PT  - JOURNAL ARTICLE
AU  - Paschalis Gavriilidis
AU  - Emil Bota
TI  - Limberg flap versus Karydakis flap for treating pilonidal sinus disease: a systematic review and meta-analysis
AID  - 10.1503/cjs.003018
DP  - 2019 Apr 01
TA  - Canadian Journal of Surgery
PG  - 131--138
VI  - 62
IP  - 2
4099  - http://canjsurg.ca/content/62/2/131.short
4100  - http://canjsurg.ca/content/62/2/131.full
SO  - CAN J SURG2019 Apr 01; 62
AB  - Background: The Limberg flap reconstruction and the Karydakis flap reconstruction are the 2 most used off-midline closure techniques in pilonidal sinus surgery. The current evidence is inconclusive as to which is the optimal technique. The aim of this systematic review and meta-analysis was to compare differences in outcomes between these 2 flap-based techniques.Methods: We identified studies by a systematic literature search of the Embase, MEDLINE (PubMed), Cochrane Library and Google Scholar databases and studies selected as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Only randomized controlled trials (RCTs) that compared the Limberg flap (standard or modified) and the Karydakis flap were included in this review.Results: Operative time was shorter by 7 minutes in the Karydakis group than in the Limberg group (mean difference 7.00 min, 95% confidence interval [CI] 0.53 to 13.48). The seroma formation rate was significantly higher in the Karydakis cohort (odds ratio [OR] 0.36, 95% CI 0.24 to 0.56); however, after excluding studies with a high risk of bias, the sensitivity analysis showed no significant differences in seroma formation rate between the 2 techniques (OR 0.76, 95% CI 0.31 to 1.85). Other outcomes of interest showed no significant differences between the Limberg and Karydakis techniques.Conclusion: There were no significant differences between the Limberg and Karydakis techniques. Future RCTs with strict adherence to CONSORT guidelines will further elucidate the efficacy of these surgical procedures.