{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:59:34Z","timestamp":1785423574628,"version":"3.56.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,6,13]],"date-time":"2024-06-13T00:00:00Z","timestamp":1718236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>We evaluated the clinical effect of utilizing a Limberg rhomboid flap graft in conjunction with Enhanced Recovery After Surgery (ERAS) protocols for the management of pilonidal sinus in the sacrococcygeal region to demonstrate the feasibility of applying ERAS to the treatment of pilonidal sinus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between January 2010 and August 2018, prospective data analysis was undertaken on 109 patients who received surgical treatment for pilonidal sinus in the sacrococcygeal region at the Department of Colorectal and Anal Surgery, Jingzhou Hospital affiliated to Yangtze University, and Taizhou Affiliated Hospital of Nanjing University of Chinese Medicine. The patients were randomly separated into two groups based onoperation technique: the control group (pilonidal sinus resection with primary suture) and the observation group (pilonidal sinus resection with Limberg flap graft). Some patients in the above two groups received ERAS after surgery, which included early feeding and early ambulation, etc. Therefore, we further subdivided each group into group A (without ERAS) and group B (with ERAS) according to whether they received ERAS. Comparative analysis was conducted to assess differences in pertinent data before and after surgery across the respective groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The length of postoperative hospitalization was shorter and wound dehiscence was more common in control group B than in control group A [(9.00\u2009\u00b1\u20091.20) vs. (11.07\u2009\u00b1\u20091.78), 26.7% (8\/30) vs. 7.1% (2\/28), <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05]. Observation group B exhibited significantly shorter wound recovery periods and postoperative hospital stays compared to observation group A [(8.08\u2009\u00b1\u20091.20) vs. (9.16\u2009\u00b1\u20092.21), (26.23\u2009\u00b1\u20093.97) vs. (29.08\u2009\u00b1\u20094.74), <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05]. The hospitalization duration and wound healing time in observation group B were notably shorter than those observed in control group B [(8.08\u2009\u00b1\u20091.20) vs. (9.00\u2009\u00b1\u20091.20), [26.23\u2009\u00b1\u20093.97 vs. (43.67\u2009\u00b1\u20097.26), <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05], but the operation time was longer and scar acceptance was lower [(78.85\u2009\u00b1\u200910.16) vs. (43.30\u2009\u00b1\u20096.06), (4.00\u2009\u00b1\u20090.69) vs. (7.53\u2009\u00b1\u20090.86), <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05]. The VAS score, infection rate, wound dehiscence rate, subcutaneous hematoma rate and 5-year recurrence rate in observation group B were lower than those in control group B [(5.00\u2009\u00b1\u20091.39) vs. (7.13\u2009\u00b1\u20090.78), 3.8% (1\/26) vs. 23.3% (7\/30), 3.8% (1\/26) vs. 26.7% (8\/30), 3.8% (1\/26) vs. 26.7%(8\/30), 7.7% (2\/26) vs. 30.0% (9\/30), <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05], but the rate of flap ischemia or necrosis was higher [15.4% (4\/26) vs. 0(0\/30), <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The combination of ERAS with pilonidal sinus resection using Limberg flap graft demonstrated a reduction in infection rates, wound dehiscence, subcutaneous hematoma occurrence, and recurrence rates, along with alleviation of postoperative pain and acceleration of healing time. Comparatively, this approach offers superior advantages over pilonidal sinus resection with primary suture in the management of sacrococcygeal pilonidal sinus.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2024.1120923","type":"journal-article","created":{"date-parts":[[2024,6,13]],"date-time":"2024-06-13T04:38:34Z","timestamp":1718253514000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["The application of ERAS in pilonidal sinus: comparison of postoperative recovery between primary suture and Limberg flap procedure in a multicenter prospective randomized trial"],"prefix":"10.3389","volume":"11","author":[{"given":"Wei","family":"Lu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shujuan","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shang","family":"Xiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangsheng","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,6,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1097\/00000441-183408000-00013","article-title":"Observations on injuries and diseases of the rectum","volume":"28","author":"Mayo","year":"1834","journal-title":"Am J Med Sci"},{"key":"B2","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1056\/NEJM188011181032101","article-title":"Pilo-nidal sinus","volume":"103","author":"Hodges","year":"1880","journal-title":"Boston Med Surg J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1007\/BF02235591","article-title":"Simple and effective surgical treatment of pilonidal sinus: asymmetric excision and primary closure using suction drain and subcuticular skin closure","volume":"43","author":"Akinci","year":"2000","journal-title":"Dis Colon Rectum"},{"key":"B4","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1111\/j.1445-2197.1992.tb07208.x","article-title":"Easy and successful treatment of pilonidal sinus after explanation of its causative process","volume":"62","author":"Karydakis","year":"1992","journal-title":"Aust N Z J Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1007\/s12262-010-0226-x","article-title":"Etiological factors in umbilical pilonidal Sinus","volume":"73","author":"Co\u015fkun","year":"2011","journal-title":"Indian J Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"E1","DOI":"10.1097\/01.ASW.0000491324.29246.96","article-title":"Pilonidal Sinus disease: 10 steps to optimize care","volume":"29","author":"Harris","year":"2016","journal-title":"Adv Skin Wound Care"},{"key":"B7","doi-asserted-by":"publisher","first-page":"63","DOI":"10.17219\/acem\/44483","article-title":"The dufourmentel modification of the Limberg flap: does it fit all?","volume":"26","author":"Sebastian","year":"2017","journal-title":"Adv Clin Exp Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1177\/000313481608200728","article-title":"Gluteal fascial advancement for pilonidal cyst disease: a 10-year review","volume":"82","author":"Powell","year":"2016","journal-title":"Am Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1111\/j.1445-2197.1992.tb07208.x","article-title":"Easy and successful treatment of pilonidal sinus after explanation of its causative process","volume":"62","author":"Karydakis","year":"2010","journal-title":"ANZ J Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/S0022-3468(81)80139-X","article-title":"Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment: J. 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