A Comparative Study Between Excision with Primary Closure and Rhomboid Excision with Limberg Flap for Pilonidal Sinus

Background: Pilonidal sinus disease is a chronic condition of the sacrococcygeal region that commonly affects young adults and is associated with prolonged morbidity, delayed wound healing, and frequent recurrence following surgery. Selection of an appropriate surgical technique is essential to improve outcomes and reduce recurrence. Aim: To compare the outcomes of excision with primary closure and rhomboid excision with Limberg flap in the management of sacrococcygeal pilonidal sinus. Materials and Methods: A prospective comparative study was conducted on 60 patients with uncomplicated pilonidal sinus admitted to a tertiary care hospital over a period of 24 months. Patients were randomly divided into two equal groups. Group A underwent rhomboid excision with Limberg flap, while Group B underwent excision with primary closure. Operative time, postoperative pain, complications, duration of hospital stay, time to suture removal, return to work, scar outcome, and recurrence were evaluated and statistically analyzed. Results: The mean operative time was longer in the Limberg flap group; however, postoperative complications were significantly lower compared to the primary closure group. Patients treated with the Limberg flap experienced less postoperative pain, shorter hospital stay, earlier return to work, and better scar outcomes. Recurrence at six-month follow-up was markedly lower in the Limberg flap group. Conclusion: Rhomboid excision with Limberg flap provides superior postoperative outcomes and lower recurrence rates when compared to excision with primary closure. It is a safe and effective surgical option for the management of sacrococcygeal pilonidal sinus.