Keywords
Therapy
long-term Recurrence Rate
Incidence
Observation bias
Limberg flap
modified Limberg flap
How to Cite
Abstract
Aim: In the surgery of pilonidal sinus disease (PSD), positioning any incision away from the central axis of the crenae is expected to yield a reduced recurrence rate. If so, it can be anticipated that the modified Limberg flap (MLF) exhibits a lower recurrence rate than the Limberg flap (LF).
Material and Methods: To perform a comparative meta-analysis of the recurrence rates, 1,338 studies encompassing 153,098 patients were identified. Out of these, 210 studies (both randomized controlled and nonrandomized controlled trials) with n=16,588 patients who had undergone either LF or MLF were included in the Kaplan-Meier Survival analysis.
Results: In non-RCT analysis, the LF group exhibited a 5-year recurrence rate of 7.1% (CI 6.3-8.0), while the MLF group showed a 5-year recurrence rate of 4.9% (CI 3.7-6.1) (p<0.0001). After 8 years, which represents the most extended observation period for the MLF group, the recurrence rate was 10.9% (CI 9.6-12.1) for LF and 7.3% (CI 5.4-9.1) for MLF (p<0.0001).
In the RCT analysis, the curves differ as a trend but not significantly, as PT numbers are scarce beyond year 2. The RCT-versus-nonRTC analysis of LF shows significantly higher RR for RCT studies, which is the same for MLF.
Conclusion: This meta-analysis, which focused on recurrence rates associated with Limberg flap variants and analyzed data from 16,588 patients, shows that the modified Limberg flap technique effectively reduces the risk of recurrence compared to the already low recurrence rate associated with the classical Limberg flap. The presence of a scar in the caudal midline, as observed in the classical Limberg variant but not in the modified Limberg, is strongly correlated with a higher recurrence rate. Therefore, the modified Limberg flap variant is recommended in future surgical procedures.
What does this paper add to the literature? This paper contributes significantly to the existing literature by providing robust evidence supporting the modified variant of the Limberg flap technique. While the Limberg flap's recurrence rate is already low, its modification notably diminishes recurrence rates even further. Consequently, the modified Limberg plasty may be considered the emerging gold standard.
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