Previously operated recurrent pilonidal sinus treated with crystallized phenol: Twenty-year experience in a cohort study.

Objectives: Postoperative recurrent pilonidal sinus disease is troublesome, and its treatment is a challenge. In this study, it was aimed to present the long-term efficacy of crystallized phenol treatment on postoperative recurrent pilonidal sinus disease through our results collected within the last 20 years. Material and Methods: Two hundred and twenty-seven patients who had been previously operated on and suffered from recurrent pilonidal sinus disease were enrolled. The operation was applied in our outpatient clinic under local anesthesia. Demographic data of the patients, number of crystallized phenol treatment, duration of follow-up and recurrence numbers were prospectively recorded. Treatment success and factors affecting recurrence were examined. Results: Our success rate was found as 71.5%. This success rate belongs to the group of patients who never quit treatment and complied with the treatment. The patients were followed up for a mean 45.8 months. Of the post-crystallized phenol treatment recurrences, 72.4% took place within the first five years, while 97.4% did so within the first 10 years. Mean number of crystallized phenol applications was 2.6. The longer the duration of the disease before treatment, the more recurrence was observed after treatment (p= 0.02). There was no correlation between the number of previous operations and recurrence after treatment. As the number of sinus openings increased, so did the number of applications (p= 0.001). Conclusion: Crystallized phenol treatment yields promising long-term results in recurrent pilonidal sinus disease as well and may be recommended as the first choice in recurrent pilonidal sinus disease treatment since it is an effective non-operative treatment modality.

Role of glucose/potassium ratio and shock index in predicting mortality in patients with isolated thoracoabdominal blunt trauma.

BACKGROUND: The aim of this study, investigate the prognostic value of shock index (SI), which has been accepted for a long time, and glucose-potassium ratio (GPR), which has limited data in patients with trauma and those with isolated blunt thoracoabdominal trauma. METHODS: This retrospective observational study was conducted at the tertiary reference hospital. Consecutive patients aged 18 years and older treated for blunt thoracoabdominal trauma in the emergency department between August 2020 and February 2022 were included in the study. The ability of GPRs obtained from arterial blood gases and SI levels on admission to predict mortality and indication for surgery was evaluated by calculating areas under receiver operating characteristic curves Area under the curve (AUCs). RESULTS: A total of 102 patients, of which 91 in the survivor group and 11 in the non-survivor group, were analyzed. The AUCs for estimating mortality with GPR and SI were 0.854 (95% confidence interval [CI], 0.742-0.967) and 0.809 (95%, 0.666-0.952), respectively. The AUCs of GPR and SI to estimate the indication for surgery were 0.761 (95% CI, 0.657-0.864) and 0.582 (95% CI, 0.416-0.747), respectively. CONCLUSION: This study reported the efficacy of SI and GPR in predicting surgical indication and mortality in patients with isolated blunt thoracoabdominal trauma and the superior predictive role of GPR over SI.

Long-term outcomes of crystallized phenol application for the treatment of pilonidal sinus disease.

OBJECTIVE: This study aimed to better demonstrate the long-term outcomes and effectiveness of crystallized phenol treatment (CPT) by presenting our 20 years experience. METHODS: One thousand and twenty-six patients who have primer pilonidal sinus were enrolled. The operation was applied outpatient clinic under local anesthesia. Recurrence rate, application number, healing time, and factors affecting them were analyzed. RESULTS: The success rate was 84.3%. The mean number of CPT applications was 2.1 and the mean recovery time was 8.9 weeks. The rate of recurrence was higher in patients with a long disease duration prior to initiating treatment (p = .04). The rate of recurrence was higher in patients with a higher number of opening and CPT application, those with longer application time, and those with a positive family history (respectively p = .01, p = .002, p = .008). CONCLUSIONS: Long-term outcomes are also very successful in the treatment of pilonidal disease with CPT. We believe that CPT should be the first choice in the treatment of pilonidal disease because it is inexpensive, can be applied as an outpatient treatment, is a noninvasive procedure, has results comparable to surgical procedures, and does not cause loss of work and strength.

Is Hair Removal Necessary after Crystallized Phenol Treatment in Pilonidal Disease?

OBJECTIVE: The most important cause of posttreatment recurrence of pilonidal sinus disease (PSD) is the reentry of hair into the skin. The study aimed to investigate the effect of hair removal and its duration on the prevention of recurrence after crystallized phenol treatment. SUBJECT AND METHODS: Patients with PSD who were treated with crystallized phenol treatment were evaluated. Hair in the sacrococcygeal area was removed with depilatory cream before every crystallized phenol procedure, during the treatment, and after treatment once a month for 6 years. Of 1,016 patients, 735 were contacted by telephone or e-mail regarding the frequency of sacrococcygeal hair removal and recurrence. Demographic and sinus features and crystallized phenol application data of patients treated with crystallized phenol for PSD, as well as recurrences were retrospectively assessed. RESULTS: The mean follow-up time was 46.23 ± 33 (range, 11-240) months, with 139 (18.9%) patients experiencing recurrence. Patients who underwent hair removal experienced significantly less recurrence than those who did not (p = 0.003, odds ratio [OR]: 0.54 [95% CI: 0.36-0.82]). The OR of recurrence decreased by 0.8% every month as the hair removal time increased (OR: 0.992, 95% CI: 0.985-1.000, p = 0.049). The cutoff value for sensitivity was 0.636, specificity 0.466, and area under the curve 0.562 in hair removal procedures that lasted for over 30 months. CONCLUSION: Regular hair removal during, and at least 30 months after, crystallized phenol treatment reduced recurrences in patients with PSD.

Crystallized phenol for sacral hidradenitis suppurativa.

OBJECTIVE: Multiple treatment options for hidradenitis suppurativa (HS) have been suggested; none 100% successful. We assessed crystallized phenol treatment (CPT) for sacral HS. METHODS: Twenty-five patients with sacral HS were enrolled. HS severity was assessed by Hurley Score and HS-Physician's Global Assessment (HS-PGA). All the leaking openings were dilated by a thin mosquito clamp after local anesthesia. Any hair present was removed, and phenol was applied. RESULTS: Patients were followed-up for a mean 36.8 months. The mean number of CPT application was 3.98. After CPT mean Hurley score decreased from 2.1 ± 0.68 to 1.2 ± 0.4 and HS-PGA score from 3 ± 1.22 to 0.72 ± 8.4 (p = .01). Recurrence was seen in 10 patients during follow-up period but they were re-treated with CPT. CONCLUSION: CPT may be useful as a first-line treatment of sacral HS.

Evaluation of the efficacy of platelet-rich plasma in preventing postoperative intraabdominal adhesions.

OBJECTIVES: Postoperative intraabdominal adhesions still maintain their currency as serious causes of morbidity and mortality. This study aimed at evaluating the role of platelet-rich plasma (PRP) in the prevention of intraabdominal adhesions. MATERIAL AND METHODS: A total of 16 healthy rabbits were used within the scope of the study. The animals were allocated into two groups as Group 1 (control group) and Group 2 (study group). In all subjects, cecal abrasion was formed by laparotomy. In the study group, platelet rich plasma was administered intraabdominally. At the end of the study, the adhesions were evaluated by Nair's Score. RESULTS: Total adhesion score in Group 1 was 8, while the mean score was 1. On the other hand, total adhesion score in Group 2 was 12, while the mean score was 1.5. There was no statistical difference between both groups by total adhesion score and mean fibrosis score. However, mean scores for inflammatory cell infiltration and angiogenesis were higher in Group 2 and the differences were statistically significant (p= 0.021). CONCLUSION: We were not able to report the positive results of PRP; however, we believe that we shed an important light for future studies which might be conducted using the combination of different methods.

Is the superior laryngeal nerve really safe when using harmonic focus in total thyroidectomy? A prospective randomized study.

BACKGROUND: Harmonic focus (HF) was introduced in thyroid surgery in an effort to reduce operation time and complications. OBJECTIVE: The present study aimed to compare function of superior laryngeal nerve and incidence of other postoperative complications in total thyroidectomies using HF and conventional ligation (CL). METHODS: The trial is a randomized single-center, single-blinded study. Patients aged ≥ 18 years scheduled for total thyroidectomy were considered for participation. An ultrasonic dissector was used for coagulation and cutting in the HF group, while the standard technique was used in the CL group. Demographic, surgical data, and complications were recorded. Data were analyzed using SPSS for Windows. RESULTS: Of 244 eligible patients, data of 206 patients who completed the study were analyzed. The groups were similar in terms of age, sex, and indication for operation. The mean operative time in the HF group was significantly shorter than that in CL group (p=0.01). Drain necessity, duration of drainage, duration of postoperative hospitalization, and the incidence of postoperative complications was similar in the groups (p>0.05). The external branch of the superior laryngeal nerve and recurrent laryngeal nerve palsy were noted in three and two patients in the HF group and in two and one patients in the CL group at 6 months. CONCLUSION: To the best of our knowledge, this is the first study comparing conventional technique with HF in total thyroidectomy, focusing on the function of the external branch of the superior laryngeal nerve using laryngostroboscopy; results showed that HF is as safe as the conventional technique.

Lateral internal sphincterotomy versus 0.25 % isosorbide dinitrate ointment for chronic anal fissures: a prospective randomized controlled trial.

PURPOSE: To compare the healing properties of lateral internal sphincterotomy (LIS) and isosorbide dinitrate (ISDN) ointment for chronic anal fissure. METHODS: Patients with a chronic anal fissure were randomly assigned to a group treated with ISDN ointment (n = 105) or a group treated with LIS (n = 102). The same investigators examined the patients in a blinded manner, 1, 2, 3, 6, and 12 months after the treatments. RESULTS: The anal fissure had healed completely by 4 weeks in 64.7 versus 92.2 %, and by 6 months in 77.1 versus 97.1 % of the ISDN and LIS group patients, respectively. At 12 months, the recurrence rates were 4.8 versus 1 % for the ISDN and LIS groups, respectively, and the success rates of the treatments were 72.4 versus 96.1 %, respectively. Six patients in the LIS group experienced minor fecal incontinence, and seven (6.7 %) patients in the ISDN group experienced headaches that responded well to paracetamol. CONCLUSION: ISDN ointment was reported by all patients to be easy to use. Although its success rate was lower than that of surgery, ISDN can be offered to selected patients with a chronic anal fissure, as it has a low recurrence rate and rare side effects are rare.