Initial experience with minimally invasive treatment of pilonidal sinus in children.

Abstract

Introduction Sinus pilonidalis (SP) is an acquired inflammatory disease, which is relatively common in the paediatric population. Surgery is indicated in symptomatic patients. In 2017, minimally invasive pilonidal sinus treatment (EPSiT) was adapted to the paediatric population. Aim To evaluate the first experience with minimally invasive endoscopic treatment of SP (PEPSiT) in children and adolescents in the Czech Republic. Material and methods A retrospective review of all consecutive paediatric patients who underwent PEPSiT from November 2018 to February 2020. The monitored parameters were demographics, perioperative course of the disease, surgery, length of hospitalisation, postoperative complications, healing, disease recurrence, and follow-up. Results Seventeen patients were enrolled in the study. The median age at surgery was 17.1 years (range: 12.5–18). The subjects comprised 76% males, and the median body mass index was 25.6 kg/m 2 (range: 17–30.3 kg/m 2 ). Thirteen patients underwent previous surgical treatment (76%) under local anaesthesia. The median duration of PEPSiT was 50 min (range: 30–85 min). The subjective evaluation of pain by patients on the VAS scale was 0 on the day of discharge. There were no postoperative complications up to the 30 th postoperative day. Two disease recurrences were successfully managed by re-PEPSiT. By the end of follow-up, 14/15 patients had healed. Two patients are still within 3 months of surgery, which is too soon to definitively evaluate possible recurrence of the disease. Conclusions These preliminary results show that PEPSiT is a highly promising method. It is safe and well-tolerated by patients (short hospital stay, quick return to normal life, low pain and analgesic consumption). Two recurrences of disease were treated by re-PEPSiT.

Endoscopic approach to complex or recurrent pilonidal sinus: A retrospective analysis

“…Moreover, the endoscopic surgery has been used for the acute pilonidal abscess treatment 30 , 39 , 40 with reduced postoperative pain, lower duration of wound healing and time off work as shown by two comparative studies. 30 , 39 Similar results have been obtained by paediatric surgeons such as Esposito et al 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 achieving low postoperative pain, short length of hospital stay and better outcomes than open technique.…”

Endoscopic Treatment of Pilonidal Sinus Disease: State of Art and Review of the Literature

“…Several non-comparative reports have demonstrated similar results, with a recurrence rate ranging from 0 to about 6% ( 32 , 34 – 38 , 40 , 41 ). In this setting, several authors considered the PEPSiT as the gold standard of care in cases of PSD in the pediatric population.…”

Endoscopic pilonidal sinus treatment (EPSIT) versus sinus laser therapy (SiLaT) for sacrococcygeal pilonidal sinus.

“…Esposito et al adapted EPSIT to the pediatric population as PEPSIT (pediatric EPSIT) and presented it in 2018 [16]. Dotlacil et al reported one of the largest series on PEPSIT, in which they achieved 87% healing after the first PEPSIT and confirmed minimal invasiveness, short hospital stay, and low requirement of analgesics [15].…”

“…These methods promise shorter wound healing time and time to return to work, and improved pain control and cosmesis. Endoscopic procedures can also be used in adolescent patients, and these methods also reduce the sense of embarrassment that patients experience [ 14 , 15 ]. EPSIT is a minimally invasive method described by Meinero et al [ 2 ].…”