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Published on: January 19, 2022
Pediatric endoscopic pilonidal sinus treatment (PEPSiT): what we learned after a 3-year experience in the pediatric
Ciro Esposito1, Ernesto Montaruli2, Giuseppe Autorino1
1Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy.
Insights
Pediatric endoscopic pilonidal sinus treatment (PEPSiT) offers a minimally invasive solution for children and teenagers with pilonidal sinus disease (PSD). This technique demonstrates high success rates, excellent patient satisfaction, and a low recurrence rate, making it a viable standard of care.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Procedures
- Pilonidal Sinus Disease Treatment
Background:
- Pilonidal sinus disease (PSD) affects children and adolescents, often requiring surgical intervention.
- Traditional treatments can involve significant morbidity and prolonged recovery.
- There is a need for effective, minimally invasive techniques for pediatric PSD.
Purpose of the Study:
- To report a multi-institutional 3-year experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT).
- To describe the technical aspects and outcomes of PEPSiT in pediatric patients.
- To evaluate the success, healing, and complication rates of PEPSiT.
Main Methods:
- Retrospective review of patients under 18 with primary or recurrent PSD undergoing PEPSiT (2017-2020).
- Standardized protocol including pre-operative and post-operative laser therapy and dressing.
- Assessment of success rate, healing time, pain scores, complications, recurrence, and patient satisfaction.
Main Results:
- 152 patients (median age 17.1 years) were included; 9.8% had recurrent PSD.
- 100% resumed daily activities day after surgery with a painless post-operative course (median VAS <2).
- 95.4% achieved complete healing within 8 weeks; recurrence rate was 4.6%.
Conclusions:
- PEPSiT is a technically easy procedure with excellent outcomes for pediatric PSD.
- The technique offers a short, painless recovery and high patient satisfaction.
- PEPSiT should be considered the standard of care for surgical treatment of PSD in children and teenagers.
Abstract:
This paper aimed to report a multi-institutional 3-year experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT) and describe tips and tricks of the technique. We retrospectively reviewed all patients < 18 years, with primary or recurrent pilonidal sinus disease (PSD), undergoing PEPSiT in the period 2017-2020. All patients received pre-operative laser therapy, PEPSiT and post-operative dressing and laser therapy. Success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. A total of 152 patients (98 boys) were included. Median patient's age was 17.1 years. Fifteen/152 patients (9.8%) presented a recurrent PSD. All patients resumed full daily activities 1 day after surgery. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10). Patient satisfaction was excellent (median score 4.8). The median follow-up was 12.8 months (range 1-36). Complete healing in 8 weeks was achieved in 145/152 (95.4%) and the median healing time was 24.6 days (range 16-31). We reported post-operatively immediate Clavien grade 2 complications (3 oedema, 2 burns) in 5/152 (3.3%) and delayed Clavien grade 2 complications (3 granulomas, 8 wound infections) in 11/152 (7.2%). Disease recurrence occurred in 7/152 (4.6%), who were re-operated using PEPSiT. PEPSiT should be considered the standard of care for surgical treatment of PSD in children and teenagers. PEPSiT is technically easy, with short and painless post-operative course and low recurrence rate (4.6%). Standardized treatment protocol, correct patient enrollment and information, and intensive follow-up are key points for the success of the procedure.
