Comparison of modified Limberg flap transposition and lateral advancement flap transposition with Burow’s triangle in the treatment of pilonidal sinus disease

• We compare 2 flap transposition techniques used in pilonidal sinus disease surgical treatment.
• This study was planned as a prospective randomized clinical trial.
• We examine Visual Analog Scale scores, recurrence, postoperative complications, and surgical site infections in the first 12 months postoperatively.
• No statistically significant differences were found between the groups (P > .05)
• We recommend lateral advancement flap transposition with Burow’s triangle, especially in cases in which the pilonidal sinuses settle on the upper segment and do not have a very deep natal cleft. We recommend the modified Limberg flap transposition technique in cases in which the sinuses settle close to the anal region according to our clinical experiences.

BackgroundAlthough many options exist for surgical treatment of pilonidal sinus disease (PSD), consensus has not yet been achieved, as all surgical methods have various rates of complications, postoperative infection, and recurrence.MethodsThis study was a prospective, randomized, clinical trial, and was conducted with consecutive 100 patients admitted to Ankara Military Hospital General Surgery Service for treatment of PSD from May 2013 to August 2013. This study compared two surgical treatments for PSD: modified Limberg flap transposition and lateral advancement flap transposition with Burow's triangle.The patients received surgical treatment with either modified Limberg flap transposition (n = 50) or lateral advancement flap transposition with Burow’s triangle (n = 50).Clinical healing period, length of hospital stay, operative time, postoperative complications including recurrence, wound dehiscence, and surgical site infection, as noted during postoperative follow-up period; Visual Analog Scale scores for pain.ResultsThe mean follow-up period was 12 months. No significant differences were observed between the 2 groups in length of hospital stay (P = .515), operative time (P = .175), wound dehiscence (P = .645), and Visual Analog Scale pain scores (P = .112). The mean operative times were 42.5 minutes in the modified Limberg group and 40.0 minutes in the lateral advancement group.ConclusionsAlthough lateral advancement flap transposition with Burow’s triangle is used less often than modified Limberg flap transposition, we could not determine a parameter that was statistically different such as operative time, postoperative complication, or the length of hospital stay. Hence, the lateral advancement flap is as viable an option as other more preferable techniques in the treatment of PSD, which particularly settled on the upper segment without a deep natal cleft.