ORIGINAL CONTRIBUTION Crystallized Phenol in Nonoperative Treatment of Previously Operated, Recurrent Pilonidal Disease Erhan Aygen, M.D. 1 • Kemal Arslan, M.D. 2 • Osman Dogru, M.D. 2 Murat Basbug, M.D. 1 • Cemalettin Camci, M.D. 1 1 Firat (Euphrates) University School of Medicine, Department of Surgery, Elazig, Turkey 2 Konya Training and Teaching Hospital, General Surgery Clinic, Konya, Turkey 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 2 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. KEY WORDS: Recurrent pilonidal disease; Crystallized phenol; Outpatient treatment. D espite recent technological and technical achieve- ments and advances in surgery for pilonidal dis- ease, 1 recurrence remains a great challenge, even 5 or more years after operative treatment. 2 Repeated futile operations are often undertaken— 8 or more in some pa- tients. 3,4 Although few data are available regarding nonop- erative treatment of recurrent pilonidal disease, minimally invasive nonoperative approaches such as the use of phe- nol as a sclerosing agent may be appropriate for the man- agement of this problematic condition. 5 Phenol was ini- tially applied in the form of an 80% solution injected into the sinus tract. 6 We successfully used a crystallized form of phenol in the treatment of patients with primary pilonidal disease. 7 Although that study also included 6 patients with recurrent pilonidal disease, the use of crystallized phenol to treat recurrent pilonidal sinuses has never been specifically addressed. We therefore conducted a prospective study of the application of crystallized phenol in patients who had recurrence of pilonidal disease after previous surgical treatment. Financial Disclosure: None reported. Presented at the Coloproctology and Stomatherapy Symposium, Adana, Turkey, April 12 to 14, 2007. Correspondence: Osman Dogru, M.D., Konya Training and Teaching Hospital, General Surgery Clinic, Konya, Turkey. E-mail: konya422003 @yahoo.com Dis Colon Rectum 2010; 53: 932–935 DOI: 10.1007/DCR.0b013e3181d8283b ©The ASCRS 2010 932 DISEASES OF THE COLON &RECTUM VOLUME 53: 6 (2010)