“Flag Excision and Flap” Procedure: a Novel Modification for Off-Midline Closure After Pilonidal Sinus Excision

Pilonidal sinus surgery has evolved with the novel flap techniques, and off-midline closure became a preferred surgical procedure due to shorter recovery time and low recurrence rates. To obtain a better off-midline closure without maceration and a possible wound problem, we modified a novel excision technique. We aimed to present this novel flag modification of rhomboid excision and flap reconstruction experience. From December 2007 to June 2009, 100 patients were treated with flag excision and flap reconstruction under regional anesthesia and followed with a mean of 42 (range 35–55) months. Competent closure results were obtained successfully in all patients without an overlap between incision line and midline. None of the patients had seroma. Two patients (2 %) had partial wound detachment superiorly. None of the patients had recurrence during follow-up. The flag excision and flap reconstruction procedure is an effective and comfortable technique both for the surgeon and the patient with a quick healing period and low complication rates without maceration

Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence

Abstract We systematically searched available databases. We reviewed 6,143 studies published from 1833 to 2017. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract. We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3–0.9%) 12 months and 1.8% (95%CI 1.1–2.4%) respectively 24 months postoperatively. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1–0.3%) 12 months and 0.6% (95%CI 0.5–0.8%) 24 months postoperatively. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3–82.4%) 240 months post-surgery. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure