Crystallized Phenol in Nonoperative Treatment of Previously Operated, Recurrent Pilonidal Disease

Purpose: Recurrence after surgery for pilonidal disease remains a challenge. We investigated the application of crystallized phenol as a nonoperative treatment for patients with recurrent, previously operated pilonidal disease.

Methods: Participants were patients treated for recurrent pilonidal disease at our clinics from January 1995 through August 2007. Crystallized phenol was administered on an outpatient basis. Patient and disease characteristics including age, gender, body mass index, occupation, family history, time from previous operation to recurrence and to phenol treatment, number and type of previous operations, and characteristics of recurrent sinuses at entry were prospectively recorded. Outcome variables included number of phenol applications, recovery time, recurrence, and treatment success or failure.

Results: A total of 36 patients with recurrent pilonidal disease were treated with crystallized phenol (mean recurrence time after previous surgery, 16.2 +/- 4.6 months; number of previous operations, 1.47 +/- 0.9). The mean number of phenol applications per patient was 3.7 +/- 1.3 (range, 1-7). No serious side effects were observed. Exfoliation of a 2-cm area around the sinus openings in 3 patients (8.3%) was easily treated with ointments locally; patients reported minimal pain. Healing was obtained in all patients in a median of 48 (range, 10-153) days. During follow-up (mean duration, 54.4 +/- 5.2 months; range, 29-169 months), 31 patients (86.1%) had no recurrence and 5 patients (13.9%) had recurrence. Recurrent sinuses were successfully treated by a second course of crystallized phenol in 2 patients, 1 patient refused retreatment, and healing was not obtained with a second treatment course in 2 patients, yielding an overall success rate of 91.7% and failure rate of 8.3%.

Conclusion: Crystallized phenol application is a simple, inexpensive nonoperative procedure that can be performed in an outpatient setting and is suitable for the treatment of previously operated recurrent pilonidal disease.