Pediatric endoscopic pilonidal sinus treatment (PEPSiT): what we learned after a 3-year experience in the pediatric population

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.

Keywords: Dressing; Fistuloscope; Laser; PEPSiT; Technique; Teenagers.

Fig. 1

Communicating pilonidal cyst was reached introducing a clamp (a) or the fistuloscope through the external pit (b, c)

Fig. 2

Fistuloscope can be adopted in normal position (a) or in upside down position (b)

Fig. 3

Wound healing outcome of primary PEPSiT at 1 (a), 7 (b), 14 (c), 21 (d) days postoperatively

Fig. 4

Clinical presentations of primary PSD: multiple non secreting median pits (a); multiple secreting median pits (b); pilonidal abscess (c); median and paramedian pits (d)

Fig. 5

Clinical presentations of recurrent PSD: multiple median granulomas (a); multiple secreting median pits and paramedian granuloma (b); single non secreting paramedian pit (c); multiple non secreting median pits

Fig. 6

Hair removed from the cavity at the end of procedure

Fig. 7

Terrible three: too low pit (black arrow) close to the anal orifice (red arrow) (a); too many (b) pits (black arrows); too hairy (c) around the PSD site (black arrow)