Pilonidal sinus disease surgery in children: the first study to compare crystallized phenol application to primary excision and closure

Ateş, Ufuk; Ergün, Ergun; Göllü, Gülnur; Sözduyar, Sümeyye; Koloğlu, Meltem Bingöl; Çakmak, Murat; Dindar, Hüseyin; Yağmurlu, Aydın

doi:10.1016/j.jpedsurg.2017.05.012

Cited by 24 publications

(18 citation statements)

References 15 publications

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“…Other authors reported a shorter mean LOS of 2.7 days (range: 1 to 14 days) for excision and midline closure and even for outpatient treatment, e.g., for Gips procedure or application of crystallized phenol in the treatment of PSD [ 9 , 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…Phenolization has been shown to result in a shortened time to complete wound healing (mean 16 days) and no time off work in adults [ 64 ]. Application of crystallized phenol in children suffering from PSD should be performed under anesthesia even in the day clinic setting [ 9 ]. It must be noted that use of crystallized phenol is forbidden in some countries (e.g., Germany) due to the severe toxicity of phenol [ 2 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…To protect the skin surrounding the sinus orifices from maceration, necrosis, and burns after phenol application, many authors recommend applying oily pomades around the sinus orifices [ 9 ]. To prevent fat tissue necrosis and cellulitis due to phenol application, meticulous hemostasis and instillation of phenol crystals or instillation of liquid phenol solution without applying pressure have been recommended [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…To prevent chronic or acute infections, surgical excision of the sinus and its fistulas represent the most common intervention [ 1 , 6 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Nevertheless, no gold standard for the treatment for PSD has emerged so far [ 1 , 2 , 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…The cohort of patients undergoing primary wound closure should be subdivided into patients treated by midline or off-midline suture techniques [ 4 , 10 , 11 , 14 ]. Although midline closure results in a shorter healing time than open wound methods, this approach is associated with a higher recurrence rate [ 4 , 9 , 11 , 14 , 20 ]. Several off-midline suture techniques and reconstructive operations to correct the deep and hairy natal cleft have been published [ 1 , 10 , 11 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

2020

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We aimed to compare the outcome of two different operative methods to correct pilonidal sinus disease (PSD) in children, i.e., excision and open wound care (OW) versus excision and primary transverse closure (PC) of the wound. In this retrospective, observational study, we extracted data from the medical records of 56 patients who underwent surgery for PSD at our institution between 1 January 2006 and 31 December 2016. To test whether the primary variable, i.e., rate of PSD recurrence, differed between the two surgical groups, a logistic regression model was fitted. Secondary explanatory variables were total length of stay (LOS) at the hospital, complications, sex and age of patients, seniority of the surgeon in charge, and volume of excised specimen. Overall, 32 (57%) children and young adults underwent OW, while 24 (43%) patients were treated by PC. Mean age at operation was 15.5 years in either group. PSD recurred in 12 of 32 (37.5%) children in the OW group and in 3 of 24 (12.5%) children in the PC group (ratio: 0.19, 95% confidence interval [95% CI] 0.03–1.07). Thus, treatment of primary PSD by PC proved superior with respect to PSD recurrence. Moreover, our study did not bring to light any high-grade complications in the PC group, and postoperative pain was minimal. Less invasive treatment approaches for chronic PSD are typically performed in an outpatient setting and offer reduced morbidity, low rates of PSD recurrence, and shortened periods of time to return to work or social activities. More radical operations of PSD should be reserved for recurrent PSD where less invasive approaches have failed several times.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

2020

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Management of Pilonidal Disease

2023

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ImportanceThe management of pilonidal disease continues to be a challenge due to high rates of recurrence and treatment-associated morbidity.ObservationsThere is a heterogeneous repertoire of treatment modalities used in the management of pilonidal disease and wide practice variation among clinicians. Available treatment options vary considerably in their level of invasiveness, associated morbidity and disability, risks of complications, and effectiveness at preventing disease recurrence. Conservative nonoperative management strategies, including persistent improved hygiene, depilation, and lifestyle modification, focus on disease prevention and minimization of disease activity. Epilation techniques using both laser and intense pulse light therapy are also used as primary and adjunct treatment modalities. Other nonoperative treatment modalities include phenol and fibrin injection to promote closure of pilonidal sinuses. The traditional operative management strategy for pilonidal disease involves excision of affected tissue paired with a variety of closure types including primary midline closure, primary off-midline closure techniques (ie, Karydakis flap, Limberg flap, Bascom cleft lift), and healing by secondary intention. There has been a recent shift toward more minimally invasive operative approaches including sinusectomy (ie, trephination or Gips procedure) and endoscopic approaches. Overall, the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies.Conclusions and RelevancePilonidal disease is associated with significant physical and psychosocial morbidity. Optimal treatments will minimize disease and treatment-associated morbidity. There is a need for standardization of definitions used to characterize pilonidal disease and its outcomes to develop evidence-based treatment algorithms.

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Using phenol for treating pilonidal sinus: a systematic review and meta-analysis

et al. 2019

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Pilonidal sinus disease surgery in children: the first study to compare crystallized phenol application to primary excision and closure

Cited by 24 publications

References 15 publications

Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

Management of Pilonidal Disease

Using phenol for treating pilonidal sinus: a systematic review and meta-analysis

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