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Session: ePoster: Benign Anorectal 8 (Sat315)

EP111 - Optimal Treatment of Pilonidal Disease: A Meta-Analysis Comparing Surgical, Endoscopic, and Phenol Treatments

Saturday, May 10, 2025
3:31 PM – 3:36 PM PT
Location: Monitor 2, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Mariagiulia Giugliano, MD (she/her/hers)

    Resident
    Università degli Studi di Milano
    milano, Lombardia, Italy

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Narjes Sweis, MD

    Research Fellow
    The University of Illinois Chicago
    chicago, IL, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • MA

    Mohamad A. Abdulhai, MD

    Assistant Professor of Surgery
    University of Illinois at Chicago College of Medicine
    Chicago, Illinois, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • VC

    Vivek Chaudhry, MD, FACS, FASCRS

    Clin Prof of Surgery
    University of Illinois
    Chicago, Illinois, United States

    Disclosure information not submitted.

  • AP

    Alejandra Perez-Tamayo, MD

    Assistant Professor of Surgery
    University of Illinois Chicago
    Chicago, Illinois, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • GG

    Gerald Gantt, MD

    Associate Professor of Surgery
    University of Illinois Chicago
    Chicago, Illinois, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • PS

    Pierpaolo Sileri, Head Colorectal Surgery

    full professor of surgery
    University Vita Salute San Raffaele, IRCCS San Raffaele
    milan, Lombardia, Italy

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Mariagiulia Giugliano, MD: This individual has no financial relationships with ineligible companies.
Narjes Sweis, MD: This individual has no financial relationships with ineligible companies.
Mohamad A. Abdulhai, MD: This individual has no financial relationships with ineligible companies.
Alejandra Perez-Tamayo, MD: This individual has no financial relationships with ineligible companies.
Gerald Gantt, MD: This individual has no financial relationships with ineligible companies.
Pierpaolo Sileri, Head Colorectal Surgery: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Pilonidal sinus disease (PSD) is a chronic inflammatory condition of the sacrococcygeal region that commonly affects young adults, particularly males, causing significant pain and discomfort. While multiple treatment modalities exist, there is no consensus on the optimal approach. This meta-analysis compares three major interventions—surgery with primary closure, endoscopy, and phenol-based treatments—focusing on recurrence rates and wound complications. Although phenolization is rarely used in the United States, it has shown promise in countries such as Turkey and Pakistan.

Methods/Interventions: A systematic literature search was conducted on PubMed and Scopus, following PRISMA guidelines, using the terms: “Pilonidal sinus disease,” “surgical treatment,” “endoscopic treatment,” “phenol injection,” “EPSiT,” “surgical outcomes,” and “recurrence rates.” Eligible studies assessed peri- and post-operative outcomes across surgical, endoscopic, and phenol treatments. Data on recurrence rates, complication rates, recovery time, and hospital stay length were extracted. Statistical analysis was performed using RevMan 5.3, with a primary focus on recurrence and complications, and secondary outcomes including operative duration and hospitalization time.

Results/Outcomes: Twenty-four publications were included in the meta-analysis, with 14 comparing phenol treatment to open approaches and 10 comparing endoscopic to open approaches. While the phenol group showed a slightly higher rate of disease recurrence than the surgical group, the difference was not statistically significant (RR = 0.96, 95% CI [0.66–1.40], p = 0.84). Conversely, recurrence rates were lower in the endoscopic group (RR = 0.55, 95% CI [0.39, 0.77], p = 0.01). Both the phenol and endoscopic groups experienced significantly fewer wound complications compared to the surgical group (RR = 0.33, 95% CI [0.24, 0.47], p < 0.05; RR = 0.31, 95% CI [0.22, 0.43], p < 0.05, respectively). Additionally, the phenol group had a significantly shorter postoperative complete healing time (MD = -17.11, 95% CI [-32.18, -2.03], p < 0.05), whereas the endoscopic group had a longer healing time (MD = 17.84, 95% CI [0.70, 34.98], p < 0.05).

Conclusion/Discussion: This meta-analysis provides a comparative assessment of three major approaches to PSD treatment, identifying key differences in recurrence and wound complication rates. Both endoscopic and phenol treatments emerge as effective alternatives to traditional surgery, offering lower wound complications. Phenol treatment provides faster healing times, while the endoscopic approach, despite requiring a longer healing period, demonstrates lower recurrence rates. Although phenolization is not widely used in the United States due to concerns about toxicity and regulatory barriers, evidence from other countries highlights its potential as a viable option. These findings underscore the need for further research to confirm long-term outcomes and optimize treatment protocols globally.