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Quality of life (QOL) outcome is an ideal method for determining the efficacy of a surgical treatment. In children operated for pilonidal sinus disease (PSD), open procedures imply prolonged wound care, significant morbidity, and high recurrence rates. Endoscopic treatment (PEPSIT) overcomes these limitations. We report our experience in the management of PSD to evaluate the QOL of patients undergoing open and endoscopic treatment. The records of 177 patients undergoing surgery for PSD from 2008 to 2021 were retrospectively reviewed. Twenty patients were operated with open surgery (G1) and 157 with PEPSIT (G2). We analyzed QOL through the following criteria: hospital stay (HS), healing time (HT), return to sport (RTSp), return to school (RTSc), resumption of social life (RSL), and recurrence rate and reoperation (RRR). Moreover, we used Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q) for a more subjective evaluation of life satisfaction. We found significant differences in all the analyzed criteria: HS varied from 3 to 7 days in G1 and from 1 to 2 days in G2; HT from 40 to 75 days in G1 while from 20 to 41 days in G2; RTSp from 50 to 80 days in G1 while from 7 to 21 days in G2; RTSc from 9 to 15 days in G1 while from 2 to 4 days in G2; RSL from 13 to 20 days in G1 while from 2 to 5 days in G2; RRR was 25% in G1 and 4.4% in G2.Conclusion: Endoscopic treatment (PEPSIT) significantly improves the quality of life of patients operated for PSD. Compared to open surgery, PEPSIT presents shorter hospital stay, faster healing time, return to sport activities, return to school and resumption of a normal social life, and lower rates of recurrence and reoperation. In addition, PQ-LES-Q demonstrated a good overall quality of life and life satisfaction. Further prospective studies should be obtained to consider PEPSIT as the gold standard for the treatment of PSD in pediatric patients. What is Known: • Many techniques have been proposed in the last 20 years for the surgical treatment of PSD. • PEPSIT is showing promising results in terms of safety and long-term efficacy. What is New: • The main impact in QOL of patients operated with PEPSIT is on their daily activity, including a shorter hospital stay, faster healing time, return to sport activities, return to school and resumption of a normal social life, lower rates of recurrence and reoperation. • After PEPSIT, children maintain a satisfactory quality of life according to the analysis of PQ-LES-Q

Robotic-assisted surgery (RAS) is increasingly adopted in the pediatric population. This retrospective multicenter study aimed to report application of RAS for pediatric gynecological indications. The medical records of all children and adolescents with gynecological pathology, operated in 3 different institutions over a 3-year period, were retrospectively collected. Robot docking time, total operative time, length of stay (LOS), requirement time of pain medication, complication rate, conversion rate, and pathology results were analyzed. Sixteen girls, with median age of 11.7 years (range 0.6-17.9) and median weight of 47.2 kg (range 9-73), received the following RAS procedures: ovarian cystectomy for serous cystoadenoma (n=2), salpingo-oophorectomy for immature teratoma (n=6), bilateral gonadectomy for ovotestis (n=2) and Turner syndrome SRY+ (n=1), salpingectomy for fallopian tube lesion (n=1), Gartner cyst excision (n=1), paravaginal ganglioneuroma resection (n=1), fistula closure in urogenital sinus (n=1) and vaginoplasty using ileal flap in cloaca malformation (n=1). Median operative time was 131.3 minutes (range 65-360), and median docking time was 13.9 min (range 7-20). Conversion to open or laparoscopy was not necessary in any case. Median LOS was 2.3 days (range 1-7), and median analgesic requirement was 1.5 days (range 1-4). One patient needed redo-surgery for recurrent Gartner cyst. This preliminary experience showed that RAS is safe and feasible for surgical management of pediatric gynecological pathology, although no conclusive data are available to confirm its superiority over traditional laparoscopy. Randomized, prospective, comparative studies are needed to confirm these preliminary results and identify the gold standard approach in such patients.

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