Adoption of a standardized treatment protocol for pilonidal disease leads to low recurrence
Talha Rafeeqi1, Claire Abrajano1, Fereshteh Salimi-Jazi1
1Division of Pediatric Surgery, Department of Surgery, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, United States.
Background:
Pilonidal disease may present as acute abscesses or chronic draining sinuses. There is no standardized treatment and recurrence rates can be as high as 30%. Within our five-hospital network we have established a standardized treatment protocol including minimally invasive surgical trephination and aggressive epilation. We hypothesize that such a treatment protocol can be established across different hospital settings and lead to low overall recurrence.
Methods:
Patients with pilonidal disease were enrolled in the study on presentation to our hospital network. Those that underwent initial surgery outside our hospital system or were noncompliant with our treatment protocol were excluded. Patients were grouped based on surgeon and treating facility. Frequency of recurrence per surgeon and per hospital was calculated and compared.
Results:
Out of 132 patients, 80 patients were included (45 female, 35 male) while 52 were excluded because of initial surgery at a non-network hospital or for protocol noncompliance. Median age was 17 (16-19) years and median length of follow-up was 352 (261-496) days. There were 6 patients who experienced at least one recurrence. There was an overall 8% recurrence rate with no significant difference noted between surgeons or hospitals (p = 0.15, p = 0.64, respectively).
Conclusions:
We have successfully implemented a standardized treatment protocol for pilonidal disease across different hospital settings and by different surgeons, with an overall low recurrence rate. Our findings suggest that adoption of a standardized protocol for treatment of pilonidal disease can lead to low recurrence.
Level Of Evidence:
Level IV.
Insights
A standardized treatment for pilonidal disease, involving minimally invasive surgery and epilation, was successfully implemented across multiple hospitals. This protocol resulted in a low recurrence rate of 8%, demonstrating its effectiveness and consistency regardless of the surgeon or facility.
Area of Science:
- Surgical Innovation
- Clinical Protocol Implementation
- Pilonidal Disease Management
Background:
- Pilonidal disease presents as acute abscesses or chronic draining sinuses with high recurrence rates (up to 30%) due to a lack of standardized treatment.
- A novel treatment protocol involving minimally invasive surgical trephination and aggressive epilation was developed within a five-hospital network.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of a standardized treatment protocol for pilonidal disease across different hospital settings.
- To determine if the standardized protocol can achieve low recurrence rates consistently among various surgeons and facilities.
Main Methods:
- A cohort of 132 patients with pilonidal disease was identified, with 80 patients meeting inclusion criteria for the study.
- Patients were grouped by surgeon and treating facility to compare recurrence rates.
- Exclusion criteria included prior surgery outside the network or noncompliance with the treatment protocol.
Main Results:
- The study included 80 patients (45 female, 35 male) with a median follow-up of 352 days.
- An overall recurrence rate of 8% was observed among the included patients.
- No significant differences in recurrence rates were found between different surgeons (p=0.15) or hospitals (p=0.64).
Conclusions:
- A standardized treatment protocol for pilonidal disease, incorporating minimally invasive surgery and epilation, was successfully implemented across multiple hospital settings.
- The standardized protocol demonstrated a low overall recurrence rate of 8%, indicating its effectiveness and reproducibility.
- Adoption of this standardized protocol can lead to improved patient outcomes by reducing pilonidal disease recurrence.
