Phenol Injection Versus Excision With Open Healing in Pilonidal Disease: A Prospective Randomized Trial.

Background: Minimally invasive procedures may be an alternative to surgical excisions for pilonidal disease.

Objective: The aim of the study was to compare phenol injection versus excision with open healing technique.

Design: This is a prospective randomized study (ACTRN12612000868886).

Settings: This study was conducted at the Ankara University and Ufuk University Departments of Surgery.

Patients: One hundred forty patients were randomly assigned to phenol injection (n = 70) or excision with open healing (n = 70).

Main Outcome Measures: The primary end point of the study was the time to complete wound healing. Secondary end points were visual analog scale pain score, painkiller intake, time to resume daily activities, recurrence rate, Short Form 36 Health Survey, and Nottingham Health Profile at 3 weeks after surgery.

Results: Time to complete wound healing (16.2 ± 8.7 versus 40.1 ± 9.7 days) was significantly in favor of the phenol injection group (p < 0.001). The median operation time was 14.0 ± 3.8 minutes in the phenol group versus 49.0 ± 24.2 minutes in the excision with open healing group (p <  0.001). The time to resume daily activities (pain-free mobilization and defecation) was 0.8 ± 2.8 and 16.2 ± 12.6 hours after phenol injection and 9.3 ± 10.0 and 22.5 ± 15.1 hours after the excision with open healing treatment (p <  0.001, p = 0.008). Visual analog pain score at 48 hours and painkiller intake within 48 hours were significantly in favor of the phenol injection group. At the mean follow-up of 39.2 ± 9.0 months after surgery, no differences were seen in the recurrence rate between the treatment arms (13 recurrences in phenol vs 9 in excision with open healing; p = not significant). Short Form 36 and Nottingham Health Profile scores at 3 weeks after surgery were also in favor of phenol injection.

Limitations: The present study was not double blinded, and a history of abscess drainage was significantly higher in the surgery group.

Conclusions: Based on the results, we conclude that phenol injection is as effective as the excision with open healing technique.