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Outcomes of pediatric pilonidal disease treatment: excision with off-midline flap reconstruction versus endoscopic
William G Lee1,2, Celia Short3, Allen Zhong3
1Department of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA. William.Lee@cshs.org.
Insights
For pediatric pilonidal disease (PD), excision with off-midline flap (OMF) reconstruction shows lower recurrence and reoperation rates than endoscopic pilonidal sinus treatment (EPSiT), despite higher complication rates.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes Research
- Pilonidal Disease Management
Background:
- Pilonidal disease (PD) presents challenges in pediatric patients due to chronic inflammation and high recurrence rates.
- Optimal surgical strategies for pediatric PD remain a subject of ongoing clinical debate.
Purpose of the Study:
- To compare the efficacy and safety of two surgical approaches for pediatric PD: excision with off-midline flap (OMF) reconstruction versus endoscopic pilonidal sinus treatment (EPSiT).
Main Methods:
- A single-center retrospective study evaluated pediatric patients (1-21 years) undergoing OMF reconstruction or EPSiT between 2011 and 2021.
- Key outcomes assessed included disease recurrence, reoperation rates, and wound complications.
- Statistical analysis utilized Chi-square and Mann-Whitney U tests for comparisons.
Main Results:
- The OMF group (18 patients) had significantly lower recurrence (5.6% vs. 33.3%) and reoperation (5.6% vs. 31.1%) rates compared to the EPSiT group (45 patients).
- However, the OMF group experienced higher wound complication rates (22.2% vs. 0%) and longer operative times (60 min vs. 17 min).
- The OMF cohort also showed a higher prevalence of male patients and prior pilonidal infections.
Conclusions:
- Excision with OMF reconstruction appears to reduce recurrence and reoperation rates in pediatric PD patients compared to EPSiT.
- This benefit may come at the cost of increased operative time and wound complications.
- Further research may refine treatment selection based on individual patient factors and disease severity.
Purpose:
Pilonidal disease (PD) is marked by chronic inflammation and frequent recurrence which can decrease quality of life. However, debate remains regarding the optimal treatment for PD in the pediatric population. This study compares two recommended treatment approaches-excision with off-midline flap reconstruction (OMF: Bascom cleft lift flap, modified Limberg flap) and minimally invasive endoscopic pilonidal sinus treatment (EPSiT).
Methods:
Single-center retrospective evaluation of patients 1-21 years of age with PD who underwent either excision with OMF reconstruction or EPSiT between 10/1/2011 and 10/31/2021. Outcomes included were disease recurrence, reoperation, and wound complication rates. Comparisons were performed using Chi-square and Mann-Whitney U tests.
Results:
18 patients underwent excision/OMF reconstruction and 45 patients underwent EPSiT. The excision/OMF reconstruction cohort was predominantly male (44.4% vs 17.8% p = 0.028), with history of prior pilonidal infection (33.3% vs 6.7%; p = 0.006), and longer median operative time (60 min vs 17 min; p < 0.001). The excision/OMF reconstruction cohort had a higher rate of wound complications (22.2% vs 0%; p = 0.001), but lower rates of disease recurrence (5.6% vs 33.3%; p = 0.022) and reoperation (5.6% vs 31.1%; p = 0.031).
Conclusion:
In pediatric patients with PD, excision with OMF reconstruction may decrease recurrence and reoperation rates with increased operative times and wound complication rates, compared to EPSiT.
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