International Surgery Journal | October-December 2016 | Vol 3 | Issue 4 Page 1831 International Surgery Journal Gandhi JA et al. Int Surg J. 2016 Nov;3(4):1831-1836 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Original Research Article A modified surgical approach to sacrococcygeal pilonidal disease: our experience Jignesh A. Gandhi, Pravin H. Shinde*, Saneya A. Pandrowala, Rohan D. Digarse INTRODUCTION Sacrococcygeal pilonidal sinus disease, a commonly encountered disease, is equally frustrating for the patient to have and the surgeon to treat. There are various surgical and nonsurgical modalities described for the management of pilonidal sinus disease; however the main problem with all these is recurrence apart from the complications of the procedure chosen. Sacrococcygeal pilonidal sinus disease is a chronic inflammatory disorder characterised by an abscess or a sinus tract in the natal cleft region with seropurulent discharge. Karyadaki’s theory is the most accepted theory to explain the pathogenesis of the disease. He proposed that pilonidal sinus results from the interplay of three main factors which result into the insertion of hair into the natal cleft which are: The presence of loose hair (the invader), some force facilitating hair insertion into the skin, and the vulnerability of the skin such as the intergluteal sulcus depth. 1 Thus a deep natal cleft which favours sweating, hair penetration and bacterial contamination as well as buttock movements while walking which cause hair to penetrate the skin and cause foreign body reaction and inflammation form a part of the etiologic process. 2,3 Understanding the etiopathogenesis helps to treat the disease effectively with minimal recurrence. ABSTRACT Background: Pilonidal disease is a fairly common condition encountered in clinical practice with recurrent follicular infection being the causative factor. Inspite of many surgical options available, controversy still exists for the best procedure. Pilonidal disease has been treated for a long time with the conventional open excision technique. Limberg procedure is a safe and reliable technique in the treatment of sacrococcygeal pilonidal disease, with low complications and recurrence rates if performed according to appropriate surgical principles. Epilation is a very useful adjunct to the surgery for Pilonidal disease to prevent recurrence, which is almost a rule. Methods: In our study we recruited 27 patients of pilonidal disease who underwent modified Limberg flap procedure and were followed up for two years post-surgery. All the patients were subjected to epilation in preoperative period and post operatively for 6 months. Results: During our study period (2011-2016) 27 patients were enrolled with a median age of 25 years and were followed up 2 years post-surgery. 22 patients were males while 5 were females, 13 were recurrent cases with previous history of one or more surgeries, 11 cases had a sinus without any surgical intervention in the past and 3 had an abscess. There was no recurrence noted for a follow up period of 2 years and there was no flap failure as well. Conclusions: Modified Limberg flap with epilation for pilonidal disease is safe and easy to perform with minimal morbidity, early recovery and no recurrence. Keywords: Pilonidal disease, Recurrence, Rhomboid excision, Modified Limberg flap reconstruction, Epilation Department of General Surgery, Seth G.S. Medical College and KEM Hospital, Mumbai, India Received: 08 August 2016 Accepted: 13 August 2016 *Correspondence: Dr. Pravin H. Shinde, E-mail: drpravinshinde@yahoo.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2349-2902.isj20162884