Short-term outcomes of radical excision vs. phenolisation of the sinus tract in primary sacrococcygeal pilonidal sinus disease: a randomized-controlled trial

Comparison of laser ablation, simple excision, and flap reconstruction in the treatment of pilonidal sinus disease

Pilonidal sinus disease (PSD) is a common condition that typically affects young adults. PSD may cause significant morbidity due to its chronic nature and tendency to recur. Laser ablation has recently shown promising results in the treatment of PSD, but comparative studies are sparse. We aimed to compare laser ablation with two conventional treatment options: simple excision with direct closure and excision with flap reconstruction. This retrospective study material included patients who underwent PSD surgery in the plastic surgery department of a single academic teaching hospital. Patients were divided into three groups based on the operation technique: laser group, direct closure group, and flap group. Preoperative and postoperative data were compared between the groups including patient characteristics, residual disease, recurrent disease, complications, and re-operations. Among the 278 patients, 66 underwent laser treatment, 134 excision with direct closure, and 78 excision with flap closure. The follow-up time ranged from 15.4 ± 7.6 months in the laser group to 87.6 ± 29.3 months in the flap group. Eventless healing occurred in 67.7% of the patients in the laser group, 66.4% of the patients in the direct closure group, and 56.4% of the patients in the flap group. There was significantly more residual disease in the laser group whereas significantly more complications were found in the direct closure and flap groups. The advantages of laser treatment include fast postoperative recovery and reduced risk of complications.

A meta-analysis comparing phenol treatment with surgical excision for pilonidal sinus

Pilonidal sinus is a chronic condition characterized by inflammation, swelling, and pain in the sacrococcygeal region. In recent years, the rate of recurrence and wound complications in PSD remains high, and no treatment is universally accepted. This study aimed to compare the efficacy of phenol treatment with surgical excision treatment for PSD through a meta-analysis of controlled clinical trials. We searched three electronic databases, PubMed, Embase, and Cochrane library, to comprehensively search the literature comparing phenol treatment and surgical treatment of pilonidal sinus. Fourteen publications were included, including five RCTs and nine non-RCTs. The phenol group had a slightly higher rate of disease recurrence than the surgical group (RR = 1.12, 95% CI [0.77,1.63]), but the difference was not statistically significant (P = 0.55 > 0.05). As compared to the surgical group, wound complications were considerably less common (RR = 0.40, 95% CI [0.27,0.59]). Phenol treatment resulted in a significantly shorter operating time than surgery treatment (weighted mean difference -22.76, 95% CI [-31.13,-14.39]). The time to return to daily work was considerably shorter than in the surgical group (weighted mean difference -10.11, 95% CI [-14.58,-5.65]). Postoperative complete healing time was significantly shorter than surgical healing time (weighted mean difference -17.11, 95% CI [-32.18,-2.03]). Phenol treatment is effective for pilonidal sinus disease, and its recurrence rate is not significantly different from surgical treatment. The greatest advantage of phenol treatment is the low incidence of wound complications. Moreover, the time required for treatment and recovery are significantly lower than for surgical treatment.

Long-term Outcome of Radical Excision Versus Phenolization of the Sinus Tract in Primary Sacrococcygeal Pilonidal Sinus Disease: A Randomized Controlled Trial

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.

Comparative analysis on the effect of the endoscopic versus conventional treatment for pilonidal sinus: A meta-analysis of controlled clinical trials

BACKGROUND

Pilonidal sinus is a common disease in the sacrococcygeal region. Although many treatments have been described in recent years, the recurrence of each method remains high. Surgeons did not reach a consensus on the preferred approach for pilonidal sinus. We carried out a meta-analysis of controlled clinical trials comparing the outcomes of endoscopic treatment versus conventional treatment for pilonidal sinus disease in this study.

METHODS

We performed a systematic literature search, and we used electronic databases such as PubMed/Medline, Embase, and the Cochrane library to search for the relevant literature comparing endoscopic management to other conventional treatments for pilonidal sinus disease. The primary outcome parameters were operative time, recurrence, postoperative complications and pain, and total healing time.

RESULTS

Six studies were included in the review. Endoscopic pilonidal sinus treatment had a lower overall complication rate than the conventional surgery group (risk ratio = 0.33 [0.19-0.58], P = .0001) and lower pain score with a weighted mean difference of -2.44 (95% confidence interval: (-3.96) to (-0.92), I2 = 99%, P = .002). There was no significant difference in recurrence (risk ratio = 0.75, 95% confidence interval [0.30-1.90],P = .55). Compared to the excision followed by the primary closure technique, the operation time, time to complete wound healing, and satisfaction were similar.

CONCLUSIONS

Endoscopic pilonidal sinus treatment is a unique and potential method of sacrococcygeal pilonidal disease treatment. The foremost benefits of this technique are mild postoperative pain, lower complications rate, and return to routine for a shorter time. However, due to the limited number of articles, we need to conduct more rigorous large-sample prospective randomized controlled trials to clarify the efficiency of endoscopic treatment for pilonidal cysts.

Phenolisation of the Sinus Tract in Recurrent Sacrococcygeal Pilonidal Sinus Disease: A Prospective Cohort Study

Purpose

Phenolisation is a minimally invasive treatment option in patients with primary pilonidal disease. However, most studies focus on patients with primary pilonidal sinus disease, while data of patients with recurrent pilonidal disease are very scarce. The purpose of this study was to evaluate phenolisation of the sinus tract in patients with recurrent pilonidal sinus disease after previous surgery for SPSD.

Methods

This single-center prospective cohort study included 60 patients with recurrent pilonidal disease. Loss of days of normal daily activities, surgical site infection, wound epithelization, quality of life, and complaints related to pilonidal disease were postoperatively assessed.

Results

A total of 57 patients (95%) were treated with phenolisation and the median loss of days of normal daily activities was 5.0 (1.0 - 12.0) days. Fifty-one patients (89.5%) resumed normal daily activities after two weeks. Surgical site infection occurred in five patients (8.8%). Compared to preoperative scores, quality of life was significantly higher 12 weeks postoperatively (p=0.014) and pain and itch scores were lower after six and 12 weeks (p ≤ 0.005). Wounds were completely healed in 45 of 51 patients (89.8%) who were available after 12 weeks of follow-up.

Conclusion

Phenolisation for recurrent pilonidal disease is safe with a median complete return to daily activities within five days and complete wound healing after three months in 90%. Therefore, phenolisation should be considered as a treatment option in patients with recurrent pilonidal sinus disease.