title: [Sequential intervention with primary excision and Limberg plastic surgery procedure for treatment of sacrococcygeal pilonidal sinus : Results of a pilot study].
abstract: BACKGROUND
  The current German S3 guidelines recommend radical excision for pilonidal sinus disease. Furthermore, the Karydakis operation and the plastic surgery procedure according to Limberg are also recommended. Contrary to the S2 guidelines of 2008, these two plastic surgery procedures for coverage are recommended for the treatment of the first-time manifestation of this disease. Most studies on the classical Limberg plastic surgical procedure are comparative in nature and describe a simultaneous intervention from which patients with an abscess are excluded.
  
  
  OBJECTIVE
  The aim of this present study was to analyze the results of a sequential procedure including primary excision followed by a Limberg plastic surgery procedure for the treatment of acute abscesses and chronic pilonidal sinus disease.
  
  
  METHODS
  From July 2010 to June 2013 a total of 50 patients with pilonidal sinus disease were treated at the University Hospital Jena with an initial radical excision. In accordance with the Association of the Scientific Medical Societies in Germany (AWMF) guidelines which were valid during that time, patients were offered plastic surgery coverage for recurrence prophylaxis and in cases of recurrence a Limberg plastic surgery procedure was recommended.
  
  
  RESULTS
  Of the 50 patients 22 opted for a Limberg plastic surgery procedure during the interval. The mean follow-up after the Limberg plastic surgery procedure was 20.1 months (range 2-36 months). During the follow-up period, there were no recurrences (0 %) but four major complications (18.2 %) and one minor complication (4.5 %) were observed.
  
  
  CONCLUSIONS
  This concept can be applied in cases of acute abscess formation and in chronic pilonidal sinus disease. The patient's decision with respect to a Limberg plastic surgery procedure for recurrence prophylaxis does not have to be made immediately. In addition, the Limberg plastic surgery procedure is performed in an infection-free stage. The second inpatient stay, second surgical procedure and prolonged time off work are a disadvantage.
authors.affiliation: Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Deutschland, michael.ardelt@med.uni-jena.de.
authors.forename: M
authors.initials: M
authors.lastname: Ardelt
authors.forename: Y
authors.initials: Y
authors.lastname: Dittmar
authors.forename: H
authors.initials: H
authors.lastname: Scheuerlein
authors.forename: R
authors.initials: R
authors.lastname: Fahrner
authors.forename: F
authors.initials: F
authors.lastname: Rauchfuß
authors.forename: U
authors.initials: U
authors.lastname: Settmacher
mesh_terms: D000038:Abscess / Q000601:surgery; D000328:Adult; D003050:Coccyx / Q000601:surgery; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D010864:Pilonidal Sinus / Q000601:surgery*; D010865:Pilot Projects; D011183:Postoperative Complications / Q000517:prevention & control / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D012086:Reoperation; D012447:Sacrum / Q000601:surgery; D013524:Surgical Flaps / Q000601:surgery*