A minimally invasive pilonidal protocol improves quality of life in adolescents

Henry, Owen S.; Farr, Bethany J.; Check, Nikki M; Mooney, David P.

doi:10.1016/j.jpedsurg.2020.11.012

Cited by 7 publications

(3 citation statements)

References 14 publications

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“…Minimally invasive treatment involves a shorter hospital stay and less postoperative scarring, and thus can rapidly resolve the negative impact of the disease on young patients’ quality of life 17 , 134 . Hence, EPSiT, VAAPS, and Gips trephination can be used as the preferred minimally invasive technique 135 . For SPSs with large lesions that are difficult to treat with minimally invasive techniques, there is currently no clear difference in outcomes between various flap techniques; however, judging from the current research, we are of the opinion that the Bascom cleft-lift, LF, and KF techniques, which are widely used at present, can be used as the preferred treatment methods.…”

Section: Discussionmentioning

confidence: 99%

Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review

Zhang

Wang

2023

International Journal of Surgery

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Background: A pilonidal sinus (PS) is an acquired disease resulting from recurrent infections and chronic inflammation. A PS involving the sacrococcyx is referred to as a sacrococcygeal PS (SPS). An SPS is a rare chronic infectious disease for which surgery is a good choice. The incidence of SPS has gradually increased worldwide in recent years. However, surgeons have not reached a consensus on the preferred surgical approach for SPS. The authors performed a systematic review and meta-analysis to analyze differences in the efficacy of different surgical approaches for the treatment of SPS. Methods: A systematic search was conducted in the PubMed database covering the period from 1 January 2003, to 28 February 2023. The primary outcome parameters were recurrence and infection. Finally, statistical analysis (meta-analysis) was carried out using RevMan 5.4.1 software. In addition, we systematically reviewed the latest progress in the surgical treatment of SPS over the past 20 years, especially as reported in the past 3 years. Results: Twenty-seven articles, 54 studies, and 3612 participants were included in this meta-analysis. The recurrence rate following the midline closure (MC) technique was much higher than that of other techniques. Among the techniques analyzed, the differences between MC and Limberg flap (LF), and between MC and marsupialization were statistically significant [P=0.0002, risk ratio (RR)=6.15, 95% CI 2.40, 15.80; P=0.01, RR=12.70, 95% CI 1.70, 95.06]. The recurrence rate of open healing was higher than that of the Karydakis flap (KF) technique, and the difference was statistically significant (P=0.02, RR=6.04, 95% CI 1.37, 26.55). Most of the results comparing MC with other techniques suggested that the former had a higher infection rate, and the difference between MC and LF was statistically significant (P=0.0005, RR=4.14, 95% CI 1.86, 9.23). Comparison between KF and LF, modified LF and KF showed that the differences were not statistically significant in terms of recurrence and infection (P≥0.05). Conclusions: There are various surgical treatment options for SPS, including incision and drainage, excision of diseased tissue with primary closure and secondary healing, and minimally invasive surgery. It is still not possible to determine which surgical technique should be considered the gold standard for treatment, as even the results of different researchers using the same operation method are conflicting. But what is certain is that the midline closure technique has a much higher incidence of postoperative recurrence and infection than other techniques. Therefore, the anorectal surgeon should formulate the most suitable individualized plan for the patient based on a comprehensive evaluation of the patient’s wishes, appearance of the SPS, and the professional ability of the surgeon.

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Section: Discussionmentioning

confidence: 99%

Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review

Zhang

Wang

2023

International Journal of Surgery

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“…The goal of surgical management is to treat not only the lesion but also address all risk factors associated with recurrence such as re-growth of hair in the natal cleft and poor perineal hygiene (8). The historically used open, closed or ap based excisional treatments are associated with prominent levels of both recurrence and morbidity which is particularly distressing in the paediatric cohort (12,13). Due to the unsatisfactory outcomes they were having in their paediatric patients treated with traditional methods for PSD, Meneiro and Milrone et al concomitantly developed the endoscopic pilonidal sinus disease treatment technique based on their experience with the VAAFT procedure in anal stulas.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Treatment of Pilonidal Sinus Disease in Paediatric Patients – A Study in Western Australia

O’Sullivan,

Gera

2024

Preprint

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Background Pilonidal disease is considered a spectrum of disease ranging from acute abscesses to a chronic state most often associated with draining sinuses in the gluteal fold. An increasing prevalence is seen in children with 3 out of every 250,000 children developing pilonidal sinus disease (PSD). Although this is a common disease within general and paediatric surgery departments worldwide, there is yet to be an agreement on a ‘Gold Standard ‘of treatment. Minimally invasive treatment techniques such as EPSiT are a more recent development for pilonidal disease that are showing promising results. Method This study is a retrospective study of children and adolescents who underwent excision of pilonidal disease using EPSiT by a single paediatric surgeon in Western Australia. The primary outcome measure is recurrence, secondary outcomes include complications, length of hospital stay, time to return to school/work, post-operative pain, and time to complete wound healing. Results No patients suffered recurrence or wound complications at mean follow up of thirteen months. No patients were readmitted to hospital for procedure related complications. All patients reported complete wound healing at an average of twenty-eight days and definitive total wound closure at six weeks post operatively. All patients reported the ability to resume daily activities at 2-4 days post operatively. Conclusion PEPSiT is a promising method of treating paediatric PSD and may represent a new 'Gold Standard’ of treatment in these patients. Our results were comparable to other studies in the literature. However, more studies and large-scale randomized control trials are necessary in the paediatric patient cohort. Level of Evidence: IV

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“…In the United States, this affects 26 per 100,000 people with an increased frequency of occurrence in males and adolescents (14–25 years of age) [ 3 , 4 ]. For adolescent patients with PD, the associated sequelae such as recurrent discharge or bleeding, pain, infection, abscess formation, and frequent healthcare encounters for treatment have been shown to significantly decrease quality of life and lead to increased absences from school or work [ 5 , 6 ]. In rare cases, PD-related chronic inflammation can also increase the risk for squamous cell carcinoma formation in patients with compromised immune systems [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of pediatric pilonidal disease treatment: excision with off-midline flap reconstruction versus endoscopic pilonidal sinus treatment

Lee,

Short,

Zhong

et al. 2024

Pediatr Surg Int

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Purpose Pilonidal disease (PD) is marked by chronic inflammation and frequent recurrence which can decrease quality of life. However, debate remains regarding the optimal treatment for PD in the pediatric population. This study compares two recommended treatment approaches—excision with off-midline flap reconstruction (OMF: Bascom cleft lift flap, modified Limberg flap) and minimally invasive endoscopic pilonidal sinus treatment (EPSiT). Methods Single-center retrospective evaluation of patients 1–21 years of age with PD who underwent either excision with OMF reconstruction or EPSiT between 10/1/2011 and 10/31/2021. Outcomes included were disease recurrence, reoperation, and wound complication rates. Comparisons were performed using Chi-square and Mann–Whitney U tests. Results 18 patients underwent excision/OMF reconstruction and 45 patients underwent EPSiT. The excision/OMF reconstruction cohort was predominantly male (44.4% vs 17.8% p = 0.028), with history of prior pilonidal infection (33.3% vs 6.7%; p = 0.006), and longer median operative time (60 min vs 17 min; p < 0.001). The excision/OMF reconstruction cohort had a higher rate of wound complications (22.2% vs 0%; p = 0.001), but lower rates of disease recurrence (5.6% vs 33.3%; p = 0.022) and reoperation (5.6% vs 31.1%; p = 0.031). Conclusion In pediatric patients with PD, excision with OMF reconstruction may decrease recurrence and reoperation rates with increased operative times and wound complication rates, compared to EPSiT.

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A minimally invasive pilonidal protocol improves quality of life in adolescents

Cited by 7 publications

References 14 publications

Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review

Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review

Endoscopic Treatment of Pilonidal Sinus Disease in Paediatric Patients – A Study in Western Australia

Outcomes of pediatric pilonidal disease treatment: excision with off-midline flap reconstruction versus endoscopic pilonidal sinus treatment

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