Abstract
This paper aimed to report a multi-institutional 3-year experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT) and describe tips and tricks of the technique. We retrospectively reviewed all patients < 18 years, with primary or recurrent pilonidal sinus disease (PSD), undergoing PEPSiT in the period 2017–2020. All patients received pre-operative laser therapy, PEPSiT and post-operative dressing and laser therapy. Success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. A total of 152 patients (98 boys) were included. Median patient’s age was 17.1 years. Fifteen/152 patients (9.8%) presented a recurrent PSD. All patients resumed full daily activities 1 day after surgery. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10). Patient satisfaction was excellent (median score 4.8). The median follow-up was 12.8 months (range 1–36). Complete healing in 8 weeks was achieved in 145/152 (95.4%) and the median healing time was 24.6 days (range 16–31). We reported post-operatively immediate Clavien grade 2 complications (3 oedema, 2 burns) in 5/152 (3.3%) and delayed Clavien grade 2 complications (3 granulomas, 8 wound infections) in 11/152 (7.2%). Disease recurrence occurred in 7/152 (4.6%), who were re-operated using PEPSiT. PEPSiT should be considered the standard of care for surgical treatment of PSD in children and teenagers. PEPSiT is technically easy, with short and painless post-operative course and low recurrence rate (4.6%). Standardized treatment protocol, correct patient enrollment and information, and intensive follow-up are key points for the success of the procedure.
Highlights
Pediatric endoscopic pilonidal sinus treatment (PEPSiT) represents the new frontier in the surgical management of pilonidal sinus disease (PSD) in the pediatric population
This paper reported a multi-institutional 3-year experience with PEPSiT with the aim to evaluate its effectiveness and safety in the pediatric population and describe the tips and tricks of the technique
Based upon our 3-year experience, we outline some key points for the success of PEPSiT protocol
Summary
Pediatric endoscopic pilonidal sinus treatment (PEPSiT) represents the new frontier in the surgical management of pilonidal sinus disease (PSD) in the pediatric population. Since its first report in the pediatric population in 2017 [1, 2], PEPSiT has dramatically revolutioned the surgical approach to pediatric patients with PSD. This technique provided a safe, effective and real minimally invasive care for both primary and recurrent PSD, that may be a socially. The main objective of the surgical management should be focused to treat the lesion and all risk factors associated with disease recurrence. The most common risk factors for recurrence are represented by poor local hygiene and re-growth and re-accumulation of hair in the treatment area [8, 9]. A recent systematic literature review explained the importance of laser hair removal in patients treated for PSD, reporting a recurrence rate of 9% in patients undergoing laser therapy, 23.4% in those receiving razor shaving/cream depilation and 19.7% in those who had no hair
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