Abstract
Aim
Pediatric Endoscopic Pilonidal SInus Treatment (PEPSiT) has favorable short-term-outcomes, but there is a lack of reliable data on medium and long-term follow-up. The objective of our study was to evaluate the effectiveness and advantages of PEPSiT vs conventional surgery of pilonidal sinus in the pediatric population.
Methods
A quasi-experimental study was carried out in pediatric patients undergoing pilonidal sinus surgery at a single institution from 2019 to 2022. Excision and healing by secondary intention (EHSI), excision and primary closure (EPC), and PEPSiT were compared. The surgical technique chosen was surgeon-dependent.
Results
149 patients were studied – 100 undergoing PEPSiT, 28 undergoing EHSI, and 21 undergoing EPC. Median full healing process was 4 weeks (IQR: 3–8) in PEPSiT, 16 weeks in EHSI (IQR: 12-26.5) and 7 weeks (IQR: 4–10) in ECP (p < 0.01). Pain on the Visual Analogue Scale (VAS) and need for analgesics were lower in the PEPSiT group (p < 0.01). Mean time to return to normal life was shorter with PEPSiT – 177 days earlier than EHSI (CI95%: 124.7-230.2; p < 0,01) and 7.2 days earlier tan EPC (CI95%: 20.2-138.6; p < 0,009). Complications with PEPSiT were 9.3 times lower tan EHSI (OR: 9.3; CI95% 3.5–24.7) and 8.5 times lower than ECP (OR = 8.5; CI95% 2.9–24.4). EHSI had 5.3 times more probability of recurrence than PEPSiT (OR = 5.3; CI95% 1.3–22.7), and ECP 15.2 times more (OR = 15.2; CI95% 3.2–71.7).
Conclusions
Endoscopic pilonidal sinus treatment is effective in medium-term follow-up, with fewer complications than classic techniques. It allows for an early return to normal life without restrictions.