Limberg flap reconstruction for recurrent pilonidal sinus disease: A single-center U.S. Cohort

PURPOSE: Recurrent pilonidal sinus disease (PSD) presents a significant surgical challenge. Although Limberg flap (LF) reconstruction has demonstrated favorable outcomes in the international literature, long-term outcome data from U.S. institutions, particularly in recurrent cases, remain limited. This study evaluated the long-term outcomes of LF reconstruction in a single-center U.S. cohort with recurrent PSD. METHODS: A retrospective analysis was conducted of patients who underwent LF for recurrent PSD between 2014 and 2023. Data on patient demographics, operative details, and postoperative courses were collected. Long-term follow-up, including assessment for recurrence, was obtained via structured telephone interviews and chart reviews. RESULTS: Thirty-seven patients were included. The cohort was predominantly male (76%) with a median BMI of 29.4 kg/m². 59% were active smokers, and 52% had undergone multiple previous pilonidal operations. The median operative time was 72 min. 92% of the patients were discharged on the same day, and no surgical drains were used. The postoperative complication rate was 11%, primarily consisting of wound dehiscence. No recurrence was observed during the median follow-up of 4.5 years. CONCLUSION: In this retrospective cohort study of patients with recurrent pilonidal sinus disease, Limberg flap reconstruction was associated with durable disease control and acceptable postoperative morbidity while remaining compatible with early discharge. These findings support Limberg flap reconstruction as a viable option for patients with complex recurrent disease.