntemi olmasına rağmen, total kür hakkında hala ortak bir görüş yoktur. Ancak birçok çalışmada Limberg flep tekniği nüks ve komplikasyon oranları açısından bir adım öndedir. Karydakis flep uygulamasının da alternatif bir tedavi metodu olduğu öne sürülmüştür. Sonuç: Çalışmamızda yara ayrışması ve enfeksiyon oranları Limberg grubunda Karydakis flep grubuna göre daha yüksek bulundu, ancak erken enfeksiyon veya nüks oranları açısından iki teknik arasında istatistiksel olarak anlamlı bir fark yoktu. Bu konuda daha fazla klinik araştırma yapılması gerekmektedir.

Keywords

• Pilonidal sinus
• Karydakis flep
• Limberg flep

Comparison of Karydakis flap and the Limberg flap in pylonidal sinus surgery

Abstract

Introduction: Pylonidal sinus is found most commonly in the sacrococcygeal region and affect patient’s daily activities and living comfort. A large number of surgical techniques and medical methods have been defined for the treatment of this disease. The modified Karydakis(KAR) flap and the modified Limberg flap are commonly used in the surgical management of sacrococcygeal pilonidal sinus disease. The goal of this retrospective study is to assess the efficacy of the KAR procedure and Limberg flap.Material and method: In this study, 31 cases who were diagnosed with chronic pilonidal sinus disease and underwent pilonidal sinus excision and Karydakis flap in the General Surgery clinic between October 2011 and September 2012 and 32 cases who underwent pilonidal sinus excision and Limberg flap method were evaluated and the results were compared.Results :In our study, 17 of the 63 patients were female and 46 were male. It was statistically significantly observed that the operation time was shorter (p<0.001) in the Karydakis Flap group compared to the Limberg Flap group. There was no significant difference between complaints and was no difference between them in terms of early recurrence (p=0.982). The infection was less on day 15 (p=0.006) in the Karydakis Flap group compared to the Limberg Flap group. Wound dehiscence and infection rates were higher in Limberg flap than in Karydakis flap. Discussion: Pylonidal sinus is a common disease in society and refers to the young males most commonly. Although there had been many different treatment methods defined until today, there is stil not a common opinion about total cure. In many studies, Limberg flap technique is one step ahead in means of recurrence and complication rates The KAR procedure has also been suggested to be an alternative treatment method. Conclusion: In our study rates of wound dehiscence and infection were found to be higher in Limberg group compared to the Karydakis Flap group but, there was not a statistically significant difference between the two techniques in means of early infection or recurrence rates. There is need to be make more clinical research about this subject.

Keywords

• Karydakis flap
• Limberg flap
• Pylonidal sinus

References

1. Anderson JH, Yip CO, Nagabhushan JS, Connelly SJ Daycase(2008) Karydakis flap for pilonidal sinus. Dis Colon Rectum 51:134–138
2. Anyanwu AC, Hossain S, Williams A, Montgomery AC.(1998) Karydakis operation for sacrococcygeal pilonidal sinus disease: experience in a district general hospital. Ann R Coll Surg Engl 80:197-9.
3. Aren A.,Sağban A.D., Gökçe A.H.(2010) Pilonidal sinus’un Cerrahi tedavisinde Limberg Flep ile ModifiyeLimberg Flep karşılaştırılması İstanbul Tıp Dergisi 2010 11(4): 149-153.
4. Ateş M, Dirican A, Sarac M, Aslan A, Colak C (2011) Short and long-term results of the Karydakis flap versus the Limberg flap for treating pilonidal sinus disease: a prospective randomized study. Am J Surg 202:568–573
5. Bozkurt MK, Tezel E(1998) Management of pilonidal sinus with the Limberg flap. Dis Colon Rectum; 41:775 777
6. Cameron J.L.(2001) Current Surgical Therapy 6th Ed. Philadelphia: Mosby 298-303.
7. Dal M. B. , Altun H.(2021)Pilonidal Sinüsün Cerrahi Tedavisinde Limberg Flep ile Karydakis Flep Karşılaştırılması: Retrospektif Klinik Çalışma. The Medical Journal of Mustafa Kemal University. 12(44): 140-143.
8. Daphan C, Tekelioglu MH, Sayilgan C(2004) Limberg flap repair for pilonidal sinus disease. Dis Colon Rectum 47:233–237.

9. Ertan T, Koc M, Gocmen E, Aslar AK, et al.(2005) Does technique alter quality of life after pilonidal sinus surgery? Am J Surg;190(3):388-92.
10. Eryilmaz R, Sahin M, Alimoglu O, Dasiran F (2003) Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap. Surgery 2003;134:745–749.
11. Gulay H.(2005) Pilonidal sinus hastalığı.Gulay H.(Ed.)Temel ve Sistematik Cerrahi, İzmir Guven Kitabevi Ltd.Sti.,1970-77.
12. Hamaloğlu E, Yorgancı K.(2004) Pilonidal sinus. Temel cerrahi’de. ed: Sayek İ. Ankara: Gunes Kitapevi 2004:126;1273.
13. Harlak A, Mentes O, Kilic S, Coskun K, Duman K, Yilmaz F Sacrococcygeal pilonidal disease: analysis of previously proposed risk factors. Clinics (Sao Paulo) 2010; 65:125–131.
14. Humphries AE, Duncan JE (2010)Evaluation and management of pilonidal disease. Surg Clin North Am 2010; 90:113–124.
15. Isbister WH, Prasad J. (1995)Pilonidal disease. ANZ Journal of Surgery 65:561 563.
16. Karydakis GE. (1973)New approach to the problem of pilonidal sinus. Lancet 2:1414-5.
17. Karydakis GE.(1992) Easy and successful treatment of nidal sinus after explanation of its causative process. Aust N Z J Surg 62:385-9.
18. Kapan M., Kapan S., Pekmezci S., Durgun V.(2002) Sacrococcygeal pilonidal sinus disease with Limberg flap repair. Tech Coloproctol.; 6:27 32
19. Keighley MRB, Williams NS.(1984) Surgery of the Anus Rectum & Colon 2nd Ed. Vol:1. London: Saunders. 539–63.
20. Keshava A, Young CJ, Rickard MJ, Sinclair G(2007) Karydakis flap repair for sacrococcygeal pilonidal sinus disease: how important is technique? ANZ J Surg 77:181–183.
21. Kitchen PR.(1996) Pilonidal sinus: experience with the Karydakis flap. br J Surg 83:1452-5.
22. Kulacoglu H, Dener C, Tumer H, Aktimur R (2006)Total subcutaneous fistulectomy combined with Karydakis flap for sacrococcygeal pilonidal disease with secondary perianal opening. Colorectal Dis 2006; 8:120–123. Mentes O, Bagci M, Bilgin T, Ozgul O, Ozdemir M (2008) Limberg flap procedure for pilonidal sinus disease: results of 353 patients. Langenbecks Arch Surg 393:185–189 .
23. Müller K, Marti L, Tarantino I, Jayne DG, Wolff K, Hetzer FH(2011) Prospective analysis of cosmesis, morbidity, and patient satisfaction following Limberg flap for the treatment of sacrococcygeal pilonidal sinus. Dis Colon Rectum 54:487–494 .
24. Sondenaa K, Andersen E, Nesvik I, Soreide JA(1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis; 10:39–42.
25. Sondenaa K, Nesvik I.(1996) Recurrent pilonidal sinus after excision with closed or open treatment: final result of a randomized trial. Eur J Surg 1996;162:237-40.
26. Thompson MR, Senapati A, Kitchen P(2011) Simple day-case surgery for pilonidal sinus disease. Br J Surg 2011; 98:198–209.
27. Topgül K, Ozdemir E, Kilic¸ K, Gökbayir H, Ferahköse Z(2003) Long-term results of limberg flap procedure for treatment of pilonidal sinus: a report of 200 cases. Dis Colon Rectum 46:1545–1548.