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Trephination for primary pediatric pilonidal sinus disease: medium term functional and recurrence outcome of a large
Catalin Iacob1,2, Eleonora Niazov1,2, Osnat Zmora3,4
1Department of Pediatric Surgery, Shamir Medical Center, Be'er Ya'acov, Israel.
Insights
Trephination for pediatric pilonidal sinus disease shows good function but has a high recurrence rate, with most issues appearing within two years.
Area of Science:
- Pediatric surgery
- Pilonidal sinus disease management
- Minimally invasive surgical outcomes
Background:
- Minimal incision techniques are suggested for pediatric pilonidal sinus disease.
- Evidence is based on limited studies with short follow-up periods.
Purpose of the Study:
- To evaluate medium-term outcomes of trephination in a large pediatric cohort.
- To assess functional results and recurrence rates after trephination.
Main Methods:
- Retrospective chart review and telephone interviews of 100 children.
- Data collected on demographics, clinical details, and functional/recurrence outcomes.
- Median follow-up of 31.4 months.
Main Results:
- Excellent functional outcomes reported, with quick return to activity.
- High rates of recurrence (pain 37%, discharge 35%, abscess 15%) noted.
- 18% reoperation rate, primarily within the first two years.
Conclusions:
- Trephination offers good functional results for pediatric pilonidal sinus disease.
- Medium-term efficacy is less favorable due to significant recurrence rates.
- Most adverse events, including reoperations, occur within two years post-surgery.
Purpose:
Minimal incision procedures have been recommended for pediatric pilonidal sinus disease, based on small studies with short follow-up. We aimed to describe medium-term outcomes of trephination in a large cohort.
Methods:
Retrospective chart review and additional concluding telephone interviews for all children who underwent primary trephination in our institution over 5.5 years, collecting demographic and clinical data, and updated functional and recurrence outcome data.
Results:
100 patients were included. Median follow-up time was 31.4 (16.2-52.8) months. Post-operative analgesics were used for 1.25 (0-4) days, sick days were 7 (3-11), and time to full activity was 14 (14-30) days. Recurrent pain, discharge, and abscess/es were reported by 37%, 35%, and 15% of patients, with 80-85% occurring within the first post-operative year. Reoperation rate was 18%, with 95% occurring within 2 years. No significant associations were found between demographic or clinical characteristics and either functional or recurrence medium-term outcomes.
Conclusion:
Trephination carries excellent functional outcome with less favorable medium-term efficacy for the treatment of primary pediatric pilonidal sinus disease. Most adverse outcomes, including reoperations, occur within the first two years.
