Minimally Invasive, Maximally Effective: Outpatient Strategies for Paediatric Pilonidal Disease.

Area of Science:

• Pediatric Surgery
• Wound Management
• Clinical Pathways

Background:

• Pilonidal sinus disease (PNS) management in pediatric patients lacks standardized protocols.
• Limited pediatric-specific data exists for minimally invasive and outpatient strategies.
• There's a need to evaluate structured approaches for pediatric PNS.

Purpose of the Study:

• To assess outcomes of a structured, tiered outpatient pathway for pediatric PNS.
• To evaluate recurrence rates, time to healing, and clinic utilization.
• To identify factors associated with recurrence in pediatric PNS management.

Main Methods:

• Retrospective single-center cohort study of patients aged ≤18 years treated for PNS.
• Implementation of a stepwise protocol: conservative care, in-clinic debridement, and operative intervention.
• Primary outcome: recurrence after healing; secondary outcomes: time to healing, clinic utilization.

Main Results:

• 69 pediatric patients (median age 15 years) were included.
• Recurrence rates were 26.1% in the operative group vs. 2.2% in the non-operative group (p=0.0045).
• Conservative management was associated with lower recurrence, but operative patients may represent a more severe subgroup.

Conclusions:

• A structured outpatient pathway for pediatric PNS demonstrates low overall recurrence rates.
• Conservative management appears to yield better recurrence outcomes.
• Further prospective, severity-adjusted studies are needed to optimize pediatric PNS wound management.