Aim: Evaluation of outcome of pilonidal sinus excision using a radiofrequency device and comparing its results with wide excision and open granulation procedure.

Methods: Patients with sacro-coccygeal pilonidal sinus disease (n=44) were randomly assigned to undergo either a wide excision and healing by open granulation procedure [WEG] (n=23) or a radiofrequency sinus excision [RSE] (n=21). A Ellman radiofrequency generator was used for sinus excision. Peri and postoperative events, complexity and outcome data were recorded and analyzed by student’s unpaired t-test with 95% confidence interval. (95%CI)

Results: The significant differences in the two group WEG and RSE were as follows- mean hospital stay [47 vs. 10 hours, p<0.001], period off work [29 vs. 8 days, p<0.001], mean analgesic requirement [39 vs. 15 tablets, p<0.001], time for complete wound healing [84 vs. 49 days, p<0.001]. At the mean follow-up of 30 months, two patients from the wide excision and open granulation group and one patient from the radiofrequency sinus excision group developed recurrence.

Conclusion: These findings suggest that sinus excision with radiofrequency is a simple and swift procedure. It needs a short hospital stay and is associated with less postoperative pain and early resumption to work. As compared to excision and healing by granulation technique, the radiofrequency sinus excision procedure achieves faster wound healing and a better outcome.

Keywords: Pilonidal sinus. Excision and open wound Radiofrequency. Recurrence.

1. Dogru O, Camci C, Aygen E, Girgin M, Topuz O. Pilonidal sinus treated with crystallized phenol: an eight-year experience. Dis Colon Rectum 2004; 47:1934-1938.
2. Duchateau J, De Mol J, Bostoen H, Allegaert W. Pilonidal sinus. Excision--marsupialization--phenolization? Acta Chir Belg. 1985; 85: 325-328.
3. Fuzun M, Bakir H, Soylu M, Tansug T, Kaymak E, Harmancioglu O. Which technique for treatment of pilonidal sinus- open or closed? Dis Colon Rectum1994; 37: 1148-1150.
4. Sondenaa K, Nesvik I, Andersen E, Soreide JA. Recurrent pilonidal sinus after excision with closed or open treatment: final result of a randomised trial. Eur J Surg. 1996; 162: 237-240.
5. Spivak H, Brooks VL, Nussbaum M, Friedman I. Treatment of chronic pilonidal disease. Dis Colon Rectum 1996; 39: 1136-1139.
6. Iesalnieks I, Furst A, Rentsch M, Kaich KW. Primary midline closure after excision of pilonidal sinus is associated with a high recurrence rate. Chirurg. 2003; 74:461-468.
7. Chintapatla S, Safarani N, Kumar S, Haboubi N. Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. Tech Coloproctol. 2003; 7:3-8.
8. Lee HC, Ho YH, Seow CF, Eu KW, Nyam D. Pilonidal disease in Singapore: clinical features and management. Aust N Z J Surg. 2000; 70: 196-198.
9. Blanco G, Giordano M, Torelli I. Surgical treatment of pilonidal sinus with open surgical technique. Minerva Chir. 2003; 58:181-187.
10. Chiedozi LC, Al-Rayyes FA, Salem MM, Al-Haddi FH, Al-Bidewi AA. Management of pilonidal sinus. Saudi Med J 2002; 23: 786-788.
11. Lord PH, Millar DM. Pilonidal sinus: a simple treatment. Br J Surg. 1965; 52:298-300.
12. Al-Homoud SJ, Habib ZS, Abdul Jabbar AS, Isbister WH. 2001. Management of sacrococcygeal pilonidal disease. Saudi Med J 2001; 22: 762-764.
13. Huang SK. Advances in applications of radiofrequency current to catheter ablation therapy. Pacing Clin Electrophysiol.1991; 14: 28-42.
14. Goldberg SN, Gazelle GS. Radiofrequency tissue ablation: Physical principles and techniques for increasing coagulation necrosis- Hepatogastroenterology 2001; 48: 359-367.
15. Gunawardhana PA, Deen KI. Comparison of hydrogen peroxide instillation with Goodsall’s rule for fistula-in-ano. ANZ J Surg. 2001; 71: 472-474.
16. Hull TL, Wu J. Pilonidal disease. Surg Clin North Am. 2002; 82: 1169-1185
17. Destito C, Romagnoli A, Pucello D, Mercuri M, Marin AW. Pilonidal sinus: long term results of excision and closure technic. Review of the literature. G Chir. 1997; 18: 441-446.
18. Zieger K. Complications after surgery for pilonidal cyst. An introduction to a new debate on a "costly" disease. Ugeskr Laeger 1999; 161: 6056-6058.
19. Petersen S, Koch R, Stelzner S, Wendlandt TP, Ludwig K. Primary closure techniques in chronic pilonidal sinus: a survey of the results of different surgical approaches. Dis Colon Rectum 2002; 45: 1458-1467.
20. Meban S, Hunter E. Outpatient treatment of pilonidal disease. Can Med Assoc J 1982; 126: 941.
21. Goldberg SN, Gazelle GS, Dawson SL, Rittman WJ, Mueller PR, Rosenthal DI. Tissue ablation with radiofrequency: effect of probe size, gauge, duration and temperature on lesion volume. Acad Radiol. 1995; 2: 399-404.
22. Niamtu J. Oral and Maxillofacial surgical clinics of North America. Cosmetic facial surgery 2000; 12:771-780.
23. Hussain SA, Hussain S. Incisions with knife or diathermy and postoperative pain. Br J Surg. 1988; 75:1179-1180.
24. Friedman M, Mikityansky I, Kam A, Libutti SK, Walther MM, Neeman Z et al. Radiofrequency ablation of cancer. Cardiovasc Intervent Radiol. 2004; 27:427-434.
25. Filingeri V, Gravante G, Baldessari E, Casciani CU. Radiofrequency fistulectomy vs. diathermic fistulotomy for submucosal fistulas: a randomized trial. Eur Rev Med Pharmacol Sci. 2004; 8:111-116.
26. Masala S, Roselli M, Massari F, Fiori R, Ursone A, Fossile E et al.Radiofrequency Heat Ablation and Vertebroplasty in the treatment of neoplastic vertebral body fractures. Anticancer Res. 2004; 24: 3129-3133.
27. Hurst DW. The evolution of management of pilonidal sinus disease. Can J Surg. 1984; 27: 603-605.
28. da Silva JH. Pilonidal cyst: cause and treatment. Dis Colon Rectum 2000; 43: 1146-1156.
29. Isbister WH, Prasad J. Pilonidal disease. Aust N Z J Surg. 1995; 65: 561-563.
30. Shafik A. Electrocauterization in the treatment of pilonidal sinus. Int Surg. 1996; 81: 83-84.
31. Filingeri V, Gravante G, Baldessari E, Craboledda P, Bellati F, Casciani CU. A randomised trial comparing submucosal haemorrhoidectomy with radiofrequency bistoury vs. diathermic haemorrhoi-dectomy. Eur Rev Med Pharmacol Sci. 2004; 8:79-85.
32. Oyake D, Ochi K, Takatsu M, Shintani T, Umehara T, Koizuka I. Clinical effect of bipolar radiofrequency thermotherapy on allergic rhinitis. Nippon Jibiinkoka Gakkai Kaiho. 2004; 107: 695-701.
33. Oshima F, Yamakado K, Akeboshi M, Takaki H, Nakatsuka A, Makita M et al. Lung radiofrequency ablation with and without bronchial occlusion: experimental study in porcine lungs. J Vasc Interv Radiol. 2004; 15:1451-1456.
34. Terk AR, Levine SB. Radiofrequency volume tissue reduction of the tonsils: case report and histopathologic findings. Ear Nose Throat J 2004; 83: 572, 574.
35. Palesty JA, Zahir KS, Dudrick SJ, Ferri S, Tripodi G. Nd: YAG laser surgery for the excision of pilonidal cysts: a comparison with traditional techniques. Lasers Surg. 2000; 26: 380-385.
36. Lavelle M, Jafri Z, Town G. Recurrent pilonidal sinus treated with epilation using a ruby laser. J Cosmet Laser Ther. 2002; 4: 45-47.
37. Brown J.S. Radiosurgery. In Minor Surgery- A Text and Atlas. 3^rd edition; London. Chapman and Hall: 1997.
38. Pfenninger JL, DeWitt DE. Radio frequency surgery. In Pfenninger JL, Fowler GC editors. Procedures for primary care physicians. St.Louis: Mosby; 1994. p 91-101.
39. Kainz C, Tempfer C, Sliutz G, Breitenecker G, Reinthaller A. Radiosurgery in the management of cervical intraepithelial neoplasia.J Reprod Med. 1996; 41:409-414.
40. Breuninger H. Treatment of pilonidal sinus and acne inversa. Hautarzt 2004; 55: 254-258.
41. Miocinovic M, Horzic M, Bunoza D. The treatment of pilonidal disease of the sacrococcygeal region by the method of limited excision and open wound healing. Acta Med Croatica 2000; 54: 27-31.
42. Menzel T, Dorner A, Cramer J. Excision and open wound treatment of pilonidal sinus. Rate of recurrence and duration of work incapacity. Dtsch Med Wochenschr. 1997; 122: 1447-1451.

Dr Smita Uday Vaidya

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