Ps is a disease that can lead to loss of workforce, absenteeism from school and alienation from social life. The fact that the patient group evaluated in this study consisted of adolescents especially emphasizes the importance of the choice of the treatment method of the disease.
Many treatment modalities such as; open surgical primary suturing, flap shifting, phenol application, endoscopic excision or laser have been described to date (3). Among the reasons for the spread of minimally invasive methods that started in the late 1900s are; easy applicability, adequacy of success rates, good cosmetic results, short hospital stay, less postoperative pain, and the fast return to social life (4). In the study, the type of surgical intervention has evolved towards minimally invasive over the years. As the surgeon gained experience, one preferred less invasive treatment method. Among the most effective factors in this orientation are; the rapid return of patients to social life, shorter operation time, no difference between less invasive methods in terms of complications and recurrences. There are publications in the literature comparing surgical excision and phenol, surgical excision and laser methods (5). What distinguishes the study from other studies in the literature is the comparison of 3 methods performed by the same surgeon.
In the literature, although there is no study in the pediatric age group in the surgical excision primary suturing, 30% in the phenol application, and 15% in the laser application, there are publications that found the infection rate in adult patients to be 9.5% (6–8). In this study, infection rates were found similar to the literature. Although the decrease in invasiveness in the treatment is effective in decreasing the infection rate, intravenous antibiotic administration to all patients regardless of the treatment method may have decreased the incidence of infection in minimally invasive methods compared to surgical excision. The necessity of postoperative dressing in surgical excision, the need for suture removal and the longer recovery period, and the delay of the patient's wound care due to this may be effective in the high rate of infection.
Recurrence is quite common after Ps surgery. In the literature, recurrence has been reported in approximately 25% after surgical excision and approximately 10% after phenol and laser application (2, 5). In the study of Ufuk and his friends (9) in which they compared the recurrence rates in surgical excision and phenol application, although the recurrence rate was significantly lower in phenol application, in our study, no significant difference was found between surgical excision and phenol application, and also between phenol application and laser application in terms of recurrence rates. The fact that the number of patients in the study is higher than the publications in the literature, the applications are performed by the same surgeon, the number of sinus openings, the application of the same surgical procedure to each patient periodically, regardless of the width of the cavity, are the positive aspects of this study. The application of the same operation to every patient diagnosed with Ps periodically contributes to the literature in terms of allowing the comparison of the 3 techniques regardless of the patient, disease and surgeon variables.
Body mass index, hygienic conditions, hair removal of the area and treatment modalities were mostly evaluated in cases of recurrence after ps surgery (10, 11). The effect of postoperative infection on recurrence is unknown. Since the body mass index of the patients, which is also a limitation of the study, is not known, it is difficult to say the effect of infection on recurrence. However, as it was determined in the study, the higher rate of recurrence, independent of the treatment method applied in patients with infection, suggests that the infection alone is significant in terms of susceptibility to recurrence. When we examine the treatment methods one by one, The use of antibiotics on postoperative patients after infection and/or surgical excision lowered chances of recurrence. On the other hand, the fact that the surgical excision group had the highest recurrence rate in the absence of infection among the 3 groups suggests that the difficulty in postoperative care and prolonged treatment period increase the susceptibility to recurrence. Again, as seen in the study, the fact that the group in which phenol was administered was the group with the highest rate of recurrence when there was an infection and the group with the least recurrence when there was no infection indicates the necessity of discharging the patients with oral antibiotics after minimally invasive methods. In our study, similar to the literature, it was observed that infection formation after minimally invasive applications increased the recurrence susceptibility more than infection after surgical excision (12).
The preferred secondary or tertiary surgeries in recurrent cases are surgical excision, and in our study, the success of phenol application in patients with recurrence after surgical excision showed that surgical excision is not necessary in recurrent cases.
In conclusion, in current times, there are many invasive treatment methods used for pilonidal sinus. Laser application can be used safely in the childhood age group. Minimally invasive methods are very promising in terms of surgical success and can be preferred in both primary and recurrent cases. Close follow-up and early treatment of patients is important in terms of presence of postoperative infection in order to reduce recurrence rates.