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

Barbosa-Sequeira, Joana; Coelho, Ana; Marinho, Ana Sofia; Bonet, Berta; Carvalho, Fátima; Moreira-Pinto, João

doi:10.1016/j.jpedsurg.2018.02.094

Cited by 36 publications

(40 citation statements)

References 22 publications

(35 reference statements)

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“…Introduction of MIT created expectations that the relapse rate would be reduced. However, the great majority of studies reporting this results in children have < 1–2 years of follow-up (17, 18, 24). Our study clearly demonstrates that relapse is more dependent on time than operative technique, which explains the variability in the relapse rates we can find in the literature, likely because it depends on the time elapsed from surgery in the study (3, 11).…”

Section: Discussionmentioning

confidence: 83%

Minimally Invasive Surgical Treatment of Pilonidal Disease: Mid-Term Retrospective Analysis of a Single Center

et al. 2019

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Background: Sacrococcygeal Pilonidal Disease (PD) is commonly treated with excision and primary closure techniques (EPC). Minimally invasive techniques (MIT), such as EPSiT and Pit-picking , had been recently advocated promising better outcomes. We analyzed mid-term results from our center after introduction of MIT to treat PD. Methods: Patients submitted to MIT ( n = 44) with a median follow-up of 37 months were analyzed and compared with patients submitted to EPC ( n = 70) with a median follow-up of 5 years. Both groups included patients operated in our department between 2011 and 2016 and have similar demographic and clinical characteristics. We compared operative time and post-operative parameters such as time with pain, dressing time and time to relapse. Results: The post-operative time with pain was significantly lower, whereas the dressing time was significantly longer, in MIT when compared to the EPC group. The relapse rate was similar in both groups but the follow-up is shorter in the MIT group. In addition, the analysis of patients free of disease using Kaplan-Meier curves revealed that relapse tends to occur more precociously in MIT than in EPC patients ( p = 0.014). Interestingly, in the subgroup of patients with previous surgery, MIT's relapse rate was significantly lower than in the EPC group (30 vs. 100%, p < 0.001). Conclusions: MIT has the advantage of having a shorter time with pain in the postoperative period, while EPC benefits from a shorter dressing time. In general, the relapse of the disease tends to manifest more precociously in MIT patients. Moreover, in the subgroup of patients with previous surgery, MIT seems to have significantly better results when compared to EPC.

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Section: Discussionmentioning

confidence: 83%

Minimally Invasive Surgical Treatment of Pilonidal Disease: Mid-Term Retrospective Analysis of a Single Center

et al. 2019

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“…In EPSit, a monopolar electrode inserted through the working channel of the fistuloscope is used to coagulate the wall of the pilonidal sinus cavity and shrink the fistulous tracts under direct endoscopic vision [ 52 , 53 ]. In children, EPSiT yielded promising results with low rates of wound infections (5.2%) and PSD recurrence (18.9%) at a follow-up interval of 11.9 months [ 20 ]. Pini Prato et al, who popularized minimally invasive EPSiT treatment of PSD, stated that PSD recurrence rates range from 20% to 30% regardless of the treatment method used [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

“…The various treatment options can be categorized into those involving open wound treatment, those applying various forms of primary wound closure, and those involving newer, minimally invasive interventions [ 4 , 19 , 20 ]. Open wound treatments are associated with a low recurrence rate but are cumbersome.…”

Section: Introductionmentioning

confidence: 99%

“…The cohort of patients undergoing primary wound closure should be subdivided into patients treated by midline or off-midline suture techniques [ 4 , 10 , 11 , 14 ]. Although midline closure results in a shorter healing time than open wound methods, this approach is associated with a higher recurrence rate [ 4 , 9 , 11 , 14 , 20 ]. Several off-midline suture techniques and reconstructive operations to correct the deep and hairy natal cleft have been published [ 1 , 10 , 11 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

2020

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We aimed to compare the outcome of two different operative methods to correct pilonidal sinus disease (PSD) in children, i.e., excision and open wound care (OW) versus excision and primary transverse closure (PC) of the wound. In this retrospective, observational study, we extracted data from the medical records of 56 patients who underwent surgery for PSD at our institution between 1 January 2006 and 31 December 2016. To test whether the primary variable, i.e., rate of PSD recurrence, differed between the two surgical groups, a logistic regression model was fitted. Secondary explanatory variables were total length of stay (LOS) at the hospital, complications, sex and age of patients, seniority of the surgeon in charge, and volume of excised specimen. Overall, 32 (57%) children and young adults underwent OW, while 24 (43%) patients were treated by PC. Mean age at operation was 15.5 years in either group. PSD recurred in 12 of 32 (37.5%) children in the OW group and in 3 of 24 (12.5%) children in the PC group (ratio: 0.19, 95% confidence interval [95% CI] 0.03–1.07). Thus, treatment of primary PSD by PC proved superior with respect to PSD recurrence. Moreover, our study did not bring to light any high-grade complications in the PC group, and postoperative pain was minimal. Less invasive treatment approaches for chronic PSD are typically performed in an outpatient setting and offer reduced morbidity, low rates of PSD recurrence, and shortened periods of time to return to work or social activities. More radical operations of PSD should be reserved for recurrent PSD where less invasive approaches have failed several times.

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“…Less invasive procedures for pilonidal sinus may be favorable as an initial approach in children (Cevik et al 2017;Speter et al 2016;Zagory et al 2016). Recently, endoscopic pilonidal sinus treatment has been reported to be feasible and safe in children (Pini Prato et al 2018;Sequeira et al 2018).…”

Section: Treatmentmentioning

confidence: 99%

Pilonidal Sinus

Fraser¹,

Peter²

2020

Pediatric Surgery

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Pilonidal sinus disease is a relatively common condition that affects hirsute adolescents and young adults. The generally accepted pathophysiology is the burrowing of hairs into the base of the gluteal cleft. This can cause acute and chronic infections. Treatment options of the chronic wound are varied including excision and closure, excision while allowing the wound to heal by secondary intention or with a vacuum-assisted closure, or a variety of flap repairs. There is however no clear consensus as to which operative treatment is the ideal.

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

Abstract: Therapeutic study - level III.

Cited by 36 publications

References 22 publications

Minimally Invasive Surgical Treatment of Pilonidal Disease: Mid-Term Retrospective Analysis of a Single Center

Minimally Invasive Surgical Treatment of Pilonidal Disease: Mid-Term Retrospective Analysis of a Single Center

Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

Pilonidal Sinus

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