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

Efficacy of crystallized and liquid form phenol application in pilonidal sinus disease: a single-center retrospective study

AIM AND OBJECTIVE

Pilonidal sinus is a frequently observed disease in young adult male patients. Although its treatment is traditionally surgical, the tendency to use minimally invasive interventions has increased over time. This study aims to compare the clinical results of the non-surgical treatment methods for pilonidal sinus: crystallized and liquid phenol applications.

MATERIALS AND METHODS

We retrospectively analyzed the data of 102 patients treated with phenol application in the General Surgery Clinic of our hospital between July 2017 and July 2019. Eighty patients were included in the study: 40 treated with crystallized phenol and 40 with liquid phenol. In the 1st month following the application, the recovery rates, complication rates, persistence of complaints, and recurrence at the end of the 1st year were compared between the groups.

RESULTS

The mean age was 25.60 ± 7.16 and 25.78 ± 7.83 years in the crystallized (group 1) and liquid phenol group (group 2), respectively. Complications observed up to the 3rd week of follow-up were considered early complications, while those observed after the 3rd week were considered late complications. Early complications were observed in 15% and 37.5% of patients in groups 1 and 2, respectively (p = 0.042). Early complications were significantly higher in the liquid phenol group compared to the crystallized phenol group. At the end of the 1st year, 90% improvement was detected in group 1 and 95% in group 2. However, there was no significant difference between the recovery and recurrence rates between the groups.

CONCLUSION

In pilonidal sinus treatment, successful results are obtained with both crystallized and liquid phenol application. Both methods can be performed safely and easily as an alternative treatment method to surgery.

Efficacy of catheter cleaning methods using intravenous indwelling catheter, 10% silver nitrate solution and a monofilament nylon thread for deeply progressed superficial driveline infections: case series

Driveline infection (DLI) is treated by local irrigation via driveline exit site (DLES) and surgical debridement is considered in patients with deep DLI. We describe three cases of deeply progressed superficial DLI that were considered to require surgical debridement but could be treated with a unique catheter cleaning method using intravenous indwelling catheter, a cotton swab with 10% silver nitrate solution and a monofilament nylon thread. Case 1 was a 60-y-old man with ischemic cardiomyopathy with left ventricular assist device implantation 2 y before. Daily bedside debridement with 10% silver nitrate solution was performed via the DLES. Case 2 was a 43-y-old man with ischemic cardiomyopathy who had recurrent DLI with methicillin-resistant Staphylococcus aureus, and case 3 was a 49-y-old woman with hypertrophic cardiomyopathy, who also showed improvement in their DLI with Pseudomonas aeruginosa. These cleaning methods may be useful for the deeply progressed superficial DLI.

Room for Improvement: The Trephination Procedure for Pediatric Patients with Pilonidal Disease

BACKGROUND

Pilonidal disease is common amongst adolescent males and females and often leads to recurrent symptoms and life-altering morbidity. The traditional surgical approach includes wide excision of the involved area and carries a high rate of postoperative morbidity. A minimally invasive surgical approach using trephines was described by Gips in 2008 and has since been widely adopted by many surgeons. The aim of this study was to explore outcomes of the trephination procedure for pediatric and adolescent patients by evaluating postoperative wound healing and disease recurrence.

MATERIALS AND METHODS

A retrospective cohort study for patients that underwent the trephination procedure as part of standard of care for the treatment of pilonidal disease from November 1, 2019-November 1, 2020 was performed. Patient demographics, presenting characteristics, and previous treatment history were identified. Outcome measures included healing time, recurrent disease, and need for reoperation.

RESULTS

A total of 19 patients underwent the trephination procedure at a mean age of 16.4 years of age. An average of 3.8 pits were excised and there were no reported intraoperative complications. Following trephination, 26.3% of patients were healed at 30-day's, with just over 40% showing complete healing by 6-months. The recurrence rate was 16.1% at 6-months and approximately 15% of patients required a second surgery.

CONCLUSION

Early results for trephination at our institution show a high rate of healing complications and frequent reoperation. Future research is needed to establish the role of the trephination procedure in the context of defining the best practices for treating this challenging disease.