A Dual-Approach Strategy for Pilonidal Sinus Management: Limberg Flap Reconstruction with Adjuvant Diode Laser Epilation — A Case Series Evaluating Recurrence and Outcomes

Abstract

Objective: To evaluate recurrence rates, healing outcomes, and patient satisfaction following Limberg flap reconstruction combined with diode laser hair removal in individuals with primary pilonidal sinus disease.

Methodology: This prospective, single-center case series was conducted at the Department of Surgery, Nishtar Medical University and Hospital, Multan, between January 2023 and April 2025. Forty-nine patients aged 16 to 45 years with clinically confirmed primary pilonidal sinus were treated with standardized rhomboid excision and Limberg flap closure. Diode laser epilation was initiated after wound healing and repeated in four sessions. Data on recurrence, healing time, complications, pain scores, and satisfaction were collected at regular follow-up intervals for up to 24 months.

Results: The cohort included 46 males and 3 females (mean age: 29.9 ± 8.5 years). Over half were obese, and 71% reported sedentary work. Most patients (89.8%) had chronic symptoms exceeding 6 months. Flap necrosis occurred in 2 patients (4.1%), while wound infection and dehiscence were seen in two cases each. Mean time to epithelialization was 21 ± 2.3 days, with routine activities resumed in 22.6 ± 2.5 days. Pain scores declined progressively over the first postoperative week. One patient (2.0%) experienced recurrence at 18 months, yielding a 24-month recurrence-free rate of 97.9%. Compliance with laser sessions was high (81.6%), and 91.8% of patients reported satisfaction with treatment.

Conclusion: Limberg flap surgery combined with diode laser hair removal appears to be a well-tolerated and effective method for treating primary pilonidal sinus disease. This approach may offer improved outcomes in high-risk individuals, particularly in regions with limited long-term follow-up capacity.

Keywords: Pilonidal sinus, Limberg flap, laser epilation, recurrence, surgical outcome, Pakistan