Comparison of excision and primary closure vs. crystallized phenol treatment in pilonidal sinus disease: A comparative retrospective study

Year 2021, Volume: 5 Issue: 10, 1007 - 1010, 01.10.2021

Veysel Barış Turhan , Abdulkadir Ünsal , Doğan Öztürk , Bülent Öztürk , Hakan Buluş

https://doi.org/10.28982/josam.1001636

Abstract

Background/Aim: Pilonidal sinus is an inflammatory condition that affects the intergluteal sulcus. Since there is no standard treatment for pilonidal sinus, comparative studies are needed. Our study aimed to comparatively evaluate the treatment success, postoperative complications and recurrence in excision/primary repair surgery and crystallized phenol application in pilonidal sinus disease.
Methods: A total of 376 pilonidal sinus patients over the age of 18 years who visited our general surgery clinic between January 2017-January 2020 were included in this retrospective cohort study. They were divided into two groups based on whether they underwent phenol treatment or surgery. The patients' age, body mass index (BMI), gender, number of pits, length of stay in the hospital, return to normal life, mean follow-up times, complications, and satisfaction data were recorded. At the end of the follow-up period, all patients were contacted by telephone and the recurrence rates were noted.
Results: Both groups were similar in terms of age, gender, and BMI (P>0.05 for all). The mean age of 374 patients included in the study was 23.38 (4.9) years. The mean follow-up time was 25.47 months. Patients in the crystallized phenol group did not require hospitalization. In the primary repair group, the median length of hospital stay was 1.15 days. Complications such as wound infection, hematoma, and wound dehiscence were significantly less in the phenol group. The recurrence rates in the phenol and primary repair groups were 8% and 10%, respectively (P=0.326). Return to normal life was significantly faster in the phenol group. The success rate in the phenol group was 92%.
Conclusion: Although the recurrence rates are similar, crystallized phenol therapy is superior to primary repair due to better wound healing rates, ease of application, and fewer complication rates. More than one application is recommended in phenol treatment.

Keywords

Pilonidal sinus disease, Crystallized phenol, Primary repair

References

• 1. Allen-Mersh T. Pilonidal sinus: finding the right track for treatment. Br J Surg. 1990;77:123-32.
• 2. Yiğit B, Yetkin SG, Çitgez B, Eken KG, Özşahin H. Intermammary pilonidal sinus: A case report of a 23-year-old girl. J Surg Med. 2020;4(2):170-2.
• 3. Khan N, Singhal P, Chandrashekhar S, Goel D, Patel K, Deshpande N. Is limberg flap better than excision and primary closure for treatment of sacrococcygeal pilonidal sinus: a prospective randomised study of 30 cases. Int Surg J. 2021;8:699-703.
• 4. Sequeira JB, Coelho A, Marinho AS, Bonet B, Carvalho F, Moreira-Pinto J. Endoscopic pilonidal sinus treatment versus total excision with primary closure for sacrococcygeal pilonidal sinus disease in the pediatric population. J Pediatr Surg. 2018;53:2003-7.
• 5. Jabbar MS, Bhutta MM, Puri N. Comparison between primary closure with Limberg Flap versus open procedure in treatment of pilonidal sinus, in terms of frequency of post-operative wound infection. Pak J Med Sci. 2018;34:49.
• 6. Sinnott CJ, Glickman LT. Limberg flap reconstruction for sacrococcygeal pilonidal sinus disease with and without acute abscess: Our experience and a review of the literature. Arch Plast Surg. 2019;46:235.
• 7. Romaniszyn M, Swirta J, Walega P. Long‐term results of endoscopic pilonidal sinus treatment vs Limberg flap for treatment of difficult cases of complicated pilonidal disease: a prospective, nonrandomized study. Colorectal Dis. 2020;22:319-24.
• 8. Akkurt G, Ataş H. Comparison of Crystallized Phenol Application and the Karydakis Flap Technique in the Treatment of Sacrococcygeally Localized Pilonidal Sinus Disease. Cureus. 2021;13(5):e15030 .
• 9. Maurice B, Greenwood R. A conservative treatment of pilonidal sinus. Br J Surg. 1964;51:510-2.
• 10. Dogru O, Camci C, Aygen E, Girgin M, Topuz Ö. Pilonidal Sinus Treated With Crystallized Phenol. Dis Colon Rectum. 2004;47:1934-8.
• 11. Dag A, Colak T, Turkmenoglu O, Sozutek A, Gundogdu R. Phenol procedure for pilonidal sinus disease and risk factors for treatment failure. Surgery. 2012;151:113-7.
• 12. Kayaalp C, Olmez A, Aydin C, Piskin T, Kahraman L. Investigation of a one-time phenol application for pilonidal disease. Med Princ Pract. 2010;19:212-5.
• 13. Tavassoli A, Noorshafiee S, Nazarzadeh R. Comparison of excision with primary repair versus Limberg flap. Int J Surg. 2011;9(4):343-6.
• 14. Cubukçu A, Carkman S, Gönüllü NN, Alponat A, Kayabaşi B, Eyüboğlu E. Lack of evidence that obesity is a cause of pilonidal sinus disease. Eur J Surg. 2001 Apr;167(4):297-8.
• 15. Turkoglu A, Bozdag Z, Gumus M, Oguz A, Gul M, Yılmaz A, et al. Comparison of crystallized phenol treatment and simple primary closure methods for pilonidal sinus disease. Int Sur. 2018;103:424-8.
• 16. Karakayali F, Karagulle E, Karabulut Z, Oksuz E, Moray G, Haberal M. Unroofing and marsupialization vs. rhomboid excision and Limberg flap in pilonidal disease: a prospective, randomized, clinical trial. Dis Colon Rectum. 2009;52:496-502.
• 17. Roshdy H, Ali Y, Askar W, Awad I, Farid M, Farid M. Rhomboid flap versus primary closure after excision of saccrococcigeal pilonidal sinus (a prospective randomized study). Egypt J Surg. 2010;29:146-52.
• 18. Al-Jaberi TM. Excision and simple primary closure of chronic pilonidal sinus. Eur J Surg. 2001;167:133-5.
• 19. Kaya B, Uçtum Y, Şimşek A, Kutaniş R. Treatment of pilonidal sinus with primary closure. A simple and effective method. Turk J Colorectal Dis. 2010;20:59-65.
• 20. Calikoglu I, Gulpinar K, Oztuna D, Elhan AH, Dogru O, Akyol C, et al. Phenol injection versus excision with open healing in pilonidal disease: a prospective randomized trial. Dis Colon Rectum. 2017;60:161-9.
• 21. Attaallah W, Coşkın Ş, Coşkun M, Solmaz A, Yeğen C, Gençosmanoğlu R. The impact of crystalline phenol application as a minimal invasive treatment modality for pilonidal sinus disease. Turk J Colorectal Dis. 2015;25:28-33.
• 22. Akan K, Tihan D, Duman U, Özgün Y, Erol F, Polat M. Comparison of surgical Limberg flap technique and crystallized phenol application in the treatment of pilonidal sinus disease: a retrospective study. Ulus Cerrahi Derg. 2013;29:162.
• 23. Kayaalp C, Aydin C. Review of phenol treatment in sacrococcygeal pilonidal disease. Tech Coloproctol. 2009;13(3):189-93.
• 24. Sakçak İ, Avşar FM, Coşgun E. Comparison of the application of low concentration and 80% phenol solution in pilonidal sinus disease. JRSM Short Rep. 2010;1:1-5.
• 25. Aygen E, Arslan K, Dogru O, Basbug M, Camci C. Crystallized phenol in nonoperative treatment of previously operated, recurrent pilonidal disease. Dis Colon Rectum. 2010;53:932-5.
• 26. Yuksel ME. Pilonidal sinus disease can be treated with crystallized phenol using a simple three-step technique. Acta Dermatovenerol Alp Pannonica Adriat. 2017;26:15-7.
• 27. Bayhan Z, Zeren S, Duzgun SA, Ucar BI, Yumun HNA, Mestan M. Crystallized phenol application and modified Limberg flap procedure in treatment of pilonidal sinus disease: A comparative retrospective study. Asian J Surg. 2016;39:172-7.