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Huurman EA, Galema HA, de Raaff CAL, Wijnhoven BPL, Toorenvliet BR, Smeenk RM. Non-excisional techniques for the treatment of intergluteal pilonidal sinus disease: a systematic review. Tech Coloproctol 2023; 27:1191-1200. [PMID: 37930579 PMCID: PMC10638206 DOI: 10.1007/s10151-023-02870-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023]
Abstract
Non-excisional techniques for pilonidal sinus disease (PSD) have gained popularity over the last years. The aim of this study was to review short and long-term outcomes for non-excisional techniques with special focus on the additive effect of treatment of the inner lining of the sinus cavity and the difference between primary and recurrent PSD. A systematic search was conducted in Embase, Medline, Web of Science Core Collection, Cochrane and Google Scholar databases for studies on non-excisional techniques for PSD including pit picking techniques with or without additional laser or phenol treatment, unroofing, endoscopic techniques and thrombin gelatin matrix application. Outcomes were recurrence rates, healing rates, complication rates, wound healing times and time taken to return to daily activities. In total, 31 studies comprising 8100 patients were included. Non-excisional techniques had overall healing rates ranging from 67 to 100%. Recurrence rates for pit picking, unroofing and gelatin matrix application varied from 0 to 16% depending on the follow-up time. Recurrence rates after additional laser, phenol and endoscopic techniques varied from 0 to 29%. Complication rates ranged from 0 to 16%, and the wound healing time was between three and forty-seven days. The return to daily activities varied from one to nine days. Non-excisional techniques are associated with fast recovery and low morbidity but recurrence rates are high. Techniques that attempt to additionally treat the inner lining of the sinus have worse recurrence rates than pit picking alone. Recurrence rates do not differ between primary and recurrent disease.
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Affiliation(s)
- E A Huurman
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
| | - H A Galema
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands
| | - C A L de Raaff
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - B P L Wijnhoven
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - B R Toorenvliet
- Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands
| | - R M Smeenk
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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Iesalnieks I. [Is Pit Picking Surgery the Standard of Treatment for Uncomplicated Pilonidal Disease?]. Zentralbl Chir 2023; 148:254-258. [PMID: 37267980 DOI: 10.1055/a-2044-0850] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Minimally invasive surgery for pilonidal disease was first described in 1965, but it has only become widespread in the last two decades. The present manuscript discusses the technique of pit picking surgery, its variations, indications, alternatives and the results.
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Affiliation(s)
- Igors Iesalnieks
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Ev. Krankenhaus Köln-Kalk, Köln, Deutschland
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Long-term Outcome of Radical Excision Versus Phenolization of the Sinus Tract in Primary Sacrococcygeal Pilonidal Sinus Disease: A Randomized Controlled Trial. Dis Colon Rectum 2022; 65:1514-1521. [PMID: 36102853 DOI: 10.1097/dcr.0000000000002475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Phenolization of pilonidal sinus disease has been shown to have advantages over radical excision with regard to short-term outcome; however, long-term outcomes are essentially lacking. OBJECTIVE The aim of this randomized controlled trial was to compare the long-term outcome of pit excision and phenolization of the sinus tracts vs radical excision with primary wound closure in pilonidal sinus disease. DESIGN Single-center, randomized controlled trial. SETTINGS A primary teaching hospital in the Netherlands. PATIENTS The study population included patients with primary pilonidal sinus disease presented between 2013 and 2017. INTERVENTIONS Patients were randomly assigned to either pit excision with phenolization of the sinus tract(s) or excision with primary off-midline wound closure. MAIN OUTCOME MEASURES The main outcomes included recurrence, quality of life (Short-Form 36), and patient's satisfaction. RESULTS A total of 100 patients were randomized. Seventy-four patients (77.1%) were available for long-term follow-up. The mean (±SD) time to follow-up was 48.4 (±12.8) months for the phenolization group and 47.8 (±13.5) months for the excision group. No significant difference was found between both groups regarding quality of life. Two patients in the phenolization group (5.6%) and 1 in the excision group (2.6%) developed a recurrence ( p = 0.604). The impact of the whole treatment was significantly less after phenolization ( p = 0.010). LIMITATIONS The response rate was almost 80% in this young patient population, patients and assessors were not blinded for the type of surgery, and the results are only applicable to primary pilonidal sinus disease. CONCLUSIONS Because of the previously shown favorable short-term results and the currently reported comparable long-term recurrence rate and quality of life between phenolization and excision, phenolization should be considered the primary treatment option in patients with pilonidal sinus disease. See Video Abstract at http://links.lww.com/DCR/C27 . DUTCH TRIAL REGISTER ID NTR4043. RESULTADO A LARGO PLAZO DE LA ESCISIN RADICAL FRENTE AL TRATAMIENTO CON FENOL DEL TRACTO SINUSAL EN LA ENFERMEDAD DEL SENO PILONIDAL SACRO COCCGEO PRIMARIO UN ENSAYO ALEATORIO CONTROLADO ANTECEDENTES:El tratamiento con fenol de la enfermedad del seno pilonidal ha demostrado tener ventajas sobre la escisión radical con respecto al resultado a corto plazo; sin embargo, los resultados a largo plazo aún se encuentran escasos.OBJETIVO:El objetivo de este ensayo aleatorio controlado fue comparar el resultado a largo plazo de la escisión de la fosa del quiste y el tratamiento con fenol de los trayectos sinusales frente a la escisión radical con cierre primario de la herida en la enfermedad del seno pilonidal.DISEÑO:Ensayo aleatorio controlado de un solo centro.AJUSTES:Hospital de enseñanza primaria en los Países Bajos.PACIENTES:Pacientes con enfermedad primaria del seno pilonidal presentados entre 2013 y 2017.INTERVENCIONES:Los pacientes fueron asignados de manera aleatoria a la escisión de la fosa del quiste y posterior administración de fenol de los tractos sinusales o a la escisión con cierre primario de la herida fuera de la línea media.PRINCIPALES MEDIDAS DE RESULTADO:Recurrencia, calidad de vida (Short-Form 36) y satisfacción del paciente.RESULTADOS:Un total de 100 pacientes con enfermedad primaria del seno pilonidal fueron aleatorizados; 50 pacientes fueron sometidos al tratamiento con fenol y 50 a la escisión radical. Eventualmente, 74 pacientes (77,1%) estuvieron disponibles para seguimiento a largo plazo; 36 pacientes después del uso del fenol y 38 después de la escisión. El tiempo medio (± desviación estándar) de seguimiento fue de 48,4 (± 12,8) y 47,8 (± 13,5) meses, respectivamente. No hubo diferencia significativa entre ambos grupos con respecto a la calidad de vida. En el grupo tratado con fenal, dos pacientes (5,6%) desarrollaron recurrencia y un paciente (2,6%) en el grupo de escisión ( p = 0,604). El impacto de todo el tratamiento fue significativamente menor después del uso del fenol (p = 0,010).LIMITACIONES:La tasa de respuesta fue de casi el 80% en esta población de pacientes jóvenes, los pacientes y los evaluadores no estaban cegados por el tipo de cirugía, los resultados son solo aplicables a la enfermedad primaria del seno pilonidal.CONCLUSIONES:Debido a los resultados favorables a corto plazo descritos y a la tasa de recurrencia a largo plazo y la calidad de vida comparables actualmente informadas entre la administración de fenol y la escisión con cierre primario de la herida para la enfermedad primaria del seno pilonidal, la administración de fenol del tracto sinusal debe considerarse como opción de tratamiento primario en pacientes con enfermedad del seno pilonidal. Consulte Video Resumen en http://links.lww.com/DCR/C27 . (Traducción-Dr. Osvaldo Gauto )Registro de prueba holandés-ID:NTR4043.
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Pilonidal disease: A new look at an old disease. SEMINARS IN COLON AND RECTAL SURGERY 2022. [DOI: 10.1016/j.scrs.2022.100909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Şengül S, Güler Y, Çalış H, Kubat M, Karabulut Z. Crystallized phenol treatment vs excision and primary closure in pilonidal sinus disease: A randomized clinical trial in adolescent patients. J Pediatr Surg 2022; 57:513-517. [PMID: 33814182 DOI: 10.1016/j.jpedsurg.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Pilonidal sinus is a chronic inflammatory disease seen in the intergluteal sulcus. A wide variety of treatment modalities have been described for the management of this disease, however optimal therapy remains controversial. The study aims to compare phenol treatment, a minimally invasive method used in the treatment of pilonidal sinus disease, with the commonly practiced surgical methods of excision and primary closure in the adolescent age group. PATIENTS AND METHODS Adolescent patients who presented with pilonidal sinus disease between January 2018 and December 2018 were randomized into 2 groups as phenol treatment and surgical treatment (after obtaining consent for the study). Early complications and recurrence rates after 24 months of follow-up were the two main endpoints of the study. RESULTS A total of 100 patients (phenol group n = 50, surgery group n = 50) were included in the study. Both groups were similar in terms of age, gender, and BMI. The mean duration of the procedure was 12.4 ± 2.84 min in the phenol group and 42.3 ± 7.22 min in the surgery group (p = 0.00). There was no difference in postoperative complications between the groups (p = 0.22). After 24 months of follow-up, recurrence was found in 8% (n = 4) of the cases in the phenol group and 10% (n = 5) of the cases in the surgery group (p = 0.5). CONCLUSION In our study, phenol treatment and excision/primary closure methods for pilonidal sinus disease have similar complication and recurrence rates. However, phenol treatment seems to be the method of choice in the adolescent age group as it has the advantage of being a minimally invasive method and it does not affect subsequent surgical treatments. LEVEL OF EVIDENCE Level II treatment study.
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Affiliation(s)
- Serkan Şengül
- Alanya Alaaddin Keykubat University Medical Faculty, Department of General Surgery, 07400 Alanya, Antalya, Turkey
| | - Yılmaz Güler
- Alanya Alaaddin Keykubat University Medical Faculty, Department of General Surgery, 07400 Alanya, Antalya, Turkey.
| | - Hasan Çalış
- Alanya Alaaddin Keykubat University Medical Faculty, Department of General Surgery, 07400 Alanya, Antalya, Turkey
| | - Mehmet Kubat
- Alanya Alaaddin Keykubat University Medical Faculty, Department of General Surgery, 07400 Alanya, Antalya, Turkey
| | - Zülfikar Karabulut
- Alanya Alaaddin Keykubat University Medical Faculty, Department of General Surgery, 07400 Alanya, Antalya, Turkey
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Iesalnieks I, Ommer A, Herold A, Doll D. German National Guideline on the management of pilonidal disease: update 2020. Langenbecks Arch Surg 2021; 406:2569-2580. [PMID: 33950407 PMCID: PMC8097120 DOI: 10.1007/s00423-020-02060-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The present German National Guideline is an updated version of previous Guideline published in 2014. It aims to compare various treatment methods and to assist physicians with evidence-based recommendations. METHODS Systemic literature review. RESULTS Three types of disease manifestation could be differentiated: asymptomatic disease, an acute abscess, and the chronic pilonidal disease. At present, there is no treatment method fulfilling all desired criteria: simple, painless procedure associated with rapid wound healing, and low recurrence rate. Thus, treatment modality should be tailored to disease manifestation and extent. CONCLUSION Asymptomatic pilonidal disease should not be treated. A pilonidal abscess should be unroofed. After resolution of the acute inflammation, the disease should be treated definitely. As for today, sinus excision is the standard treatment of the chronic pilonidal disease. Wide excision and open treatment of chronic disease is a safe procedure which, however, leads to prolonged secondary healing and time off-work, as well as to considerable recurrence rate. The extent of excision should be as limited as possible. Excision and midline wound closure is associated with impaired outcomes. Today, it has become obsolete. Minimally invasive procedures (e.g., pit picking surgery) represent a treatment option for chronic pilonidal disease. However, the recurrence rate is higher compared to excision procedures. Nevertheless, they may be used for small primary disease. Off-midline procedures should be used for disease not suitable for minimally invasive treatments. The Limberg flap and the Karydakis procedure are two best described methods which are associated with similar short- and long-term results.
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Affiliation(s)
- I Iesalnieks
- Dept. of Surgery, München Klinik Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany.
| | - A Ommer
- End- und Dickdarm-Zentrum Essen, Essen, Germany
| | - A Herold
- End- und Dickdarmzentrum Mannheim, Mannheim, Germany
| | - D Doll
- Dept. of Procto-Surgery, St. Marienhospital Vechta, Vechta, Germany
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Ommer A, Iesalnieks I, Doll D. S3-Leitlinie: Sinus pilonidalis. 2. revidierte Fassung 2020. COLOPROCTOLOGY 2020. [DOI: 10.1007/s00053-020-00488-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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The management of pilonidal disease: A systematic review. J Pediatr Surg 2019; 54:2210-2221. [PMID: 30948198 DOI: 10.1016/j.jpedsurg.2019.02.055] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/02/2019] [Accepted: 02/27/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to derive recommendations from the medical literature regarding the management of pilonidal disease. METHODS The PubMed, Cochrane, Embase, Web of Science, and Scopus databases from 1965 through June 2017 were queried for any papers addressing operative or non-operative management of pilonidal disease. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Consensus recommendations were derived for three questions based on the best available evidence, and a clinical practice guideline was constructed. RESULTS A total of 193 articles were fully analyzed. Some non-operative and minimally invasive techniques have outcomes at least equivalent to operative management. Minimal surgical procedures (Gips procedure, sinusectomy) may be more appropriate as first-line treatment than radical excision due to faster recovery and patient preference, with acceptable recurrence rates. Excision with midline closure should be avoided. For recurrent or persistent disease, any type of flap repair is acceptable and preferred by patients over healing by secondary intention. There is a lack of literature dedicated to the pediatric patient. CONCLUSIONS There is a definitive trend towards less invasive procedures for the treatment of pilonidal disease, with equivalent or better outcomes compared with classic excision. Midline closure should no longer be the standard surgical approach. TYPE OF STUDY Systematic review of level 1-4 studies. LEVEL OF EVIDENCE Level 1-4 (mainly level 3-4).
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Demirel AH, Polat M. Long-Term Outcomes of Crystallized Phenol Application after Punch Excision for the Treatment of Pilonidal Sinus Disease. Am Surg 2019. [DOI: 10.1177/000313481908501126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of the study was to present the outcomes of topical crystallized phenol application in the treatment of pilonidal sinus disease. Under local anesthesia, a punch biopsy tool is used for the excision of the sinus opening holes; after cleaning the cavity, 150 to 250 mg of crystallized phenol was administered. Three sessions of additional therapy were given one week apart without anesthesia. The technique was well tolerated, and early results were observed two months after the procedure. Recurrence was detected in five patients (11.9%), one of whom underwent two more sessions, resulting in recovery. In the long-term results, 39 patients were available after 16 to 38 months (mean 23.7 months). Of these, recurrence was detected in five patients (12.8%). Analysis of the data was unable to identify significant effects of the characteristics of the disease (primary or recurrent), gender of patients, and the number of opening holes (single or multiple) on early and late recurrence ( P > 0.05). A close correlation can be drawn from the early- and long-term results after treatment ( P < 0.0001). In this study, the use of the punch biopsy tool in the treatment of pilonidal sinus disease with crystallized phenol was described first. This minimally invasive method achieved excellent aesthetic outcomes, and it can successfully be applied without the need for surgical intervention, especially in patients who are at the initial stage and with small in size openings.
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Affiliation(s)
- Arif Hakan Demirel
- General Surgery Clinic, Ankara Education and Research Hospital, Health Sciences University, Ankara, Turkey and
| | - Mikail Polat
- General Surgery Clinic, Yenimahalle Education and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
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Impact of geography and surgical approach on recurrence in global pilonidal sinus disease. Sci Rep 2019; 9:15111. [PMID: 31641150 PMCID: PMC6805955 DOI: 10.1038/s41598-019-51159-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022] Open
Abstract
Pilonidal sinus disease (PSD) is increasing globally. A recent meta-analysis and merged-data analysis showed that recurrence rates in PSD depend essentially on follow-up time and specific surgical procedures. However, the global distribution of surgical approaches and respective recurrence rates have never been studied in PSD. We aimed at studying the impact of geographic distribution of surgical approaches to treat PSD and subsequent geography-specific recurrence rates. We searched relevant databases as described previously. Recurrence rates were then associated with reported follow-up times and geographic origin. We simulated individual patients to enable analogy across data. Globally, recurrence rates range from 0.3% for Limberg/Dufourmentel approaches (95% CI 0.2–0.4) and flaps (95% CI 0.1–0.5) and up to 6.3% for incision (95% CI 3.2–9.3) at 12 months. Recurrence rates range from 0.3% for Karydakis/Bascom approaches (95% CI 0.0–0.8) up to 67.2% for incision (95% CI 7.5–100) in the USA, and 0.0% for primary asymmetric closure in Germany (95% CI 0.0–0.0). Our analysis shows that recurrence rates in PSD not only depend on therapeutic approaches and follow-up time but also on geography. Primary asymmetric closure and various flap techniques remain superior regardless of the geographical region. Some approaches have extraordinarily good outcomes in specific countries.
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Short-term outcomes of radical excision vs. phenolisation of the sinus tract in primary sacrococcygeal pilonidal sinus disease: a randomized-controlled trial. Tech Coloproctol 2019; 23:665-673. [PMID: 31278458 DOI: 10.1007/s10151-019-02030-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Phenolisation of Sacrococcygeal pilonidal sinus disease (SPSD) seems to have advantages over radical excision; however, a randomized-controlled trial (RCT) comparing both techniques is lacking. The aim of our study was to compare sinus pit excision and phenolisation of the sinus tract with radical excision in SPSD in terms of return to normal daily activities. METHODS This study was a single-center RCT. Fifty patients who presented with primary SPSD were randomized to phenolisation and 50 patients to excision. The primary endpoint was time to return to normal daily activities. Secondary endpoints were quality of life, complaints related to SPSD, surgical site infection, and wound epithelialization. Patients were treated in a 1-day surgery setting. Complaints related to SPSD were evaluated and symptoms were scored by the participants on a 6-point scale before surgery, and patients kept a diary for 2 weeks on complaints related to the surgical treatment (the same scoring system as preoperatively) and pain, evaluated with a VAS. Quality of life (QoL) was measured preoperatively with a VAS and the Short Form-36 Health Survey (SF-36). At 2, 6, and 12 weeks after surgery, patients were evaluated using a questionnaire containing the following items: patients' satisfaction (disease, compared with preoperatively, scored as cured, improved, unchanged or worsened), five complaints related to the surgical treatment (the same scoring system as preoperatively and in the diary), QoL (VAS and SF-36), and return to normal daily activities. The wound was assessed 2, 6, and 12 weeks postoperatively by one of the investigators (EF or NS), using an assessment form RESULTS: The mean time to return to normal daily activities was significantly shorter after phenolisation (5.2 ± SD 6.6 days vs. 14.5 ± 25.0 days, p = 0.023). 2 weeks after surgery, all patients in the phenolisation group and 85.4% of patients in the excision group returned to normal daily activities (p = 0.026). Pain was significantly lower after phenolisation at 2 weeks postoperatively (0.8 ± 1.0 vs. 1.6 ± 1.3, p = 0.003). Surgical site infection occurred significantly more often after radical excision (n = 10, 21.7% vs. n = 2, 4.0%, p = 0.020). At 6 and 12 weeks, complete wound epithelialization was more frequently achieved after phenolisation (69.0% vs. 37.0%, p = 0.003 and 81.0% vs. 60.9%, p = 0.039, respectively). CONCLUSIONS Pit excision with phenolisation of SPSD resulted in a quicker return to normal daily activities, less pain, and quicker wound epithelialization compared to radical excision. Surgeons should consider phenolisation in patients with primary SPSD.
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The American Society of Colon and Rectal Surgeons' Clinical Practice Guidelines for the Management of Pilonidal Disease. Dis Colon Rectum 2019; 62:146-157. [PMID: 30640830 DOI: 10.1097/dcr.0000000000001237] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Stauffer VK, Luedi MM, Kauf P, Schmid M, Diekmann M, Wieferich K, Schnüriger B, Doll D. Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep 2018; 8:3058. [PMID: 29449548 PMCID: PMC5814421 DOI: 10.1038/s41598-018-20143-4] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/15/2018] [Indexed: 12/24/2022] Open
Abstract
We systematically searched available databases. We reviewed 6,143 studies published from 1833 to 2017. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract. We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3-0.9%) 12 months and 1.8% (95%CI 1.1-2.4%) respectively 24 months postoperatively. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1-0.3%) 12 months and 0.6% (95%CI 0.5-0.8%) 24 months postoperatively. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3-82.4%) 240 months post-surgery. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure.
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Affiliation(s)
- V K Stauffer
- Lindenhofspital, Lindenhofgruppe, 3010, Bern, (VS), Switzerland
| | - M M Luedi
- Department of Anaesthesiology, Bern University Hospital Inselspital, University of Bern, 3010, Bern, (MML), Switzerland
| | - P Kauf
- Biomedical Statistics PROGNOSIX AG, 8001, Zurich, (PK, MS), Switzerland
| | - M Schmid
- Biomedical Statistics PROGNOSIX AG, 8001, Zurich, (PK, MS), Switzerland
| | - M Diekmann
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377, Vechta, (KW, DD), Germany
| | - K Wieferich
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377, Vechta, (KW, DD), Germany
| | - B Schnüriger
- Department of Visceral Surgery and Medicine, Bern University Hospital Inselspital, University of Bern, 3010, Bern, (BS), Switzerland
| | - D Doll
- Department of Procto-Surgery, St. Marien-Krankenhaus Vechta, Teaching Hospital of the Hannover University, 49377, Vechta, (KW, DD), Germany.
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Mutus HM, Aksu B, Uzun E, Gulcin N, Gercel G, Ozatman E, Durakbasa CU, Okur H. Long-term analysis of surgical treatment outcomes in chronic pilonidal sinus disease. J Pediatr Surg 2018; 53:293-294. [PMID: 29217319 DOI: 10.1016/j.jpedsurg.2017.11.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/08/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Chronic pilonidal sinus disease (PSD) is relatively common in adolescents and can be treated by various surgical techniques. This study aimed to evaluate the outcome in adolescents surgically treated for PSD in a single clinic. METHODS PSD patients surgically treated over an 8-year period were retrospectively evaluated. Classical midline incision and excision with primary repair was performed in all. Regular follow up visits were scheduled. Evaluation of postoperative outpatient clinic records as well as telephone interviews for patients who were operated more than 6months ago were done for the long-term results, including coherence to regional hair care. RESULTS There were 268 patients with a median age of 16years; 146 (54%) were males, and 122 (46%) were females. Outpatient follow up records were available for 249 (92.9%) patients with a median of postoperative 3months (7days-49months). Moreover, 114 (42.5% of total) patients were interviewed by telephone 6-63 (median 25) months after the surgery. In 36 (13.4%) patients, wound infection or dehiscence occurred within the first month of surgery and was treated by secondary healing. Recurrences were observed in 21 (7.8%) patients all having poor local hygiene. Laser epilation was employed in 32 (28%) patients, and none of these had recurrences. CONCLUSIONS Classical midline incision and primary closure approach for surgical treatment of PSD in adolescents has similar results to adults. Postoperative hair removal seems to reduce recurrences. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE Level IV (Retrospective case series with no comparison group).
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Affiliation(s)
- Huseyin Murat Mutus
- Department of Pediatric Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Burhan Aksu
- Department of Pediatric Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Ersan Uzun
- Department of Pediatric Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Neslihan Gulcin
- Department of Pediatric Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Gonca Gercel
- Department of Pediatric Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Erdem Ozatman
- Department of Pediatric Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Cigdem Ulukaya Durakbasa
- Department of Pediatric Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.
| | - Hamit Okur
- Department of Pediatric Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
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15
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Abstract
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.
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Affiliation(s)
- Arda Isik
- Department of General Surgery, School of Medicine, Erzincan University, Erzincan, Turkey.
| | - Oguz Idiz
- Department of General Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Deniz Firat
- Department of General Surgery, Sevket Yılmaz Training and Research Hospital, Bursa, Turkey
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Emiroğlu M, Karaali C, Esin H, Akpınar G, Aydın C. Treatment of pilonidal disease by phenol application. Turk J Surg 2017; 33:5-9. [PMID: 28589180 PMCID: PMC5448572 DOI: 10.5152/ucd.2016.3532] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 03/24/2016] [Indexed: 12/22/2022]
Abstract
The literature indicates various approaches regarding the properties of phenol, the target patient group, and the complication and recurrence rates. Although phenol is most frequently used to treat the fistulated form of the disease, it can also be applied for other types. The overall success and complication rates of the application is reported as 62-95% and 0%-2%, respectively. Phenol treatment in pilonidal disease can be used more frequently as an alternative method with acceptable success, complication, and recurrence rates.
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Affiliation(s)
- Mustafa Emiroğlu
- Department of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Cem Karaali
- Department of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Hüseyin Esin
- Department of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Göksever Akpınar
- Department of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Cengiz Aydın
- Department of General Surgery, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
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18
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Phenol Injection Versus Excision With Open Healing in Pilonidal Disease: A Prospective Randomized Trial. Dis Colon Rectum 2017; 60:161-169. [PMID: 28059912 DOI: 10.1097/dcr.0000000000000717] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Minimally invasive procedures may be an alternative to surgical excisions for pilonidal disease. OBJECTIVE The aim of the study was to compare phenol injection versus excision with open healing technique. DESIGN This is a prospective randomized study (ACTRN12612000868886). SETTINGS This study was conducted at the Ankara University and Ufuk University Departments of Surgery. PATIENTS One hundred forty patients were randomly assigned to phenol injection (n = 70) or excision with open healing (n = 70). MAIN OUTCOME MEASURES The primary end point of the study was the time to complete wound healing. Secondary end points were visual analog scale pain score, painkiller intake, time to resume daily activities, recurrence rate, Short Form 36 Health Survey, and Nottingham Health Profile at 3 weeks after surgery. RESULTS Time to complete wound healing (16.2 ± 8.7 versus 40.1 ± 9.7 days) was significantly in favor of the phenol injection group (p < 0.001). The median operation time was 14.0 ± 3.8 minutes in the phenol group versus 49.0 ± 24.2 minutes in the excision with open healing group (p < 0.001). The time to resume daily activities (pain-free mobilization and defecation) was 0.8 ± 2.8 and 16.2 ± 12.6 hours after phenol injection and 9.3 ± 10.0 and 22.5 ± 15.1 hours after the excision with open healing treatment (p < 0.001, p = 0.008). Visual analog pain score at 48 hours and painkiller intake within 48 hours were significantly in favor of the phenol injection group. At the mean follow-up of 39.2 ± 9.0 months after surgery, no differences were seen in the recurrence rate between the treatment arms (13 recurrences in phenol vs 9 in excision with open healing; p = not significant). Short Form 36 and Nottingham Health Profile scores at 3 weeks after surgery were also in favor of phenol injection. LIMITATIONS The present study was not double blinded, and a history of abscess drainage was significantly higher in the surgery group. CONCLUSIONS Based on the results, we conclude that phenol injection is as effective as the excision with open healing technique.
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Iesalnieks I, Ommer A, Petersen S, Doll D, Herold A. German national guideline on the management of pilonidal disease. Langenbecks Arch Surg 2016; 401:599-609. [DOI: 10.1007/s00423-016-1463-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/08/2016] [Indexed: 01/30/2023]
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20
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Kayaalp C, Ertugrul I, Tolan K, Sumer F. Fibrin sealant use in pilonidal sinus: Systematic review. World J Gastrointest Surg 2016; 8:266-273. [PMID: 27022454 PMCID: PMC4807328 DOI: 10.4240/wjgs.v8.i3.266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the current data about the success rates of fibrin sealant use in pilonidal disease.
METHODS: Fibrin sealant can be used for different purposes in pilonidal sinus treatment, such as filling in the sinus tracts, covering the open wound after excision and lay-open treatment, or obliterating the subcutaneous dead space before skin closure. We searched Pubmed, Google-Scholar, Ebsco-Host, clinicaltrials, and Cochrane databases and found nine studies eligible for analysis; these studies included a total of 217 patients (84% male, mean age 24.2 ± 7.8).
RESULTS: In cases where fibrin sealant was used to obliterate the subcutaneous dead space, there was no reduction in wound complication rates (9.8% vs 14.6%, P = 0.48). In cases where sealant was used to cover the laid-open area, the wound healing time and patient comfort were reported better than in previous studies (mean 17 d, 88% satisfaction). When fibrin sealant was used to fill the sinus tracts, the recurrence rate was around 20%, despite the highly selected grouping of patients.
CONCLUSION: Consequently, using fibrin sealant to decrease the risk of seroma formation was determined to be an ineffective course of action. It was not advisable to fill the sinus tracts with fibrin sealant because it was not superior to other cost-effective and minimally invasive treatments. New comparative studies can be conducted to confirm the results of sealant use in covering the laid-open area.
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Emiroglu M, Karaali C, Salimoglu S, Sert I, Ugurlu L, AydÄ N C. The effect of phenol concentration on the treatment of pilonidal sinus disease: Early results of a prospective randomized study. Int Surg 2016; 101:127-132. [PMID: 27007030 DOI: 10.9738/intsurg-d-15-00120.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVE Our hypothesis was that a low concentration (30%) of phenol would be more effective than a high concentration (80%) in the treatment of pilonidal disease. The purpose of our study was to compare the effects of high and low doses of liquid phenol in the treatment of pilonidal disease. SUMMARY OF BACKGROUND DATA In the treatment of the pilonidal disease, the phenolization technique and concentration of the phenol solution is not well defined. METHODS Consecutive patients being treated for pilonidal disease with high and low concentrations of phenol were included in this randomized prospective study. The demographic data, pilonidal disease characteristics, and results of phenol application were examined. RESULTS Of 101 subjects, 52 were treated with 80% phenol while 49 were treated with 30% phenol. The mean observation period was approximately 1 year. The total recovery rate was higher among the 80% phenol group (P: 0.046). The recovery period, the period of leave from work, and complication rates were similar in both groups (p: 0.414, 0.328, 0.256). Also, in the Likert-type survey administered by validated methods, there was no difference in the degree of satisfaction (P: 0.494). CONCLUSION The low concentrations of phenol did not achieve faster recovery, faster return to work, or less complications in the treatment of pilonidal disease. An 80% concentration of phenol should be used for a higher rate of recovery.
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Affiliation(s)
- Mustafa Emiroglu
- 1 Tepecik Training and Research Hospital, Department of General Surgery, Izmir, Turkey
| | - Cem Karaali
- 1 Tepecik Training and Research Hospital, Department of General Surgery, Izmir, Turkey
| | - Semra Salimoglu
- 1 Tepecik Training and Research Hospital, Department of General Surgery, Izmir, Turkey
| | - Ismail Sert
- 1 Tepecik Training and Research Hospital, Department of General Surgery, Izmir, Turkey
| | - Levent Ugurlu
- 1 Tepecik Training and Research Hospital, Department of General Surgery, Izmir, Turkey
| | - Cengiz AydÄ N
- 1 Tepecik Training and Research Hospital, Department of General Surgery, Izmir, Turkey
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22
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The treatment of pilonidal disease: guidelines of the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol 2015; 19:607-13. [DOI: 10.1007/s10151-015-1369-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
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23
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Furnée EJB, Davids PHP, Pronk A, Smakman N. Pit excision with phenolisation of the sinus tract versus radical excision in sacrococcygeal pilonidal sinus disease: study protocol for a single centre randomized controlled trial. Trials 2015; 16:92. [PMID: 25872666 PMCID: PMC4359780 DOI: 10.1186/s13063-015-0613-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 02/18/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Excision of the pit of the sinus with phenolisation of the sinus tract and surgical excision are two treatment modalities for patients with sacrococcygeal pilonidal sinus disease. Phenolisation seems to have advantages over local sinus excision as it is performed under local anaesthesia with a relatively small surgical procedure, less postoperative pain, minor risk of surgical site infection (8.7%), and only a few days being unable to perform normal activity (mean of 2.3 days). The disadvantage may be the higher risk of recurrence (13%) and the necessity to perform a second phenolisation in a subgroup of patients. Wide surgical excision of sacrococcygeal pilonidal sinus disease has a recurrence rate of 4 to 11%. The disadvantages, however, are postoperative pain, high risk of surgical site infection, and a longer period being unable to perform normal activity (mean of 10 days). The objective of this study is to show that excision of the pit of the sinus of sacrococcygeal pilonidal sinus disease with phenolisation of the sinus tract is a successful first-time treatment modality for sacrococcygeal pilonidal sinus disease accompanied by a quicker return to normal daily activity compared to local excision of the sinus. METHODS/DESIGN Patients with sacrococcygeal pilonidal sinus disease will be randomly allocated to excision of the pit of the sinus followed by phenol applications of the sinus tract or radical surgical excision of the sinus. Patients are recruited from a single Dutch teaching, non-university hospital. The primary endpoint is loss of days of normal activity/working days. Secondary endpoints are anatomic recurrence rate, symptomatic recurrence rate, quality of life, surgical site infection, time to wound closure, symptoms related to treatment, pain, usage of pain medication and total treatment time. To demonstrate a reduction of return to normal activity from 7.5 days in the excision group to 4 days in the phenolisation group, with 80% power at 5% alpha, a total sample size of 100 is required. DISCUSSION This study is a randomised controlled trial to provide evidence that phenolisation of the sinus tract compared to radical excision reduces the total number of days unable to perform normal activity. TRIAL REGISTRATION Dutch trial register NTR4043 , registered on 24 June 2013.
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Affiliation(s)
- Edgar J B Furnée
- Diakonessenhuis, Department of Surgery, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, Netherlands.
| | - Paul H P Davids
- Diakonessenhuis, Department of Surgery, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, Netherlands.
| | - Apollo Pronk
- Diakonessenhuis, Department of Surgery, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, Netherlands.
| | - Niels Smakman
- Diakonessenhuis, Department of Surgery, Bosboomstraat 1, P.O. Box 80250, 3508 TG, Utrecht, Netherlands.
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Ommer A, Berg E, Breitkopf C, Bussen D, Doll D, Fürst A, Herold A, Hetzer F, Jacobi T, Krammer H, Lenhard B, Osterholzer G, Petersen S, Ruppert R, Schwandner O, Sailer M, Schiedeck T, Schmidt-Lauber M, Stoll M, Strittmatter B, Iesalnieks I. S3-Leitlinie: Sinus pilonidalis. COLOPROCTOLOGY 2014. [DOI: 10.1007/s00053-014-0467-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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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. ULUSAL CERRAHI DERGISI 2013; 29:162-6. [PMID: 25931870 DOI: 10.5152/ucd.2013.2457] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 11/22/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was designed to compare the efficacy of crystallized phenol method with Limberg flap in pilonidal sinus treatment. MATERIAL AND METHODS Patients with a diagnosis of pilonidal sinus disease treated with surgical excision + Limberg rhomboid flap technique and crystallized phenol method between 2010-2011 in the Şevket Yılmaz Training and Research Hospital, Department of General Surgery were evaluated retrospectively. Patients' age, sex, length of hospital stay, complications and recurrence rates were evaluated. RESULTS Eighty eight percent of patients were male and mean age was 26.84±6.41 in the Limberg group, and 24.72±5.00 in the crystallized phenol group. Sinus orifice locations and nature, and duration of symptoms before surgery were similar in the two groups. Length of hospital stay in the Limberg group was 1.46±0.61 days; whereas all patients in the crystallized phenol group were discharged on the same day. Infection, hematoma, wound dehiscence, and cosmetic problems were significantly higher in the Limberg group. There was no difference between the two groups in terms of recurrence and seroma formation. CONCLUSION The less invasive method of crystallized phenol application may be an alternative approach to rhomboid excision and Limberg flap in patients with non-complicated pilonidal sinus disease, yielding acceptable recurrence rates.
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Affiliation(s)
- Kaan Akan
- Department of General Surgery, Bursa Şevket Yılmaz Teaching and Training Hospital, Bursa, Turkey
| | - Deniz Tihan
- Department of General Surgery, Bursa Şevket Yılmaz Teaching and Training Hospital, Bursa, Turkey
| | - Uğur Duman
- Department of General Surgery, Bursa Şevket Yılmaz Teaching and Training Hospital, Bursa, Turkey
| | - Yiğit Özgün
- Department of General Surgery, Bursa Şevket Yılmaz Teaching and Training Hospital, Bursa, Turkey
| | - Fatih Erol
- Department of General Surgery, Bursa Şevket Yılmaz Teaching and Training Hospital, Bursa, Turkey
| | - Murat Polat
- Department of General Surgery, Bursa Şevket Yılmaz Teaching and Training Hospital, Bursa, Turkey
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27
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Invited comment on Elsey and Lund: Fibrin glue in the treatment of pilonidal sinus: high patient satisfaction and rapid return to normal activities. Tech Coloproctol 2012; 17:105-6. [DOI: 10.1007/s10151-012-0963-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 12/03/2012] [Indexed: 10/27/2022]
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