Preliminary report on endoscopic pilonidal sinus treatment in children: results of a multicentric series

Prato, Alessio Pini; Mazzola, Cinzia; Mattioli, Girolamo; Escolino, Maria; Esposito, Ciro; D’Alessio, Antonio; Abati, L.; Leonelli, Lorenzo; Carlini, Claudio; Rotundi, Franco; Meinero, Pier Carlo

doi:10.1007/s00383-018-4262-0

Cited by 37 publications

(25 citation statements)

References 15 publications

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“…We modified the endoscopic technique, first described by Meinero in adults, to adapt it to pediatric patients and we renamed it PEPSiT (Pediatric Endoscopic Pilonidal Sinus Treatment) ( 12 ). We already published our preliminary experience with the technique in two single-center studies and in an Italian multicentric survey ( 12 – 14 ). After a 36-month experience, we have standardized the steps of the technique ( 13 ) and we obtained a success rate higher than 95% but with a painless post-operative course and a very short hospital stay.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Background: The advent of pediatric endoscopic pilonidal sinus treatment (PEPSiT) has dramatically changed the surgical management of pilonidal sinus disease (PSD) in children and adolescents. This study aimed to report the outcome of our new structurated protocol, including PEPSiT, laser epilation, and oxygen-enriched oil-based gel dressing, for treatment of PSD in pediatric patients and describe tips and tricks of the technique. Methods: We retrospectively reviewed the data of 127 pediatric patients, who underwent PEPSiT for PSD in our institutions over a 36-month period. All patients received laser epilation (LE) before and after surgery. Post-operative dressing was performed using silver sulfadiazine spray and in the last 18 months oxygen-enriched oil-based gel. We divided the patients in two groups according to the protocol adopted: G1 (laser + oxygen-enriched oil-based gel dressing) included 72 patients and G2 (laser + silver sulfadiazine spray dressing) included 55 patients. The two groups were compared regarding success rate, recurrence, wound infection rate, wound healing time, post-operative outcome, time to full daily activities and patient satisfaction. Results: No difference emerged between the two groups regarding the average operative time, the average post-operative pain score, the average analgesic requirement, the average hospitalization and the average time to full daily activities ( p = 0.33). No intra- or post-operative complications including wound infection occurred in both groups. The patients required an average number of 7 LE sessions (range 4–10) to achieve complete hair removal. The overall success rate was significantly higher in G1 ( n = 71, 98.6%) compared with G2 ( n = 50, 90.9%) [ p = 0.001]. The recurrence rate was also significantly lower in G1 ( n = 1, 1.4%) compared with G2 ( n = 5, 9%) [ p = 0.001]. Furthermore, G1 reported a faster wound healing (average 21 days) compared with G2 (average 29 days) [ p = 0.001] and a higher patient satisfaction score (average 4.9) compared with G2 (average 4.2) [ p = 0.001]. Conclusions: Based upon our experience, PEPSiT may be considered the standard of care for surgical treatment of PSD in children and adolescents. Our new structurated protocol consisting of pre-operative LE, PEPSiT, and post-operative wound management with oxygen-enriched oil-based gel dressing and LE, allowed to achieve an excellent outcome, with a success rate > 98%.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…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 ]. Their findings compare well with ours.…”

Section: Discussionmentioning

confidence: 99%

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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“…In summary, in the era of minimally invasive surgery, EPSiT appears to be a safe and promising technique for the treatment of pilonidal sinus disease, with multiple authors emphasising its particular role in the paediatric population . However, this technique has yet to be standardised and its cost‐effectiveness, long‐term outcomes, and applicability to recurrent disease, as well as its comparative efficacy and safety against current surgical options need further evaluation.…”

Section: Chronic Disease Treatmentsmentioning

confidence: 99%

Management of sacrococcygeal pilonidal sinus disease

Harries

Alqallaf

Torkington

et al. 2018

International Wound Journal

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The ideal treatment for patients who suffer from pilonidal sinus disease should lead to a cure with a rapid recovery period allowing a return to normal daily activities, with a low level of associated morbidity. A variety of different surgical techniques have been described for the primary treatment of pilonidal sinus disease and current practice remains variable and contentious. Whilst some management options have improved outcomes for some patients, the complications of surgery, particularly related to wound healing, often remain worse than the primary disease. This clinical review aims to provide an update on the management options to guide clinicians involved in the care of patients who suffer from sacrococcygeal pilonidal sinus disease.

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Preliminary report on endoscopic pilonidal sinus treatment in children: results of a multicentric series

Abstract: EPSiT proved to be feasible and safe even in the pediatric population. The effectiveness and safety of the procedure suggest that this technique can represent a valid alternative for the treatment of pilonidal disease in children.

Cited by 37 publications

References 15 publications

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

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

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

Management of sacrococcygeal pilonidal sinus disease

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