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Meta-Analysis
. 2019 Apr 1;62(2):131-138.
doi: 10.1503/cjs.003018.

Limberg flap versus Karydakis flap for treating pilonidal sinus disease: a systematic review and meta-analysis

Paschalis Gavriilidis  1 , Emil Bota  1
Affiliations
Meta-Analysis

Limberg flap versus Karydakis flap for treating pilonidal sinus disease: a systematic review and meta-analysis

Paschalis Gavriilidis et al. Can J Surg. .

Abstract
in English, French

Background: The Limberg flap reconstruction and the Karydakis flap reconstruction are the 2 most used off-midline closure techniques in pilonidal sinus surgery. The current evidence is inconclusive as to which is the optimal technique. The aim of this systematic review and meta-analysis was to compare differences in outcomes between these 2 flap-based techniques.

Methods: We identified studies by a systematic literature search of the Embase, MEDLINE (PubMed), Cochrane Library and Google Scholar databases and studies selected as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Only randomized controlled trials (RCTs) that compared the Limberg flap (standard or modified) and the Karydakis flap were included in this review.

Results: Operative time was shorter by 7 minutes in the Karydakis group than in the Limberg group (mean difference 7.00 min, 95% confidence interval [CI] 0.53 to 13.48). The seroma formation rate was significantly higher in the Karydakis cohort (odds ratio [OR] 0.36, 95% CI 0.24 to 0.56); however, after excluding studies with a high risk of bias, the sensitivity analysis showed no significant differences in seroma formation rate between the 2 techniques (OR 0.76, 95% CI 0.31 to 1.85). Other outcomes of interest showed no significant differences between the Limberg and Karydakis techniques.

Conclusion: There were no significant differences between the Limberg and Karydakis techniques. Future RCTs with strict adherence to CONSORT guidelines will further elucidate the efficacy of these surgical procedures.

Contexte: Les reconstructions à l’aide de lambeaux de Limberg et de Karydakis sont 2 des techniques de fermeture décalées de la ligne médiane les plus utilisées pour la chirurgie du sinus pilonidal. Les preuves actuelles ne permettent pas de conclure à la supériorité de l’une par rapport à l’autre. Le but de la présente revue systématique/méta-analyse était de comparer les différences de résultats entre ces 2 techniques de lambeaux.

Méthodes: Nous avons recensé des études au moyen d’une interrogation systématique des bases de données Embase, MEDLINE (PubMed), bibliothèque Cochrane et Google Scholar et les études sélectionnées à l’aide de la liste de vérification PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Seuls les essais randomisés et contrôlés (ERC) qui comparaient les lambeaux de Limberg (standard ou modifié) et de Karydakis ont été inclus dans cette revue.

Résultats: Les interventions ont duré 7 minutes de moins dans le groupe Karydakis que dans le groupe Limberg (différence moyenne 7,00 min, intervalle de confiance [IC] de 95 % 0,53 à 13,48). Le taux de formation de séromes a été significativement plus élevé dans la cohorte Karydakis (rapport ces cotes [RC] 0,36, IC de 95 % 0,24 à 0,56); par contre, après avoir exclu les études comportant un important risque de biais, l’analyse de sensibilité n’a montré aucune différence significative quant au taux de formation de séromes entre les 2 techniques (RC 0,76, IC de 95 % 0,31 à 1,85). Les autres paramètres d’intérêt n’ont montré aucune différence significative entre les techniques de Limberg et de Karydakis.

Conclusion: On n’a noté aucune différence significative entre les techniques de Limberg et de Karydakis. De prochains ERC strictement conformes aux lignes directrices CONSORT permettront de préciser davantage l’efficacité de ces interventions chirurgicales.

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Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
(A) Karydakis technique. (B) Limberg technique with rhomboid transposition flap.
Fig. 2
Fig. 2
Flow diagram of literature search strategy.
Fig. 3
Fig. 3
Rate of seroma formation. Top: total sample; bottom: subgroup analysis of higher-quality studies. CI = confidence interval; SLF = standard Limberg flap; MLF = modified Limberg flap.
See this image and copyright information in PMC

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