Treatment Of Pilonidal Disease Research Articles

Establishing an Association between Polycystic Ovarian Syndrome and Pilonidal Disease in Adolescent Females

We sought to determine whether pilonidal disease (PD) is associated with polycystic ovarian syndrome (PCOS) in adolescent females. Retrospective cohort study SETTING: Urban tertiary children's hospital PARTICIPANTS: All girls aged 12 to 21 who received a diagnosis of PD and/or PCOS from 2012 to 2019 INTERVENTIONS: Treatment for PCOS and PD MAIN OUTCOME MEASURES: The variables analyzed included age, race/ethnicity, body mass index, age at menarche, tobacco use, payer status, treatment of PCOS and PD, and serum markers of hyperandrogenism and metabolic syndrome. During the study period, 100,043 patients presented to an urban tertiary medical center. Of these patients, 966 were diagnosed with PD, and 219 were diagnosed with both PD and PCOS. Compared with patients with only PD, patients with both diagnoses had a higher body mass index (31.4 vs 27.4 kg/m2; P < .01) and were older (18.76 vs 18.30 years; P=.003). The prevalence ratio for patients with PD having PCOS per the original Rotterdam criteria was 26.1 (CI, 22.0-31.0) and 28.7 (CI, 24.3-33.9) for having PCOS per the modified Rotterdam criteria. Patients with both diagnoses were less likely to receive intervention for PD (OR=0.22; CI, 0.13-0.37; P < .001). Adolescent females diagnosed with PD are likely to demonstrate features of PCOS. PCOS treatment could positively alter the disease course of PD. As such, surgical providers should consider referring adolescent females with PD to endocrinologists, gynecologists, and adolescent medicine specialists for evaluation of PCOS.

TH3.9 Cleft closure is an effective procedure for the treatment of pilonidal disease with low recurrence rate

Abstract Aims The surgical treatment of pilonidal sinus disease has evolved over time, with reported time to healing, post-operative complications and disease recurrence rates still significant. The modified Karydakis procedure such as the Bascom's cleft lift operation or “cleft closure” flattens the cleft and has shown promising results. The purpose of this single-centre study is to analyse outcomes of this technique. Method This is a retrospective study of 192 patients undergoing cleft closure as a day case over 10 years. The technique involves an off-midline cleft closure with an advancement flap and primary closure. Outcome measures were postoperative complications, time to healing and recurrence requiring surgery. Results The median age at surgery was 25 years (IQR 21–33), with males representing 76%. Overall, 91 (47%) were smokers. 141(73%) patients had previous emergency treatment. The median numbers of pits/sinuses were 3 and in 71% of patients were localized in the midline. The median time to wound healing was 3 weeks (IQR 2–6). Twenty-five (13%) patients had postoperative complications including infection (n=21) and hematoma (n=4). Disease recurrence requiring surgery occurred in 7 (3.6%) patients. Median time to recurrence was 9 months (IQR 5–15). Conclusion Cleft closure is an effective procedure for the treatment of pilonidal disease, with a low rate of postoperative complications and recurrence.

Burden of pilonidal disease and improvement in quality of life after treatment in adolescents

Pilonidal Disease (PD) affects adolescents in different aspects. We hypothesized that patients with different gender, ethnicity, and age have different quality of life (QOL) measurements which could improve with minimally invasive treatment (MIT). 131 PD patients underwent MIT (laser epilation ± trephination) from 2019 to 2021. Patients' demographics were recorded. Before and after MIT, patients received QOL questionnaire consisting of four categories: daily activities, sports participation, school/work attendance, and socializing. Data were analyzed using Student and multivariate t test. P < 0.05 was considered statistically significant. 101 (51 male, 50 female) patients were included. 30 patients with incomplete data were excluded. 54% of patients were < 18years old. 47.5% were Hispanic. Median symptom duration prior to presentation was 5.4 (1.3-15) months. Prior to MIT, patients' ability to perform daily activities, participate in sports, attend school/work, and socialize was moderately or severely impacted in 66%, 57%, 45%, and 23% of respondents, respectively; after MIT, only 7%, 8%, 2%, and 4% were affected (p < 0.01). Recurrence rate was 6%. Pre-MIT, older patients and non-Hispanics reported worse impact on their QOL. Symptom duration or PD recurrence did not correlate with patient's pre- or post-MIT QOL. Patients' ethnicity and age impacted QOL in PD. All patients' QOL significantly improved with MIT. Considering the importance of socializing, playing sports, and school/work attendance in adolescents, our study highlights importance of early treatment of PD.

Adoption of a standardized treatment protocol for pilonidal disease leads to low recurrence

BackgroundPilonidal disease may present as acute abscesses or chronic draining sinuses. There is no standardized treatment and recurrence rates can be as high as 30%. Within our five-hospital network we have established a standardized treatment protocol including minimally invasive surgical trephination and aggressive epilation. We hypothesize that such a treatment protocol can be established across different hospital settings and lead to low overall recurrence. MethodsPatients with pilonidal disease were enrolled in the study on presentation to our hospital network. Those that underwent initial surgery outside our hospital system or were noncompliant with our treatment protocol were excluded. Patients were grouped based on surgeon and treating facility. Frequency of recurrence per surgeon and per hospital was calculated and compared. ResultsOut of 132 patients, 80 patients were included (45 female, 35 male) while 52 were excluded because of initial surgery at a non-network hospital or for protocol noncompliance. Median age was 17 (16–19) years and median length of follow-up was 352 (261–496) days. There were 6 patients who experienced at least one recurrence. There was an overall 8% recurrence rate with no significant difference noted between surgeons or hospitals (p = 0.15, p = 0.64, respectively). ConclusionsWe have successfully implemented a standardized treatment protocol for pilonidal disease across different hospital settings and by different surgeons, with an overall low recurrence rate. Our findings suggest that adoption of a standardized protocol for treatment of pilonidal disease can lead to low recurrence. Level of evidenceLevel IV.

Minimally invasive treatment of pilonidal sinus disease in a paediatric population: comparison of two techniques.

Pilonidal disease (PD) is a common and debilitating inflammatory condition with significant impact on quality of life. Minimally invasive techniques (MIT) have shown promising results comparing to traditional excision. Herein we present a comparison of two MIT techniques -sinusectomy (SE) and pit-picking plus laser ablation (PPL). All cases of paediatric PD treated by PPL and SE at our center between August 2018 and August 2020 were retrospectively reviewed. One-hundred and six patients were included, with a median age of 16 years (IQR 15-16). PPL was the procedure of choice in 36 patients (34%) and the remaining underwent SE (66%). Median healing time was significantly lower in SE group (20 days), comparing to PPL (30 days) (p=0.002). Early healing failure occurred more frequently in the PPL group (p=0.003). Recurrence rate was similar between groups - PPL 17% versus SE 16% (p=0.89). Overall complication rate was 9% and was significantly higher in PPL (p=0.03). MIT techniques are promising solutions in PD treatment. Although similarly easy and fast to perform, SE technique showed better healing profile and lower complication rate but no significant difference on recurrence rates was observed.

Sinus pilonidalis und Hidradenitis suppurativa: 2 anspruchsvolle Hauterkrankungen

Pilonidal disease (PD) and hidradenitis suppurativa (HS) are skin conditions which are characterized by formation of abscesses and fistulae. Both conditions are usually treated surgically. Follicular occlusion has been thought to be the central pathogenetic mechanism of both diseases. However, there are still controversies regarding the etiology of PD. Although PD and HS frequently occur simultaneously, the surgical treatment of the two diseases differs considerably. Numerous minimally invasive treatment options are available for PD; thus, open excision is losing its popularity due to prolonged traumatic secondary wound healing. HS is treated mainly by complete excision of the diseased skin. Laser procedures, preoperative antibiotics and biologic therapy are frequently used to treat HS prior to surgery to minimize trauma. In contrast, the treatment of PD is solely surgical.

Surgical treatment of pilonidal disease with the use of «closed» techniques

The OBJECTIVE was to evaluate long-term results of the use of «closed» techniques of surgical treatment of pilonidal disease.METHODS AND MATERIALS. The study included 147 patients who underwent excision of the pilonidal sinuses according to Karydakis – 28 and excision of the pilonidal sinuses with mobilization of the gluteal fascia – 89, laser obliteration using Filac Fistula Probe – 30 patients. To assess the long-term results, a questionnaire survey of patients, a face-to-face examination and ultrasound of the soft tissues of the postoperative scar area, statistical data processing were carried out.RESULTS. By primary intention, wounds healed in 91.4 % of patients. Complications were observed in 10 (8.5 %) patients: postoperative wound seromas – 8, wound hematoma – 1, postoperative wound suppuration – 1. After mobilization of the gluteal fascia, recurrence of the disease was established in 4 (4.4 %) patients, after obliteration with the use of laser energy and Filac Fistula Probe – in 4 (13.3 %) patients. No relapse was diagnosed after Karydakis procedure.CONCLUSIONS. Operations using «closed» techniques are effective methods of surgical treatment of pilonidal disease. At the same time, there is a low percentage of complications, relapses of the disease and a short period of rehabilitation.

Alterations in the expression of IGF‑I isoforms and binding proteins during the wound healing process

There is increasing evidence to indicate that insulin‑like growth factor (IGF)‑1 plays a crucial role in the regeneration of different tissues following injury. Notably, despite the escalating number of animal studies, studies investigating the role of IGF‑1 in the wound healing process in humans are fewer. In this context, the aim of the present study was to evaluate the variations in the expression IGF‑1 isoforms (IGF1‑Ea, IGF1‑Eb and IGF1‑Ec), as well as its binding protein and receptor (IGF‑BP3 and IGF‑1R) during wound healing in patients. The study population comprised of 21 patients presenting with the first episode of sacrococcygeal pilonidal disease. Samples were obtained during surgery, as well as on days 2, 7 and 14 post‑operatively. The expression levels of IGF‑1 isoforms, as well as that of its binding protein and receptor were evaluated using reverse transcription‑quantitative PCR. Statistical analyses were performed using GraphPad Prism software. The Kruskal‑Wallis test and Dunn's post hoc test were utilized. The results revealed a statistically significant difference in the expression of IGF‑BP3 and IGF‑1R during wound healing (P=0.014 and P=0.018, respectively). Specifically, the pairwise post‑hoc Dunn test indicated that IGF‑BP3 expression was significantly decreased on the 2nd post‑operative day compared to the day of surgery, while IGF‑1R expression was significantly increased at 14 days post‑operatively. The expression of the remaining IGF‑1 isoforms was not significantly altered during wound healing. On the whole, as demonstrated herein, IGF‑BP3 and IGF‑1R appear to play a crucial role during the wound healing process, particularly in patients with large open wounds following pilonidal disease treatment. Further studies are warranted to evaluate the exact role, as well as the possible use of these proteins as enhancers of wound healing.

Sinus laser-assisted closure (SiLaC®) for pilonidal disease: results of a multicentre cohort study.

An emerging and promising minimally invasive treatment for pilonidal disease (PD) is sinus laser-assisted closure (SiLaC®). Previous studies have shown encouraging results concerning safety, patient satisfaction, wound healing and acceptable recurrence rates. This study investigated outcomes for a large cohort of PD patients treated with SiLaC®. A multicentre cohort study with a prospective design and partial retrospective data collection for patients with PD treated with SiLaC® in three hospitals in the Netherlands (Albert Schweitzer Hospital, Flevoziekenhuis and Medical Centre Zuiderzee) from January 1st 2017 to March 1st 2020. The primary outcome was recurrence. Secondary outcomes were incidence of complete wound closure, time until wound closure, postoperative complications, ability to perform daily activities and reported patient satisfaction. A total of 311 patients were included with a median follow-up of 10months (range 1-52months). The recurrence rate after one SiLaC® treatment was 26% with 7% experiencing incomplete wound closure, resulting in an initial success rate of 66% after one SiLaC® procedure. This increased to 92% and 98% after two and three SiLaC® procedures, respectively. Mean time until wound closure was 6weeks (range1-24weeks). Seven patients (2%) were still unsuccessfully treated after three SiLaC® treatments and required additional and extensive surgery. Mean time to perform regular daily activities including working was 6days (range 0-42days) and the vast majority of patients (84%) did not require painkillers or only paracetamol. Twelve patients (4%) developed a postoperative wound infection. The mean satisfaction score was 9 (range 5-10). SiLaC® is a promising minimally invasive treatment for PD with high patient satisfaction and an acceptable success rate. These results suggest that SiLaC® could be used as a safe and effective primary treatment for PD.

Extensive suppuration and being overweight are factors associated with the failure of laser treatment for pilonidal disease: lessons from the first French retrospective cohort.

The aim of our study was to assess the efficacy of sinus laser therapy (SiLaT) for the treatment of pilonidal disease. All adult patients treated with SiLaT in our department between June 1, 2018, and August 23, 2019, were included in the study. Success was defined as the closure of cutaneous orifices and the absence of discharge or abscesses. We included 29 consecutive patients (22 males) with a median age of 32.5 ± 10.5years. Eight patients had already undergone prior surgery for pilonidal disease. The procedure was performed under spinal (55%) or general (45%) anesthesia. The mean follow-up was 370.3days (± 165.8days). We observed 2 primary failures (6.9%) and 7 recurrences (24.1%). Ultimately, 20 patients were considered to have been cured (69%). The mean time to healing was 25days (± 8.1days). No serious complications were reported. Usual activities were resumed within a mean of 4.9days (± 7.2), and 86% of patients reported being "very satisfied" with the treatment. The body mass index was lower for patients who were cured (24.0 ± 3.6) than for those who experienced treatment failure (27.6 ± 3.4; p = 0.018). The cured patients were less likely to have one or more secondary openings (35.0 versus 88.9%, p = 0.014). Almost 70% of our patients were cured by SiLaT. Complications were rare and mild. The technique appeared to be less effective for overweight patients and those with one or more secondary openings associated with pilonidal pits.

Fistuloscopy in the management of pediatric pilonidal sinus disease

The treatment of pilonidal disease is often challenging, due to frequent recurrences and adverse events. Most operative treatments require a lengthy hospital stay, and absence from school or work. We aimed towards assessing the effectivity of PEPSiT (pediatric endoscopic pilonidal sinus treatment). In this study, we included patients subjected to PEPSiT from 2019 to 2020 between ages 0-18 years. Patients operated via cystoscope and patients who did not attend follow-up examinations were excluded. Adverse events, recurrences, length of hospital stay, wound healing time and return to everyday activity were assessed. The majority of our patients were male (24 male, 4 female), the mean age was 15.6 years. 31 PEPSiT operations were recorded on 28 patients (3 were redo surgeries). 6 recurrences and 1 wound suppuration were documented. Some patients were treated within the confines of one-day surgery, while most of them stayed one night (mean length of stay was 1.74 days). Return to everyday activity was an average 1.37 days, and mean wound healing time was 5.9 weeks. PEPSiT is a minimally invasive operative approach with a very short hospital stay. Patients return to everyday activity faster. New operative scarring does not happen apart from the preexisting fistula opening. Recurrence rate is similar to that of other treatment techniques. PEPSiT technique is applicable, however, reduction of the recurrence rate is important. Orv Hetil. 2021; 162(43): 1740-1743.

Pediyatrik Pilonidal Sinüs Hastalığında Klasik Açık Cerrahi Tekniğine Göre Deri Dokusunda Kayıp Olmaksızın Ters 'ᗡ' Tekniği

Aim: Although the pilonidal sinus disease is commonly treated with surgical methods, search for optimal surgical procedures and minimally invasive methods continues. The aim of this study was to evaluate the inverted 'ᗡ' technique which provides a tension-free closure with minimal tissue loss, by comparing with the classical open surgery technique. Material and Methods: Sixty-five patients, 37 (56.9%) male and 28 (43.1%) female, with a mean age of 15.85±1.82 years, admitted between January 2014 and October 2020 and underwent inverted 'ᗡ' surgery and classical midline open surgery were retrospectively evaluated. Results: As an early postoperative complication, bleeding was observed in 2 (7.4%) patients in inverted 'ᗡ' group and 3 (11.1%) patients had wound infection. The same complications were 4 (10.5%) and 4 (10.5%) in classical group, respectively. The time to return to full activities was statistically different between two groups (10.36±0.43 versus 11.30±0.93 days, p&amp;lt;0.001). During the follow-up period, 1 (3.7%) recurrence in the inverted 'ᗡ' group and 9 (23.7%) recurrences in the classical group were statistically significant (p=0.037). Conclusion: The present technique aims to remove the pathological tissue that causes sacrococcygeal pilonidal disease by the subcutaneous surgical work area under the flap created through the 'ᗡ' incision and to close it without tension, away from the midline without tissue loss. We believe that the operation involving the 'ᗡ' incision and primary suture method should be considered as the first choice in the pediatric patient group because of being a simple and effective surgical technique for sacrococcygeal pilonidal disease treatment.

Endoscopic Pilonidal Sinus Treatment: A Tertiary Care Academic Center Experience.

Background: Pilonidal disease (PD) represents one of the most common proctological diseases in young adults. Although several approaches to treating PD have been described, there is still a lack of agreement on which is the best. The aim of this study was to evaluate the long-term efficacy of endoscopic pilonidal sinus treatment (EPSiT) at a tertiary care academic center.Methods: Between June 2017 and January 2021, a total of 32 patients [12 women (37.5%) and 20 men (62.5%)] with a mean age of 29.22 ± 12.98 years were treated with EPSiT. Pre- and post-operative symptoms were assessed with a score of 0–5. Success was defined as the absence of any subjective symptoms, as well as by complete post-operative wound healing.Results: Most of the patients had a midline external opening (17/32; 53.1%), with a mean number of external openings of 2.41 (1–4) ± 1.04. The median post-operative pain score was 0, and the mean follow-up period was 22 (4–42) ± 11.49 months. The time to wound healing was reduced in patients with one opening (28.14 ± 4.06 days) compared to patients with two or more openings (33.64 ± 7.3 days) (p = 0.067). The mean operative time was longer in patients who subsequently had a recurrence (41.75 ± 6.24 vs. 34.18 ± 6.24 min; p = 0.031). The overall success rate was 87.5% (28/32), and the mean time to recurrence was 3.25 (2–5) ± 1.26 months.Conclusions: EPSiT represents a viable option for the treatment of PD. More evidence and a longer follow-up period are needed to validate the results.

Laser treatment of pilonidal disease: a systematic review.

Pilonidal disease (PD) is a common condition, and there is still an ongoing debate on ideal management that should be minimally invasive, safe, and efficient. The use of radially emitting laser in the treatment of chronic PD is a novel minimally invasive technique, and initial studies with a small number of patients showed promising results. This study aimed to assess the efficacy and safety of chronic PD treatment with a laser using a systematic review of the published literature. A systematic review was conducted after PubMed, Scopus, Embase, Web of Science, and the Cochrane database search for studies reporting laser treatment of chronic PD. Also, our unpublished prospective single-center study was included in this review. Ten of 87 studies were eligible for the review, including 971 patients. The median age of the patients was 26 (range 13-68), and the median operative time was 26 (range 6-65) min. With a median follow-up of 12 (range 7-25) months, 917 (94.4%) patients achieved primary healing with a weighted mean recurrence rate of 3.8%. The weighted mean complication rate was 10% (95% CI 5.7-14.3%, I2 = 82.28, p < 0.001), and all were minor. The published literature demonstrates that laser treatment is a promising procedure in the management of chronic PD. Furthermore, the review showed that standardized operative techniques and perioperative steps were used. The results were limited to the mild chronic PD. Classification of PD severity and standardized outcome reporting is required to define indications and contraindications for laser PD treatment. Randomized controlled trials are needed to determine the long-term effectiveness and superiority of laser treatment over other methods.

Room for Improvement: The Trephination Procedure for Pediatric Patients with Pilonidal Disease

BackgroundPilonidal disease is common amongst adolescent males and females and often leads to recurrent symptoms and life-altering morbidity. The traditional surgical approach includes wide excision of the involved area and carries a high rate of postoperative morbidity. A minimally invasive surgical approach using trephines was described by Gips in 2008 and has since been widely adopted by many surgeons. The aim of this study was to explore outcomes of the trephination procedure for pediatric and adolescent patients by evaluating postoperative wound healing and disease recurrence. Materials and MethodsA retrospective cohort study for patients that underwent the trephination procedure as part of standard of care for the treatment of pilonidal disease from November 1, 2019-November 1, 2020 was performed. Patient demographics, presenting characteristics, and previous treatment history were identified. Outcome measures included healing time, recurrent disease, and need for reoperation. ResultsA total of 19 patients underwent the trephination procedure at a mean age of 16.4 years of age. An average of 3.8 pits were excised and there were no reported intraoperative complications. Following trephination, 26.3% of patients were healed at 30-day’s, with just over 40% showing complete healing by 6-months. The recurrence rate was 16.1% at 6-months and approximately 15% of patients required a second surgery. ConclusionEarly results for trephination at our institution show a high rate of healing complications and frequent reoperation. Future research is needed to establish the role of the trephination procedure in the context of defining the best practices for treating this challenging disease.

US Guided Si.La.D. A new technique for minimally invasive pilonidal disease treatment, using ultrasound guided laser ablation

ABSTRACT Background: The destruction of the pilonidal sinus with a radial laser probe has been suggested as a safe procedure with good results and low morbidity. Nevertheless, the drawbacks of this technique are: a blind technique, if the sinus has some ramifications or a non-linear development, we cannot be sure for their destruction. Methods: 17 patients (12 men, 5 women) were operated with US guided laser destruction – US guided Si.La.D. Laser destruction of the pathological tissue (cavity, sinus) was performed using a 400 μ radial optical fiber, connected and locked to a radiopaque biopsy needle 14 G, using a 12 MHz linear probe, to introduce and real-time echo guide the fiber in order to achieve laser ablation with 120–140 J /cm of pathological tissue Results: No significant complications were recorded. Conclusion: Real-time echo guided laser ablation of pilonidal sinus and cavities proved to be safe and efficient, providing controlled emission of laser energy only to the pathological tissue, increasing the accuracy of identify the right track to deliver energy, decreasing the risk of traumatic progression of surgical instrument into healthy subcutaneous tissue, accidental progression of the disease and missing in the same time tracts that need to be ablate.

689 Silac (Sinus Laser-Assisted Closure) For Pilonidal Sinus: Our NHS Experience

Abstract Introduction The accepted treatment of pilonidal disease still consists of surgical excision with primary wound closure. This treatment has complications such as excessive pain, delayed wound healing, and recurrence. We introduced this technique using a radial laser probe (SiLaCTM, Biolitec, Germany). Previous studies have shown encouraging results with respect to safety, patient satisfaction, and minimal recurrence rates. Method The pilot project was planned with the objectives to assess postoperative complications and reoperation rates. All operations were performed as day case procedures under general anaesthesia. We studied the data of our first 25patients operated with this technique between January 2019 and December 2019 using a prospective database and outpatient clinic follow up. Results The median follow up duration was 13 months. The initial success rate was 64%(16/25), reoperation was required in 32%(8/25) and one patient was lost to follow up. one patient returned with abscess formation in the postoperative period. Conclusions SiLaC is a safe and minimally invasive technique for the destruction of the pilonidal cyst and sinus. The success rate is modest, making this new therapy a minimally invasive option for the majority of the patients with pilonidal disease but it should be offered with caution.

91. Association of Pilonidal Disease with Polycystic Ovarian Syndrome in Adolescent Females

<h3>Background</h3> Polycystic Ovarian Syndrome (PCOS) and Pilonidal Disease (PD) have been associated with a number of dermatologic conditions such as hirsutism, acne, seborrheic dermatitis, androgenetic alopecia, psoriasis and hidradenitis suppurativa. These conditions share similar risk factors including obesity, elevated androgens and metabolic syndrome. There is scant evidence about association between PCOS and PD. Prevalence of PD in adolescents is 0.7% and of PCOS is 8 to 13%. Pilonidal disease and PCOS are associated with significant morbidity and decreased quality of life, thus early diagnosis and treatment are important. We sought to determine whether pilonidal disease is associated with PCOS and whether severity of PD is greater in patients with concurrent PCOS and whether treatment of PCOS reduces pilonidal disease severity. <h3>Methods</h3> This was a retrospective chart review approved by the Institutional Review Board. Inclusion criteria was all girls aged 12 to 21 receiving a diagnosis of PCOS or PD from 2012-2019 at a tertiary medical center. Variables analyzed included age, race/ethnicity, BMI, menarche, tobacco use, payer status, treatment of PCOS and PD, serum markers of hyperandrogenism and metabolic syndrome. Data was analyzed with Student's t-test, chi-squared test, and multiple logistic regression <h3>Results</h3> In total, 100, 043 patients presented to an urban tertiary medical center with 769 patients diagnosed with PD of which 209 patients were diagnosed with both PD and PCOS. Patients with both diagnoses were more likely to have a higher BMI (31.4 v. 27.4, p<0.01), and be older (18.8 v. 18.3, p=0.04). The odds of patients with PD having PCOS was 34.6 times that of patients without PD [CI 29.2,40.9] (p<0.001). Patients with both diagnoses were less likely to receive intervention for PD (OR 0.22 [CI 0.13,0.37] (p<0.001)). Subgroup analysis of patients age < 18 years reduced confounding due to age and payer status. <h3>Conclusions</h3> There is a higher prevalence of PCOS among adolescent girls diagnosed with PD. PCOS treatment appears to confer a protective effect in reducing risk of intervention for PD. Increased awareness of the association between PCOS and PD among providers taking care of female adolescents with PD should result in lower threshold for screening for PCOS and/or referral to adolescent gynecology for further evaluation. If future studies involving diverse population show replicability of these findings, formalized practice guidelines aimed at screening for PCOS in girls presenting with PD should be developed. This approach may improve early detection and ultimately treatment of PCOS.

The EPIC procedure (Endoscopic-assisted Pilonidal Irrigation and Cleaning): a simple and effective treatment for pilonidal disease.

Pilonidal disease (PD) is a common condition of the sacrococcygeal region leading to inflammation and abscess formation. PD is a topic of renewed interest due to the lack of satisfactory management options. Minimally invasive techniques have recently been investigated, with promising results in adult and pediatric populations. Our technique, the "EPIC procedure," Endoscopic-assisted Pilonidal Irrigation and Cleaning, involves removal of hair under direct visualization using a small endoscope while flushing saline through the cavity via an angiocatheter. We aim to show that the EPIC procedure is a safe and effective operation for the treatment of pilonidal disease in the pediatric population. We performed a retrospective chart review including 20 consecutive patients. All had a primary sacrococcygeal pilonidal sinus; all underwent the EPIC procedure. Post-operative care instructions included daily bathing and weekly depilatory application. We evaluated gender, age, weight, disease severity, operative duration, recurrence of PD, and other complications. In the 20 patients studied, 22 EPIC procedures were performed. The median follow-up duration was 27.95 (range 0.63-45.27) months. The mean operative duration was 28.8 (SD 10.2) min. There was a 15% recurrence rate (95% CI 0.00%, 30.65%). The EPIC procedure is an endoscopic-assisted operation that simplifies previously published techniques in pursuit of reduced operative complexity, cost, and time, with comparable recurrence and complication rates. All three recurrences occurred in patients that did not follow instructions for post-operative depilatory care. Two of these patients underwent repeat EPIC procedure and had no further complications. The third was lost to follow-up. The EPIC procedure provides a simple, effective, and minimally invasive approach to the treatment of pilonidal disease.

Analysis of Outcomes in Adolescents and Young Adults With Pilonidal Disease.

Purpose: Numerous definitive surgical techniques exist for the treatment of pilonidal disease with varied recurrence rates and wound complications. Due to the wide array of techniques and lack of consensus on the best approach, we proposed to study our experience treating pilonidal disease in adolescents and young adults.Methods: A retrospective analysis was conducted of patients 10–24 years old treated at a tertiary medical center from 2011 to 2016. Data including demographics, management, and outcomes were collected and analyzed. Primary outcome was recurrence of disease.Results: One hundred and thirty three patients with pilonidal disease underwent operative management. Fifty one percent underwent primary closure and 49% healed by secondary intention with no significant difference in recurrence rates (primary 18%, secondary 11%; p = 0.3245). Secondary healing patients had significantly lower wound complication rates (primary 51%, secondary 23%; p = 0.0012). After accounting for sex, race, weight, and operative technique, age was predictive of disease recurrence with an adjusted odds ratio (OR) of 0.706 (0.560–0.888; p = 0.003). Age and sex were both predictive of wound complications. Older patients had decreased risk of wound complication (adjusted OR 0.806, 95% CI 0.684–0.951; p = 0.0105), and male patients had increased risk of wound complication (adjusted OR 2.902, 95% CI 1.001–8.409; p = 0.0497).Conclusion: In summary, there is no significant difference in the recurrence rates between operative techniques for pilonidal disease. Older patients have decreased risk of recurrence following intervention. Wound complication rates are lower in patients undergoing secondary healing, though this may be better explained by differences in age and sex. Additional research investigating newer, minimally-invasive techniques needs to be pursued.