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

Kaynakça

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