Comparison of Primary Midline Closure and Karydakis Flap Technique for the Surgical Treatment of Pilonidal Sinus Disease: An Updated Systematic Review and Meta-analysis

This meta-analysis was conducted to compare the effectiveness of primary midline closure technique with that of the Karydakis flap technique for the surgical management of sacrococcygeal pilonidal disease. The primary outcome of interest was “recurrence” while other outcomes included “seroma formation,” “surgical site infection,” “wound dehiscence,” and “overall complication rate.” A systematic database search in PubMed, Embase, and Cochrane central register of controlled trials was conducted from inception to May 2024. Random effects meta-analysis was performed comparing recurrence, seroma formation, surgical site infections, wound dehiscence, and overall complication rate in patients undergoing the primary midline closure and Karydakis flap surgical techniques for sacrococcygeal pilonidal disease. After a thorough literature search, a total of seven studies were included. There was no significant difference in seroma formation between the two groups. A significant difference was seen in recurrence (p = 0.03, I² = 38%), surgical site infections (p = 0.001, I² = 0%), wound dehiscence (p = 0.03, I² = 27%), and overall complication rate (p = 0.01, I² = 62%), all favoring the Karydakis flap technique. Karydakis flap was found to be superior to primary midline closure in terms of reducing recurrence, surgical site infections, wound dehiscence, and overall complication rate. For seroma formation, there was no significant difference between the two groups.