A pediatric surgeon's 35-year experience with pilonidal disease in a Canadian children's hospital

Abstract

Background:There is an ongoing debate regarding the optimal surgical management for pilonidal disease in the pediatric population. The purpose of this study was to evaluate a pediatric surgeon's experience at a Canadian children's hospital over 35 years. Methods:We performed a retrospective review of the charts of patients seen and treated from July 1969 to December 2003, inclusive. All patients were evaluated for age, sex, clinical diagnosis, infection, treatment, healing time, complications and results.Results: In all, 121 adolescents with pilonidal disease (64 boys, 57 girls) with a mean age of 15 (range 12-19) years were evaluated at the same children's hospital. The 107 (88%) patients with infection (46% acute) underwent surgery. At operation, all 107 pilonidal cysts were either excised and packed open, marsupialized or excised and closed primarily without drainage under general anesthesia; the operation performed was arbitrarily chosen. Vacuum-assisted closure was not used. All patients received antibiotics. The time for healing after the initial operation in the group whose cysts were excised and packed open was at least twice as long (75 d) as in the other 2 groups (p = 0.031). Disease recurred in 24 (22%) patients, 6 (25%) of whom experienced 2 recurrences. Among the 90 patients in the excised and packed open group, 20 (22%) experienced recurrences and 5 (25%) experienced 2 recurrences. Among the 13 patients in the marsupialized group, 3 (23%) experienced recurrences and 1 (33%) experi enced 2 recurrences. Among the 4 patients in the excised and closed primarily without drainage group, 1 (25%) experienced a recurrence and none experienced 2 recurrences (p = 0.12). Each recurrence was smaller than the original. All wounds eventually healed. There were no other complications and no deaths. A multivariable logistic regression analysis revealed that the type of surgical approach was not predictive of recurrence after controlling for age and sex. Conclusion:Age, sex and surgical approach were not predictive of recurrence. From our experience, excision and packing open the wound produced a longer morbidity but offered the same results compared with marsupialization or excision and primary closure without drainage.Contexte : Le débat se poursuit au sujet de la prise en charge chirurgicale optimale de la maladie pilonidale dans la population pédiatrique. Cette étude visait à évaluer l'expérience qu'un chirurgien pédiatrique a acquise en 35 ans dans un hôpital canadien pour enfants. Méthodes :Nous avons procédé à une étude rétrospective des dossiers de patients vus et traités de juillet 1969 à décembre 2003 inclusivement. Nous avons évalué tous les patients selon l'âge, le sexe, le diagnostic clinique, l'infection, le traitement, la durée de la guérison, les complications et les résultats.Résultats : Au total, 121 adolescents qui avaient une maladie pilonidale (64 garçons, 57 filles) et qui étaient âgés en moyenne de 15 (de 12 à 19) ans ont été évalués au même hôpital pour enfants. Les 107 (88 %) patients qui av...

Novel use of porcine urinary bladder matrix for pediatric pilonidal wound care: preliminary experience

“…NPWT also requires home nursing or frequent visits to outpatient centers to change dressings, as well as the inconvenience of carrying an external device. In this study, mean time to complete healing compares favorably with reported mean healing times for wet-to-dry [4,13] and NPWT [14,15] after pilonidal resection in adolescents and adults. (Table 2) The reported mean healing time for adult open pilonidal wounds treated with MatriStem was nearly identical at 52 days [9].…”

Hair epilation versus surgical excision as primary management of pilonidal disease in the pediatric population

“…3 During a telephone interview, the patients treated with surgical excision and LE expressed frustration with the number of emergency department procedures (e.g, incision and drainage, multiple courses of antibiotics). This frustra tion prompted them to explore various treatment options, which could account for the increased recurrence rates among these patients compared with those who were satis fied with observation.…”

“…5 It has also been established that once a pilonidal sinus recurs, the patient is more likely to keep experiencing recurrences, with decreasing time intervals in between. 3 Telephone followup revealed that some patients who had been referred for LE declined to pursue this treatment owing to cost. In London, Ont., the average cost for 1 LE treatment is $150, and the average participant needed 9.5 treatments over several weeks.…”

“…3 The recurrence rate after surgical treatment has been attributed to persist ent hair near the surgical site. 4 Laser epilation (LE) has been studied as a tool in the treatment of pilonidal disease and is often used postoperatively to reduce recurrence rates.…”

Endoscopic pilonidal sinus treatment versus total excision with primary closure for sacrococcygeal pilonidal sinus disease in the pediatric population

“…Although little has been reported concerning pediatric populations, SPS is a common entity amongst children and adolescents, with complication and recurrence rates similar to the adult population [1,5].…”