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The Minimally Invasive Pilonidal Protocol: Low Short-Term Recurrence after Completion in a Single-Center
Gheed Murtadi1, Anna Ghelfi1, Rachael Cohen1
1Boston Children's Hospital, Department of Surgery, Massachusetts, United States, Boston.
Background:
The optimal treatment of pilonidal disease remains uncertain, with recurrence rates up to 30% after resection or sinusectomy. This retrospective single-center cohort study evaluates the recurrence rate after graduation from our Pilonidal Care Clinic's (PCC) Minimally Invasive Pilonidal Protocol (MIPP).
Methods:
We conducted a retrospective review of a single center's prospectively collected demographic and treatment data for patients with pilonidal disease who completed the MIPP between January 2021 and December 2024. Follow-up appointments were scheduled every 6 to 8 weeks, continuing until disease resolution and completion of laser ablation sessions. The analysis focused on patients who graduated. Patients still receiving care at study completion and those lost to follow-up were excluded. Recurrence was defined as any PCC visit after graduation with pilonidal disease on examination. Graduated patients who had not returned to the PCC were contacted via text message and queried about new symptoms since graduation.
Results:
Of the initial 884 patients, 8 patients presented for a second opinion only, 353 were lost to follow-up, and 226 were still receiving care, leaving the study group of 297 patients who completed the protocol and graduated. They graduated after an average of 6.4 PCC visits, two pit-picking procedures, and 5.3 laser epilations. The average disease duration before treatment was 11.4 months. The mean treatment duration was 12.3 months (standard deviation: 8), with a median of 10 months (interquartile range: 6-17). The follow-up period for these patients ranged from 4 to 55 months. Of the 297 graduates, 17 patients (5.7%) returned to the PCC with recurrence concerns; however, only 12 (4.0%) showed physical evidence of recurrence: 8 of them (66.7%) had new pits and 4 (33.3%) had both pits and a nidus. The other 5 showed no signs of pilonidal disease on examination. Recurrence occurred on average 16.3 months after graduating, and 9 of 12 patients with a recurrence were successfully regraduated; 3 were lost to follow-up. Among the 280 patients who did not revisit the clinic, 72 (25.7%) replied to the text survey: 68 (94.4%) of respondents remained disease-free, whereas 4 (5.6%) reported recurrence, 2 of whom sought medical care.
Conclusion:
Completion of the MIPP at this center is associated with a 4.0% recurrence rate within 16 months, with most recurrences mild and again resolved with minimally invasive care.
Insights
The Minimally Invasive Pilonidal Protocol (MIPP) shows a 4.0% recurrence rate in pilonidal disease patients after graduation. Most recurrences were mild and successfully treated with further minimally invasive care.
Area of Science:
- Surgery
- Dermatology
- Gastroenterology
Background:
- Pilonidal disease treatment remains challenging with high recurrence rates (up to 30%) after traditional resection or sinusectomy.
- The Pilonidal Care Clinic (PCC) developed the Minimally Invasive Pilonidal Protocol (MIPP) to address these limitations.
Purpose of the Study:
- To evaluate the recurrence rate of pilonidal disease in patients who successfully completed the MIPP.
- To assess the long-term outcomes and effectiveness of the MIPP for pilonidal disease management.
Main Methods:
- A retrospective review of prospectively collected data from patients who completed the MIPP between January 2021 and December 2024.
- Follow-up occurred every 6-8 weeks until disease resolution and laser ablation completion; recurrence was defined as disease presence upon examination after graduation.
- Graduated patients were contacted via text message to assess post-graduation symptoms; patients lost to follow-up or still in treatment were excluded.
Main Results:
- Out of 884 initial patients, 297 completed the MIPP and graduated. The average treatment duration was 12.3 months.
- A recurrence rate of 4.0% (12 out of 297 graduates) was observed, with recurrences occurring an average of 16.3 months post-graduation.
- Of the 12 recurrent cases, 8 had new pits and 4 had both pits and a nidus; 9 of these patients were successfully re-graduated.
- A text survey of 280 non-returning graduates revealed 5.6% reported recurrence, with 94.4% remaining disease-free.
Conclusions:
- Completion of the MIPP is associated with a low recurrence rate of 4.0% for pilonidal disease.
- The majority of recurrences were mild and amenable to further minimally invasive treatment, suggesting MIPP's effectiveness.
- The MIPP offers a promising approach for managing pilonidal disease with favorable long-term outcomes.
