Patience is a virtue: Multiple preoperative visits are associated with decreased recurrence in pediatric pilonidal
James M Prieto1, Hariharan Thangarajah1, Romeo C Ignacio1
1Division of Pediatric Surgery, Department of Surgery, University of California San Diego 3020 Children's Way, MC 5136, San Diego, CA 92123.
Insights
More preoperative clinic visits may reduce pilonidal disease recurrence in children treated with trephination. Longer medical management before surgery appears beneficial for preventing recurrence.
Area of Science:
- Pediatric surgery
- Pilonidal disease management
Background:
- Pilonidal disease is a common condition in children.
- Trephination is a surgical option for pilonidal disease.
Purpose of the Study:
- To compare preoperative management strategies for pediatric trephination.
- To identify risk factors for pilonidal disease recurrence after trephination.
Main Methods:
- Retrospective review of 120 children undergoing trephination for pilonidal disease (Sept 2017-Apr 2019).
- Standardized intraoperative and postoperative care.
- Analysis of demographic and perioperative data.
Main Results:
- 20% of patients experienced recurrence.
- Multiple preoperative clinic visits correlated with lower recurrence (11% vs 26%).
- Earlier surgery post-consultation was linked to recurrence (32 vs 54 days).
Conclusions:
- Increased preoperative clinic visits are associated with reduced recurrence rates.
- Extended preoperative medical management may be key.
- Further prospective studies are needed to confirm findings.
Background/Purpose:
This study aimed to compare preoperative management strategies for patients undergoing trephination for pilonidal disease and evaluate risk factors for recurrence.
Methods:
A retrospective review was performed of children undergoing index surgical treatment with trephination for pilonidal disease between September 2017 and April 2019. Intraoperative and postoperative management were standardized. Demographic and perioperative data were collected and analyzed.
Results:
One-hundred twenty patients were identified with a median follow-up time of 7.5 months (interquartile range 4.1-13.2 months). Overall, 24 (20%) patients had a postoperative recurrence of pilonidal disease. Patients with multiple preoperative surgery clinic visits were less likely to have recurrent disease compared to those seen only once preoperatively (11% vs 26%, p = 0.040). Compared to patients without recurrence, those who recurred went to the operating room sooner from the time of initial surgical consultation (32 days vs 54 days, p < 0.001). Perioperative antibiotics, history of acute infection, and prior drainage procedures were not risk factors for recurrence.
Conclusions:
Multiple preoperative clinic visits are associated with a lower recurrence rate in children undergoing trephination for pilonidal disease. An increased duration of preoperative medical management may be responsible for this finding. Prospective study is needed to confirm these findings and identify additional factors that influence recurrence.
Type Of Study:
Treatment Study.
Level Of Evidence:
III (Retrospective Comparative).
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