Fenolizasyon ve SILaC Lazer: Pilonidal Sinüs Hastalığının Tedavisinde Hangisi Daha Başarılı?

Yıl 2022, , 518 - 526, 29.09.2022

Mustafa Yener Uzunoğlu , Ömer Yalkın

https://doi.org/10.31832/smj.1101780

Öz

Amaç: Bu çalışmada pilonidal sinüs hastalığının (PSD) tedavisinde fenol uygulaması ile sinüs lazer yardımıyla kapatma (SiLaC) yöntemlerini karşılaştırmayı amaçladık.
Gereç ve Yöntemler: Fenol grubunda 73, lazer grubunda 68 hasta olmak üzere toplam 141 hasta iki gruba ayrıldı. Hastaların demografik özellikleri, sigara içme durumu, komorbidite varlığı, apse drenajı öyküsü, geçirilmiş PSD cerrahisi, nüks durumu, tekrar ameliyat ihtiyacı, postoperatif komplikasyonlar, orifisin orta hattan uzaklığı ve sinüs trakt sayısı retrospektif olarak kaydedildi ve gruplar arasında karşılaştırıldı.
Bulgular: Demografik özellikler ve hastalıksız sağkalım (DFS) açısından iki grup arasında istatistiksel olarak anlamlı bir fark gözlenmedi. Daha önce pilonidal sinüs cerrahisi geçirmiş hastalarda, sigara içen hastalarda ve komplikasyon gelişen hastalarda DFS istatistiksel olarak anlamlı derecede daha kısa idi. Her iki grup arasında nüks oranı benzerdi. Daha önce geçirilmiş pilonidal sinüs cerrahisi, sigara kullanımı ve komplikasyonlar ,hastalıksız sağkalımı etkileyen faktörler olarak saptandı. Sinüs traktlarının sayısı ve orifisin orta hatta olan mesafesi nüksü etkileyen faktörlerdi. ROC eğrisi analizine göre orifis mesafesi >1.4 cm için cut-off değeri rekürens gelişimini %100 duyarlılık ve %92.91 özgüllük ile öngörmüştür.
Sonuç: Bu çalışmanın sonuçları, nispeten daha yeni olan SILaC yöntemi ile fenolizasyon tekniği arasında nüks ve başarı oranlarının benzer olduğunu göstermektedir. Komplikasyon oranları da benzerdir. PSD tedavisinde her iki yöntem de güvenli ve etkin bir şekilde kullanılabilir.

Anahtar Kelimeler

Pilonidal sinüs hastalığı, orifis, sinüs yolu, fenol, lazer, SILaC

Phenolization vs SILaC Laser: Which is More Successful in the Treatment of Pilonidal Sinus Disease?

Öz

Objective: In this study we aimed to compare phenol application and sinus laser-assisted closure (SiLaC) methods for the treatment of pilonidal sinus disease (PSD).
Materials and Methods: A total of 141 patients were divided into two groups with 73 patients being in the phenol group and 68 patients in the laser group. Patients’ demographic characteristics, smoking status, presence of co-morbidities, history of abscess drainage, previous PSD surgery, recurrence status, need for re-operation, postoperative complications, distance of orifice from the midline and number of sinus tract were retrospectively recorded and compared between the groups.
Results: No statistically significant difference was observed between the two groups in terms of demographic features and disease free survival (DFS). DFS was statistically significantly shorter in the patients with previous pilonidal sinus surgery, in smoker patients and in the patients with complications. Recurrence rate was similar between both groups. Previous pilonidal sinus surgery, smoking and complications are the factors affecting disease free survival. Number of sinus tracts and distance of the orifice to the midline are the factors affecting recurrence. According to the ROC curve analysis, a cut-off value for orifice distance >1.4 cm predicted the development of recurrence sensitivity 100%, specificity 92.91%.
Conclusion: The results of this study indicate that recurrence and success rates are similar between the relatively newer SILaC method and phenolization technique. Rate of complications is also similar. Both treatment methods can be safely and effectively used for the treatment of PSD.

Anahtar Kelimeler

Pilonidal sinus disease, orifice, sinus tract, phenol, laser, SILaC

Kaynakça

• 1. Bailey HR, Ford DB: Pilonidal Disease. Shackelford's Surgery of the Alimentary Tract 5th Ed, Vol 4 . Zuidema GD, Yeo JC (ed): Saunders, Philadelphia, PA; 2002.
• 2. de Parades V, Bouchard D, Janier M, Berger A. Pilonidal sinus disease. J Visc Surg. 2013;150(4):237-247.
• 3. Doll D. Practice parameters for the management of pilonidal disease-do no further harm?. Dis Colon Rectum. 2014;57(3):e32-e33.
• 4. 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(4):162-166.
• 5. Aysan E, Ilhan M, Bektas H, et al. Prevalence of sacrococcygeal pilonidal sinus as a silent disease. Surg Today. 2013;43(11):1286-1289.
• 6. Pini Prato A, Mazzola C, Mattioli G, et al. Preliminary report on endoscopic pilonidal sinus treatment in children: results of a multicentric series. Pediatr Surg Int. 2018;34(6):687-692.
• 7. Dessily M, Charara F, Ralea S, Allé JL. Pilonidal sinus destruction with a radial laser probe: technique and first Belgian experience. Acta Chir Belg. 2017;117(3):164-168.
• 8. Yalcin S, Ergul E. A single-surgeon, single-institute experience of 115 Lichtenstein hernia repairs under local anesthesia. Bratisl Lek Listy. 2009;110(1):43-44.
• 9. Tavassoli A, Noorshafiee S, Nazarzadeh R: Comparison of excision with primary repair versus Limberg flap . Int J Surg. 2011, 9:343-6.
• 10. Calikoglu I, Gulpinar K, Oztuna D, et al. Phenol Injection Versus Excision With Open Healing in Pilonidal Disease: A Prospective Randomized Trial. Dis Colon Rectum. 2017;60(2):161-169.
• 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(1):113-117.
• 12. Gulpinar K, Pampal A, Ozis SE, Kuzu MA. Non-operative therapy for pilonidal sinus in adolescence: crystallised phenol application, 'report of a case'. BMJ Case Rep. 2013;2013:bcr2012008382.
• 13. Olmez A, Kayaalp C, Aydin C. Treatment of pilonidal disease by combination of pit excision and phenol application. Tech Coloproctol. 2013;17:201–20
• 14. Georgiou GK: Outpatient laser treatment of primary pilonidal disease: The PiLaT technique. Tech Coloproctol 2018;22:773-778.
• 15. Pappas AF, Christodoulou DK: A new minimally invasive treatment of pilonidal sinus disease with the use of a diode laser: A prospective large series of patients. Colorectal Dis 2018;20:O207–O214.
• 16. Harju J, Söderlund F, Yrjönen A, Santos A, Hermunen K. Pilonidal disease treatment by radial laser surgery (FiLaC™): The first Finnish experience. Scand J Surg. 2021;110(4):520-523.
• 17. Dogru O, Kargin S, Turan E, Kerimoğlu RS, Nazik EE, Ates D. Long-term outcomes of crystallized phenol application for the treatment of pilonidal sinus disease [published online ahead of print, 2020 Oct 19]. J Dermatolog Treat. 2020;1-8.
• 18. Cubukçu A, Gönüllü NN, Paksoy M, Alponat A, Kuru M, Ozbay O. The role of obesity on the recurrence of pilonidal sinus disease in patients, who were treated by excision and Limberg flap transposition. Int J Colorectal Dis. 2000;15(3):173-175.
• 19. 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.
• 20. Altintoprak F, Gundogdu K, Ergonenc T, Dikicier E, Cakmak G, Celebi F. Retrospective review of pilonidal sinus patients with early discharge after Limberg flap procedure. Int Surg. 2014;99(1):28-34.
• 21. Iesalnieks I, Deimel S, Zülke C, Schlitt HJ. Smoking increases the risk of pre- and postoperative complications in patients with pilonidal disease. J Dtsch Dermatol Ges. 2013;11(10):1001-1005.
• 22. Al-Khayat H, Al-Khayat H, Sadeq A, et al. Risk factors for wound complication in pilonidal sinus procedures. J Am Coll Surg. 2007;205(3):439-444.
• 23. Vahedian J, Nabavizadeh F, Nakhaee N, Vahedian M, Sadeghpour A. Comparison between drainage and curettage in the treatment of acute pilonidal abscess. Saudi Med J. 2005 Apr;26(4):553-555.
• 24. Fabricius R, Petersen LW, Bertelsen CA. Treatment of pilonidal sinuses in Denmark is not optimal. Dan Med Bull. 2010;57(12):A4200.
• 25. 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(4):162-166.
• 26. Algazar M, Zaitoun MA, Khalil OH, Abdalla WM. Sinus laser closure (SiLaC) versus Limberg flap in management of pilonidal disease: A short term non-randomized comparative prospective study [published online ahead of print, 2021 May 6]. Asian J Surg. 2021;S1015-9584(21)00243-8.