Pediatric endoscopic pilonidal sinus treatment (PEPSiT): what we learned after a 3-year experience in the pediatric population

Esposito, Ciro; Montaruli, Ernesto; Autorino, Giuseppe; Mendoza-Sagaon, Mario; Escolino, Maria

doi:10.1007/s13304-021-01094-4

Cited by 14 publications

(19 citation statements)

References 20 publications

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“…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.…”

Section: Discussionsupporting

confidence: 78%

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

Maione

D’Amore

Milone

et al. 2022

International Wound Journal

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Pilonidal Sinus is a benign, chronic disease that affects the hair follicles of the natal cleft of the sacrococcygeal area. Its ideal treatment is controversial, especially in complex or recurrent cases. The aim of this study is to evaluate the use of minimally invasive endoscopic approach in this setting. We enrolled patients affected by complex or recurrent sacrococcygeal pilonidal sinus from January 2015 through December 2020 who underwent Video‐Assisted Ablation of Pilonidal Sinus. All patients enrolled were re‐evaluated once a year with a standard physical examination. The patients included were 38. Recurrence rate at 1‐, 3‐ and 5‐years follow‐ups were 28.9%, 22.2% and 38.1% respectively. Of interest, the mean (SD) distance from the most lateral orifice to the midline was higher in group of patients with recurrence and the multivariate analysis demonstrated that it was the limiting factor, which influences the recurrence rate. In complex or recurrent pilonidal sinus disease with pits off the midline the endoscopic approach should not be the first choice. This makes us think that these cases should have their own classification to be identified and guide surgeons in choosing the appropriate approach.

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Section: Discussionsupporting

confidence: 78%

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

Maione

D’Amore

Milone

et al. 2022

International Wound Journal

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“…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.…”

Section: Discussionmentioning

confidence: 53%

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

et al. 2022

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Background: Pilonidal sinus disease (PSD) is a chronic troublesome pathology of the natal cleft of the sacrococcygeal region, with an estimated incidence of 26 cases in every 100,000 inhabitants. The aim of this review is to give a snapshot of the current literature on the endoscopic approach to PSD.Methods: A search on endoscopic treatment of pilonidal disease was performed according to PRISMA guidelines, adopting the following search terms: (pilonidal OR sacrococcygeal) and (endoscopic OR VAAPS OR EPSiT OR minimally invasive OR video-assisted OR video assisted).Results: Thirty-four articles were included in the final analysis, among which 23 were on adults and 11 were on pediatric population. The endoscopic approach is associated with painless postoperative pain, good aesthetic results, short time off work, and high patient satisfaction.Despite these advantages in short-term outcomes, results on recurrence rate in a long-term follow up are needed to definitively confirm the importance of this technique.Conclusions: The endoscopic approach is associated with significant postoperative advantages over other standard surgical approaches, and it should be included in the surgical portfolio for the treatment of PSD. According to the Italian guidelines, this technique could be considered as the gold standard for limited PSD. However, the favorable short-term-outcomes and lack of reliable data on long-term follow-up must be a stimulus to perform further high-quality studies to give definitive conclusions on this technique.

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“…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).…”

Section: Resultsmentioning

confidence: 99%

Outcomes of Pediatric Endoscopic Pilonidal Sinus Treatment: A Systematic Review

et al. 2023

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Treatment of pilonidal sinus disease with conventional excision techniques is associated with recurrence up to 20 to 30% (primary closure) or with prolonged healing that might last months (closure by secondary intention). Endoscopic pilonidal sinus treatment (EPSiT) is gaining increasing popularity. This systematic review aims to summarize and evaluate the reported outcomes of pediatric EPSiT (PEPSiT) to date. Systematic search was performed for all studies on PEPSiT in patients younger than 18 years, pertaining to demographics, technique, and outcomes. Fisher's test was used to assess the associations between success/recurrence rates and different approaches (fistuloscope vs. cystoscope, different wound care protocols). A total of 320 patients (9 studies, 2018–2022) with a weighted mean age of 15.7 years and follow-up duration of 13.5 months were included. PEPSiT was successful in 290 patients (90.9%) with weighted mean time to healing of 4.1 weeks. Recurrence was reported in 29 patients (9.1%) with weighted mean time to recurrence of 4.6 months. Outcomes were not significantly altered by the use of fistuloscope versus pediatric cystoscope (p = 1.0), or with perioperative laser epilation (p = 0.06), or postoperative regular shaving, depilatory creams, light pulse, or laser (p = 0.31). The weighted mean operative time was 38 minutes and hospital stay was 16 hours. Summary of available evidence confirms that PEPSiT is safe and effective. Added to its noninvasiveness, PEPSiT's pooled outcomes appear superior to those of numerous conventional techniques. Comparison with conventional techniques, particularly off-midline flap and semi-closure procedures, is, however, lacking. The superiority of PEPSiT needs to be confirmed in future comparative studies, including cost–benefit analysis.

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Pediatric endoscopic pilonidal sinus treatment (PEPSiT): what we learned after a 3-year experience in the pediatric population

Cited by 14 publications

References 20 publications

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

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

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

Outcomes of Pediatric Endoscopic Pilonidal Sinus Treatment: A Systematic Review

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