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Pediatric Pilonidal Disease Surgical Approach (PPiDSA) Study
Marta Rodríguez Ruiz1, Isabella Garavis Montagut2, Inmaculada Ruiz Jiménez3
1Pediatric Surgery Department, Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain.
Insights
Endoscopic treatment for pediatric pilonidal sinus disease offers fewer complications and faster healing than traditional surgery. Recurrence rates were similar between the endoscopic and surgical excision groups in this study.
Area of Science:
- Pediatric surgery
- Minimally invasive procedures
- Pilonidal sinus disease management
Background:
- Traditional pilonidal sinus treatment involves wide surgical excision, often leading to prolonged recovery.
- Minimally invasive techniques are being explored to improve patient outcomes.
- Pediatric patients may benefit from less invasive surgical options.
Purpose of the Study:
- To compare the outcomes of radical surgery versus endoscopic treatment for pilonidal sinus in pediatric patients.
- To evaluate postoperative complications, healing time, and recurrence rates.
- To assess the efficacy of minimally invasive endoscopic treatment in a pediatric population.
Main Methods:
- A multicenter randomized comparative study involving 102 pediatric patients with pilonidal sinus.
- Patients were divided into two groups: en bloc excision (Group 1) and endoscopic treatment (Group 2).
- Data collected included demographic and clinical variables, complications, healing times, and recurrence rates over a median follow-up of 19 months.
Main Results:
- Endoscopic treatment (Group 2) showed significantly fewer postoperative complications (20.8%) compared to radical surgery (Group 1) (53.7%).
- Patients undergoing endoscopic treatment experienced faster healing (median 45 days) versus radical surgery (median 100 days).
- No significant difference in recurrence rates was observed between the two groups after a median follow-up of 19 months.
Conclusions:
- Endoscopic treatment for pediatric pilonidal sinus is associated with reduced postoperative complications and accelerated recovery compared to radical surgery.
- The study found no significant difference in recurrence rates between endoscopic treatment and radical surgery.
- Further long-term follow-up is recommended to validate these findings on recurrence rates.
Abstract:
Background: Wide surgical excision is considered the traditional treatment for pilonidal sinus disease but is associated with prolonged wound healing and delayed recovery. This study aims to compare the outcomes of radical surgery versus a minimally invasive alternative in pediatric patients. Methods: A multicenter randomized comparative study was conducted on patients undergoing surgery for pilonidal sinus between January 2023 and December 2024 in four pediatric institutions. Patients were divided into two groups according to the surgical approach: Group 1 (en bloc excision) and Group 2 (endoscopic treatment). Demographic and clinical variables, postoperative complications, and recurrence rates were analyzed. Results: A total of 102 patients were included in this study (Group 1: n = 54; Group 2: n = 48). Baseline demographic and clinical characteristics were similar between groups. Postoperative complications occurred more frequently in Group 1 compared with Group 2 (53.7% vs. 20.8%; p < 0.001). Moreover, Group 1 presented a higher proportion of emergency department visits (44.4% vs. 8.36%; p < 0.001) and a longer median time to complete healing (100 vs. 45 days; p < 0.001). After a median follow-up of 19 months (interquartile range, 10-24 months), no significant differences were observed between groups in recurrence rates (14.8% vs. 16.7%; p = 0.797) or in median time from treatment to recurrence (198 vs. 184 days; p = 0.672). Conclusions: Endoscopic treatment of pilonidal sinus in pediatric patients is associated with fewer postoperative complications and faster recovery compared to radical surgery, with no observed differences in recurrence rates. Longer follow-up is needed to confirm these findings.
