Comparative Meta-Analysis of Recurrence Rates in Classical vs. Modified Limberg Flap Techniques for Pilonidal Sinus Disease Surgery: Evidence for Enhanced Efficacy
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)....
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Albanian Society for Trauma and Emergency Surgery
2025-07-01
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| Series: | Albanian Journal of Trauma and Emergency Surgery |
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| Online Access: | https://journal.astes.org.al/AJTES/index.php/AJTES/article/view/466 |
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| author | Dietrich Doll Matthias Maak Theo Hackmann Christina Oetzmann von Sochaczewski Myriam Braun-Münker PiloNERDs International |
| author_facet | Dietrich Doll Matthias Maak Theo Hackmann Christina Oetzmann von Sochaczewski Myriam Braun-Münker PiloNERDs International |
| author_sort | Dietrich Doll |
| collection | DOAJ |
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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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| format | Article |
| id | doaj-art-25ed5215a4cb4dbd843bfa134229463f |
| institution | DOAJ |
| issn | 2521-8778 2616-4922 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Albanian Society for Trauma and Emergency Surgery |
| record_format | Article |
| series | Albanian Journal of Trauma and Emergency Surgery |
| spelling | doaj-art-25ed5215a4cb4dbd843bfa134229463f2025-08-20T02:41:10ZengAlbanian Society for Trauma and Emergency SurgeryAlbanian Journal of Trauma and Emergency Surgery2521-87782616-49222025-07-019210.32391/ajtes.v9i2.466Comparative Meta-Analysis of Recurrence Rates in Classical vs. Modified Limberg Flap Techniques for Pilonidal Sinus Disease Surgery: Evidence for Enhanced EfficacyDietrich Doll0Matthias Maak1Theo Hackmann2Christina Oetzmann von Sochaczewski3Myriam Braun-Münker4PiloNERDs International5Department of Procto-Surgery & Pilonidal Sinus, St Marienhospital Vechta, Academic Teaching Hospital of the Medical School Hannover, Vechta, GERMANY,Department of Surgery, University Hospital Erlangen of the Friedrich-Alexander University Erlangen-Nuremberg, ErlangenDepartment of Procto-Surgery & Pilonidal Sinus, St Marienhospital Vechta, Academic Teaching Hospital of the Medical School Hannover, Vechta, GERMANY,Department of Surgery, University Hospital of Bonn, Venusberg-Campus Bonn,Fulda University of Applied Sciences, Department of Food Technology,Pilonidal Network for Expertise, Research and Development (PiloNERDs International), DENMARK & GERMANY ** Members of the PiloNerds Group are provided in the Acknowledgment. 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. https://journal.astes.org.al/AJTES/index.php/AJTES/article/view/466Pilonidal SinusTherapylong-term Recurrence RateIncidenceObservation biasLimberg flap |
| spellingShingle | Dietrich Doll Matthias Maak Theo Hackmann Christina Oetzmann von Sochaczewski Myriam Braun-Münker PiloNERDs International Comparative Meta-Analysis of Recurrence Rates in Classical vs. Modified Limberg Flap Techniques for Pilonidal Sinus Disease Surgery: Evidence for Enhanced Efficacy Albanian Journal of Trauma and Emergency Surgery Pilonidal Sinus Therapy long-term Recurrence Rate Incidence Observation bias Limberg flap |
| title | Comparative Meta-Analysis of Recurrence Rates in Classical vs. Modified Limberg Flap Techniques for Pilonidal Sinus Disease Surgery: Evidence for Enhanced Efficacy |
| title_full | Comparative Meta-Analysis of Recurrence Rates in Classical vs. Modified Limberg Flap Techniques for Pilonidal Sinus Disease Surgery: Evidence for Enhanced Efficacy |
| title_fullStr | Comparative Meta-Analysis of Recurrence Rates in Classical vs. Modified Limberg Flap Techniques for Pilonidal Sinus Disease Surgery: Evidence for Enhanced Efficacy |
| title_full_unstemmed | Comparative Meta-Analysis of Recurrence Rates in Classical vs. Modified Limberg Flap Techniques for Pilonidal Sinus Disease Surgery: Evidence for Enhanced Efficacy |
| title_short | Comparative Meta-Analysis of Recurrence Rates in Classical vs. Modified Limberg Flap Techniques for Pilonidal Sinus Disease Surgery: Evidence for Enhanced Efficacy |
| title_sort | comparative meta analysis of recurrence rates in classical vs modified limberg flap techniques for pilonidal sinus disease surgery evidence for enhanced efficacy |
| topic | Pilonidal Sinus Therapy long-term Recurrence Rate Incidence Observation bias Limberg flap |
| url | https://journal.astes.org.al/AJTES/index.php/AJTES/article/view/466 |
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