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Surgical management of pilonidal sinus disease in pediatric population: An updated systematic review and
Muhammad Meeran Saleem1, Shajie Ur Rehman Usmani1, Mahnoor Rehan Hashmi1
1Dow Medical College, Dow University of Health Sciences, Baba-E-Urdu Road, Karachi, 74200, Pakistan.
Insights
Off-midline closure and minimally invasive techniques, particularly PEPSiT, significantly reduce pilonidal disease recurrence and complications in pediatric patients. Combining these methods with laser epilation further enhances recovery and quality of life.
Area of Science:
- Pediatric Surgery
- Inflammatory Conditions
- Surgical Outcomes
Background:
- Pilonidal disease (PD) is a chronic inflammatory condition affecting the pediatric population, causing significant morbidity and frequent recurrences.
- Current surgical approaches lack consensus, with limited pediatric-specific evidence, impacting patient quality of life.
Purpose of the Study:
- To compare recurrence rates, wound complications, and recovery outcomes among different surgical techniques for pediatric patients with pilonidal disease.
- To identify optimal surgical strategies for managing pilonidal disease in individuals 18 years or younger.
Main Methods:
- A systematic review and meta-analysis of 59 studies (N=5075) involving pediatric patients with pilonidal disease.
- Data extraction included recurrence, wound complications, healing time, operative time, hospital stay, return to daily activities, pain scores, and reoperation rates.
- Random-effects models and meta-regression were employed to analyze pooled estimates and explore heterogeneity.
Main Results:
- Off-midline closures demonstrated the lowest recurrence (10.2%) and moderate complications (19.5%), with rapid healing (as short as 8 days).
- Minimally invasive techniques (MITs), such as PEPSiT, showed low recurrence (11.4%), minimal complications (6.5%), and early return to daily activities (1-3 days).
- Adjunctive laser epilation improved outcomes across all techniques, while longer follow-up was associated with lower recurrence, except for open healing.
Conclusions:
- Off-midline closure and minimally invasive surgical strategies are superior for managing pediatric pilonidal disease.
- Combining these techniques with laser epilation offers optimal outcomes regarding recurrence, complications, and patient recovery.
- Evidence supports a shift towards less invasive and off-midline approaches for improved pediatric pilonidal disease management.
Background:
Pilonidal disease (PD) is a chronic inflammatory condition of the natal cleft that commonly affects pediatric population, leading to high morbidity, frequent recurrences, and impaired quality of life. Despite various surgical approaches, no consensus exists on the optimal technique, and pediatric-specific evidence is limited.
Objectives:
To compare recurrence, wound complications, and recovery outcomes across surgical techniques in patients ≤18 years with PD.
Methodology:
A systematic search of MEDLINE, Cochrane, and Google Scholar (inception-Dec 2024) identified 59 studies (N = 5075). Data on recurrence, wound complications, healing time, operative time, hospital stay, return to daily activities (ADL), pain scores, and reoperation rates were extracted. Random-effects models were used for pooled estimates. Subgroup analyses and meta-regression explored heterogeneity and impact of follow-up duration. Study quality was assessed using the Newcastle-Ottawa Scale and ROB-2.
Results:
Open healing showed the highest recurrence (20.1%) and moderate wound complication rates (16.2%), with healing times up to 98 days. Midline primary closure had a recurrence rate of 17.5%, the highest wound complication rate (43.5%), and a reoperation rate of 29.8%. Off-midline closures had the lowest recurrence (10.2%) and moderate complications (19.5%), with healing times as short as 8 days. Minimally invasive techniques (MITs), particularly PEPSiT, demonstrated low recurrence (11.4%), minimal complications (6.5%), short operative times (17-50 min), early return to ADL (1-3 days), and low postoperative pain (VAS 0-2). Adjunctive laser epilation improved outcomes across all techniques. Meta-regression showed longer follow-up was associated with lower recurrence in most groups, except open healing.
Conclusion:
Off-midline closure and minimally invasive strategies, especially when combined with laser epilation, offer superior outcomes in recurrence, complications, and recovery.
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