Rhomboid Excision with Limberg Flap Repair versus Primary Closure in the Management of Sacrococcygeal Pilonidal Sinus: A Prospective Randomized Comparative Study

Abstract

Background: Sacrococcygeal pilonidal sinus is a common condition in young adults with significant morbidity and high recurrence after conventional surgery. Rhomboid excision with Limberg flap repair has emerged as a technique that addresses the root cause of recurrence by obliterating the natal cleft. This study compares the outcomes of Limberg flap repair versus primary closure following excision of pilonidal sinus. Methods: A prospective randomized comparative study was conducted in the Department of General Surgery, Government Medical College and Hospital, Kota, from October 2023 to December 2024. Sixty patients with sacrococcygeal pilonidal sinus were randomized into two equal groups: Group A (Limberg flap repair, n=30) and Group B (primary closure, n=30). Outcomes assessed included operative time, postoperative pain (VAS score), wound complications (infection, seroma, dehiscence), hospital stay, and recurrence at six months. Results: Both groups were comparable in age and sex distribution. Mean operative time was significantly longer in Group A (36.3±3.24 min vs 24.93±3.06 min; p<0.0001). Group A demonstrated significantly lower rates of wound infection (3.33% vs 33.33%; p=0.006), seroma formation (3.33% vs 26.67%; p=0.026), wound dehiscence (3.33% vs 30%; p=0.012), hospital stay (2.27±0.52 vs 3.57±1.43 days; p=0.0001), and recurrence (3.33% vs 26.67%; p=0.026). Long-term pain was significantly lower in Group A at 3 and 6 months. Conclusion: Limberg flap repair is superior to primary closure for sacrococcygeal pilonidal sinus in terms of wound complications, hospital stay, and recurrence, with the trade-off of a longer operative time and slightly higher early postoperative pain. It is recommended as the preferred surgical technique for primary pilonidal sinus disease.

Keywords: Pilonidal sinus, Limberg flap, primary closure, rhomboid excision, recurrence, wound complications