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Pediatric Endoscopic Pilonidal Sinus Treatment: An Effective Procedure for Children with Recurrent Pilonidal Sinus
Ciro Esposito1, Francesca Gargiulo1, Serena Izzo1
1Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.
Insights
Pediatric endoscopic pilonidal sinus treatment (PEPSiT) offers a minimally invasive approach for pilonidal sinus disease (PSD). This technique provides a fast recovery and high patient satisfaction, even for recurrent cases after open surgery.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
- Pilonidal sinus disease treatment
Background:
- Traditional open excision for pilonidal sinus disease (PSD) often results in significant postoperative pain and high recurrence rates.
- Recurrent PSD poses a challenge, necessitating effective treatment options.
- Pediatric endoscopic pilonidal sinus treatment (PEPSiT) has emerged as a novel technique.
Purpose of the Study:
- To evaluate the long-term outcomes of PEPSiT for pediatric patients with pilonidal sinus disease.
- To assess the efficacy of PEPSiT in treating recurrent PSD following previous open surgical repair.
Main Methods:
- A cohort of pediatric patients with recurrent PSD after open excision who underwent PEPSiT was studied over two years.
- The PEPSiT technique involved endoscopic removal of hair, debridement, and ablation of the sinus cavity.
- External openings were intentionally left unclosed post-procedure.
Main Results:
- Ten pediatric patients with recurrent PSD underwent PEPSiT, with an average operative time of 27.7 minutes.
- No perioperative complications were reported; patients experienced short analgesic requirements (20 hours) and hospitalization (22.4 hours).
- Full return to daily activities averaged 2.3 days, with high patient satisfaction, complete healing at 1 month, and no recurrences at a mean 18-month follow-up.
Conclusions:
- PEPSiT is a technically straightforward and rapid endoscopic technique for treating pediatric pilonidal sinus disease.
- The procedure leads to a short, less painful hospital stay and enables an early return to activities.
- PEPSiT demonstrates effectiveness and high patient satisfaction, including for recurrent PSD cases previously treated with open surgery.
Abstract:
The traditional open excision of pilonidal sinus disease (PSD) is associated with a painful postoperative course and high recurrence rates. We recently published our technique of pediatric endoscopic pilonidal sinus treatment (PEPSiT). We aimed to report our long-term outcome including using PEPSiT for recurrent PSD after failed open repair. All patients with recurrent PSD after open excision who underwent PEPSiT in our unit over the past 2 years were included in the study. During surgery a fistuloscope was introduced through the fistula's orifice. All identifiable hairs were removed using endoscopic forceps. Thereafter, the cavity was debrided with endobrush and ablated with monopolar electrode. External openings were not closed. In the past 2 years, 40 patients with PSD underwent PEPSiT. Ten of 40 patients (6 boys and 4 girls with an average age of 16.8 years [range = 14-18]) had recurrent PSD after open surgery and were included in the study. The average operative time was 27.7 minutes (range = 24-43). No perioperative complications occurred. The average analgesic requirement was 20 hours (range = 16-26) and the average hospitalization was 22.4 hours (range = 18-36). The average time to return to full daily activities was 2.3 days (range = 1-5) and all patients were highly satisfied of postoperative course. At 1 month postoperatively, the external openings were completely healed. No recurrence was recorded at a mean follow-up of 18 months (range = 6-24). Our results demonstrated that PEPSiT is an excellent technique for surgical treatment of PSD in children and teenagers. In fact, it is technically easy and fast to perform, with a short and painless hospital stay and it allows to the operated patients an early return to full daily activities without any physical limitations compared with open repair. In addition, it is also effective for treatment of recurrent PSD after failed open repair.
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