Karydakis Versus Limberg Flap in Primary Sacrococcygeal Pilonidal Sinus: A Retrospective Comparative Study of Functional Recovery.
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Habeeb Tamer A A M, Hussain Abdulzahra, Bueno-Lledó Jose, Giménez Mariano Eduardo, Aiolfi Alberto, Abdelsamad Ahmed, Chiaretti Massimo, Kryvoruchko Igor A, Manangi Mallikarjuna N, Algalaly Nasreldin Mohammed, Abbas Mohammed, Labib Mohamed Fathy, Almezaien Osama, Elkaseer Mohamed Hassan Mohamed, Abdelkader Hamada Rashad Mohamed, Swelam Mohamed, Nagaty Mahmoud E, Alhady Mahmoud Abd Alhady Abd Alaziz Abd, Henish Mohamed Ibrahim, Farag Hamdy, Shalamesh Mohamed Ibrahim, Shamy Ibtsam AbdElMaksoud Mohamed El, Fiad Alaa A, Elbelkasi Hamdi, Alsaad Mohamed Ibrahim Abo, Al-Shareef Mahmoud Moustafa, Eissa Mahmoud Abdelnasser, Elsadek Mahmoud Elghonimy Abd, Ali Abouelatta K H, Youssef Maged Z, Mohamed Mohamed Abdelbar, Hamdy Ahmed, Khedr Ali Hussein, Khater Ayman A, Ali Hazem E, Siam Mohammed, Elnahas Mohamad Naeem, Saqr Mohamed Adel, Ahmed Mostafa Fathy Ibrahim, Mohamed Mohamed Mahmoud Mokhtar, Elnemr Mohamed, Mousa Bassam, Wasefy Tamer, El Teliti Ahmed M, Abozaid Mohamed, Morsi Adel, Biomy Taha A, Atef Baher, Almeniawy Mohamed Mahmoud, Moussa Mohamad S, Hebeishy Mohamed H, Metwally Hasnaa, Bayomi Mohamed S, Mostafa Abdelshafy, Saleh Ahmed Attia, Yassin Mahmoud Abdou
Аннотация
METHODS: This multicenter retrospective cohort study (FLARE study) included employed, sexually active patients who underwent surgery for primary PSD (July 2017-July 2024). The primary outcome was time to sexual activity resumption; the secondary outcome was time to resumption of driving. Outcomes were assessed at 1 year using a structured Likert-scale questionnaire. Kaplan-Meier curves and Cox regression analyses with adjustment were used.
RESULTS: A total of 352 patients were divided into 176 KF and 176 LF. KF patients resumed sexual activity earlier (2.88 ± 0.7 vs. 4.58 ± 1.1 weeks; mean difference -1.7 weeks, 95% CI -1.89 to -1.49, p < 0.001). KF reported significantly less pain, less avoidance, and lower analgesic use during sex. LF reported lower sexual satisfaction (mean 3.94 vs. 2.15; mean difference -1.78, 95% CI -2.02 to -1.53). KF resumed driving earlier (median 9 vs. 19 days; r = 0.7, large effect, p < 0.001) and had longer sitting tolerance (OR 0.3, 95% CI 0.2-0.4, p < 0.001). LF had higher pain while sitting (mean Likert 4 vs. 2; mean difference of -1.94, 95% CI -2.19 to -1.68), higher VAS pain (median 4 vs. 2; r = 0.5), greater need for cushions/analgesics, and more driving-related work/social limitations (all p < 0.001). Time to resume sexual activity and driving was significantly shorter for KF. On multivariable analysis, LF was independently associated with delayed return to sexual activity (adjusted OR 4.02, 95% CI 2.1-7.5, p < 0.001) and delayed return to driving (adjusted OR 2.8, 95% CI 1.5-5.2, p < 0.001).
CONCLUSIONS: In this retrospective cohort, KF may be associated with significantly faster return to sexual and driving activity compared with LF. These results underscore the importance of incorporating patient-centered functional outcomes into surgical decision-making for PSD.
TRIAL REGISTRATION: Number: NCT07271537.