Comparison of crystallized phenol and Karidakis flap treatment in pilonidal sinus disease.

PURPOSE: In this study, we aimed to compare the results of Karidakis flap reconstruction with crystallized phenol in pilonidal sinus treatment. METHODS: 216 patients treated for pilonidal sinus disease with the researched methods between June 2016 and July 2019 were included in the study. RESULTS: 142 (65.7%) of the patients were treated with the KFR technique and 74 (34.3%) with the crystallized phenol method. Of the patients included in the study, 157 (72.7%) were male, and 59 (27.3%) were female. The mean age was calculated as 24.89 (± 8.4). The mean hospital stay in the KFR group was 1.21 (± 0.4) days. The mean time to return to work was 2.79 (± 1.03) days in the phenol group and 15.35 (± 3.39) days in the KFR group. In 4 (5.4%) patients, the improvement could not be achieved despite multiple sessions of phenol administration, and the procedure was considered unsuccessful. Recurrence occurred in 6 patients (4.22%) in the KFR group. The mean follow-up period was 13.44 (11-16) months in the KFR group and 13.67 (11-16) months in the phenol group. CONCLUSION: It is thought that phenol administration can be applied in selected single-pit cases with high success, low complications, hospitalization, and early return to work. While the KFR method's lower recurrence rates are advantageous, it was noteworthy that the complication rates were higher. KEY WORDS: Crystallized phenol, Karydakis flap reconstruction, Pilonidal sinus disease.

Clinical outcomes of crystallized phenol as a first treatment option in patients with recurrent pilonidal sinus.

AIM: This study aimed to observe the clinical outcomes of phenol treatment in patients with recurrent pilonidal sinus disease. MATERIAL AND METHODS: This study retrospectively collected data from 107 patients with recurrent the pilonidal disease who received phenol treatment in a single institute. Patients were divided into two groups as successful treatment (ST) and unsuccessful treatment (UST) after phenol application. A comparison was held between groups to define factors associated with failure treatment. RESULTS: There were 89 patients in ST and 18 patients in UST group. The treatment success rate after phenol treatment was 83.2%. We observed no difference between ST and UST in terms of age, gender, family history, surgical technique at the first operation, time to recurrence, procedure time, follow-up time, time to return to work, walk without pain or sit on the toilet without pain (p>0.05). However, smoking rate, presence of comorbidity, and mean BMI were statistically significantly higher in the UST group compared to the ST group (p<0.05). In addition, being obese (OR: 2.45, 95% CI: 1.07 - 5.60), having a comorbid disease (OR: 3.11, 95% CI: 1.29 - 7.47), and smoking (OR: 1.97, 95% CI: 0.85 - 4.53) were significantly associated with treatment failure. CONCLUSION: Phenol treatment is an effective and simple procedure that could be easily applied even in rural hospitals in an outpatient fashion. Therefore, it should be considered for patients suffering from recurrence without the need for an aggressive surgical excision. KEY WORDS: Crystallized phenol, Pilonidal sinus, Recurrence.

Effect of treatment of pilonidal sinus with phenol on patients' clinical condition and quality of life.

BACKGROUND: Pilonidal sinus is a common disease. Curative treatment is surgical excision. However, minimally invasive surgery is preferred day by day. Our study aimed to compare the effects of phenol and excision on postoperative results and quality of life in the treatment of pilonidal sinus. METHODS: The patients who underwent surgery with the diagnosis of the pilonidal sinus in our clinic between June 2019 and June 2021 were examined. Demographic data, anthropometric measurements, clinical information, treatment, and postoperative data of the patients were recorded. Daily pain follow-up with daily visceral pain scale (VPS) was performed in the first ten days postoperatively, and a short form 36 (SF-36) questionnaire was used in the first and fourth weeks. The patients were grouped as phenol and excision groups and compared. RESULTS: The study included 145 patients. Phenol was applied to 83 (57.2%) patients, and excision was applied to 62 (42.8%) patients. There was no statistically significant difference between the groups regarding age, gender, BMI, number of pilonidal sinuses, and family history (p>0.05). Return to work, painless walking and sitting on the toilet, and mean daily VPS values in the phenol group were significantly shorter than the excision group (p<0.05). All subscale values in the postoperative first week SF-36 results were significantly higher than in the excision group (p<0.001) in the phenol group. CONCLUSION: Phenol is effective in the treatment of pilonidal sinus. Despite excision, treatment with phenol affects the patient's quality of life less in the early postoperative period. KEY WORDS: Minimally invasive surgery , Pilonidal sinus, Phenol, Quality of life.

A comparison of crystal phenol treatment, midline primary closure and Limberg flap reconstruction methods in female patients with primary pilonidal sinus disease.

Pilonidal sinus disease (PSD) is a chronic problem often occurs in healthy hirsute men, however, women may also be affected. A range of conservative techniques to surgical flaps have been used to treat this condition. Currently, midline primary closure (MPC) is considered the standard of therapy; however, no statistically significant difference has been noted between primary versus secondary (Karydakis flap or Limberg flap) closure. Recently, flap reconstruction methods have been applied and superiority of these methods have been shown. Treatment methods should be employed to the individual, taking into account recurrence and complication rates of the method, recovery time, patients' preference and surgeon's skill. KEY WORDS: Crystal Phenol Treatment, Female Patient, Pilonidal Sinus, Limberg Flap Reconstruction, Primary Midline Closure.

Crystallized phenol for treatment of pilonidal sinus disease in children: a comparative clinical study.

BACKGROUND: The aim of this study was to present our experience in the use of crystallized phenol (CP) to treat pediatric patients with 'simple' and complex' Pilonidal sinus disease (PSD). MATERIALS AND METHODS: Patients who underwent CP treatment in between January 2015 and January 2020 were evaluated retrospectively, using prospectively collected data. The patients were divided into simple and complicated groups. The groups were assigned depending on the number of sinuses and clinical presentation. The groups were compared in terms of age, sex, number of sessions, cost analysis, body mass index (BMI), recurrence, time resolution, cosmetic results, results /improvement, and complications. RESULTS: This study included 54 patients: 28 (52%) girls and 26 (48%) boys. The mean number of sinuses was 2.4. Symptoms included discharge in 50 (92%) patients, and pain in 42 (78%) patients. Fifty (93%) patients experienced mild pain during the procedure, whereas four (7%) patients had moderate pain. The mean number of CP sessions was 2.9; mean numbers of CP sessions were 2.2 and 4.2 in the Simple and Complicated groups. In total, 5 of 54 patients (9%) had recurrence.At the end of treatment, therapeutic success was achieved in 49 of 54 (91%) patients: 31 of 33 (94%) patients in the Simple group and 18 of 21 patients (86%) in the complicated group. The mean treatment cost for the whole cohort was $17.40. One patient (2%) presented with moderate skin burns. Cosmesis was deemed acceptable by patients, although there was evidence of minor skin burns following the procedure. CONCLUSIONS: The findings showed that the CP procedure was advantageous for treatment of PSD, because it was minimally invasive, cost-effective, provided good cosmesis, and had a high success rate and low complication rate. Furthermore, it did not require prior examination, and could be performed under local anesthesia. Therefore, the CP procedure may be useful as a first-line treatment option in children with PSD.

Is Hair Removal Necessary after Crystallized Phenol Treatment in Pilonidal Disease?

OBJECTIVE: The most important cause of posttreatment recurrence of pilonidal sinus disease (PSD) is the reentry of hair into the skin. The study aimed to investigate the effect of hair removal and its duration on the prevention of recurrence after crystallized phenol treatment. SUBJECT AND METHODS: Patients with PSD who were treated with crystallized phenol treatment were evaluated. Hair in the sacrococcygeal area was removed with depilatory cream before every crystallized phenol procedure, during the treatment, and after treatment once a month for 6 years. Of 1,016 patients, 735 were contacted by telephone or e-mail regarding the frequency of sacrococcygeal hair removal and recurrence. Demographic and sinus features and crystallized phenol application data of patients treated with crystallized phenol for PSD, as well as recurrences were retrospectively assessed. RESULTS: The mean follow-up time was 46.23 ± 33 (range, 11-240) months, with 139 (18.9%) patients experiencing recurrence. Patients who underwent hair removal experienced significantly less recurrence than those who did not (p = 0.003, odds ratio [OR]: 0.54 [95% CI: 0.36-0.82]). The OR of recurrence decreased by 0.8% every month as the hair removal time increased (OR: 0.992, 95% CI: 0.985-1.000, p = 0.049). The cutoff value for sensitivity was 0.636, specificity 0.466, and area under the curve 0.562 in hair removal procedures that lasted for over 30 months. CONCLUSION: Regular hair removal during, and at least 30 months after, crystallized phenol treatment reduced recurrences in patients with PSD.

Use of Silver Nitrate Application as Mini-Invasive Treatment of Pilonidal Sinus Disease.

OBJECTIVES: To investigate the cure rate and adverse effects of silver nitrate application for treatment of pilonidal sinus disease (PSD). Methods: Number of sinus pit orifices, and complications with silver nitrate application and debridement for sacrococcygeal PSD between January 2015 and July 2018 were analyzed in this retrospective study. Data were obtained from surgical, discharge, and outpatient follow-up records. Among 56 patients who were treated with silver nitrate stick, 11 patients with incomplete hospital records were excluded from the study. Demographic data including age, gender, length of follow-up, number of silver nitrate applications, number of involved sinuses and recurrence and complication rates were recorded. Results were expressed as frequencies, means, and range of values. The Mann Whitney U and chi square tests were used to evaluate significance. Results: Mean age was 24.3 +- 5.18 (range, 14 - 36) years, and recurrence occurred in 4 (8.9%) patients. Complications developed in 10 (22.2%) patients and included abscess, erythema, and necrosis in 5 (11.1%), 2 (4.4%), and 3 (6.6%) patients, respectively. The recurrence rate was significantly higher in patients who developed abscesses during the follow-up period (p = 0.001) than those who did not. There was no statistically significant correlation between the recurrence rate and number of sinuses or the number of silver nitrate applications. CONCLUSION: Low morbidity and high healing rates achieved with silver nitrate provide support for this application as a feasible and effective conservative outpatient treatment for PSD in certain patients.

Pilonidal sinus disease surgery in children: the first study to compare crystallized phenol application to primary excision and closure.

INTRODUCTION: Pilonidal sinus (PS) is an infectious and inflammatory disease of sacrococcygeal region. Current methods include; surgical excision with/without suturing the defect, rhomboid excision and flap and chemical substance application. In this study, crystallized phenol application was compared to excision and primary closure. PATIENTS AND METHODS: This retrospective study included pediatric patients with PS who were treated with excision and primer closure technique and phenol application. The patients' medical data were analyzed retrospectively. RESULTS: This study included 117 patients with PS. There were 52 girls (44%) and 65 boys (56%). Mean age of children was 15.6 (12-20) years. Excision and primary closure were applied to 77 patients (66%) and phenol was applied to 40 patients (34%). The children in phenol group were discharged on the operation day; mean hospitalization time in the excision and primary closure group was 2.7 (1-14) days. Mean follow up was 44.6 (8-82) months for primary excision and closure group and 8.1 (1-19) months for phenol group. CONCLUSION: Although many surgical and non-surgical treatment modalities have been described for PS, the optimal one remains unknown. Limited with the retrospective nature of the data, crystallized phenol application seems a feasible minimal invasive alternative to primary closure of PS with lower recurrence and complication rates in children. TREATMENT STUDY: Level III.

Pilonidal sinus disease can be treated with crystallized phenol using a simple three-step technique.

INTRODUCTION: Pilonidal sinus disease can be treated with various surgical techniques. However, invasive surgical techniques harbor the risk of wound infection and require a long postoperative wound healing period. The treatment of pilonidal sinus disease with crystallized phenol is minimally invasive with a short postoperative recovery period. This article explains how to treat pilonidal sinus disease with crystallized phenol using a quick and easy three-step technique. METHODS: Between August 2014 and January 2016, 43 male and 7 female patients with pilonidal sinus disease were treated with crystallized phenol. Hair was gently removed from the sinus openings with a mosquito clamp. Afterwards, the pilonidal sinus openings were gently filled with crystallized phenol. RESULTS: The closure of pilonidal sinus openings without any leakage after a single application of crystallized phenol was accepted as healing. The treatment failed in two of the female patients, who had had prior pilonidal sinus surgery, and in four of the male patients, who had a recurrence after wound site infection. The overall cure rate was 88%. CONCLUSIONS: Treatment of pilonidal sinus disease with crystallized phenol using the three-step technique is simple, fast, and comfortable. Therefore, crystallized phenol should be preferentially considered in the treatment of pilonidal sinus disease.

Novel Approaches in Pilonidal Sinus Treatment.

Pilonidal sinus is a very common inflammatory disease of the gluteal region. The ideal method of pilonidal sinus treatment should have a low recurrence rate with minimum excision. Moreover, the treatment method should have a short hospitalization time, should let the patient return to his normal life rapidly, should cause minimum loss of labour and should result a small scar only. In the presented review, modalities in pilonidal sinus treatment in the light of current information in the literature are evaluated.

Comparison of early surgery (unroofing-curettage) and elective surgery (Karydakis flap technique) in pilonidal sinus abscess cases.

BACKGROUND: The aim of this study is to compare the effectiveness and success of early (acute) period local surgical intervention (unroofing-curettage) followed by dressing and secondary healing with the surgery performed in elective conditions (pilonidal sinus excision and Karydakis flap) following conventional abscess treatment (drainage-antibiotic therapy) in pilonidal sinus abscess cases. METHODS: The data of the patients treated for pilonidal sinus abscesses in our clinic between January 2012 and March 2013 were analyzed, retrospectively. Those who had early surgery were determined as Group S, and those who had elective surgery following drainage-antibiotic therapy were determined as Group K. Patients in both groups were compared in terms of age, gender, complications, recurrence rate and healing time. Patients were followed for an average of 14 months. RESULTS: Of the 53 patients included in the study, 28 were in Group S and 25 in Group K. The mean age and gender distribution of both groups were similar and a significant difference was not found between the groups in terms of complication development and recurrence. However, there was a statistically significant difference between the groups in terms of treatment duration (p=0.02). CONCLUSION: In treating acute pilonidal abscesses, the Karydakis method, following drainage-antibiotic therapy, is a preferable method due to its shorter treatment duration and higher patient comfort.

Is gentamicin-impregnated collagen sponge to be recommended in pilonidal sinus patient treated with marsupialization? A prospective randomized study.

BACKGROUND: The ideal treatment method for pilonidal sinus has always been a matter of debate. Although primary closure or various flap applications offer shorter wound healing times, their infection rates are very high. Secondary recovery involves long recovery period. The aim of this study is to investigate the effects of gentamicin-impregnated collagen sponge on wound healing and infection in patients undergoing marsupialization. PATIENTS AND METHODS: Fifty patients were included in the study. Twenty-five patients in control group (Group 1) underwent excision and marsupialization. Gentamicin-impregnated collagen sponge was used postoperatively in twentyfive patients in group 2. Three-dimensional wound measurements were made on the 0.7 and 15th days and recorded. RESULTS: No significant difference was observed between the groups in terms of development of hemorrhage and infection. Excessive granulation was detected in five patients (two in group 1 and three in group 2). There was no significant difference between the groups with respect to this criterion. Full recovery times were 29.6 and 28.2 days respectively. No statistically significant difference was observed between the groups (p = 0.571). None of the patients developed recurrence at the end of the follow-up period of 6-30 months. CONCLUSION: In accordance with the results obtained in this randomized and controlled study, no significant difference was observed between gentamicin-impregnated collagen sponge group and control group with respect to development of infection, hemorrhage and wound healing times. Therefore, we do not recommend the use of gentamicin-impregnated collagen sponge after marsupialization. KEY WORDS: Gentamicin-impregnated collagen sponge, Marsupialization, Pilonidal sinus.

Non-operative therapy for pilonidal sinus in adolescence: crystallised phenol application, 'report of a case'.

Pilonidal sinus (PS) is an acquired disease at the sacrococcygeal region that can be treated by different surgical techniques. Crystallised phenol application seems to be an alternative therapy to surgery with higher success rates, lower costs, faster recovery and earlier return to work. We aimed to state the success of phenol application for PS in adolescence. A 14-year-old boy with recurrent PS, an 18-year-old girl with the history of pilonidal abscess and a 15-year-old girl with PS was hospitalised. All patients underwent phenol application in an outpatient setting. The patients were followed thereafter. The 14-year-old boy and 18-year-old girl did not face any problems and all sinuses healed completely. The 15-year-old girl was followed for 2 weeks because of intergluteal maceration and ongoing drainage. She underwent another phenol application and the course after intervention was uneventful with complete healing of the sinus. Crystallised phenol application seems to be a promising non-operative therapy for PS in adolescents.

Treatment of pilonidal disease by combination of pit excision and phenol application.

AIM: To examine the results of our minimal invasive treatment for pilonidal disease. METHODS: Total 83 patients treated by pit excision and consecutive phenol applications on an outpatient setting. All procedures were performed under local anesthesia, without any preoperative testing, colon cleansing, prophylactic antibiotics or sedation. A pit excision (mean length 1.3 ± 0.5 cm) including several close midline orifices was done. Separated pit excisions were done to the remaining midline and lateral orifices. Sinus cavity was cleared of hair and debris, and the walls of the cavity were sclerosed using a cotton bud dipped in 80% liquid phenol. Phenolization was repeated twice on day one and seven. RESULTS: Mean procedure time was 22.2 ± 7.4 min. Rates of patients who did not required analgesics at first, second, third and fourth days after surgery were 58, 85, 91 and 100%, respectively. All the patients returned to work/school after 3 days. Mean wound closure time was 28.5 ± 14.9 days. Total 86.7% of the patients were asymptomatic after a mean 25.7 ± 8.5 months follow-up. CONCLUSION: Simple pit excision and sclerosing the pilonidal sinus cavity consecutively was an effective and minimal invasive method for relief of pilonidal symptoms.

Converting emergency pilonidal abscess into an elective procedure.

BACKGROUND: Improvements in outcome after surgery for elective pilonidal sinus disease have yet to be matched for those presenting with acute disease. Traditional approaches to the management of acute pilonidal abscess have been associated with slow healing and significant loss of working time. OBJECTIVE: The aim of this study was to report our approach in which a temporizing intervention allows subsequent definitive treatment with low morbidity. DESIGN: This article presents a prospective cohort study. SETTING: This study was performed in acute admissions to the Surgical Unit in York Teaching Hospital. PATIENTS: Patients presenting with acute pilonidal abscess, not septic, immune-compromised, or diabetic, and without skin necrosis, underwent aspiration on the surgical ward. INTERVENTION: Aspiration of pilonidal abscess under local anesthetic was performed with the use of a wide-bore needle. The abscess cavity was drained to dryness, samples were sent to the laboratory for microbiology, and empirical oral antibiotics were commenced, covering anaerobes and aerobes. Review was arranged for within 7 days to plan elective excision and primary closure of the underlying pilonidal sinus. MAIN OUTCOME MEASURES: The primary outcomes measured were the number of days required to return to normal activities, response to treatment, and any residual inflammation. RESULTS: Fifty-six patients were referred with acute pilonidal abscess. Forty patients met the criteria for aspiration and empirical antibiotic treatment. All were allowed to go home the same day and were reviewed within a median of 5 days. Thirty-eight (38/40) patients demonstrated complete resolution of acute inflammation and were back to normal activities the following day. Fifteen patients subsequently underwent day-case excision and primary closure at a median of 9 weeks. Another 13 are awaiting surgery, and 10 patients have declined further treatment. Two (2/40) patients did not respond, one of whom did not receive the appropriate antibiotics. Both were managed with incision and drainage. CONCLUSIONS: Aspiration and antibiotic management of pilonidal abscess is effective in 95% of acute cases in preventing the need for emergent laying open and allows for subsequent elective surgery.

Pilonidal sinus disease and tuberculosis.

Pilonidal disease is a disease of young people, usually men, which can result in an abscess, draining sinus tracts, and moderate debility for some. It probably results from hair penetration beneath the skin, for reasons that are not totally clear. A pilonidal sinus in the sacrococcygeal region is associated with recurrent infection, abscess formation, cellulitis, and fistulae. The infection is usually chronic and non-specific. However, few reports of granulomatous infection like tuberculosis and actinomycosis in pilonidal sinus have been observed. The presentation of tuberculosis in these sinuses may have wide forms, with atypical and uncharacteristic clinical picture, making it difficult to make a diagnosis preoperatively. This paper discusses about pilonidal sinus disease and tubercular infiltration in these sinuses. The diagnosis of tuberculosis in pilonidal sinus disease is elusive, necessitating a high index of suspicion. The literature on the tubercular affliction of pilonidal sinus is scant. Novel diagnostic modalities such as adenosine deaminase levels and polymerase chain reaction (PCR) can be useful in doubtful situations. Physicians should obtain a thorough history focusing on risk behaviors for human immunodeficiency virus infection (HIV) and tuberculosis. Treatment comprises of standard regimen of antitubercular medication and a modest surgical approach towards the sinuses.

A pediatric surgeon's 35-year experience with pilonidal disease in a Canadian children's hospital.

BACKGROUND: There is an ongoing debate regarding the optimal surgical management for pilonidal disease in the pediatric population. The purpose of this study was to evaluate a pediatric surgeon's experience at a Canadian children's hospital over 35 years. METHODS: We performed a retrospective review of the charts of patients seen and treated from July 1969 to December 2003, inclusive. All patients were evaluated for age, sex, clinical diagnosis, infection, treatment, healing time, complications and results. RESULTS: In all, 121 adolescents with pilonidal disease (64 boys, 57 girls) with a mean age of 15 (range 12-19) years were evaluated at the same children's hospital. The 107 (88%) patients with infection (46% acute) underwent surgery. At operation, all 107 pilonidal cysts were either excised and packed open, marsupialized or excised and closed primarily without drainage under general anesthesia; the operation performed was arbitrarily chosen. Vacuum-assisted closure was not used. All patients received antibiotics. The time for healing after the initial operation in the group whose cysts were excised and packed open was at least twice as long (75 d) as in the other 2 groups (p = 0.031). Disease recurred in 24 (22%) patients, 6 (25%) of whom experienced 2 recurrences. Among the 90 patients in the excised and packed open group, 20 (22%) experienced recurrences and 5 (25%) experienced 2 recurrences. Among the 13 patients in the marsupialized group, 3 (23%) experienced recurrences and 1 (33%) experienced 2 recurrences. Among the 4 patients in the excised and closed primarily without drainage group, 1 (25%) experienced a recurrence and none experienced 2 recurrences (p = 0.12). Each recurrence was smaller than the original. All wounds eventually healed. There were no other complications and no deaths. A multivariable logistic regression analysis revealed that the type of surgical approach was not predictive of recurrence after controlling for age and sex. CONCLUSION: Age, sex and surgical approach were not predictive of recurrence. From our experience, excision and packing open the wound produced a longer morbidity but offered the same results compared with marsupialization or excision and primary closure without drainage.