Web-Exclusive Content: Didactic Video Collection
Fu, Chuangang M.D.; Deng, Yewei M.D.; Liu, Mengcheng M.D.
Department of Colorectal Surgery, Shanghai East Hospital, School of Medicine, Tongji University, China
Funding/Support: None reported.
Financial Disclosure: None reported.
Correspondence: Chuangang Fu, M.D., Department of Colorectal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 200120, No. 150, Jimo Rd, Pudong New Area, Shanghai 200120, China. E-mail: [email protected]
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
TEACHING POINTS
Patient Preparation
- Complete the preoperative examination, such as MRI, to clarify the scope of the lesion.
- Preoperative bowel preparation: the patient keeps fasting after lunch the day before surgery and then takes oral laxatives for bowel preparation.
- Preoperative skin preparation: shave the body hair of the sacrococcygeal and perianal area the day before surgery.
- Preoperative indwelling catheter.
Patient Position
- Patient is positioned in the Jackknife position.
- Patient is given spinal anesthesia.
Key Steps
- Designation the surgical margin.
- Excision of the affected lesion.
- Preparation of Limberg flap.
- Placement of drainage tubes.
- Flap rotation and closure of the incision.
Technical Tips
- Ensure that the subcutaneous tissues are freed to make rotation of the flap easier and decrease tension.
- Ensure complete removal of the lesion.
- Minimize the depth of tissue excision.
- Minimize incision tension.
- Take only the amount of tissue necessary during the excision.
- Keep the prone position for 1 week after the operation.
Potential Complication
- Watch out for wound infections. If wound infection occurs, active anti-infection treatment should be taken.
VIDEO SUMMARY
This video demonstrates the Limberg flap procedure for the management of recurrent pilonidal sinus. We show the complete management of the pilonidal sinus, including preoperative preparation, key steps and techniques of the surgery, and postoperative care. The basic causes of recurrence after surgical treatment of pilonidal sinus are possible incomplete resection, postoperative dead space, chronic inflammation, secondary infections, and so on. Therefore, it is important to resect the lesion completely and suture the flap without leaving dead space.
KEY IMAGE
See video on DCR YouTube Channel at https://youtu.be/66Sk0nb6uF
{"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video.","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_40dz6gas"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]}
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Colon and Rectal Surgeons.
