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Quality of life of pediatric patients operated for pilonidal sinus disease
Ciro Esposito1, Benedetta Lepore2, Mariapina Cerulo1
1Pediatric Surgery Unit, Department of Translational Medical Science, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy.
Insights
Pediatric endoscopic treatment for pilonidal sinus disease (PEPSIT) significantly improves quality of life compared to open surgery. PEPSIT offers faster recovery, reduced complications, and better patient satisfaction for children with PSD.
Area of Science:
- Pediatric surgery
- Minimally invasive procedures
- Quality of Life research
Background:
- Pilonidal sinus disease (PSD) in children often requires surgical intervention.
- Open surgical procedures for PSD are associated with prolonged recovery, significant morbidity, and high recurrence rates.
- Endoscopic treatment, specifically PEPSIT, has emerged as a promising alternative with potential for improved outcomes.
Purpose of the Study:
- To evaluate and compare the quality of life (QOL) outcomes for pediatric patients undergoing open surgery versus PEPSIT for PSD.
- To analyze key QOL indicators including hospital stay, healing time, and return to daily activities.
- To assess recurrence and reoperation rates between the two surgical approaches.
Main Methods:
- Retrospective review of 177 pediatric patients treated for PSD between 2008 and 2021.
- Patients were divided into two groups: open surgery (n=20) and PEPSIT (n=157).
- QOL was assessed using metrics such as hospital stay, healing time, return to sport/school/social life, and recurrence/reoperation rates. The PQ-LES-Q questionnaire was used for subjective satisfaction evaluation.
Main Results:
- PEPSIT group showed significantly shorter hospital stays (1-2 days vs. 3-7 days) and healing times (20-41 days vs. 40-75 days) compared to open surgery.
- Patients undergoing PEPSIT had a faster return to sport (7-21 days vs. 50-80 days), school (2-4 days vs. 9-15 days), and social life (2-5 days vs. 13-20 days).
- The recurrence and reoperation rate was substantially lower in the PEPSIT group (4.4%) compared to open surgery (25%).
Conclusions:
- Endoscopic treatment (PEPSIT) significantly enhances the quality of life for pediatric patients with PSD.
- PEPSIT offers advantages over open surgery, including reduced hospital stay, faster recovery, and lower recurrence rates.
- The PQ-LES-Q confirmed good overall quality of life and satisfaction in patients treated with PEPSIT, supporting its consideration as a gold standard.
Abstract:
Quality of life (QOL) outcome is an ideal method for determining the efficacy of a surgical treatment. In children operated for pilonidal sinus disease (PSD), open procedures imply prolonged wound care, significant morbidity, and high recurrence rates. Endoscopic treatment (PEPSIT) overcomes these limitations. We report our experience in the management of PSD to evaluate the QOL of patients undergoing open and endoscopic treatment. The records of 177 patients undergoing surgery for PSD from 2008 to 2021 were retrospectively reviewed. Twenty patients were operated with open surgery (G1) and 157 with PEPSIT (G2). We analyzed QOL through the following criteria: hospital stay (HS), healing time (HT), return to sport (RTSp), return to school (RTSc), resumption of social life (RSL), and recurrence rate and reoperation (RRR). Moreover, we used Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q) for a more subjective evaluation of life satisfaction. We found significant differences in all the analyzed criteria: HS varied from 3 to 7 days in G1 and from 1 to 2 days in G2; HT from 40 to 75 days in G1 while from 20 to 41 days in G2; RTSp from 50 to 80 days in G1 while from 7 to 21 days in G2; RTSc from 9 to 15 days in G1 while from 2 to 4 days in G2; RSL from 13 to 20 days in G1 while from 2 to 5 days in G2; RRR was 25% in G1 and 4.4% in G2.
Conclusion:
Endoscopic treatment (PEPSIT) significantly improves the quality of life of patients operated for PSD. Compared to open surgery, PEPSIT presents shorter hospital stay, faster healing time, return to sport activities, return to school and resumption of a normal social life, and lower rates of recurrence and reoperation. In addition, PQ-LES-Q demonstrated a good overall quality of life and life satisfaction. Further prospective studies should be obtained to consider PEPSIT as the gold standard for the treatment of PSD in pediatric patients.
What Is Known:
• Many techniques have been proposed in the last 20 years for the surgical treatment of PSD. • PEPSIT is showing promising results in terms of safety and long-term efficacy.
What Is New:
• The main impact in QOL of patients operated with PEPSIT is on their daily activity, including a shorter hospital stay, faster healing time, return to sport activities, return to school and resumption of a normal social life, lower rates of recurrence and reoperation. • After PEPSIT, children maintain a satisfactory quality of life according to the analysis of PQ-LES-Q.
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