MODİFİYE LİMBERG YÖNTEMİ UYGULANAN PİLONİDAL SİNÜS HASTALARINDA GELİŞEN NÜKSLERDE KRİSTALİZE FENOL UYGULAMASI ÇÖZÜM OLUR MU?

Year 2019, Volume: 20 Issue: 1, 172 - 176, 27.08.2019

Murat Akıcı , Murat Çilekar

https://doi.org/10.18229/kocatepetip.482834

Cited By: 1

Abstract

AMAÇ: Modifiye Limberg Yöntemi Uygulanan
Pilonidal Sinüs hastalarında gelişen nükslerde kristalize fenol uygulaması
verilerini retrospektif olarak değerlendirmektir.

GEREÇ VE YÖNTEM: Çalışmaya Afyon Sağlık Bilimleri Üniversitesi Hastanesine
Ocak 2016-Ocak 2017 tarihleri arasında daha önce primer pilonidal hastalık
nedeniyle modifiye limberg flep yöntemi uygulanan ve nüks saptanan 32 hasta
dahil edildi. Primer hastalık, daha önce kristalize fenol uygulanan ve nüks
gelişen hastalar, herhangi bir kronik hastalığı olanlar çalışmaya dahil
edilmedi. Hastalar yaş, cinsiyet, uygulama sayısı, yara yeri enfeksiyonu, nüks
ve ortalama takip zamanı açısından değerlendirildi.

BULGULAR: Nüks pilonidal hastalığı olan 32 hastanın ameliyat sonrası
ve uygulanan kristalize fenol uygulama verileri analiz edildi. Hastaların
ortalama yaşı 24,4 idi. 5(% 15,6)'i kadın ve 27(% 84,4)'si  erkek idi. Kristalize fenol uygulaması
22(%68,75) hastada bir kez, 5(%15,6) hastada 2 kez, 2(%6,25) hastada üç kez
uygulandı. 3(%9,3) hastada iyileşme sağlanamadı ve başka flep yöntemleri
uygulanarak tedavi edildi. Bir kez
kristalize fenol uygulaması ile hastaların 22(%68,75)'ini, 2 İki uygulama ile
26(%81,25)'ini, 3 uygulama ile tedavi 31(%90,7)'inde tam olarak sağlandı. 3(%9,3) hastada yara yeri enfeksiyonu
gelişti. Ortalama takip zamanı 13,1 ay olarak saptandı. Takiplerde 2(%6,8)
hastada tekrar nüks gelişti.

SONUÇ: Pilonidal sinüs hastalığı tedavisinde kullanılan flep
yöntemleri diğer cerrahi yöntemlere göre her ne kadar nüks oranını azaltmış
olsada nüks halen ciddi bir sorun olarak gözükmektedir. Kristalize fenol
yönteminin kolay uygulanabilinirliği ve düşük nüks oranları açısından nüks
pilonidal sinüs hastalığında flep yöntemlerine göre daha üstün olabileceği
görüşündeyiz. 

Keywords

Pilonidal sinüs, Nüks, Kristalize fenol, Limberg

IS MODIFIED LIMBERG METHOD APPLIED IN DEVELOPING THE RECURRENCE OF PILONIDAL SINUS PATIENTS CRYSTALLIZED APPLICATION IS THE SOLUTION?

Abstract

OBJECTIVE: To evaluate retrospectively the data of crystallized phenol administration in recurrent recurrence of Pilonidal sinus patients undergoing modified Limberg method.

MATERIAL AND METHODS: Thirty-two patients who had previously undergone a modified limberg flap technique due to primary pilonidal disease were included in the study between January 2016 - January 2017. Patients were evaluated in terms of age, gender, number of applications, wound infection, recurrence and mean follow-up time.

RESULTS: The data of 32 patients with recurrent pilonidal disease and the crystallized phenol administration data were analyzed. The mean age was 24.4±5.3 years. Five (15.6%) were female and 27 (84.4%) were male. Crystalline phenol application was administered once in 22 (68.75%) patients, twice in 5 (15.6%) patients and three times in 2 (6.25%) patients. Three patients (9.3%) did not recover and were treated with other flap methods. Once crystallized phenol was administered, 22 (68.75%) of the patients, 26 (81.25%) with two applications, and 31 (90.7%) of treatment were provided with 3 treatments. Three (9.3%) patients developed wound infection. The mean follow-up time was 13.1±6.4 months. During follow-up, recurrence occurred in 2 (6.8%) patients.

CONCLUSIONS: Although flap methods used in the treatment of pilonidal sinus disease have reduced the recurrence rate compared to other surgical methods, relapse still seems to be a serious problem. We believe that crystallized phenol method can be beterness in terms of recurrent pilonidal sinus disease and low recurrence rates compared to flap methods. However, we think that there is a need for extensive research.

Keywords

Pilonidal sinus, Recurrence, Crystallızed phenol

References

• 1. Dizen H, Yoldaş O, Yıldız M, Çilekar M,Dilektaşlı E. Modified elliptical rotation flap for sacrococcygeal pilonidal sinus disease. ANZ J Surg. 2014 Oct;84(10):769-71.
• 2. Akinci OF, Bozer M, Uzunköy A, Düzgün SA, Coşkun A. Incidence and aetiological factors in pilonidal sinus among Turkish soldiers. Eur J Surg 1999; 165: 339-342.
• 3. Chintapatla S, Safarani N, Kumar S, Haboubi N. Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgi¬cal options. Tech Coloproctol 2003; 7: 3-8.
• 4. Dag A, Colak T, Turkmenoglu O, Sozutek A, Gundogdu R. Phenol procedure for pilonidal sinus disease and risk factors for treat¬ment failure. Surgery 2012; 151: 113-117.
• 5. Petersen S, Koch R, Stelzner S, Wendlandt TP, Ludwig K. Primary closure techniques in chronic pilonidal sinus: a survey of the re¬sults of different surgical approaches. Dis Colon Rectum 2002; 45: 1458-1467.
• 6. Tavassoli A, Noorshafiee S, Nazarzadeh R. Comparison of excision with primary repair versus Limberg flap. Int J Surg 2011; 9: 343-346.
• 7. Mahdy T. Surgical treatment of the pilonidal disease: primary clo¬sure or flap reconstruction after excision. Dis Colon Rectum 2008; 51: 1816-1822.
• 8. Hosam R, Yasser A, Waleed A, Ibrahim A, Mokhtar F, Moham¬med F. Rhomboid flap versus primary closure after excision of sacrococcıgeal pilonidal sinus (a prospective randomized study). EJS 2010; 29: 4.
• 9. Akan K, Tihan D, Duman U, et al. Comparison of surgical Limberg flap technique and crystallized phenol application in the treatment of pilonidal sinus disease: a retrospective study. Ulus Cerrahi Derg 2013;29:162-166.
• 10. Schoeller T, Wechselberger G, Otto A, Papp C. Definite sur¬gical treatment of complicated recurrent pilonidal disease with a modified fasciocutaneous V-Y advancement flap. Surgery 1997;121:258-63.
• 11. Eryilmaz R, Okan I, Coskun A, et al. Surgical treatment of complicated pilonidal sinus with a fasciocutaneous V-Y advancement flap. Dis Colon Rectum 2009;52:2036-2040.
• 12. Rushfeldt C, Bernstein A, Norderval S, Revhaug A. In¬troducing an asymmetric cleft lift technique as a uni-form procedure for pilonidal sinus surgery. Scand J Surg 2008;97:77-81.
• 13. Bali I, Aziret M, Sozen S, et al. Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease. Clinics (Sao Paulo) 2015;70:350-355.
• 14. Gülpınar K, Pampal A, Ozis SE, Kuzu MA. Non-operative therapy for pilonidal sinus in adolescence: crystallised phenol application, ”report of a case”. BMJ Case Rep 2013; 2013. pii: bcr2012008382.
• 15. Karakayali F, Karagulle E, Karabulut Z, Oksuz E, Moray G, Haberal M. Unroofing and marsupialization vs. rhomboid excision and Limberg flap in pilonidal disease: a prospective, randomized, clinical trial. Dis Colon Rectum 2009; 52: 496-502.
• 16. Can MF, Sevinç MM, Hançerlioğulları O, Yılmaz M, Yağcı G. Mul¬ticenter prospective randomized trial comparing modified Lim¬berg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease. Am J Surg 2010; 200: 318-327.
• 17. AL-Khamis A, McCallum I, King PM, Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Review 2010: CD006213
• 18. Dogru O, Camci C, Aygen E, et al. Pilonidal sinus treated with crystallized phenol: an 8 year experience. Dis Colon Rectum 2004;47:1934-1938.
• 19. Girgin M, Kanat BH, Ayten R, et al. Minimally invasive treatment of pilonidal disease: crystallized phenol and laser depilation.Int Surg 2012;97:288-292.
• 20. Downs AM, Palmer J. Laser hair removal for recurrent pilo¬nidal sinus disease. J Cosmet Laser Ther 2002;4:91.
• 21. Aygen E, Arslan K, Dogru O, et al. Crystallized phenol in nonoperative treatment of previously operated, recurrent pilonidal disease. Dis Colon Rectum 2010;53:932-935.
• 22.Bayhan Z, Zeren S, Düzgün ŞA.Crystallized Phenol Treatment in Postoperative Recurrent Pilonidal Disease . Journal of Clinical and Experimental Investigations 2016; 7 (1): 19-22
• 23. El-Khadrawy O, Hashish M, Ismail K, Shalaby H. Outcome of the rhomboid flap for recurrent pilonidal disease. World J Surg 2009;33:1064-1068.
• 24. Doğru O, Camci C, Aygen E, Girgin M, Topuz O (2004) Pilonidal sinus treated with crystallized phenol: an 8 year experience. Dis Colon Rectum 47(11):1934–1938