Comparison of 3 Different Techniques in the Treatment of Pilonidal Sinus

Abstract

Aim: Pilonidal sinus (Ps) is an infectious disease characterized by pain, swelling, redness and discharge. Minimally invasive interventions that allow the patient to return to daily life more easily. In this study, it was aimed to compare the surgical excision and primary suturing, liquid phenol application and laser application in Ps treatment. Materials and methods: The files of 358 patients diagnosed with Ps and operated in the years 2019-2022 were retrospectively evaluated. The patients were divided into 3 groups. Group 1 consisted of 125 patients who underwent surgical excision and primary suturing in 2019, group 2 of 194 patients who underwent liquid phenol in 2020-2021, and group 3 of 39 patients who underwent laser in 2022. The patients were evaluated at the postoperative 7th day, 1st month and 3rd month outpatient policlinic control. Results: A significant correlation was found between the groups and the development of infection (p<0.05). Infection was detected in 30.4% of those in group 1, 15.5% of those in group 2 and 10.3% of those in group 3. Recurrence was detected in 25 (20%) of 125 patients in group 1, 24 (12.2%) of 194 patients in group 2, and 3 (7.7%) of 39 patients in group 3. There was no statistically significant relationship between the groups and recurrence (p>0.05). Recurrence was seen in 14 (36.8%) of 38 patients in group 1, 18 (60%) of 30 patients in group 2, and 2 (50%) of 4 patients in group 3. A significant correlation was found between infection and recurrence (p<0.05). Recurrence is positive in 6.3% of infection-negative patients and 47.2% of infection-positive patients. Conclusion: Rapid recovery, short operative time, low complication and recurrence rates have increased the tendency for minimally invasive methods. The presence of infection may cause recurrence regardless of the method. Postoperative infection follow-up of patients is important to reduce recurrence rates.

Keywords

• Pilonidal sinus
• child
• laser

Pilonidal Sinüs Tedavisinde 3 Farklı Tekniğin Karşılaştırılması

Öz

Amaç: Pilonidal sinüs (Ps) ağrı, şişlik, kızarıklık ve akıntı ile karakterize enfeksiyöz ve inflamatuar bir hastalıktır. Tedavide hastanın günlük yaşamına daha kolay geri dönmesini sağlayan minimal invaziv girişimler popülerdir. Bu çalışmada bir cerrahın pediatrik hastalarda dönemsel tercih ettiği cerrahi eksizyon ve primer sütürasyon, sıvı fenol uygulaması ve lazer uygulamasının postoperatif takipleri, enfeksiyon ve nüks oranları açısından karşılaştırılması amaçlandı. Materyal ve metod: 2019-2022 yıllarında Ps tanısı alıp opere edilen toplam 358 hastanın dosyaları geriye dönük tarandı. Hastalar uygulanan cerrahi müdaheleye göre 3 gruba ayrıldı. 2019 yılında cerrahi eksizyon ve primer sütürasyon yapılan 125 hasta grup 1, 2020-2021 yılında sıvı fenol uygulanan 194 hasta grup 2, 2022 yılında lazer uygulanan 39 hasta ise grup 3’ ü oluşturdu. Hastalar postoperatif 7. gün, 1. ay ve 3. ay poliklinik kontrolünde değerlendirildi. Bulgular: Gruplar ile enfeksiyon gelişimi arasında anlamlı bir ilişki bulundu (p<0,05). Grup 1’ de olanların %30,4’ünde, grup 2’ de olanların %15,5’inde ve grup 3’ te olanların %10,3’ ünde enfeksiyon saptandı. Grup 1’ de 125 hastanın 25 (%20)’ inde, grup 2’ de 194 hastanın 24 (%12.2)’ ünde, grup 3’ de ise 39 hastanın 3 (%7.7)’ ünde nüks saptandı. İstatiksel olarak gruplar ile nüks arasında anlamlı bir ilişki bulunmadı (p>0,05). Grup 1’ de enfeksiyon saptanan 38 hastanın 14 (%36.8)’ ünde, grup 2’ de 30 hastanın 18 (%60)’ inde, grup 3’ de ise 4 hastanın 2 (%50)’ sinde nüks görüldü. Enfeksiyon ile nüks arasında anlamlı bir ilişki saptandı (p<0,05). Enfeksiyon negatif olanların %6,3’ ünde, enfeksiyon pozitif olanların %47,2’ sinde nüks pozitiftir. Sonuç: Hızlı iyileşme, ameliyat süresinin kısalığı, komplikasyon ve nüks oranlarının az olması minimal invaziv yöntemlere eğilimi arttırmıştır. Enfeksiyon varlığı nüks açısından yöntemden bağımsız olarak nüks oluşumuna neden olabilir. Nüks oranlarını düşürmek için hastaların postoperatif enfeksiyon takipleri önemlidir.

Anahtar Kelimeler

• Pilonidal sinüs
• Çocuk
• Lazer
• Fenol

References

1. 1. Kallis MP, Caroline M, Aaron ML. Management of pilonidal disease. Current opinion in pediatrics. 2018; 30(3), 411-416.
2. 2. Gurbanov A, Ergün E, Göllü G, Ateş, U. Management of sacrococcygeal pilonidal sinus disease in children: A survey study in Turkey. Turkish Journal of Surgery. 2021;37(3), 260.
3. 3. Golet MR, Hinojosa AS, Ruiz YG, Villacampa RE, Broto IG, Rodríguez PB. Pilonidal sinus in adolescence: is there an ideal surgical approach? Cirugia pediatrica: organo oficial de la Sociedad Espanola de Cirugia Pediatrica. 2021; 34(3), 119-124.
4. 4. Grabowski J, Oyetunji TA, Goldin AB, Baird R, Gosain A, Lal DR, Jancelewicz T. The management of pilonidal disease: a systematic review. Journal of pediatric surgery. 2019; 54(11), 2210-2221.
5. 5. Pérez-Bertólez S, Martín-Solé O, Moraleda I, Cuesta M, Massaguer C, Palazón P, Tarrado X. Advantages of endoscopic pilonidal sinus treatment. Cir Pediatr. 2021; 34, 191-9.
6. 6. Abdelnaby M, Fathy M, Emile SH, Arnous M, Balata M, Abdelmawla A, Abdallah E. Sinus laser therapy versus sinus lay open in the management of sacrococcygeal pilonidal disease. Colorectal Disease. 2021; 23(9), 2456-2465.
7. 7. Roman R, Vasyl K, Liviy V, Oleksandr S, Dmytro P, Andriy B. Surgical treatment of pilonidal sinus in children: opportuni-ties and perspectives. Current Pediatric Research. 2021.
8. 8. Lamdark T, Vuille-dit-Bille RN, Bielicki IN, Guglielmetti LC, Choudhury RA, Peters N, Adamina M. Treatment strategies for pilonidal sinus disease in Switzerland and Austria. Me-dicina. 2020; 56(7), 341.

9. 9. Dotlacil V, Michal R, Barbora F. Initial experience with mini-mally invasive treatment of pilonidal sinus in children. Vide-osurgery and Other Miniinvasive Techniques. 2021; 16(2), 417-422.
10. 10. Pfammatter M, Tobias EE, Johannes M. Primary transverse closure compared to open wound treatment for primary pi-lonidal sinus disease in children. Children. 2020; 7(10), 187.
11. 11. Sequeira JB, Coelho A, Marinho AS, Bonet B, Carvalho F, Moreira-Pinto J. Endoscopic pilonidal sinus treatment ver-sus total excision with primary closure for sacrococcygeal pi-lonidal sinus disease in the pediatric population. Journal of Pediatric Surgery. 2018; 53(10), 2003-2007.
12. 12. Pini Prato Al, Mazzola C, Mattioli G, Escolino M, Esposito C, D’Alessio A, Meinero PC. Preliminary report on endoscopic pilonidal sinus treatment in children: results of a multicen-tric series. Pediatric Surgery International. 2018; 34(6), 687-692.
13. 13. Arslan S, Okur MH, Basuguy E, Aydogdu B, Zeytun H, Cal S, Azizoglu M. Crystallized phenol for treatment of pilonidal sinus disease in children: a comparative clinical study. Pedi-atric Surgery International. 2021; 37(6), 807-813.
14. 14. Sian TS, Herrod PJJ, Blackwell JEM, Hardy EJO, Lund JN. Fibrin glue is a quick and effective treatment for primary and recurrent pilonidal sinus disease. Techniques in colo-proctology. 2018; 22(10), 779-784.
15. 15. Hardy EJO, Herrod PJ, Doleman B, Phillips HG, Ranat R, Lund JN. Surgical interventions for the treatment of sacrococcyg-eal pilonidal sinus disease in children: A systematic review and meta-analysis. Journal of pediatric surgery. 2019; 54(11), 2222-2233.
16. 16. Dessily M, Dziubeck M, Chahidi E, Simonelli V. The SiLaC procedure for pilonidal sinus disease: long-term outcomes of a single institution prospective study. Techniques in Coloproctology. 2019; 23(12), 1133-1140.
17. 17. Esposito C, Mendoza-Sagaon M, Del Conte F, Cerulo M, Coppola V, Esposito G, Escolino M. Pediatric endoscopic pi-lonidal sinus treatment (PEPSiT) in children with pilonidal si-nus disease: tips and tricks and new structurated protocol. Frontiers in Pediatrics. 2020; 8, 345.
18. 18. Ates U, Ergun E, Gollu G, Sozduyar S, Kologlu M, Cakmak M, Yagmurlu A. Pilonidal sinus disease surgery in children: the first study to compare crystallized phenol application to primary excision and closure. Journal of pediatric surgery. 2018; 53(3), 4.
19. 19. Halleran DR, Lopez JJ, Lawrence AE, Sebastião YV, Fischer BA, Cooper JN, Minneci PC. Recurrence of pilonidal disease: our best is not good enough. Journal of Surgical Research. 2018; 232, 430-436.
20. 20. Esposito C, Turrà F, Cerulo M, Del Conte F, Esposito G, Prato AP, Escolino M. Technical standardization of MIS manage-ment of children with pilonidal sinus disease using pediatric endoscopic pilonidal sinus treatment (PEPSiT) and laser epi-lation. Journal of pediatric surgery. 2020; 55(4), 761-766.
21. 21. Yildiz T, Elmas B, Yucak A, Turgut HT, Ilce Z. Risk factors for pilonidal sinus disease in teenagers. The Indian Journal of Pediatrics. 2017; 84(2), 134-138.
22. 22. Esposito C, Gargiulo F, Izzo S, Cerulo M, Del Conte F, Severi-no G, Escolino M. Pediatric endoscopic pilonidal sinus treatment: an effective procedure for children with recur-rent pilonidal sinus disease after failed open surgery. Jour-nal of Laparoendoscopic& Advanced Surgical Techniques. 2019; 29(7), 981-986.
23. 23. Braungart S, Powis M, Sutcliffe JR, Sugarman ID. Improving outcomes in pilonidal sinus disease. Journal of pediatric sur-gery. 2016; 51(2), 282-284.