Ardelt M, Dittmar Y, Scheuerlein H, Fahrner R, Rauchfuß F, Settmacher U
Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Deutschland,
Chirurg. 2015 Aug;86(8):771-5. doi: 10.1007/s00104-014-2963-z.
The current German S3 guidelines recommend radical excision for pilonidal sinus disease. Furthermore, the Karydakis operation and the plastic surgery procedure according to Limberg are also recommended. Contrary to the S2 guidelines of 2008, these two plastic surgery procedures for coverage are recommended for the treatment of the first-time manifestation of this disease. Most studies on the classical Limberg plastic surgical procedure are comparative in nature and describe a simultaneous intervention from which patients with an abscess are excluded.
The aim of this present study was to analyze the results of a sequential procedure including primary excision followed by a Limberg plastic surgery procedure for the treatment of acute abscesses and chronic pilonidal sinus disease.
From July 2010 to June 2013 a total of 50 patients with pilonidal sinus disease were treated at the University Hospital Jena with an initial radical excision. In accordance with the Association of the Scientific Medical Societies in Germany (AWMF) guidelines which were valid during that time, patients were offered plastic surgery coverage for recurrence prophylaxis and in cases of recurrence a Limberg plastic surgery procedure was recommended.
Of the 50 patients 22 opted for a Limberg plastic surgery procedure during the interval. The mean follow-up after the Limberg plastic surgery procedure was 20.1 months (range 2-36 months). During the follow-up period, there were no recurrences (0 %) but four major complications (18.2 %) and one minor complication (4.5 %) were observed.
This concept can be applied in cases of acute abscess formation and in chronic pilonidal sinus disease. The patient's decision with respect to a Limberg plastic surgery procedure for recurrence prophylaxis does not have to be made immediately. In addition, the Limberg plastic surgery procedure is performed in an infection-free stage. The second inpatient stay, second surgical procedure and prolonged time off work are a disadvantage.
当前德国S3指南推荐对藏毛窦疾病进行根治性切除。此外，还推荐采用卡里达基斯手术以及根据林贝格方法进行的整形手术。与2008年的S2指南相反，这两种用于覆盖创面的整形手术被推荐用于治疗该疾病的初次发作。大多数关于经典林贝格整形手术的研究本质上是比较性的，且描述的是同时进行的干预措施，其中排除了患有脓肿的患者。
本研究的目的是分析一种序贯治疗方法的结果，该方法包括对急性脓肿和慢性藏毛窦疾病先进行初次切除，随后进行林贝格整形手术。
2010年7月至2013年6月期间，耶拿大学医院共对50例藏毛窦疾病患者进行了初次根治性切除治疗。根据当时有效的德国科学医学协会（AWMF）指南，为患者提供整形手术覆盖以预防复发，对于复发病例推荐进行林贝格整形手术。
50例患者中有22例在间隔期选择了林贝格整形手术。林贝格整形手术后的平均随访时间为20.1个月（范围2 - 36个月）。在随访期间，未出现复发（0%），但观察到4例严重并发症（18.2%）和1例轻微并发症（4.5%）。
这一理念可应用于急性脓肿形成和慢性藏毛窦疾病的病例。患者不必立即决定是否进行林贝格整形手术以预防复发。此外，林贝格整形手术在无感染阶段进行。第二次住院、第二次手术以及延长的误工时间是其不利之处。
