Principles in treating pediatric patients with pilonidal disease - An expert perspective

Abstract

Pilonidal disease is common amongst adolescent males and females and often leads to recurrent symptoms and life-altering morbidity. Traditionally, surgery included wide excision of the involved area with primary closure. Post-operative complication rates were high and recurrence of disease common, leading to a search for alternative approaches for treating pilonidal disease. A minimally invasive (trephination) approach was described by Gips in 2008 and has since been adopted by many surgeons. Although the trephination procedure is less morbid than total excision, the risk of wound complications is not insignificant and post-operative recurrence has been reported in more than 10% of patients. The lack of a clear advantage for any single treatment strategy has led a wide variation in provider approach. To standardize the care for pediatric patients with pilonidal disease, a dedicated clinic was created at our institution in 2018. The aim of this paper is to describe an approach to treating pediatric patients with pilonidal disease that has been established through the experience of treating hundreds of adolescent males and females per year. Given the impact on quality of life for those that are affected by pilonidal disease, it is important that future research be directed toward discovery of the best practices for treating this challenging disease.

Keywords: Pediatrics; Pilonidal disease; Trephination; Wound.

Fig. 1

A personalized approach to treating the pediatric patient with pilonidal disease. Once a diagnosis is confirmed through physical exam, a treatment strategy is chosen that takes into account the patient's treatment history and perceived burden of disease. Regardless of the path chosen, all patients are encouraged to follow the preventative measures to minimize the chance for recurrence.