Technical standardization of MIS management of children with pilonidal sinus disease using pediatric endoscopic pilonidal sinus treatment (PEPSiT) and laser epilation

Esposito, Ciro; Turrà, Francesco; Cerulo, Mariapina; Conte, Fulvia Del; Esposito, Giulia; Prato, Alessio Pini; Escolino, Maria

doi:10.1016/j.jpedsurg.2019.04.031

Cited by 24 publications

(39 citation statements)

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“…Based upon our experience, the key factors for the success of the technique are the use of PEPSiT with the advantages and the precision of endoscopic surgery but also the laser epilation treatment before and after surgery and the post-operative wound management that allowed us to report a very low recurrence rate (<5%). As we already published ( 13 ), we believe that it is crucial to standardize not only the procedure itself, but also the pre-operative preparation and the post-operative management.…”

Section: Discussionmentioning

confidence: 98%

“…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%

“…Regarding the operative technique, we already standardized PEPSiT as a 5-step procedure ( 12 , 13 ) and we can outline some tips and tricks based upon our experience. A key point is the use of the fistuloscope, that can be easily managed using the handle and rotated in different angles in order to improve the intra-operative visualization and ease the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Two screens were placed, one at patient's feet and one at patient's head, to be adopted alternatively according to the lower or upper extension of the fistula. The 5-step operative technique, that we already described ( 12 , 13 ), was adopted in all cases. In the 1st step, the fistuloscope was introduced through the fistula's external opening.…”

Section: Methodsmentioning

confidence: 99%

“…We modified the endoscopic technique, first described by Meinero in adults ( 10 ), in order to apply it in the pediatric population and we called it PEPSiT (Pediatric Endoscopic Pilonidal Sinus Treatment) ( 12 ). After a 3-year experience with PEPSiT, we believe that the key factor to achieve the complete healing of PSD was not only the standardization of the surgical procedure but also pre- and post-operative laser epilation and accurate post-operative wound treatment ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

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

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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: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

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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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Standardization of Pre‐ and Postoperative Management Using Laser Epilation and Oxygen‐Enriched Oil‐Based Gel Dressing in Pediatric Patients Undergoing Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT)

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Background and Objective Pediatric endoscopic pilonidal sinus treatment (PEPSiT) has become the new standard of care for pilonidal sinus disease (PSD) in pediatric patients. This study aimed to compare our current wound treatment protocol (laser epilation (LE) and oxygen‐enriched oil‐based gel dressing) with our previous protocol (silver sulfadiazine spray) and demonstrate its efficacy as means to prevent PSD recurrence in children undergoing PEPSiT. Study Design/Materials and Methods We retrospectively reviewed the data of 87 pediatric patients, 52 boys and 35 girls, with an average age of 17.1 years (range, 12–18) affected by chronic PSD, who underwent PEPSiT over a 24‐month period (December 2017–December 2019). The patients were divided into two groups: G1 (n = 47) treated with pre‐ and postoperative LE and oxygen‐enriched oil‐based gel dressing; and G2 (n = 40) treated with only postoperative dressing using silver sulfadiazine spray. The two groups were compared regarding the operative outcome, wound‐healing time, disease recurrence, wound infections, and other complications. Furthermore, efficacy, safety, and tolerability of LE were assessed in G1. Results No significant difference emerged between the two groups regarding the median operating time, postoperative pain score, hospital stay length, and time to full daily activities (P = 0.33). The median healing time significantly decreased in G1 (21 days) compared with G2 (28.1 days) (P = 0.001]. The disease recurrence rate was significantly lower in G1 (n = 1, 2.1%) compared with G2 (n = 6, 15%) (P = 0.001), and the wound infection rate was significantly lower in G1 (n = 1, 2.1%) compared with G2 (n = 4, 10%) (P = 0.001). All patients with wound infection were treated with oral antibiotics and, after the resolution of the acute episode, received LE with no further infections (Clavien II). Granuloma of the wound occurred in two G2 patients (5%), who were treated with topical silver nitrate (Clavien II). LE was well‐tolerated and without complications in all G1 patients; a median number of 7 LE sessions (range, 4–10) at 4–6 weeks interval was required to achieve definitive hair removal. Conclusion The results of this study confirmed that our standardized pre‐ and postoperative wound management, including LE and oxygen‐enriched oil‐based gel dressing, was extremely safe and effective in reducing PSD recurrence and wound infection rate in pediatric patients undergoing PEPSiT. LE should be routinely offered as adjunctive treatment to all patients who receive PEPSiT and is strongly advocated to be started before surgery and continued after wound healing. More importantly, LE showed to have a role as a preventive modality in patients with recurrent folliculitis or infections at the intergluteal crease. It was also associated with significant improvement and acceleration of wound‐healing time. LE and oxygen‐enriched oil‐based gel dressings were clinically safe and well‐tolerated in all patients, with no adverse skin reactions or injuries to both therapies. Lasers Sur...

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Technical standardization of MIS management of children with pilonidal sinus disease using pediatric endoscopic pilonidal sinus treatment (PEPSiT) and laser epilation

Cited by 24 publications

References 24 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

Management of Pilonidal Disease

Standardization of Pre‐ and Postoperative Management Using Laser Epilation and Oxygen‐Enriched Oil‐Based Gel Dressing in Pediatric Patients Undergoing Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT)

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