Minimally Invasive Treatment of Pilonidal Sinus Disease: Which is Better? Phenol or Laser Ablation

Pilonidal sinus disease refers to a subcutaneous infection occurring in the gluteal sulcus of the sacrococcygeal region. Although the cause is not clear, it is thought to be related to obesity, hairy body, and deep gluteal sulcus. The incidence of this acquired disease is about 26/100,000 subjects worldwide. The incidence rate among males is 4 times higher than that among females. Pilonidal sinus disease was first de scribed by Herbert Mayo in 1833 as a congenital condition, but is now accepted to be an acquired disease, given its absence in childhood .

Although its cause re mains unknown, the increased hormone levels associated with puberty, the growth of thick hair, long periods of sitting, and friction imparted by tight-fitting clothing may be in play. Other risk factors are hirsutism, obesity, and a family history of the disease. As the cause of the dis ease, hairs falling from head, neck, and back are placed in the intergluteal area and hairs that penetrate the skin initiate foreign body reactions. In the affected area, the hairs are moist, sweaty, and unhygienic, readily trig gering development of the subcutaneous skin cysts and sinuses characteristic of the disease, which (in the gluteal region) present as asymptomatic pits, painful abscesses, or sinuses associated with purulent serous discharge.

The acute phase is characterized by sacral abscess, and during the chronic phase cyst formation or persistent sinus discharge may be observed. At present, no consensus exists regarding the best treatment choice, but conservative treatment can only control the symptoms, and most patients have to undergo operation. Traditional surgery has good success rates; it requires removal of all diseased skin and subcutaneous tissue, including wide excision and healing by secondary intention or reconstructive ("flap") techniques, which results in a long recovery time and a large wound. In recent years, minimally invasive surgical methods for the treatment of SPD (such as endoscopic pilonidal sinus ablation, laser ablation, phenolization, or fibrin glue injection) have improved, reducing wound scarring and pain and shortening the time it takes for patients to return to their normal lives. Surgical success is evaluated by recovery time, the time to return to daily activities, and the complication and recurrence rates.

Patients presenting with pilonidal sinus disease at the Department of General Surgery, Mersin University (Türkiye) were evaluated for participation in this study. Patients aged ≥18 years with symptoms related to pilonidal sinus disease were included in this study. A power analysis was performed using the G*Power (v3.1.7) program to determine the sample size.

Exclusion criteria include the absence of symptoms associated with pilonidal sinus disease, suspicion of an extensive subcutaneous sinus tract network, and the presence of a pilonidal abscess and previous surgery for pilonidal sinus disease, recurrent and complicated pilonidal sinüs disease.