ВДОСКОНАЛЕННЯ ХІРУРГІЧНОГО ЛІКУВАННЯ РЕЦИДИВНИХ ФОРМ ЕПІТЕЛІАЛЬНОГО КУПРИКОВОГО ХОДУ ІЗ ЗАСТОСУВАННЯМ ЛОКАЛЬНОЇ ОЗОНОТЕРАПІЇ

Recurrent pilonidal disease is characterized by pronounced tissue scarring and frequently involves the retention of infiltrated and inflamed tissues during repeat surgical interventions, thereby driving high rates of subsequent recurrence and wound complications. Objective. To develop preventive strategies for purulent complications and recurrences of pilonidal disease through a differentiated surgical approach incorporating intraoperative ultrasound monitoring and local ozone therapy. Materials and Methods. A prospective comparative study was conducted involving 102 patients with recurrent pilonidal disease and sacrococcygeal fistulas at the Department of Coloproctology, Samarkand Regional Multidisciplinary Medical Association. The control group comprised 53 patients (51.9%) receiving traditional management, whereas the intervention group included 49 patients (48.1%) managed with a differentiated approach. This approach incorporated intraoperative ultrasound monitoring, comprehensive pharmacological correction of endotoxemia, hypoxia, oxidative stress, and endothelial dysfunction, alongside local ozone therapy administered via the Medozons BM device. Evaluated parameters included the dynamics of ultrasonographic and laboratory markers (C-reactive protein [CRP], malondialdehyde [MDA], nitric oxide, and leukocyte counts), the incidence of early postoperative complications, wound healing duration, and long-term recurrence rates (follow-up up to 2 years). Written informed consent was obtained from all patients for examination, surgical intervention, and the use of anonymized clinical data for research purposes. Statistical analysis was performed using Student’s t-test and the χ² test, with statistical significance defined as p < 0.05. This study was conducted as part of the research program of the Department of Surgical Diseases at Samarkand State Medical University, focusing on the optimization of surgical management for sacrococcygeal pathologies. Results. The developed intraoperative ultrasound monitoring technique was effectively applied in 35.3% of recurrent pilonidal disease cases. Local ozone therapy, combined with comprehensive pharmacological correction, facilitated a more rapid resolution of perifocal inflammation (2.2 ± 0.42 versus 3.9 ± 0.6 days), reduced CRP levels from 132.5 ± 7.2 to 49.4 ± 5.1 mg/mL, and increased nitric oxide levels from 19.6 ± 6.2 to 27.3 ± 3.1 μmol/L. By postoperative day 3, the infiltration zone width measured 6.3 ± 0.9 mm in the intervention group, compared with 9.2 ± 0.9 mm in the control group (p < 0.05). The incidence of early postoperative complications decreased from 22.6% to 10.2%; furthermore, wound dehiscence was not observed in any patient within the intervention group, contrasting with a 7.5% incidence in the control group. Complete wound healing time was reduced from 28.3 ± 2.1 to 15.8 ± 0.9 days, and the duration of temporary work disability decreased from 32.25 ± 2.25 to 19.6 ± 0.95 days. The two-year disease recurrence rate declined from 16.6% to 5.0% (p < 0.05). Conclusions. A differentiated surgical strategy, grounded in objective criteria for determining the extent of intervention, intraoperative ultrasound monitoring, and local hydropressive ozone therapy combined with the correction of endotoxemia and oxidative stress, yields a statistically significant reduction in early postoperative complications and recurrence rates among patients with recurrent pilonidal disease.