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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

  • A. A. PronkEmail author
  • N. Smakman
  • E. J. B. Furnee
Original Article

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.

Keywords

Pilonidal sinus Phenol Minimally invasive surgical procedures Randomized-controlled trial 

Notes

Acknowledgements

Cornelis Visser Stichting.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study has been approved by the local Medical Ethics Committee (United Committees of Human Research, Nieuwegein, the Netherlands; reference number: NL43192.100.13).

Informed consent

Written informed consent was obtained from all participants.

References

  1. 1.
    Aysan E, Ilhan M, Bektas H et al (2013) Prevalence of sacrococcygeal pilonidal sinus as a silent disease. Surg Today 43:1286–1289CrossRefGoogle Scholar
  2. 2.
    Al-Khamis A, McCallum I, King PM, Bruce J (2010) Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev 1:CD006213Google Scholar
  3. 3.
    Dag A, Colak T, Turkmenoglu O et al (2012) Phenol procedure for pilonidal sinus disease and risk factors for treatment failure. Surgery 151:113–117CrossRefGoogle Scholar
  4. 4.
    Olmez A, Kayaalp C, Aydin C (2013) Treatment of pilonidal disease by combination of pit excision and phenol application. Tech Coloproctol 17:201–206CrossRefGoogle Scholar
  5. 5.
    Aksoy HM, Aksoy B, Egemen D (2010) Effectiveness of topical use of natural polyphenols for the treatment of sacrococcygeal pilonidal sinus disease: a retrospective study including 192 patients. Eur J Dermatol 20:476–481Google Scholar
  6. 6.
    Kaymakcioglu N, Yagci G, Simsek A et al (2005) Treatment of pilonidal sinus by phenol application and factors affecting the recurrence. Tech Coloproctol 9:21–24CrossRefGoogle Scholar
  7. 7.
    Furnee EJB, Davids PHP, Pronk A et al (2015) 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 16:92CrossRefGoogle Scholar
  8. 8.
    Ertan T, Koc M, Gocmen E et al (2005) Does technique alter quality of life after pilonidal sinus surgery? Am J Surg 190:388–392CrossRefGoogle Scholar
  9. 9.
    Rijnhart-De Jong HG, Draaisma WA, Smout AJPM et al (2008) The Visick score: a good measure for the overall effect of antireflux surgery? Scand J Gastroenterol 43:787–793CrossRefGoogle Scholar
  10. 10.
    Bailey IS, Karran SE, Toyn K et al (1992) Community surveillance of complications after hernia surgery. BMJ 304:469–471CrossRefGoogle Scholar
  11. 11.
    Moher D, Hopewell S, Schulz KF et al (2012) CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg 10:28–55CrossRefGoogle Scholar
  12. 12.
    Kayaalp C, Aydin C (2009) Review of phenol treatment in sacrococcygeal pilonidal disease. Tech Coloproctol 13:189–193CrossRefGoogle Scholar
  13. 13.
    Meinero P, Stazi A, Fasolini F et al (2015) Endoscopic pilonidal sinus treatment (EPSiT). A prospective multicentre trial on 250 patients. Color Dis 17:20CrossRefGoogle Scholar
  14. 14.
    Giarratano G, Toscana C, Shalaby M et al (2017) Endoscopic pilonidal sinus treatment: long-term results of a prospective series. J Soc Laparoendosc Surg 21(e2017):00043Google Scholar
  15. 15.
    Lindholt-Jensen CS, Lindholt JS, Beyer M, Lindholt JS (2012) Nd-YAG laser treatment of primary and recurrent pilonidal sinus. Lasers Med Sci 27:505–508CrossRefGoogle Scholar
  16. 16.
    Dessily M, Charara F, Ralea S, Alle J-L (2017) Pilonidal sinus destruction with a radial laser probe: technique and first Belgian experience. Acta Chir Belg 117:164–168CrossRefGoogle Scholar
  17. 17.
    Pappas AF, Christodoulou DK (2018) A new minimally invasive treatment of pilonidal sinus disease with the use of a diode laser: a prospective large series of patients. Colorectal Dis 20:O207–O214CrossRefGoogle Scholar
  18. 18.
    Salih AM, Kakamad FH, Salih RQ et al (2018) Nonoperative management of pilonidal sinus disease: one more step toward the ideal management therapy-a randomized controlled trial. Surg (United States) 164:66–70Google Scholar
  19. 19.
    Sian TS, Herrod PJJ, Blackwell JEM et al (2018) Fibrin glue is a quick and effective treatment for primary and recurrent pilonidal sinus disease. Tech Coloproctol 22:779–784CrossRefGoogle Scholar
  20. 20.
    Calikoglu I, Gulpinar K, Oztuna D et al (2017) Phenol Injection versus excision with open healing in pilonidal disease: a prospective randomized trial. Dis Colon Rectum 60:161–169CrossRefGoogle Scholar
  21. 21.
    Topuz O, Sozen S, Tukenmez M et al (2014) Crystallized phenol treatment of pilonidal disease improves quality of life. Indian J Surg 76:81–84CrossRefGoogle Scholar
  22. 22.
    Thompson MR, Senapati A, Kitchen P (2011) Simple day-case surgery for pilonidal sinus disease. Br J Surg 98:198–209CrossRefGoogle Scholar
  23. 23.
    Kayaalp C, Aydin C (2009) Review of phenol treatment in sacrococcygeal pilonidal disease. Tech Coloproctol 13:189–193CrossRefGoogle Scholar
  24. 24.
    Beal EM, Lee MJ, Hind D, Wysocki AP, Yang F, Brown SR (2019) A systematic review of classification systems for pilonidal sinus. Tech Coloproctol.  https://doi.org/10.1007/s10151-019-01988-x= Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryDiakonessenhuisUtrechtThe Netherlands
  2. 2.Department of Abdominal SurgeryUniversity Medical Center GroningenGroningenThe Netherlands

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