Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children
Michèle Pfammatter1, Tobias E Erlanger2, Johannes Mayr1
1Department of Pediatric Surgery, University Children's Hospital Basel, 4031 Basel, Switzerland.
Insights
Excision with primary transverse closure (PC) significantly reduces pilonidal sinus disease (PSD) recurrence compared to open wound care (OW) in pediatric patients. PC also shows fewer complications and less pain, making it a superior surgical option for initial PSD treatment.
Area of Science:
- Pediatric Surgery
- Wound Management
- Surgical Outcomes
Background:
- Pilonidal sinus disease (PSD) is a common condition requiring surgical intervention.
- Traditional treatments like excision and open wound care (OW) have variable recurrence rates.
- Minimally invasive techniques are sought to improve outcomes and reduce patient morbidity.
Purpose of the Study:
- To compare the efficacy of two surgical methods for pediatric pilonidal sinus disease (PSD): excision with open wound care (OW) versus excision with primary transverse closure (PC).
- To evaluate recurrence rates, complications, and postoperative pain between the two treatment groups.
Main Methods:
- Retrospective observational study of 56 pediatric patients undergoing PSD surgery between 2006 and 2016.
- Data analysis included logistic regression to compare PSD recurrence rates between OW and PC groups.
- Secondary variables analyzed: length of stay, complications, patient demographics, and surgeon seniority.
Main Results:
- The primary transverse closure (PC) group had a significantly lower recurrence rate (12.5%) compared to the open wound (OW) group (37.5%).
- No high-grade complications were reported in the PC group.
- Postoperative pain was minimal in the PC group, suggesting better patient tolerance.
Conclusions:
- Excision with primary transverse closure (PC) is a superior surgical technique for treating primary pilonidal sinus disease (PSD) in children and young adults, offering lower recurrence rates.
- The PC method is associated with minimal complications and reduced postoperative pain, supporting its use as a preferred initial treatment.
- Less invasive approaches, like PC, are recommended for initial PSD treatment, reserving more radical operations for recurrent cases after less invasive methods have failed.
Abstract:
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.
