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Updated: Jul 31, 2025
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Pediatric endoscopic pilonidal sinus treatment (PEPSiT): report of a multicentric national study on 294 patients
Ciro Esposito1, Ernesto Leva2, Piergiorgio Gamba3
1Division of Pediatric Surgery, Federico II University Hospital, Via Pansini 5, 80131, Naples, Italy.
Insights
Pediatric endoscopic pilonidal sinus treatment (PEPSiT) is a safe and effective minimally invasive option for adolescents with pilonidal sinus disease (PSD). This study shows high success rates and quick recovery, confirming PEPSiT
Area of Science:
- Pediatric surgery
- Minimally invasive procedures
- Pilonidal sinus disease management
Background:
- Pilonidal sinus disease (PSD) affects adolescents, often requiring surgical intervention.
- Traditional treatments can be invasive with prolonged recovery.
- Endoscopic techniques offer a minimally invasive alternative.
Purpose of the Study:
- To evaluate the outcomes of pediatric endoscopic pilonidal sinus treatment (PEPSiT).
- To assess the safety, efficacy, and recurrence rates of PEPSiT in pediatric patients.
- To identify predictors of recurrence in pediatric PSD treated with PEPSiT.
Main Methods:
- Retrospective review of medical records for pediatric patients (<18 years) undergoing PEPSiT (2019-2021).
- Data collected included demographics, operative details, and post-operative outcomes.
- Multivariate analysis was used to identify recurrence predictors.
Main Results:
- 294 pediatric patients (median age 14 years) were enrolled.
- Overall success rate was 95.2% with a median healing time of 23.4 days.
- Recurrence rate was 4.8%; hirsutism and sinus typology predicted recurrence.
Conclusions:
- PEPSiT is a safe, effective, and minimally invasive treatment for pediatric PSD.
- The procedure offers rapid recovery, high success rates, and improved quality of life.
- Hirsutism and specific sinus characteristics are associated with higher recurrence risk.
Abstract:
This study aimed to report a multicentric national experience about the outcomes of pediatric endoscopic pilonidal sinus treatment (PEPSiT). The medical records of all pediatric patients, aged up to 18 years, who underwent PEPSiT in the period 2019-2021, were retrospectively reviewed. Patients' demographics, operative details, and post-operative outcomes were assessed. A total of 294 patients (182 boys), with median age of 14 years (range 10-18), receiving PEPSiT in the study period, were enrolled. Pilonidal sinus disease (PSD) was primary in 258 (87.8%) and recurrent in 36 (12.2%). The median operative time was 36 min (range 11-120). The median VAS pain score was 0.86 (range 0-3) and the median duration of analgesic use was 27 h (range 12-60). The overall success rate was 95.2% (280/294) and the median time to full healing was 23.4 days (range 19-50). Six/294 (2.0%) patients developed Clavien 2 post-operative complications. The recurrence rate was 4.8% (14/294) and all recurrences were re-operated using PEPSiT. Redo-surgery for wound debridement was performed in one (0.3%) patient with late healing. On multivariate analysis, hirsutism and typology of sinus (pits ≥ 2, paramedian and more proximal to the anus) were predictors of PSD recurrence (p = 0.001). To date, this is the largest series of PEPSiT published in the pediatric population. The outcomes reported after a 3 years experience confirm that PEPSiT is a safe, effective, and real minimally invasive procedure to treat adolescents with PSD. It provides patients quick and painless recovery, satisfactory success, and high quality of life.
