RESUMEN
This study aims to determine advantages, disadvantages, and long-term results of rhomboid excision and Limberg flap procedure for sacrococygeal pilonidal sinus repair using either general or spinal anesthesia. A prospective randomized study involved 40 patients with sacrococygeal pilonidal sinus disease scheduled for elective pilonidal sinus excision using the Limberg rhomboid flap technique. The patients were asked about their complaints and choice of treatment. Physical examination was performed, and hospital records were reviewed. The 40 patients were randomized into two equal groups: group G, general anesthesia, with endotracheal intubation and group S, spinal anesthesia, who got 2.5 ml of 0.5% heavy marcaine with 25 micro g fentanyl subarachnoid injection, Total operating room time, time from entry into theatre till readiness for surgery, duration of surgery, time from end of surgery till shift to recovery room, recovery room time, onset of pain, analgesic use in recovery room, in the ward and at home, patients satisfaction, hospital stay and time taken to return to normal activity were compared. Perioperatfve side effects, wound healing and surgical complications were recorded. P <0.05 is considered statistically significant. All patients were satisfied with the final surgical results except 3 cases in group G who got seroma with negative bacterial culture and 2 cases in group S; 1 partial wound dehiscence and 1 purulent discharge. $o recurrent cases were recorded over the period of two years follow up. Time of hospital stay and time taken to return to normal activity were comparable in both groups; P > 0.05, Total operating room time and time from end of surgery till shift to recovery room were less in group S; P<0.05. However, time spent in recovery room was less in group G; P <0.05. Group S patients complained of pain after a longer period of time and required less analgesics in the first 24 postoperative hours; P<0.05. Patients were more satisfied with anesthesia in group S; P < 0.05. Anesthetic problems in group G included 2 laryngeal spasm, 3 nausea/vomiting, 1 respiratory depression, and 4 sore throat cases. On the other hand, group S problems included 1 pruritis and 1 urine retention cases. Rhomboid excision and Limberg flap procedure for managing sacrococcygeal pilonidal sinus has a low complication rate, short hospital stay, short time to return to normal activity and good long-term results. The procedure is proved to be safe whether done under general or spinal anesthesia. However, spinal anesthesia using 2.5 ml 0.5% heavy marcaine and 25 micro g fentanyl ensures less operating room time, better patient anesthesia satisfaction and prolonged postoperative analgesia. General and spinal anesthesia were proved to be safe in prone position if required precautions are followed