Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT) in Children With Pilonidal Sinus Disease: Tips and Tricks and New Structurated Protocol

Esposito, Ciro; Mendoza-Sagaon, Mario; Conte, Fulvia Del; Cerulo, Mariapina; Coppola, Vincenzo; Esposito, Giovanni; Cortese, Giuseppe; Crocetto, Felice; Montaruli, Ernesto; Escolino, Maria

doi:10.3389/fped.2020.00345

Cited by 28 publications

(23 citation statements)

References 27 publications

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“…All patients received the multi-step treatment protocol for PSD, that we have recently standardized [12][13][14]. This protocol included three steps, represented by pre-operative laser epilation therapy, surgical procedure using PEPSiT and post-operative wound management with specific dressing and laser therapy.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2021

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This paper aimed to report a multi-institutional 3-year experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT) and describe tips and tricks of the technique. We retrospectively reviewed all patients < 18 years, with primary or recurrent pilonidal sinus disease (PSD), undergoing PEPSiT in the period 2017–2020. All patients received pre-operative laser therapy, PEPSiT and post-operative dressing and laser therapy. Success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. A total of 152 patients (98 boys) were included. Median patient’s age was 17.1 years. Fifteen/152 patients (9.8%) presented a recurrent PSD. All patients resumed full daily activities 1 day after surgery. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10). Patient satisfaction was excellent (median score 4.8). The median follow-up was 12.8 months (range 1–36). Complete healing in 8 weeks was achieved in 145/152 (95.4%) and the median healing time was 24.6 days (range 16–31). We reported post-operatively immediate Clavien grade 2 complications (3 oedema, 2 burns) in 5/152 (3.3%) and delayed Clavien grade 2 complications (3 granulomas, 8 wound infections) in 11/152 (7.2%). Disease recurrence occurred in 7/152 (4.6%), who were re-operated using PEPSiT. PEPSiT should be considered the standard of care for surgical treatment of PSD in children and teenagers. PEPSiT is technically easy, with short and painless post-operative course and low recurrence rate (4.6%). Standardized treatment protocol, correct patient enrollment and information, and intensive follow-up are key points for the success of the procedure.

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Section: Methodsmentioning

confidence: 99%

“…In these 3 years of experience with the technique, we experienced some tips, tricks and technical expedients to improve the technique, that we would like to share with the pediatric surgery community [14].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…In addition, studies have found that the procedure results in a lower pain experience and patients can return to work and everyday life more quickly. Another minimally invasive surgery option would be the conduction of an endoscopic treatment, which is reported to have very low recurrence and fast recovery rates (23). However, these methods may not be suitable for abscessed pilonidal sinus, recurrent PS disease and extensive findings.…”

Section: Discussionmentioning

confidence: 99%

Combination of Side-Swing Flap With Negative-Pressure Wound Therapy Is Superior to Open Excision or Flap Alone in Children With Pilonidal Sinus—But at What Cost?

et al. 2021

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Background: Pilonidal sinus (PS) disease frequently occurs in adolescents and young adults, and in many cases involves wide excision or local flaps as treatment. These treatments are associated with a significant recurrence rate, a long healing time, and thus absence from school or work. The hybrid technique, which is a combination of side-swing plasty with negative-pressure wound therapy (NPWT) may improve these outcomes. The aim of the study was to compare the latter with other current methods.Methods: Children presenting with a pilonidal sinus to two referral centers for pediatric surgery from January 2017 till June 2019 and subsequent (1) slide-swing plasty, (2) open excision, or (3) slide-swing plasty in combination with NPWT were included in this retrospective study. Type of therapy, number of interventions, duration of hospitalization, complications, and recurrence rate were recorded. In addition, data was retrieved from the national diagnosis-related group for inpatient statistics, for all patients who underwent surgery for pilonidal sinus in 2015 and 2016.Results: In total, 85 children were included, with a mean age of 15 years and a near equal gender distribution (53% female). The minimum follow-up was 1 year. In 56% open resection was performed, while 18% underwent a slide-swing plasty and 26% a slide-swing plasty in combination with NPWT. While the hybrid technique was superior regarding recurrence rate in comparison to open excision (24 vs. 5%, p = 0.047), it had significantly longer hospital stay [17.41 (15.63) vs. 3.65 (1.68) days, p < 0.001] and number of interventions [4.14 (4.07) vs. 1.04 (0.29), p < 0.001].Conclusions: Management of PS disease using slide-swing plasty in combination with NPWT is an effective treatment and is associated with low recurrence rate and minimal morbidity. However, this type of treatment is accompanied by an elongated hospitalization time and more frequent interventions. A diligent case by case evaluation and thorough patient counseling is thus necessary when choosing the right technique for the treatment of PS disease.

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“…The severity of complications was categorized according to the Clavien-Dindo classification [ 9 ]. All patients were interviewed over the phone after obtaining verbal consent to confirm the recurrence status and assess their satisfaction by a single trained data collector (AHZ) through the use of the Likert scale/score assessment tool, which was utilized in multiple published papers [ 7 , 10 ]. The Strengthening The Reporting Of Cohort Studies in Surgery (STROCSS) guidelines have been followed in this project [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

“…Since there is a significant negative impact of SPND on the quality of life of affected subjects even after surgical management, new management techniques have become need of the hour, such as sinus laser therapy (SiLaT) or sinus laser-assisted closure (SiLaC). It has been evolving in the past few years with promising outcomes and reasonable patient satisfaction [ 6 , 7 ]. It is essential to know that SiLaT works by introducing a radial fiber connected to a diode laser into the sinus to eradicate its cavity after extracting the hair, and the sinus is curetted [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Sinus Laser Therapy in Sacrococcygeal Pilonidal Sinus Disease: A Single-Center Experience

Zubaidi¹,

Alali²,

Zikry³

et al. 2022

Cureus

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Sacrococcygeal pilonidal sinus disease (SPND) is an acquired chronic disease with no precise etiopathogenesis. The morbidity associated with the disease necessitates the implementation of new techniques, such as sinus laser therapy (SiLaT), to improve disease management. However, surgical techniques as of now are preferred as the mainstay mode of treatment.A retrospective study was conducted to evaluate and report the healing outcome of the application of SiLaT on patients with SPND at a tertiary center. All patients who underwent SiLaT for primary or recurrent pilonidal sinus from February 2012 to December 2019 were included in the study and followed up for at least six months. Forty-one participants (37 males (90.2%) and four females (9.8%)) were included. Of the participants, 58.5% presented with chief complaints of painful swelling with mucopurulent discharge. Most of the participants were students (43.9%). SiLaT was the primary intervention for 82.9% of the participants. The mean duration of hospital stays, resumption of regular activity, and complete wound healing by secondary intention were 30±21.5 hours, 18.4±14.3 days, and 6.5±6.6 weeks, respectively. Around 95.1% of wounds healed without complications. The overall recurrence rate was 24.4%, while the recurrence rate with SiLaT being the primary intervention was 11.8%. Only three (7.32%) patients experienced wound infections as postoperative complications. The visual analog scale (VAS) score decreased postoperatively in the first and second weeks to 3.9±3.2 and 1.9±1.9, respectively, and 78.1% of the total patients showed satisfaction post-surgical interventions. The current study showed that the SiLaT technique is a feasible technology with promising results to evolve. Further studies are encouraged.

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Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT) in Children With Pilonidal Sinus Disease: Tips and Tricks and New Structurated Protocol

Cited by 28 publications

References 27 publications

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

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

Combination of Side-Swing Flap With Negative-Pressure Wound Therapy Is Superior to Open Excision or Flap Alone in Children With Pilonidal Sinus—But at What Cost?

Outcomes of Sinus Laser Therapy in Sacrococcygeal Pilonidal Sinus Disease: A Single-Center Experience

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