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

Karydakis Flap With Compressing Tie-over Interrupted Sutures Without Drain versus Standard Karydakis for Treatment of Sacrococcygeal Pilonidal Sinus Disease.
Author Information (click to view)

Sewefy AM, Hassanen A, Atyia AM, Saleh SK,


Sewefy AM, Hassanen A, Atyia AM, Saleh SK, (click to view)

Sewefy AM, Hassanen A, Atyia AM, Saleh SK,

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Diseases of the colon and rectum 60(5) 514-520 doi 10.1097/DCR.0000000000000784
Abstract
BACKGROUND
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.

OBJECTIVE
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.

DESIGN
This prospective randomized controlled clinical study was conducted between January 2010 and January 2015.

SETTINGS
The study was conducted at Minia University Hospital.

PATIENTS
The study included 154 patients. Patients were randomly assigned into 2 equal groups.

INTERVENTIONS
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.

MAIN OUTCOMES AND MEASURES
The primary outcomes measured were the incidence of seroma formation, wound complications, length of hospital stay, off-work time, and recurrence rate.

RESULTS
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.

LIMITATIONS
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.

CONCLUSION
Karydakis flap with tie-over compressing interrupted sutures without a drain is safe, 1-day surgery with the lowest complications rate.

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