• Igors Iesalnieks, Sina Deimel, and Hans J Schlitt.
• Department of Surgery, Marienhospital Gelsenkirchen, Virchowstrasse 135, 45886 Gelsenkirchen, Germany. iesalnieks_igors@hotmail.com
• World J Surg. 2013 May 1;37(5):1115-20.

BackgroundPatients undergoing surgery for recurrent pilonidal disease are at high risk of developing re-recurrence. The present retrospective analysis was performed to compare long-term results in patients with recurrent disease undergoing midline excision surgery compared to patients undergoing the Karydakis flap procedure.MethodsOnly patients with previous excision surgery apart from simple abscess incision were included. Disease recurrence was defined as the need for repeat surgery.ResultsA total of 124 patients underwent surgery for recurrent pilonidal disease. Group 1 consisted of 37 patients (25 excision + midline closure, 12 excision + lay-open). Group 2 consisted of 87 patients (Karydakis flap). There were no statistically significant differences between the groups with regard to patient's age, duration of disease, body mass index, or sex. The average number of previous surgeries was significantly higher in group 1 patients (2.1 vs. 1.8, p = 0.019). The overall 1-year recurrence rate was 43 % in group 1 and 3 % in group 2 (p < 0.0001). The wound dehiscence rate after the Karydakis flap procedure was as high as 43 % between years 2005 and 2009, but it fell to 10 % thereafter (p = 0.02).ConclusionsKarydakis flap procedure is superior to midline excision surgery in patients presenting with recurrent pilonidal disease.

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