Comparative Study of Excision and Primary Closure vs Open Healing vs Limberg Flap in Pilonidal Sinus

Abstract

Background: Pilonidal sinus disease (PSD) is a common condition in young adults,
often requiring surgical intervention. Various techniques—excision with primary
closure, open healing, and Limberg flap—are employed, but the optimal approach
remains debated.
Objective: To compare the outcomes of excision with primary closure, excision with
open healing, and Limberg flap reconstruction in the surgical management of
pilonidal sinus disease.
Methods: A prospective comparative study was conducted on 100 patients diagnosed
with PSD and randomly assigned to three groups: Group A (primary closure, n=34),
Group B (open healing, n=33), and Group C (Limberg flap, n=33). Outcomes
assessed included postoperative pain (VAS), wound healing time, return to work,
surgical site infection, recurrence, and patient satisfaction. Statistical analysis was
performed using SPSS v25.0.
Results: Group C (Limberg flap) showed significantly better outcomes with the
shortest healing time (13.9 ± 2.4 days), lowest postoperative pain, quickest return to
work (15.6 ± 2.5 days), lowest recurrence (3.0%), and highest satisfaction scores (4.6
± 0.5). Group B had the slowest healing and longest time to resume activities. Group
A had higher wound complications and recurrence.
Conclusion: The Limberg flap technique offers superior outcomes compared to
primary closure and open healing, making it the preferred surgical approach for
managing pilonidal sinus disease.