Analysis of Outcomes in Adolescents and Young Adults With Pilonidal Disease

Abstract

Purpose: Numerous definitive surgical techniques exist for the treatment of pilonidal disease with varied recurrence rates and wound complications. Due to the wide array of techniques and lack of consensus on the best approach, we proposed to study our experience treating pilonidal disease in adolescents and young adults.Methods: A retrospective analysis was conducted of patients 10–24 years old treated at a tertiary medical center from 2011 to 2016. Data including demographics, management, and outcomes were collected and analyzed. Primary outcome was recurrence of disease.Results: One hundred and thirty three patients with pilonidal disease underwent operative management. Fifty one percent underwent primary closure and 49% healed by secondary intention with no significant difference in recurrence rates (primary 18%, secondary 11%; p = 0.3245). Secondary healing patients had significantly lower wound complication rates (primary 51%, secondary 23%; p = 0.0012). After accounting for sex, race, weight, and operative technique, age was predictive of disease recurrence with an adjusted odds ratio (OR) of 0.706 (0.560–0.888; p = 0.003). Age and sex were both predictive of wound complications. Older patients had decreased risk of wound complication (adjusted OR 0.806, 95% CI 0.684–0.951; p = 0.0105), and male patients had increased risk of wound complication (adjusted OR 2.902, 95% CI 1.001–8.409; p = 0.0497).Conclusion: In summary, there is no significant difference in the recurrence rates between operative techniques for pilonidal disease. Older patients have decreased risk of recurrence following intervention. Wound complication rates are lower in patients undergoing secondary healing, though this may be better explained by differences in age and sex. Additional research investigating newer, minimally-invasive techniques needs to be pursued.

Endoscopic Treatment of Pilonidal Sinus Disease in Paediatric Patients – A Study in Western Australia

“…Hirsutism or excess hair at the natal cleft is a recognized risk factor for PSD formation (3,5,6,8). Laser epilation, in multiple studies has been shown to reduce recurrence by eradication of the risk factors -excess hair in the natal cleft, being recommended by the ASCRS for the treatment of PSD (19,31,32,33). All our patients carried out post-operative laser hair epilation post total wound closure which may contribute to the low rates of recurrence.…”

“…Patients treated using the above methods often have a long and painful post-operative period with much time spent off school and work (10). The ideal treatment for PSD should have a clear, reproducible surgical procedure with a low incidence of recurrence, morbidity, minimal pain and quick return to activities of daily living (19).…”

“…Traditional surgical methods are associated with prominent levels of recurrence, varying in different techniques from 4-31% (19). A study by Abraham et al found recurrence rates in both primary closure (PC) and excision and healing by secondary intention (EHSI) to be 11-18% in their group of 135 patients (19).…”

“…Traditional surgical methods are associated with prominent levels of recurrence, varying in different techniques from 4-31% (19). A study by Abraham et al found recurrence rates in both primary closure (PC) and excision and healing by secondary intention (EHSI) to be 11-18% in their group of 135 patients (19). Research undertaken by Fike et al has demonstrated high recurrence in both EHSI (25%) and in PC (25%), showing that almost a quarter of patients treated by these methods can expect recurrence, with PC having the highest rate of wound complications (20).…”

Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review

“…Interestingly, in a 2021 retrospective study involving 133 adolescent patients, excision of diseased tissue with primary closure and secondary healing showed no significant difference with respect to recurrence rate, but the incidence of wound complications in secondary healing was lower. In addition, it was found that the recurrence rate and complications decreased with increasing age 62 . In another meta-analysis involving 3383 patients, it was concluded that open healing had a lower infection rate than primary suture 52 .…”