Limberg versus Karydakis Flap Techniques in the Surgical Management of Pilonidal Sinus Disease: A Prospective Interventional Study

Introduction: Pilonidal Sinus Disease (PSD) is a chronic condition primarily affecting the sacrococcygeal area. Limberg and Karydakis flaps are common surgical approaches due to their low complication and recurrence rates. Aim: To compare the outcomes of Limberg and Karydakis flap techniques in managing primary PSD. Materials and Methods: This prospective interventional study was conducted at the Department of General Surgery, Sree Balaji Medical College and Hospital, Chromepet, Chennai, Tamil Nadu, India, over 18 months from July 2023 to December 2024. It involved 30 patients with primary PSD, who were divided into two equal groups with n=15/group: one underwent Limberg flap reconstruction, and the other received the Karydakis procedure. The outcomes were measured by operative time, blood loss, time to drain removal, and patient satisfaction with cosmetic outcome. The statistical analysis was carried out by an Unpaired t-test for continuous variables and a Chi-square test for categorical variables. Results: The study population was predominantly male, n=20 (80%). The patients in the Limberg flap group experienced significantly shorter operative time (49.3±4.5 vs 54.7±5.6 minutes, p-value <0.001), less blood loss (58.6±10.2 and 64.3±11.1 ml, p-value <0.05), quicker return to work (9.3±2.1 and 11.1±2.4 days, p-value <0.05), and a faster time to drain removal (2.9±0.8 and 3.7±1.1 days, p-value=0.01) than Karydakis flap, respectively. The Karydakis group had one recurrence, while the Limberg group had none. However, there were no statistically significant differences in wound complications, recurrence, or patient satisfaction between the two groups. Conclusion: The study found that while both flap techniques are effective, the Limberg flap had better perioperative outcomes and faster recovery. Hence, the Limberg flap may offer better overall outcomes, but additional research is needed.