Endoscopic pilonidal sinus treatment versus Limberg flap reconstruction for uncomplicated pilonidal sinus disease: a prospective comparative study

Abstract

Optimal surgical management of sacrococcygeal pilonidal sinus disease is still controversial. Minimally invasive endoscopic pilonidal sinus treatment (EPSiT) has emerged as an alternative to established off-midline flap procedures such as the Limberg flap. Comparative prospective data remain limited. This prospective observational cohort study included adult patients with primary, uncomplicated sacrococcygeal pilonidal sinus treated with either EPSiT or Limberg flap reconstruction between March 2023 and June 2024. Primary outcomes were postoperative pain, surgical-site infection, seroma formation, wound dehiscence, and recurrence at 6 months. Secondary outcomes included operative time, hospital stay, and time to return to normal activity. Eighty patients were included (EPSiT n = 40; Limberg n = 40). Baseline demographic and clinical characteristics were comparable between groups. EPSiT was associated with significantly shorter operative time, lower postoperative pain scores, reduced length of hospital stay, and earlier return to normal activity ( p < 0.05). Postoperative complications were fewer in the EPSiT group. Six-month recurrence rates were low and comparable between groups. EPSiT provides superior short-term recovery outcomes compared with Limberg flap reconstruction while maintaining similar early recurrence rates. EPSiT represents a safe and patient-centred option for selected cases of uncomplicated pilonidal sinus disease.