Karydakis flap reconstruction versus Limberg flap transposition for pilonidal sinus disease: a meta-analysis of randomized controlled trials

Introduction The definitive treatment of pilonidal sinus disease (PSD) is surgical. There is still no consensus as to the most appropriate off-midline primary closure technique. The aim of this meta-analysis has been to compare Karydakis flap reconstruction (KF) to Limberg flap transposition (LF) with regard to short- and long-term postoperative outcomes. Methods A systematic literature search for randomized controlled trials (RCTs) comparing KF to LF was performed. Data regarding postoperative outcomes were extracted and compared by meta-analysis. The odds ratio and standardized mean differences with 95% confidence intervals (CIs) were calculated. Results Eight RCTs were identified comparing KF ( n = 554) to LF ( n = 567). There was no significant difference noted between KF and LF with regard to the primary outcome variable, recurrence rate (OR = 1.07; 95% CI [0.59–1.92]; p = 0.83; 7 studies; I 2 = 40%). LF was associated with a lower rate of post-operative seroma (OR = 2.03; 95% CI [1.15, 3.59]; p = 0.01; 7 studies; I 2 = 0%). No further significant differences were noted in the secondary endpoints between the two study groups. Conclusions Recurrence rates of PSD were found to be similar in both study groups. Post-operative seroma rate was significantly higher in the KF group. The meta-analysis did not indicate any further statistically significant differences between the two surgical procedures.