Karydakis Procedure Research Articles

Karydakis operation for pilonidal sinus disease in overweight and obese patients. A study of the efficacy of the procedure in 136 patients.

Objective: To test the efficacy of the Karydakis procedure in overweight and obese patients and to check the recurrence rates in our patients. Study Design: Multicenter Prospective study. Setting: Sughra Shafi Medical Complex Narowal. Period: May 2011 to July 2021. Material & Methods: Total 146 patients were selected for this study a formal informed consent was taken. Ten patients were lost from follow up and excluded from study. Results: Out of remaining 136 patient 130 were male and only 6 were female. Mean age of the patient was 23 year and 5 months (range 16 years to 49 years). Thirty five patients had a single sinus in the midline, Seventy two had multiple sinuses in the midline, and 38 patients had lateral tract either on the right or on the left side in addition midline sinuses. Mean operating time was 39 minutes (range 23 – 70 minutes), mean blood loss was 26 ml (10 – 70ml) and mean hospital stay was 3 days (range 2- 7 days). There were a total of 21 (15 .05 %) complications. Seven(4.29) patients developed major wound infection requiring opening of the sutures and regular dressing till the wound became healthy to be closed by secondary suturing. Seven patients developed minor wound infection, 6 patients developed seroma and 3 patients had leakage of serous fluid from drain site for a couple of days. There were only 5 (3.67%) recurrences in mean follow up period of 23 months (range 11 months to 4 years). Two (1.47%) recurrence were observed in patient with BMI of below 35 and 3 recurrences (2.20%) were observed in patient with BMI of >35. All of them occurred in obese patient who could not maintain their personal hygiene according to advice given to them. Majority of the patient were satisfied with the procedure. Conclusion: We concluded that Karydakis operation has good outcome in overweight and obese patients. It addresses the etiological factors of the disease, is less time consuming as compared to other flap operation, is not associated with wound scar in the midline, can be easily performed by surgeons in training, is associated with minimum complications, has minimum recurrence rate on short and long term follow up, avoid the painful prolong dressing regimen and well accepted by the patients.

Karydakis versus marsupialization – short-term comparative outcomes of intergluteal pilonidal disease treatment in men

Background: Intergluteal pilonidal disease (IPD) is a common chronic disease occurring in the natal cleft of the sacrococcygeal region. This disease may drastically decrease the quality of life, and lead to incapacity for work for up to several months. Various treatment methods are described in the literature, however, each of the methods has its privileges and disadvantages, and no final recommendations are available regarding a superior surgical treatment method. The present study aimed to contribute to filling the gap in the knowledge regarding the superiority of the available surgical techniques used in the treatment of IPD. Methods: The short-term outcomes of two surgical treatment options for IPD, namely the Karydakis procedure (n = 32) and the Marsupialization technique (n = 33), were retrospectively compared. The duration of complete scar formation, the rate of short-term postoperative complications, the persistence of postoperative pain and the recurrence rate during 3-month postoperative follow-up were investigated. The study was based on a retrospective analysis of data extracted from medical records of adult male patients treated for IPD. Results: The Karydakis procedure was found to be superior in terms of all the abovementioned parameters, except for the rate of short-term postoperative complications, where the two surgical techniques showed comparable results. Conclusions: The results of this retrospective study suggest that marsupialization technique could be mostly replaced by the Karydakis procedure in surgical practice. The latter appears to be associated with a faster return to daily activities and more cost effective.

Comparative study between Limberg technique and Karydakis procedure in surgical treatment of sacrococcygeal pilonidal sinus

Comparative study between Limberg technique and Karydakis procedure in surgical treatment of sacrococcygeal pilonidal sinus

EFFECTIVENESS OF LIMBERG FLAP AND KARYDAKIS PROCEDURE IN PILONIDAL SINUS DISEASE – A COMPARATIVE INTERVENTIONAL STUDY IN A TERTIARY CARE CENTRE OF EASTERN INDIA.

Objective: Pilonidal sinus disease (PSD) is a common disease of natal cleft in Sacro- coccygeal region. It is more common in young male and may recur over time with surgery. We compared the effectiveness, outcomes and recurrence rates of Limberg ap and Karydakis procedure techniques in PSD. This is a comparative interventional study among 32 enrolled patients Materials And Methods: with pilonidal sinus disease. Patients were divided into two groups 16 patients (group KD) were treated with Karydakis procedure and 16 patients (group LF) were treated with Limberg ap technique. Seroma collection, wound infection, ap edema, hematoma, partial wound separation, pain score, return to normal activities, complete healing time, painless seating and patient satisfaction were compared between 2 groups (group KD and LF). the development rates of Results: seroma collection, wound infection, ap edema, hematoma, partial wound separation were 12.5%,18.75%,6.25%, 18.75%,18.75% in KD group as compared to 25%, 12.5%,12.5%, 0%, 0% in LF group respectively. Total ap necrosis was not observed in any patient (p<0.001). During the average follow up period of 12months, 2 (12.5%) of KD pts developed recurrence. In this study, the u Conclusion: se of Limberg ap was associated with lower complication rates, shorter length of hospital stays, early return to work, low pain score, high patient satisfaction, better complete healing. Therefore, we recommend Limberg ap for treatment of pilonidal sinus

TH3.9 Cleft closure is an effective procedure for the treatment of pilonidal disease with low recurrence rate

Abstract Aims The surgical treatment of pilonidal sinus disease has evolved over time, with reported time to healing, post-operative complications and disease recurrence rates still significant. The modified Karydakis procedure such as the Bascom's cleft lift operation or “cleft closure” flattens the cleft and has shown promising results. The purpose of this single-centre study is to analyse outcomes of this technique. Method This is a retrospective study of 192 patients undergoing cleft closure as a day case over 10 years. The technique involves an off-midline cleft closure with an advancement flap and primary closure. Outcome measures were postoperative complications, time to healing and recurrence requiring surgery. Results The median age at surgery was 25 years (IQR 21–33), with males representing 76%. Overall, 91 (47%) were smokers. 141(73%) patients had previous emergency treatment. The median numbers of pits/sinuses were 3 and in 71% of patients were localized in the midline. The median time to wound healing was 3 weeks (IQR 2–6). Twenty-five (13%) patients had postoperative complications including infection (n=21) and hematoma (n=4). Disease recurrence requiring surgery occurred in 7 (3.6%) patients. Median time to recurrence was 9 months (IQR 5–15). Conclusion Cleft closure is an effective procedure for the treatment of pilonidal disease, with a low rate of postoperative complications and recurrence.

TU4.7 Audit of pilonidal sinus surgery – our experience in a district general hospital

Abstract Aim Pilonidal disease is a common condition affecting the subcutaneous tissue of the natal cleft. There are a number of different types of operations with varied success rate. The purpose of this audit is to analyse our cohort of patients who underwent pilonidal sinus surgery and look at certain risk factors such as smoking and obesity in predicting 30-day post-operative infection rates. Method A cohort of 63 patients who underwent all pilonidal sinus surgery between 2017 to 2021 were analysed. Data was gathered using our electronic patient record (Meditech V6). Result Total of 63 patients were analysed with a mean age of 27.9. 86% Male Vs 14% Female. Mean BMI of 30.1. More than half of our cohort underwent Karydakis Procedure (52%), 27% modified Bascom technique, 13% Rhomboid flap and the other 8% of patients were not primarily closed. 37% of our cohort developed post-operative wound infection. Furthermore; more than half (52%) of these patients with wound infections were smokers and also 52% were obese with a BMI of more than 30. Interestingly 83% of these patients were either smokers or obese with a BMI>30. Conclusion Post-operative wound complications are common following pilonidal sinus surgery specially in patients who are smokers and/or have obesity. Patients who undergo flap surgery should be encouraged to stop smoking and to lose weight when necessary otherwise they may face long and complicated post-operative recovery phase leading to significant financial burden on the NHS.

A Comparative Study on flap necrosis following Karydakis Flap Reconstruction and Z-Plasty in Patients with Sacrococcygeal Pilonidal Disease – Our experience

Aim: The purpose of this study was to evaluate patients with sacrococcygeal pilonidal sinus disease(SPSD) who underwent the Karydakis procedure and Z plasty at our centre concerning theperioperative findings, late postoperative results and recurrence. Patients and Methods: A total of30 patients presenting with SPSD at our centre underwent Karydakis flap repair and Z plasty fromMay 2019 to June 2021. These patients were then followed up and evaluated concerning operativetime, drain use, hospital stay, suture removal, complications, and recurrence. The adipocutaneousflap of Karydakis was devised to shift the natal cleft, while Z-plasty involves a fasciocutaneous flap.Results: The mean operative time was 60 min with a median hospital stay of 4 days. Drains wereremoved at a median of 5 days and sutures at a median of 15 days. The duration of hospitalisationfor the Karydakis procedure was found significantly lesser than that for Z-plasty Patients who werefollowed up for a median of 12 months. The overall complications were more in Z-plasty. Flapnecrosis developed in 30 % of the cases in the Z-plasty group, comparable to no recurrence seen inthe Karydakis procedure. Conclusion: Karydakis flap was found superior to Z-plasty, having lessseroma formation, no flap necrosis and no local hematoma Karydakis flap procedure is a relativelysimple procedure for SPSD and has advantages over Z-plasty technique like keeping scar away fromthe midline and flattening of the natal cleft, thus reducing local recurrence rates.

Comparison between the tie-over and Karydakis procedure in chronic sacrococcygeal pilonidal sinus

Background and Aims: Pilonidal sinus in the sacrococcygeal region is a disease with high postoperative morbidity and discomfort for the patient. Although there are various therapeutic modalities to manage these patients, Controversy for choosing the best surgical technique in order to decrease the recurrence rate, patient discomfort, and Duration of disability after surgery still exists. Therefore, the objective of the present study was to compare results reached from two methods of surgery, tie-over procedure (TOP) and Karydakis procedure(KP) for the treatment of sacrococcygeal pilonidal sinus. Methods: In this study, 70 patients with a diagnosis of pilonidal sinus disease treated randomly with surgical excision and TOP or KP, in two 35 patients group, in the educational hospital by the same surgeon, between 2009 and 2010, and followed up until December 2019. Results: Achieved data after excision of sacrococcygeal pilonidal sinus indicate that primary closure of the wound by tie-over sutures have a better result than KP in order of Pain sore during the first month after surgery (P< 0.001), Duration of disability (P <0.001), wound repair time (P <0.001) and Patient satisfaction(P=0.019). Conclusion: Overall, these results show the TOP instead of KP, because higher acceptance results may be an alternative better for the treatment of chronic pilonidal sinus for the patients who have surgery scheduled for them.

German National Guideline on the management of pilonidal disease: update 2020.

BackgroundThe present German National Guideline is an updated version of previous Guideline published in 2014. It aims to compare various treatment methods and to assist physicians with evidence-based recommendations.MethodsSystemic literature review.ResultsThree types of disease manifestation could be differentiated: asymptomatic disease, an acute abscess, and the chronic pilonidal disease. At present, there is no treatment method fulfilling all desired criteria: simple, painless procedure associated with rapid wound healing, and low recurrence rate. Thus, treatment modality should be tailored to disease manifestation and extent.ConclusionAsymptomatic pilonidal disease should not be treated. A pilonidal abscess should be unroofed. After resolution of the acute inflammation, the disease should be treated definitely. As for today, sinus excision is the standard treatment of the chronic pilonidal disease. Wide excision and open treatment of chronic disease is a safe procedure which, however, leads to prolonged secondary healing and time off-work, as well as to considerable recurrence rate. The extent of excision should be as limited as possible. Excision and midline wound closure is associated with impaired outcomes. Today, it has become obsolete. Minimally invasive procedures (e.g., pit picking surgery) represent a treatment option for chronic pilonidal disease. However, the recurrence rate is higher compared to excision procedures. Nevertheless, they may be used for small primary disease. Off-midline procedures should be used for disease not suitable for minimally invasive treatments. The Limberg flap and the Karydakis procedure are two best described methods which are associated with similar short- and long-term results.

Karydakis procedure versus Limberg flap for treatment of pilonidal sinus: an updated meta-analysis of randomized controlled trials.

The Karydakis procedure (KP) and Limberg flap (LF) are two commonly performed operations for pilonidal sinus disease (PND). The present meta-analysis aimed to review the outcome of randomized trials that compared KP and LF. Electronic databases were searched in a systematic manner for randomized trials comparing KP and LF through July 2020. This meta-analysis was reported in line with the PRISMA statement. The main outcome measures were failure of healing of PND, complications, time to healing, time to return to work, and cosmetic satisfaction. Fifteen randomized controlled trials (1943 patients) were included. KP had a significantly shorter operation time than LF with a weighted mean difference (WMD) of -0.788 (95%CI: -11.55 to -4.21, p < 0.0001). Pain scores, hospital stay, and time to healing were similar. There was no significant difference in overall complications (OR= 1.61, 95%CI: 0.9-2.85, p = 0.11) and failure of healing (OR= 1.22, 95%CI: 0.76-1.95, p = 0.41). KP had higher odds of wound infection (OR= 1.87, 95%CI: 1.15-3.04, p = 0.011) and seroma formation (OR= 2.33, 95%CI: 1.39-3.9, p = 0.001). KP was followed by a shorter time to return to work (WMD= -0.182; 95%CI: -3.58 to -0.066, p = 0.04) and a higher satisfaction score than LF (WMD= 2.81, 95%CI: 0.65-3.77, p = 0.01). KP and LF were followed by similar rates of complications and failure of healing of PND and comparable stay, pain scores, and time to wound healing. KP was associated with higher rates of seroma and wound infection, shorter time to return to work, and higher cosmetic satisfaction than LF.

Modified Karydakis procedure for uncomplicated pilonidal sinus

Background: Pilonidal sinus disease is a chronic infection of the natal cleft commonly affecting young adults. Out of the standard operative techniques, the Karydakis procedure is a relatively simple procedure associated with low rates of wound complications and recurrence. In this study we present a modified version of the Karydakis procedure to treat less extensive disease, which enables better skin closure without cavitation and tension.Methods: Patients with uncomplicated pilonidal sinus who presented to our centre during the period from April 2015 to March 2019 were prospectively enrolled. Patients with recurrent or complex sinus disease were excluded. In those enrolled, our modified Karydakis procedure was performed. In this method, after excision a flap of skin and subcutaneous tissue was raised to one side and sutured across the midline by advancement in layers.Results: 34 patients underwent our modified Karydakis procedure. 91% (31/34) of patients had uncomplicated recovery and could return to work after two weeks. There were minimal post-operative complications, in the form of erythema around the wound (8.8%), wound discharge (5.9%), seroma (5.9%) and infection (2.9%). No patient developed wound dehiscence or flap necrosis. There were excellent cosmetic results and no recurrence at one year post-surgery.Conclusions: Our modification of the Karydakis procedure is a simple and effective surgery for the management of uncomplicated pilonidal sinus disease which achieves good results.

The Management of Pilonidal Sinus.

Pilonidal disease is an acute or chronic infection in the subcutaneous fatty tissue, mainly in the natal cleft. Its incidence in Germany in 2012 was 48 cases per 100 000 persons per year. This review is based on pertinent publications retrieved by a selective literature search. The numerous minimally invasive techniques that are available for the treatment of pilonidal disease have the advantages of being relatively atraumatic and of enabling the patient to continue working almost without interruption. They are suitable for small lesions that have not been previously surgically treated. These techniques are associated with a higher recurrence rate than excisional methods (level of evidence [LoE]: Ib). It is not yet clear whether minimally invasive techniques employing laser or endoscopic technology can reduce the recurrence rate. In systematic meta-analyses, the duration of wound healing was shorter after off-midline techniques (the Karydakis procedure, the Limberg procedure, and others) than after excision with open wound treatment; the off-midline techniques should, therefore, be preferred for patients who have undergone previous surgery and for those with large lesions (LoE: Ia). Excision with midline suturing should not be performed (LoE: Ia). Postoperative permanent shaving cannot be recommended either (LoE: IV). Further randomized trials are needed to clarify the role of newer techniques in the treatment of pilonidal disease.

Could Early Postoperative Complications be Considered as Risk Factor for Recurrence after Pilonidal Sinus Surgery?

Background: There is no widespread consensus in treatment techniques of sacrococcygeal pilonidal disease (PD). Among surgical techniques, especially Karydakis procedure (KP) or modified Limberg flap (MLF), are frequently preferred. Causing prolonged follow-up and return to daily activity, postoperative complications are very annoying. We aimed to determine risk factors for possible complications and especially recurrence in the patients undergoing surgical treatment for PD. Methods: This is a seven-year retrospective study, which was conducted between January 2011 and January 2018. Eight hundred forty-one patients were evaluated in this work. We performed the same technique-the same surgeon approach in our surgical treatment. All cases were divided into two groups as KP (n=417) and MLF (n=424). Results: It was found no significant difference between the KP and MLF groups in terms of age, gender, BMI, smoking, history of acute abscess drainage (HAAD), the timing of suture removal, the follow-up period, seroma, hematoma, dehiscence, wound infection (WI), pain and recurrence. In this study, the follow-up period of patients was 48.6 21.4 months in KP group and 48.2 +- 21.7 months in MLF group (Mean - SD). American Society of Anesthesiologists (ASA) score were found to be higher in the KP group. While mean duration of operation (DO) was shorter in the KP group, the timing of drain removal, hospitalisation period and return to daily activity (RDA) were longer. There was an established enhancing effect of BMI, HAAD, DO, and RDA on the early complications (EC) development in both of the groups, and of ASA scores on the EC development in the KP group. The rate of recurrence ratio was determined to be 6% in the KP and 4.72% in the MLF groups. In both of the groups, dehiscence or WI was found to be risk factors for recurrence. Conclusion: Although its DO is short, KP technique bear some of the disadvantages such as prolonged HP and delayed RDA. A significant positive correlation was found between various factors such as higher BMI, presence of HAAD, prolonged DO, prolonged RDA and the development of EC in both groups. We concluded that dehiscence and WI from EC may be evaluated as independent risk factors for recurrence. We also concluded that recurrence may be prevented if wound care is carried out carefully in the patients who developed dehiscence or wound infection.

Karydakis procedure can be effectively performed in the lateral position.

Karydakis published a large pilonidal series in 1992, reporting a recurrence rate of less than 1% and complication rate of 8.5%. The aim of this study was to compare the outcomes of Karydakis procedure (KP) performed in the lateral versus the prone position in a consecutive series. Ninety-seven consecutive patients undergoing a KP between March 2000 and February 2018 were retrospectively assessed. Patients with disease sinuses or fistulas extending from the midline to either left or right sides only were considered for KP in the contralateral side position. Surgery was carried out for primary pilonidal disease in 71 patients (73%) and for recurrent disease in 26 patients (27%). The majority (62%) of pilonidal tracts veered off from the midline to either the left or right side only. Wound complications, mostly minor skin separation, occurred in 37 patients (38%). Disease recurrence occurred in eight patients (8%). There was no difference between patients who had KP in a lateral position compared with those operated in a prone position regarding wound complications (41% versus 35%, P = 0.675), disease recurrence (9% versus 7%, P = 1.000), mean operating time (64.6 min versus 66.6 min, P = 0.259) and mean length of hospital stay (1 day for both groups). Pilonidal surgery in the lateral position has potential benefits for patient safety, patient comfort and theatre efficiency. The clinical results of this series show that the KP can be performed safely and effectively with the patient in the lateral position for most cases of pilonidal disease.

The Surgical Management of Pilonidal Disease is Uncertain Because of High Recurrence Rates.

BackgroundPilonidal disease is a common condition with no consensus for the best management of chronic disease or current practice in Australia and New Zealand.MethodsA survey was distributed among 190 colorectal and 592 general surgeons in Australia and New Zealand. Data was obtained regarding pilonidal surgery volume, procedures performed, non-operative management and recurrence rates. Three clinical scenarios were also presented.ResultsThe response rate was 58% among colorectal surgeons, 18% among general surgeons. Nineteen percent of surgeons were high-volume (>23 operations per year), 47% low-volume (<12 operations per year). The commonest procedure was the Karydakis procedure (77%), with many others performed including rhomboid flaps (36%), Bascom cleft lift (13%), Z-plasty (7%), and gluteal rotation flaps (5%). Fifty-five percent of high-volume surgeons offered more than one operation while only 16% of low-volume surgeons did. Nineteen percent operated on all patients with pilonidal disease, 89% believing off-midline closure to be superior to midline. Disease extent was the main driver for non-operative management; patient factors such as cosmesis and time-off work being the least important. Sixty-four percent reported recurrence rates above 5%, and 37% recurrence rates >10%. Six percent reported no recurrences ever. Five percent reported recurrence rates over 20%, but 24% stated that over one-fifth of their practice consists of recurrent disease.ConclusionsThis study reports higher recurrence rates than in published series, suggesting many surgeons do not see their own recurrences, with current treatment not as successful as previously thought. Combined with the widespread variation in practice, optimal management of this disease remains unclear.

Karydakis Flap With Compressing Tie-over Interrupted Sutures Without Drain versus Standard Karydakis for Treatment of Sacrococcygeal Pilonidal Sinus Disease.

Sacroccygeal pilonidal sinus disease is a worldwide health problem, affecting young adults, mainly males, with a tendency for recurrence. Various modalities have been used for treating this condition. The Karydakis procedure is one of most commonly used asymmetric flaps for treating this condition. The study aimed to evaluate the Karydakis procedure with tie-over compressing sutures instead of the routine use of a drain in the treatment pilonidal sinus. This prospective randomized controlled clinical study was conducted between January 2010 and January 2015. The study was conducted at Minia University Hospital. The study included 154 patients. Patients were randomly assigned into 2 equal groups. The patients in group 1 were operated on by the standard Karydakis procedure, and the patients in group 2 were operated on by the Karydakis procedure with tie-over compressing sutures without a drain. The primary outcomes measured were the incidence of seroma formation, wound complications, length of hospital stay, off-work time, and recurrence rate. All patients were discharged on the same day of surgery in group 2 compared with a mean hospital stay of 4.9 ± 2.4 days in group 1. No patients developed seroma in group 2 compared with 7.8% in group 1. In group 2, 1.3% of patients developed wound infection compared with 9.1% in group 1. The average time for return to work in group 2 was 10.2 ± 1.4 days compared with 12.6 ± 4 days in group 1. No recurrences were noted in group 2 compared with 2.6% in group 1. The feedback about postoperative pain and patient satisfaction about the scar were not investigated. The extent of the disease in both groups was not investigated. The duration of follow-up too short to accurately weight recurrence rate. Karydakis flap with tie-over compressing interrupted sutures without a drain is safe, 1-day surgery with the lowest complications rate.

Comparison of results of minimal invasive surgery for pilonidal sinus with karydakis procedure: less is more

Aim: Controversy still remains regarding the best surgical technique to use for the treatment of pilonidal disease to minimize disease recurrence and patient discomfort. Minimal surgical procedures can be performed on an outpatient basis. In this study, the early results of our minimally invasive operative approach cases are compared with Karydakis flap reconstruction results. Material and methods: From January 11, 2012 to January 23, 2013, 312 patients were diagnosed with pilonidal sinus and treated in our clinic. Eighty-two of these patients (35 treated by a minimally invasive procedure (group I), 47 by the Karydakis flap procedure [Group II]) were included in the study. Data were collected by reviewing the patients’ records and by conducting telephone interviews. Results: The follow-up time of each case for Group I was 35 months and the average follow-up time was 32.5 months for Group II (interval, 24-40 months). Group I patients returned to work in 1 day; however, 40 patients (85.1%) in Group II returned in 20 days and 7 (14.9%) returned to work in 30 days. In group I, 32 patients (94%) were satisfied and 2 patients (5.7%) were not satisfied. In Group II, 32 patients (68.1%) were satisfied with the results of the surgical procedure and 15 patients (31.9%) were not satisfied. Our recurrence rates for group I and II were 5.7% and 6.4% for the first year, respectively. Conclusion: This indicated that the minimally invasive operative procedure can be performed with a low recurrence rate on a one day outpatient basis.

Risk factors for complications and recurrence after the Karydakis flap

BackgroundThis study describes risk factors leading to the development of various postoperative complications and recurrence after the Karydakis procedure. Materials and methodsIn this prospective analytic cohort study, 179 patients with sacrococcygeal pilonidal disease underwent Karydakis procedure. Characteristics of the pilonidal disease and excised ellipse were measured as possible risk factors. Postoperative complications and recurrence were recorded as outcomes. ResultsMultivariate analysis showed that the distance between the last caudal pit and anal verge and length of excised part are independent factors predicting limited superficial skin disruption and infection, respectively. Delayed wound healing was associated with the distance between the last caudal pit and anal verge and history of previous pilonidal surgery. The length of excised part was the only predictor of future recurrence. ConclusionsPatients with no history of previous pilonidal surgery, a short length of extracted part, and long distance of caudal pit from anal verge are best candidates for the Karydakis flap procedure.

Outcome of Karydakis procedure for pilonidal sinus

Objective: To analyze the Outcome of karydakis procedure for pilonidal sinus. Design: Prospective interventional study Place and Duration: Lahore General Hospital, Lahore from January 2001 to December 2004. Material and Methods: Patients with chronic pilonidal sinus and Karydakis procedure was adopted. Results: Total No of 60 patients underwent excision and asymetrical primary closure. Six patients required intravenous analgesia minor wound infection was present in twelve patients (20%). Forty eight (80%) patients were able to resume normal household activities with in two weeks while full outdoor activities were possible in two to three weeks in nearly 100 % of cases conversion to open methods was zero with recurrence rate 5% (3 Cases) patients acceptability was 90% (54 Cases)

Karydakis flap versus excision-only technique in pilonidal disease

BackgroundKarydakis flap (K-flap) and excision with healing by secondary intention (EHSI) are currently accepted methods for surgical management of sacrococcygeal pilonidal disease. This clinical trial study aimed to compare early and late outcomes of these two surgical techniques. Materials and methodsIn this controlled, prospective, randomized clinical trial, patients diagnosed with sacrococcygeal pilonidal disease were randomly allocated to two groups. Patients in the first group underwent Karydakis procedure, whereas EHSI was the surgical management in the second group. The two techniques were compared based on their overall time of wound healing, return to work, rate of complications, and recurrence. ResultsA total of 321 patients including 161 in the K-flap group and 160 in the EHSI group were included in the study. The median follow-up duration was 49 mo. The mean time of wound healing (16.44 versus 80.01 d, P < 0.001), return to work (14.44 versus 24.19, P < 0.001), rate of wound complications (18.7% versus 31.2%, P = 0.006), and recurrence (1.2% versus 7.5%, P = 0.005) were all significantly lower in the K-flap group. The mean operation time was significantly shorter in the EHSI group (15.87 versus 55.17 min, P < 0.001). The K-flap group showed significantly higher pain on their first postoperative day and significantly less pain after 1 wk (P < 0.001). ConclusionsAlthough both techniques are safe, the K-flap is associated with significantly lower rates of complications and recurrence and significantly shorter time of wound healing and return to work.