A Comparative Study of Limberg Flap and Karydakis Flap in the Management of Chronic Sacrococcygeal Pilonidal Sinus Disease

Background: Sacrococcygeal pilonidal sinus disease (SPSD) is a common condition among young adults, often causing pain, discharge, and recurrent infections. Limberg flap technique (LFT) and Karydakis flap technique (KFT) are widely used, but comparative outcomes remain variable. The aim is to compare the efficacy and outcomes of KFT and LFT in the surgical management of chronic sacrococcygeal pilonidal sinus disease. Material and Methods: This prospective observational study included 50 patients with clinically diagnosed SPSD, divided equally into KFT (Group A, n=25) and LFT (Group B, n=25). Operative time, intraoperative blood loss, drain requirement, postoperative pain (VAS on postoperative days 1, 3 and 5), hospital stay, first mobilization, painless toilet seating, wound healing, complications and patient satisfaction were assessed. Results: KFT had significantly shorter operative time (42.08 ± 5.36 vs. 48.60 ± 4.97 min; p<0.0001) and lower intraoperative blood loss (32.16 ± 8.40 vs. 41.40 ± 7.90 mL; p<0.0001). Drain requirement was lower with KFT (26.1% vs. 73.9%; p=0.002). VAS pain scores were lower with KFT on postoperative days 1, 3 and 5 (p≤0.002). KFT was associated with earlier mobilization (13.28 ± 2.70 vs. 16.68 ± 5.34 h; p=0.007), shorter hospital stay (3.92 ± 0.76 vs. 4.72 ± 1.02 days; p=0.003), faster wound healing (15.56 ± 3.86 vs. 19.96 ± 2.67 days; p<0.0001), and higher patient satisfaction (8.10 ± 0.70 vs. 7.50 ± 0.80; p=0.006). Postoperative complication rates were not significantly different (p=0.564). Conclusion: Both techniques were effective. KFT demonstrated advantages in operative efficiency, blood loss, postoperative pain, mobilization, hospital stay, wound healing and patient satisfaction, and may be preferred in selected patients.

Keywords: Pilonidal sinus; Limberg flap; Karydakis flap; postoperative outcome; recurrence; wound healing; flap surgery.