Phenol for pilonidal sinus disease: a nationwide survey of practice patterns and safety gaps among surgeons in Türkiye

Phenol is widely used as a minimally invasive treatment for pilonidal sinus disease (PSD); however, its clinical application is characterized by substantial heterogeneity in indications, technique, dosing, and safety practices. Despite its routine use in outpatient settings, standardized safety frameworks addressing occupational exposure, environmental controls, and dose documentation are lacking. These gaps may have important implications for both patient outcomes and workplace safety. This nationwide survey aimed to characterize real-world phenol practice patterns among surgeons in Türkiye, with a particular focus on safety infrastructure, exposure control measures, and clinical decision-making. A nationwide, internet-based, cross-sectional survey of surgeons managing PSD in Türkiye (July 8–August 15, 2025), aligned with CHERRIES. The 38-item instrument captured demographics; workload/experience; environmental controls (ventilation), institutional exposure-prevention policies, and personal protective equipment (PPE); patient-side protection strategies; phenol procurement, formulation/concentration, and dosing; treatment planning; and outcomes/perceptions. Descriptive statistics summarized item-level responses. A total of 132 surgeons provided responses. 81.1% evaluated more than 30 PSD patients annually, and 48.5% conducted more than 30 phenol procedures per year. Surgeons frequently procured phenol from external pharmacies (36.4%); crystalline phenol predominated (77.3%); 50.8% did not know the concentration (most reported 99.9%); and only 7.6% measured dose per procedure. The majority of surgeons performed 2 to 3 sessions (69.0%) at intervals of 2 to 3 weeks (38.6%). Key safety gaps were identified: only 34.8% reported dedicated ventilation, 53.0% reported none, and 62.1% had no institutional exposure-prevention policy. Routine mask use was reported by 53.8% (primarily surgical masks); additional PPE beyond mask and gloves was used by 22.0% (gowns 51.7%, eye protection 48.3% among those reporting). Patient-side skin protection was common (81.3%). Adverse events in patients were recorded at a rate of 20.5%, with skin burns being the most prevalent, while operator adverse effects occurred at a rate of 5.3%. Despite these gaps, perceived safety was relatively high (patients 83.3%, operators 68.9%), and 89.4% would personally choose phenol if affected. Findings support a safety-first national framework specifying permissible formulations/concentrations, mandating dose documentation and skin-protection protocols, and implementing a core safety bundle (effective ventilation, written exposure-control policies/checklists, and PPE including eye protection). Prospective exposure monitoring with standardized outcomes is warranted.