Off-midline closure techniques in the treatment of pilonidal sinus disease; Karydakis vs Limberg flap procedure

Objective: To compare the outcome of two commonly performed off-midline operations i.e., the Karydakis technique and the Limberg flap transposition in treatment of pilonidal cyst to determine the superior technique. Methodology: Of 83 patients who underwent surgery for pilonidal sinus disease between October 2018 to October 2020, 70 patients were enrolled for the study via a non-probability consecutive sampling technique. Patients were allocated randomly into two groups (35 patients in each group); group A underwent the Karydakis procedure, and group B had Limberg procedure. All were followed for six months; weekly in the 1st month, and then at 3 and 6 months interval and compared for the mean operative time, hospital stay, procedure cost, return to work, and postoperative complications such as seroma, infection, and recurrence. Results: The Karydakis procedure had lower cost, decreased operative duration, shorter mean hospital stay and early return to basic life activities compared to the Limberg procedure. (p=0.000) Pain perception (VAS score) was also lower in the Karydakis group (p=0.003). Postoperative complications i.e., seroma (p=0.673), infection (p=1.0), and recurrence (p=0.493) were comparable in both groups with all p values greater than 0.05. Conclusion: Based on the lower cost, shorter operative time and hospital stay, low VAS score, early return to physical activities, and comparable postoperative complications, we recommend the Karydakis procedure as the superior off-midline approach in the treatment of pilonidal sinus disease.