Minimally invasive treatment of pilonidal sinus disease in a paediatric population: comparison of two techniques

Abstract

Background Pilonidal disease (PD) is a common and debilitating inflammatory condition with significant impact on quality of life. Minimally invasive techniques (MIT) have shown promising results comparing to traditional excision. Herein we present a comparison of two MIT techniques ‐sinusectomy (SE) and pit‐picking plus laser ablation (PPL). Methods All cases of paediatric PD treated by PPL and SE at our center between August 2018 and August 2020 were retrospectively reviewed. Results One‐hundred and six patients were included, with a median age of 16 years (IQR 15–16). PPL was the procedure of choice in 36 patients (34%) and the remaining underwent SE (66%). Median healing time was significantly lower in SE group (20 days), comparing to PPL (30 days) (p = 0.002). Early healing failure occurred more frequently in the PPL group (p = 0.003). Recurrence rate was similar between groups ‐ PPL 17% versus SE 16% (p = 0.89). Overall complication rate was 9% and was significantly higher in PPL (p = 0.03). Conclusions MIT techniques are promising solutions in PD treatment. Although similarly easy and fast to perform, SE technique showed better healing profile and lower complication rate but no significant difference on recurrence rates was observed.

Paediatric Pilonidal Sinus Disease: Early Recurrences Irrespective of the Treatment Approaches in a Retrospective Multi‐centric Analysis

“…In adults, primary midline closure results in unacceptably high recurrence rates compared to excision and open wound treatment [40,41], whereas it is still considered the treatment of choice for children and adolescents in several reports [10][11][12][13]. Among the treatment alternatives, reports advocating their use can be found for almost every method: The conventional excision and open wound treatment [14], endoscopic [16], minimally invasive [18], and flap procedures [21]. Due to the contrasting evidence, we aimed to assess whether any surgical treatment would be favourable in children or adolescents.…”

“…Surprisingly, this was neither addressed in original studies [10,13,14,16,[19][20][21]34] nor in systematic reviews [23,44]. Recently, this issue has been raised, because the causative factors remain unknown [18]. Studies whose cohorts included patients with recurrences or report their exclusion [18,19,21,45] indicate a significant burden of disease, as up to 40% [45] of the cohort had recurrences.…”

“…Bascom's cleft lift is statistically significant with P = 0.04 date was the end of last year, so we might expect its results soon. Recently reported treatment protocols from the USA include laser depilation either if hirsutism was present [45] or for every patient [52], whereas it was uncommon on the continent [18,22,53].…”

“…Recently, this issue has been raised, because the causative factors remain unknown [ 18 ]. Studies whose cohorts included patients with recurrences or report their exclusion [ 18 , 19 , 21 , 45 ] indicate a significant burden of disease, as up to 40% [ 45 ] of the cohort had recurrences. Therefore, it has been suggested to stick to repeated minimally invasive procedures for pilonidal sinus disease in children [ 46 ].…”

“…National guidelines were developed in Italy [7], the USA [8], and Germany [9], but seldom mentioned children and adolescents specifically. The literature is divided on the procedure of choice for paediatric pilonidal sinus disease: Some favour resection and primary midline closure [10][11][12][13], others excision and open wound treatment [14,15], endoscopic [16,17], minimally invasive [18][19][20] or flap procedures [21,22]. Despite these numerous reports on a variety of treatment approaches, none of them was determined to be advantageous in a systematic review of surgical approaches to paediatric pilonidal sinus disease [23].…”