Paediatric endoscopic pilonidal sinus treatment: it is time to forget the open procedure?

Abstract

Purpose Our aim was to study the learning curve results with Paediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT). Methods A retrospective observational study was performed in paediatric patients (< 18 year) with PEPSiT procedure. Complications, length of hospital stay and recurrence rate were analysed. Result In 2019, during the study period, 12 PEPSiT procedures were done. One patient was excluded from the study, because of the loss of follow-ups and two of them because of the use of the cystoscope. Intra-or postoperative complications were not found and 1/9 recurrence was observed. Length of stay was 1 day for all patients. Conclusion Although there is limited experience in PEPSiT, it seems to be a feasible procedure. The length of hospital stay is shorter than after open surgery. Further studies are needed to evaluate the long-term results with PEPSiT.

Outcomes of Pediatric Endoscopic Pilonidal Sinus Treatment: A Systematic Review

“…Sixty studies were initially retrieved. Screening of these studies (abstract or full text when necessary) led to the exclusion of 51 studies, resulting in 9 studies [12][13][14][15][16][17][18][19][20] eligible for inclusion in this systematic review (►Fig. 1).…”

“…12,17 Of note, formal training or expertise of the performing surgeon/s on EPSiT is reported in four of the included studies, 12,13,15,18 while previous formal training or expertise is not specified in the remaining five studies. 14,16,17,19,20 Perioperative hair removal strategies varied significantly between and within studies (►Table 1). Routine preoperative and postoperative laser epilation was employed in two of the included studies 16,18 ; patients were instructed on regular hair removal postoperatively with shaving, depilatory creams, pulse light, or laser technology in six studies [13][14][15]17,19,20 ; in one study, hair removal strategies were not reported in perioperative wound care.…”

“…14,16,17,19,20 Perioperative hair removal strategies varied significantly between and within studies (►Table 1). Routine preoperative and postoperative laser epilation was employed in two of the included studies 16,18 ; patients were instructed on regular hair removal postoperatively with shaving, depilatory creams, pulse light, or laser technology in six studies [13][14][15]17,19,20 ; in one study, hair removal strategies were not reported in perioperative wound care. 12 In five of the included studies, the follow-up duration after PEPSiT exceeded 3 months for all studied patients [12][13][14][15][16][17] ; three studies included patients with shorter follow-up.…”

“…As can be seen in Table 1 , PEPSiT was undertaken with a standard pediatric cystoscope with an 8-Fr working channel in 2 studies 13 15 ; 2 studies report the use of Meinero fistuloscope or pediatric cystoscope/resectoscope 12 19 ; in 1 study, a 3-mm endoscope was used and fistulous tracts were accessed with instruments via separate openings under direct vision 20 ; and 4 of the included studies report the use of Meinero fistuloscope only. 14 16 17 18 The operative approach was overall standard with inclusion of all operative steps of removal of sinus cavity hair, sinus debridement, and sinus ablation with cautery under direct vision, as described by Meinero et al, 6 with nevertheless varied instrumentation depending on the kit available (fistuloscope or cystoscope); however, in one study, only the step of hair removal with the use of small graspers is described, 20 and two of the remaining eight studies do not report the use of brush (or curette) for debridement. 12 17 Of note, formal training or expertise of the performing surgeon/s on EPSiT is reported in four of the included studies, 12 13 15 18 while previous formal training or expertise is not specified in the remaining five studies.…”

“…12 17 Of note, formal training or expertise of the performing surgeon/s on EPSiT is reported in four of the included studies, 12 13 15 18 while previous formal training or expertise is not specified in the remaining five studies. 14 16 17 19 20…”