Burden of pilonidal disease and improvement in quality of life after treatment in adolescents

Salimi-Jazi, Fereshteh; Abrajano, Claire; Garza, Deanna; Rafeeqi, Talha; Yousefi, Razie; Hartman, Emi; Hah, Kira; Wilcox, Melissa; Diyaolu, Modupeola; Chao, Stephanie; Su, Wendy; Hui, Thomas; Mueller, Claudia; Fuchs, James A.; Chiu, Bill

doi:10.1007/s00383-022-05175-2

Cited by 14 publications

(9 citation statements)

References 30 publications

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“…Quality of life is a signi cant factor to consider, especially in the paediatric patient. In a study by a group of researchers at Stanford University comparing quality of life factors pre and post minimally invasive treatment they found that 66% of patients reported severe impact on activities of daily living by PSD, with 94% of patients reporting little to no impact of PSD post treatment and 92% experiencing improvement in sport participation, school, and work attendance as well as socializing (34). Traditional methods such as PC or EHSI, as discussed, lead to high post-operative morbidity, length of stay in hospital, time off daily activities as well as laborious and painful dressing changes.…”

Section: Discussionmentioning

confidence: 99%

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

O’Sullivan,

Gera

2024

Preprint

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Background Pilonidal disease is considered a spectrum of disease ranging from acute abscesses to a chronic state most often associated with draining sinuses in the gluteal fold. An increasing prevalence is seen in children with 3 out of every 250,000 children developing pilonidal sinus disease (PSD). Although this is a common disease within general and paediatric surgery departments worldwide, there is yet to be an agreement on a ‘Gold Standard ‘of treatment. Minimally invasive treatment techniques such as EPSiT are a more recent development for pilonidal disease that are showing promising results. Method This study is a retrospective study of children and adolescents who underwent excision of pilonidal disease using EPSiT by a single paediatric surgeon in Western Australia. The primary outcome measure is recurrence, secondary outcomes include complications, length of hospital stay, time to return to school/work, post-operative pain, and time to complete wound healing. Results No patients suffered recurrence or wound complications at mean follow up of thirteen months. No patients were readmitted to hospital for procedure related complications. All patients reported complete wound healing at an average of twenty-eight days and definitive total wound closure at six weeks post operatively. All patients reported the ability to resume daily activities at 2-4 days post operatively. Conclusion PEPSiT is a promising method of treating paediatric PSD and may represent a new 'Gold Standard’ of treatment in these patients. Our results were comparable to other studies in the literature. However, more studies and large-scale randomized control trials are necessary in the paediatric patient cohort. Level of Evidence: IV

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Section: Discussionmentioning

confidence: 99%

“…Most concerning are the high recurrence rates. This results in many days of school or work, avoidance of social scenarios, inability to participate in sport causing signi cant social isolation, emotional and psychological burden on these patients and their families at a crucial age of development (10,34).…”

Section: Discussionmentioning

confidence: 99%

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

O’Sullivan,

Gera

2024

Preprint

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“…Bascom's cleft lift is statistically significant with P = 0.04 date was the end of last year, so we might expect its results soon. Recently reported treatment protocols from the USA include laser depilation either if hirsutism was present [45] or for every patient [52], whereas it was uncommon on the continent [18,22,53].…”

Section: Discussionmentioning

confidence: 99%

Paediatric Pilonidal Sinus Disease: Early Recurrences Irrespective of the Treatment Approaches in a Retrospective Multi‐centric Analysis

Maasewerd,

Stefanescu,

König

et al. 2023

World j. surg.

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Background Incidences of pilonidal sinus disease are rising. Guidelines rarely consider children and adolescents and evidence for their treatment is rare. The literature is divided on the choice of the preferable surgical procedure. Therefore, we aimed to assess recurrences and complications following different treatment approaches in our multi-centric cohort. Methods We retrospectively assessed all patients treated for pilonidal sinus disease in the paediatric surgical departments of Bonn and Mainz between 01/01/2009 and 31/12/2020. Recurrences were defined according to the German national guidelines. The pre-specified analysis via logistic regression included the operative approach, age, sex, use of methylene blue, and obesity as independent predictors. Results We included 213 patients, of which 13.6% experienced complications and 16% a recurrence. Median time to recurrence was 5.8 months (95% confidence interval: 4.2–10.3), which was slightly higher in children than adolescents (10.3 months, 95% confidence interval: 5.3–16.2 vs. 5.5 months, 95% confidence interval: 3.7–9.7). None of the investigated procedures, excision and primary closure, excision and open wound treatment, pit picking, and flap procedures had a decisive advantage in terms of complications or recurrence. Of the independent predictors, only obesity was associated to complications (adjusted odds ratio: 2.86, 95% confidence interval: 1.05–7.79, P = 0.04). Conclusions We did not find a difference between the investigated procedures, but our analysis is limited by the small sample size in some subgroups. Our data corroborates that recurrences in paediatric pilonidal sinus disease occur early. Factors linked to these differences remain unknown.

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“…18 In another study, before treatment, patients reported a moderate to severe effect in their abilities to perform daily activities (66%), participate in sports (57%), attend school/work (45%), and socialize (23%). 19…”

Section: Psychosocial Burden Of Diseasementioning

confidence: 99%

“…A qualitative study investigating the psychosocial effects of pilonidal wounds demonstrated that all activities of daily living were affected with 3 emerging themes including difficulty adapting to life despite the wound, perceived embarrassment and lack of understanding, and loss of control . In another study, before treatment, patients reported a moderate to severe effect in their abilities to perform daily activities (66%), participate in sports (57%), attend school/work (45%), and socialize (23%) …”

Section: Introductionmentioning

confidence: 99%

Management of Pilonidal Disease

2023

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ImportanceThe management of pilonidal disease continues to be a challenge due to high rates of recurrence and treatment-associated morbidity.ObservationsThere is a heterogeneous repertoire of treatment modalities used in the management of pilonidal disease and wide practice variation among clinicians. Available treatment options vary considerably in their level of invasiveness, associated morbidity and disability, risks of complications, and effectiveness at preventing disease recurrence. Conservative nonoperative management strategies, including persistent improved hygiene, depilation, and lifestyle modification, focus on disease prevention and minimization of disease activity. Epilation techniques using both laser and intense pulse light therapy are also used as primary and adjunct treatment modalities. Other nonoperative treatment modalities include phenol and fibrin injection to promote closure of pilonidal sinuses. The traditional operative management strategy for pilonidal disease involves excision of affected tissue paired with a variety of closure types including primary midline closure, primary off-midline closure techniques (ie, Karydakis flap, Limberg flap, Bascom cleft lift), and healing by secondary intention. There has been a recent shift toward more minimally invasive operative approaches including sinusectomy (ie, trephination or Gips procedure) and endoscopic approaches. Overall, the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies.Conclusions and RelevancePilonidal disease is associated with significant physical and psychosocial morbidity. Optimal treatments will minimize disease and treatment-associated morbidity. There is a need for standardization of definitions used to characterize pilonidal disease and its outcomes to develop evidence-based treatment algorithms.

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Burden of pilonidal disease and improvement in quality of life after treatment in adolescents

Cited by 14 publications

References 30 publications

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

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

Paediatric Pilonidal Sinus Disease: Early Recurrences Irrespective of the Treatment Approaches in a Retrospective Multi‐centric Analysis

Management of Pilonidal Disease

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