Local Phenol Application Versus Excision with Modified Primary Closure Technique in Pilonidal Sinus Disease: A Comparative Study
Advances in Surgical Sciences
Volume 6, Issue 1, June 2018, Pages: 20-26
Received: Apr. 24, 2018;
Accepted: May 10, 2018;
Published: May 31, 2018
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Adel Morad Abdallah, General Surgery Department, Faculty of Medicine, October 6 University, Giza, Egypt
Mohammed Abd-Alaal Mohammed, General Surgery Department, Faculty of Medicine, October 6 University, Giza, Egypt
Radwa Mamdouh El-Sabban, Anatomy Department, Faculty of Medicine, October 6 University, Giza, Egypt
Background: Different procedures are practiced nowadays for management of pilonidal sinus disease (PSD), ranging from the minimally invasive techniques to the complex flap techniques. Each procedure has its own advantages and drawbacks in terms of patient’s satisfaction, follow up and recurrence rate. Local phenol application into the sinus track was practiced with encouraging results. The limited excision and modification of the primary closed technique has shown both low wound dehiscence and recurrence rates. The objective of this study is to evaluate and compare the local application of phenol 80% in the pilonidal sinus tracks after minimal debridement with the limited excision and modified primary closure technique. Methods: 52 patients suffering from chronic pilonidal sinus disease were divided equally into 2 groups. Patients in group I were managed with local phenol application under local anesthesia. In group II, the patients were operated upon by limited excision of the skin bearing the sinus pits and the underlying granulation tissue with modified primary closure technique using the gluteus maximus fasciae to close the cavity left followed by closure of the subcutaneous tissue and skin with leaving a suction drain inside. Results: The median duration of phenol applications procedure was 20 ± 11 minutes versus 41 ± 13 minutes in the modified primary closure technique. There was a significant difference between both groups as regards the duration of pain killers’ use. By 5 weeks, signs of complete healing were shown in 22 patients (84.5%) of the phenol group, versus 25 patients (96.2%) in the surgery group with no statistic difference between both. The recurrence of PSD in the phenol group was detected in 2 cases (7.7%) while it was one case (3.8%) in the surgery group (p=0.163). Conclusion: both procedures are simple, less surgically demanding, having simple postoperative care, low complication and recurrence rates, early recovery and good patient satisfaction.
Adel Morad Abdallah,
Mohammed Abd-Alaal Mohammed,
Radwa Mamdouh El-Sabban,
Local Phenol Application Versus Excision with Modified Primary Closure Technique in Pilonidal Sinus Disease: A Comparative Study, Advances in Surgical Sciences.
Vol. 6, No. 1,
2018, pp. 20-26.
K. Arslan, S. Said Kokcam, H. Koksal, E. Turan, A. Atay, O. Dogru: Which flap method should be preferred for the treatment of pilonidal sinus? A prospective randomized study. Tech. Coloproctol. 2014; 18:29–37.
Harlak A, Mentes O, Kilic S, Coskun K, Duman K, Yilmaz F. Sacrococcygeal pilonidal disease: analysis of previously proposed risk factors. Clinics (Sao Paulo). 2010; 65:125–131.
V. K. Stauffer, M. M. Luedi, P. Kauf, M. Schmid, M. Diekmann, K. Wieferich, B. Schnüriger, D. Doll: Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence. Scientific Reports. 2018; 8:3058.
Çağlayan K, Güngör B, Topgül K, Polat C, Çınar H, Ulusoy AN. Investigations of patient dependent factors effecting complications and recurrence in pilonidal sinus disease. Colon Rectum Hast Derg. 2011; 21: 103-8.
Isik A, Eryılmaz R, Okan I, et al. The use of fibrin glue without surgery in the treatment of pilonidal sinus disease. Int. J. Clin. Exp Med. 2014; 7:1047-1051.
Akan K, Tihan D, Duman U, Ozgun 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; 29:162-166.
Ertan T, Koc M, Gocmen E, Aslar AK, Keskek M, Kilic M. Does the technique alter quality of life after pilonidal sinus surgery? Am. J. Surg. 2005; 190:388-392.
Kaya B, Uçtum Y, Şimşek A, Kutaniş R. Treatment of pilonidal sinus with primary closure. A simple and effective method. Colon Rectum Hast Derg. 2010; 20: 59-65.
Küçükkartallar T, Tekin A, Vatansev C, Aksoy F, Erenoğlu B. The comparison of the results of different operative techniques for pilonidal sinus disease. Genel. Tıp. Derg. 2007; 17: 95-7.
Sukru Arslan, Erdem Karadeniz, Gurkan Ozturk, Bulent Aydinli, Muhammed Cagri Bayraktutan, Sabri Selcuk Atamanalp. Modified Primary Closure Method for the Treatment of Pilonidal Sinus. Eurasian Journal of Medicine. 2016; 48: 84-9.
Gidwani AL, Murugan K, Nasir A, Brown R. Incise and lay open: an effective procedure for coccygeal pilonidal sinus disease. Ir. J. Med. Sci. 2010; 179:207-210.
Aydede H, Erhan Y, Sakarya A, Kumkumoglu Y. Comparison of three methods in surgical treatment of pilonidal disease. ANZ J. Surg. 2001; 71:362-364.
Kuzu MA. Commentary. Colorectal Disease. 2008; 10:651–652.
Mahdy T: Surgical treatment of the pilonidal disease: primary closure or flap reconstruction after excision. Disease Colon Rectum. 2008; 51:1816–1822.
Ersoy OF, Karaca S, Kayaoglu HA, Ozkan N, Celik A, Ozum T: Comparison of different surgical options in the treatment of pilonidal disease: retrospective analysis of 175 patients. Kaohsiung J. Med. Sci. 2007; 23:67–70.
Doll D, Evers T, Matevossian E, Petersen S. Outcome of chronic pilonidal disease treatment after ambulatory plain midline excision and primary suture. Am. J. Surg. 2009; 197: 693-4.
Dalenback J. Prospective follow-up after ambulatory plain midline excision of pilonidal sinus and primary suture under local anaesthesia-efficient, sufficient, and persistent. Colorectal Diseases. 2006; 8: 73-4.
Dogru O, Camci C, Aygen E, Girgin M, Topuz O: Pilonidal sinus treated with crystallized phenol: an eight-year experience. Disease Colon Rectum. 2004; 47:1934–1938.
Aygen E, Arslan K, Dogru O, Basbug M, Camci C: Crystallized phenol in non-operative treatment of previously operated, recurrent pilonidal disease. Dis Colon Rectum. 2010; 53:932– 935.
Oueidat D., Dirani R., Assi M., Shams T., Jurjus A.: 25 years’ experience in the management of pilonidal sinus disease. Open Journal of Gastroenterology. 2014; 4-5.
Yuksel ME. Pilonidal sinus disease can be treated with crystallized phenol using a simple three- step technique. Acta Dermatovenerol. Alp. Pannonica Adriat. 2017; 26 (1):15-17.
Gecim I, Goktug U, Celasin H. Endoscopic Pilonidal Sinus Treatment Combined With CrystalizedPhenol Application May Prevent Recurrence. Diseases Colon Rectum. 2017; 60 (4): 405-407.
Kaya B, Uçtum Y, Şimşek A, Kutaniş R. Treatment of pilonidal sinus with primary closure. A simple and effective method. Colon Rectum Hast Derg 2010; 20: 59-65.
Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N. Z J. Surg. 1992; 62: 385-9.
Brusciano L. et al. D-shape asymmetric excision of sacrococcygeal pilonidal sinus with primary closure, suction drain, and subcuticular skin closure: an analysis of risk factors for long-term recurrence. Surg. Innov. 2015; 22, 143–148.
Doll D., Matevossian E., Hoenemann C. & Hoffmann S. Incision and drainage preceding definite surgery achieves lower 20-year long-term recurrence rate in 583 primary pilonidal sinus surgery patients. Patient info. 2013; 11, 60–64.
Rahoma A. H. Pilonidal sinus: Why does it recur? Malays. J. Med. Health Sci. 2009; 5, 69–77.
Doll D., Luedi M. M., Evers T., Kauf P., Matevossian E. Recurrence-free survival, but not surgical therapy per se, determines 583 patients’ long-term satisfaction following primary pilonidal sinus surgery. Int. J. Colorectal Disease. 2015; 30, 605–611.
Shah A., Waheed A., Malik A. Recurrence rates in pilonidal sinus surgery: Comparison of two techniques (Karydakis Versus Conventional Open Excision). Pak. J. Med. Health Sci. 2009; 3, 91–95.
Ehrl D, Choplain C, Heidekrueger P, Erne HC, Rau HG, Broer PN. Treatment Options for Pilonidal Disease. Am. Surg. 2017; 83 (5):453-457.
Giarratano G, Toscana C, Shalaby M, Buonomo O, Petrella G, Sileri P. Endoscopic Pilonidal Sinus Treatment: Long-Term Results of a Prospective Series. JSLS. 2017; 21 (3).