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Paediatric Pilonidal Sinus Disease: Early Recurrences Irrespective of the Treatment Approaches in a Retrospective
Sophie K M Maasewerd1,2, Maria-Christina Stefanescu3, Tatjana T König3
1Klinik für Kinderchirurgie, St. Marien Hospital Bonn, Bonn, Germany.
Insights
Pilonidal sinus disease in children and adolescents shows early recurrences, with obesity being a risk factor for complications. No single surgical approach demonstrated a clear advantage in this multi-center study.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes Research
- Adolescent Health
Background:
- Pilonidal sinus disease (PSD) incidence is increasing, particularly in pediatric populations.
- Existing guidelines and evidence for treating PSD in children and adolescents are scarce.
- The optimal surgical approach for pediatric PSD remains debated.
Purpose of the Study:
- To evaluate recurrence rates and complications associated with different surgical treatments for pediatric PSD.
- To identify predictors of recurrence and complications in this patient group.
Main Methods:
- Retrospective analysis of 213 patients with PSD treated between 2009-2020.
- Inclusion of operative approach, age, sex, methylene blue use, and obesity as independent predictors.
- Logistic regression analysis to assess outcomes.
Main Results:
- 13.6% of patients experienced complications and 16% had recurrences.
- Obesity was significantly associated with increased complications (aOR: 2.86).
- No surgical procedure showed a significant advantage in preventing recurrence or complications.
Conclusions:
- Surgical treatment outcomes for pediatric PSD are comparable across various methods.
- Recurrences in pediatric PSD tend to occur early, with unknown contributing factors.
- Further research with larger sample sizes is needed to elucidate factors influencing recurrence and complications.
Background:
Incidences of pilonidal sinus disease are rising. Guidelines rarely consider children and adolescents and evidence for their treatment is rare. The literature is divided on the choice of the preferable surgical procedure. Therefore, we aimed to assess recurrences and complications following different treatment approaches in our multi-centric cohort.
Methods:
We retrospectively assessed all patients treated for pilonidal sinus disease in the paediatric surgical departments of Bonn and Mainz between 01/01/2009 and 31/12/2020. Recurrences were defined according to the German national guidelines. The pre-specified analysis via logistic regression included the operative approach, age, sex, use of methylene blue, and obesity as independent predictors.
Results:
We included 213 patients, of which 13.6% experienced complications and 16% a recurrence. Median time to recurrence was 5.8 months (95% confidence interval: 4.2-10.3), which was slightly higher in children than adolescents (10.3 months, 95% confidence interval: 5.3-16.2 vs. 5.5 months, 95% confidence interval: 3.7-9.7). None of the investigated procedures, excision and primary closure, excision and open wound treatment, pit picking, and flap procedures had a decisive advantage in terms of complications or recurrence. Of the independent predictors, only obesity was associated to complications (adjusted odds ratio: 2.86, 95% confidence interval: 1.05-7.79, P = 0.04).
Conclusions:
We did not find a difference between the investigated procedures, but our analysis is limited by the small sample size in some subgroups. Our data corroborates that recurrences in paediatric pilonidal sinus disease occur early. Factors linked to these differences remain unknown.
