Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
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.

PubMed Disclaimer

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

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Lee PJ, Raniga S, Biyani DK, et al. Sacrococcygeal pilonidal disease. Colorectal Dis. 2008;10:639–50. discussion 651–2. - PubMed
    1. Hodges RM. Pilonidal sinus. Boston Med Surg J. 1880;103:485–6.
    1. Karydakis GE. New approach to the problem of pilonidal disease. Lancet. 1973;2:1414–5. - PubMed
    1. Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg. 1992;62:385–9. - PubMed
    1. Armstrong JH, Barcia PJ. Pilonidal sinus disease. The conservative approach. Arch Surg. 1994;129:914–7. - PubMed