Comparative outcomes of phenol therapy and Karydakis flap in pilonidal sinus disease

Sacrococcygeal pilonidal sinus disease (PSD) is commonly treated by surgical excision with flap reconstruction. However, minimally invasive treatment modalities based on chemical ablation have gained increasing interest because PSD is not considered a neoplastic disease. Among these techniques, phenol therapy (PT) has emerged as an effective outpatient treatment associated with rapid recovery, low morbidity, and acceptable recurrence rates. To compare the 1-year clinical outcomes of PT and the Karydakis flap (KF) procedure in patients with primary sacrococcygeal PSD. This retrospective cohort study included 125 consecutive patients treated between January 2024 and January 2025. Seventy-seven patients underwent the KF procedure, whereas 48 patients received PT. Demographic characteristics, wound healing time, return-to-work time, postoperative complications, and recurrence rates were evaluated. Patients completed at least 1 year of follow-up through scheduled outpatient visits and structured telephone interviews. The mean age of the study population was 23.68 ± 8.21 years. No significant differences were observed between the groups regarding age, sex, body mass index, family history, prolonged sitting occupation, or history of preoperative abscess drainage (all P > .05). Wound healing time was significantly shorter in the phenol group than in the KF group (15.4 ± 8.4 vs 36.1 ± 7.6 days, P < .005). Similarly, the return-to-work time was significantly shorter following PT. At 1-year follow-up, recurrence occurred in 6 patients (12.5%) in the phenol group and 7 patients (9.1%) in the KF group, with no statistically significant difference between the groups ( P = .09). PT was associated with faster wound healing and earlier return to work, while the 1-year recurrence rate did not differ significantly from that of the KF procedure. It may therefore represent a practical minimally invasive treatment alternative for carefully selected patients with primary sacrococcygeal PSD.