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

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.

Primary closure method after asymmetrical excision of a pilonidal sinus treatment: A retrospective cohort study

“…Although some studies demonstrating higher recurrence rates after primary closure have been presented, studies supporting the primary closure method have also been published, especially in recent years. While Nihat et al [1] reported the average recurrence rate after primary closure as 3%, the recurrence rate was reported to be 7.4% in the study performed by Bulent et al [6]. These different results detected in the recurrence rates after primary closure are still a topic of discussion.…”

“…The diagnosis of recurrence is made with the formation of a new cyst after the penetration of the hair follicle into the subcutaneous tissue or the presence of a hair follicle in the granulation tissue after surgery. Recurrence after primary closure was reported with a rate of 0-42% in the literature [1,4,5,12]. Although some studies demonstrating higher recurrence rates after primary closure have been presented, studies supporting the primary closure method have also been published, especially in recent years.…”

“…The cyst should be totally excised during treatment, and different methods are used for the closure. Currently, marsupialization, primary closure, and flap methods are the most frequently used surgical techniques [1,2]. Flap methods have some disadvantages, such as the need for experience, performing wide surgical excision in the gluteal region, complaints of pain and numbness during the postoperative period, and cosmetic problems.…”

“…Flap methods have some disadvantages, such as the need for experience, performing wide surgical excision in the gluteal region, complaints of pain and numbness during the postoperative period, and cosmetic problems. Longer healing periods result from techniques where the wound is left completely or partially open, and this is the most significant disadvantage [1][2][3]. In recent years, studies have been reported that favorably regard the primary closure method, although it has a high recurrence rate [3][4][5].…”

Kite excision in complicated pilonidal sinuses: A retrospective cohort study of a tissue-sparing technique

“…Pilonidal sinus can significantly impact people's social lives and overall comfort; severe cases may require individuals to take time off from work. Minimally invasive methods have been used to treatment the disease [1,2]. However, the prevalence of PS, its recurrence rate, and changes in skin quality in the intergluteal region due to procedures can pose challenges.…”