Karydakis Versus Limberg Flap in Primary Sacrococcygeal Pilonidal Sinus: A Retrospective Comparative Study of Functional Recovery

BACKGROUND: Successful surgical management of pilonidal sinus disease (PSD) in young, active patients requires rapid restoration of daily functions, including driving and sexual activity. This study compared patient-reported recovery as regards sexual function and driving ability following the KF versus the LF for primary sacrococcygeal PSD. METHODS: This multicenter retrospective cohort study (FLARE study) included employed, sexually active patients who underwent surgery for primary PSD (July 2017-July 2024). The primary outcome was time to sexual activity resumption; the secondary outcome was time to resumption of driving. Outcomes were assessed at 1 year using a structured Likert-scale questionnaire. Kaplan-Meier curves and Cox regression analyses with adjustment were used. RESULTS: A total of 352 patients were divided into 176 KF and 176 LF. KF patients resumed sexual activity earlier (2.88 ± 0.7 vs. 4.58 ± 1.1 weeks; mean difference -1.7 weeks, 95% CI -1.89 to -1.49, p < 0.001). KF reported significantly less pain, less avoidance, and lower analgesic use during sex. LF reported lower sexual satisfaction (mean 3.94 vs. 2.15; mean difference -1.78, 95% CI -2.02 to -1.53). KF resumed driving earlier (median 9 vs. 19 days; r = 0.7, large effect, p < 0.001) and had longer sitting tolerance (OR 0.3, 95% CI 0.2-0.4, p < 0.001). LF had higher pain while sitting (mean Likert 4 vs. 2; mean difference of -1.94, 95% CI -2.19 to -1.68), higher VAS pain (median 4 vs. 2; r = 0.5), greater need for cushions/analgesics, and more driving-related work/social limitations (all p < 0.001). Time to resume sexual activity and driving was significantly shorter for KF. On multivariable analysis, LF was independently associated with delayed return to sexual activity (adjusted OR 4.02, 95% CI 2.1-7.5, p < 0.001) and delayed return to driving (adjusted OR 2.8, 95% CI 1.5-5.2, p < 0.001). CONCLUSIONS: In this retrospective cohort, KF may be associated with significantly faster return to sexual and driving activity compared with LF. These results underscore the importance of incorporating patient-centered functional outcomes into surgical decision-making for PSD. TRIAL REGISTRATION: Number: NCT07271537.

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Journal
World Journal of Surgery
Published
2026-06-17
DOI
https://doi.org/10.1002/wjs.70463
Primary Topic
Anorectal Disease Treatments and Outcomes
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article
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article

Karydakis Versus Limberg Flap in Primary Sacrococcygeal Pilonidal Sinus: A Retrospective Comparative Study of Functional Recovery

Mohamed Mahmoud Mokhtar Mohamed, Baher Atef, Mahmoud Moustafa Al-Shareef, Ayman Khater et al.
World Journal of Surgery
Anorectal Disease Treatments and Outcomes
article

Karydakis Versus Limberg Flap in Primary Sacrococcygeal Pilonidal Sinus: A Retrospective Comparative Study of Functional Recovery

Mohamed Mahmoud Mokhtar Mohamed, Baher Atef, Mahmoud Moustafa Al-Shareef, Ayman Khater, Mahmoud Abdelnasser Eissa, H.I. Farag, Ahmed Abdelsamad, Mohamed Ibrahim Shalamesh, M Nagaty, mohamed swelam, Hamdi Elbelkasi, Hamada Rashad Mohamed Abdelkader, Abdulzahra Hussain, Alberto Aiolfi, Osama Almezaien, Tamer Wasefy, Tamer A. A. M. Habeeb, Mariano Giménez, Alaa Fiad, І. А. Кryvoruchko, Massimo Chiaretti, Mohamed Mahmoud Almeniawy, Mohamed S. Bayomi, Ali Hussein Khedr, Mohamed Fathy Labib, Mahmoud Abdou Yassin, Mohamed Ibrahim Abo Alsaad, Mohamed H. Hebeishy, Bassam Mousa, Mostafa Fathy Ibrahim Ahmed, Mohamed Adel Saqr, Mohamed Abdelbar Mohamed, Taha Biomy, Abdelshafy Mostafa, Hazem E. Ali, Ibtsam AbdelMaksoud Mohamed El Shamy, Mohamed Elnemr, Nasreldin Mohammed Algalaly, Mohamed Ibrahim Henish, Mohammed Siam, Ahmed Attia Saleh, Mohamad Naeem Elnahas, Mohamed Hassan Mohamed Elkaseer, Mohammed Abbas, Mahmoud Abd Alhady Abd Alaziz Abd Alhady, Ahmed M. El Teliti, Mohamed Abozaid, Maged Z. Youssef, Mahmoud Elghonimy Abd Elsadek, Jose Bueno‐Lledó, Abouelatta K. H. Ali, Hasnaa Metwally, Ahmed Hamdy, Mohamad S. Moussa, Adel Morsi, Mallikarjuna N. Manangi
article en

Abstract

BACKGROUND: Successful surgical management of pilonidal sinus disease (PSD) in young, active patients requires rapid restoration of daily functions, including driving and sexual activity. This study compared patient-reported recovery as regards sexual function and driving ability following the KF versus the LF for primary sacrococcygeal PSD. METHODS: This multicenter retrospective cohort study (FLARE study) included employed, sexually active patients who underwent surgery for primary PSD (July 2017-July 2024). The primary outcome was time to sexual activity resumption; the secondary outcome was time to resumption of driving. Outcomes were assessed at 1 year using a structured Likert-scale questionnaire. Kaplan-Meier curves and Cox regression analyses with adjustment were used. RESULTS: A total of 352 patients were divided into 176 KF and 176 LF. KF patients resumed sexual activity earlier (2.88 ± 0.7 vs. 4.58 ± 1.1 weeks; mean difference -1.7 weeks, 95% CI -1.89 to -1.49, p < 0.001). KF reported significantly less pain, less avoidance, and lower analgesic use during sex. LF reported lower sexual satisfaction (mean 3.94 vs. 2.15; mean difference -1.78, 95% CI -2.02 to -1.53). KF resumed driving earlier (median 9 vs. 19 days; r = 0.7, large effect, p < 0.001) and had longer sitting tolerance (OR 0.3, 95% CI 0.2-0.4, p < 0.001). LF had higher pain while sitting (mean Likert 4 vs. 2; mean difference of -1.94, 95% CI -2.19 to -1.68), higher VAS pain (median 4 vs. 2; r = 0.5), greater need for cushions/analgesics, and more driving-related work/social limitations (all p < 0.001). Time to resume sexual activity and driving was significantly shorter for KF. On multivariable analysis, LF was independently associated with delayed return to sexual activity (adjusted OR 4.02, 95% CI 2.1-7.5, p < 0.001) and delayed return to driving (adjusted OR 2.8, 95% CI 1.5-5.2, p < 0.001). CONCLUSIONS: In this retrospective cohort, KF may be associated with significantly faster return to sexual and driving activity compared with LF. These results underscore the importance of incorporating patient-centered functional outcomes into surgical decision-making for PSD. TRIAL REGISTRATION: Number: NCT07271537.

World Journal of Surgery
Beni-Suef University (EG), Suez University (EG), Misr University for Science and Technology (EG), Witten/Herdecke University (DE), Al-Azhar University (EG), Zagazig University (EG), Benha University (EG), Tanta University (EG), University of Alkafeel (IQ), Hospital Universitari i Politècnic La Fe (ES), Istituto Clinico Sant'Ambrogio (IT), Institut de Recherche contre les Cancers de l’Appareil Digestif (FR), General Organization For Teaching Hospitals and Institutes (EG), General Electric (India) (IN), National Water Research Center (EG), Lux Research (United States) (US), Shebin Teaching Hospital (EG), October 6 University (EG), University of Kufa (IQ), Menoufia University (EG), Université de Strasbourg (FR), Kharkiv National Medical University (UA), Sapienza University of Rome (IT), University of Sheffield (GB), Sohag University (EG)
Gender equality
Openalex Percentile: Top 5%
Anorectal Disease Treatments and Outcomes
DOISourceOpenAlex
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