Hospitalisation and back to work : Limberg flap versus primary closure for pilonidal sinus

Abstract

Overview of the topic: Pilonidal Sinus Disease is defined by the presence of an epithelial tract in the skin of the natal cleft, which usually contains hair (Hodges, 1880). In 2020, the US had reported an incidence of PSD of 26 per 100,000 compared to 48 per 100,000 in Germany (Mahmood et al., 2020). Different surgeries are provided according on the type of PSD, however there is no evidence which surgery is better. Hence, this study analysed the Limberg flap and the primary closure methods to improve the post-operative outcomes. The Research Question: ‘In patients who undergo the surgical excision of a pilonidal sinus, is the use of the Limberg Flap more effective, in achieving a shorter time to return to work & hospital stay, compared to primary closure?’ PICO elements: The Population (P) studied were post-operative patients who underwent the excision of a PSD. The Intervention (I) observed was the use of Limberg flap in Comparison (C) with primary closure, whilst the desired Outcome (O) was the shorter time to return to work and hospital stay. Method: Four different electronic databases were used to retrieve the literature search, using keywords, synonyms, Boolean operators and limiters. The articles were published in the last twelve years, peer-reviewed articles in English language, all PICO elements included, full text articles and study design. Inclusion and exclusion criteria (Table 2.5 – 2.9) were applied. The PRISMA (Diagram 2.1) was utilised for the identification for reliable articles, and afterwards, articles were critically appraised using the Critical Appraisal Skills Programme (CASP) tool as instructions. Results and Conclusion: Three studies presented statistical significance when using the Limberg flap, while two studies showed no statistical significance and one of them preferred the primary closure. Implications and Recommendations: Further research is necessary for PSD surgeries and certain guidelines for the clinical staff.