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Pediatric Surgery International Mar 2024Pilonidal sinus disease (PSD) arises in the hair follicles of the gluteal cleft with many cases occurring during adolescence. Early studies of pit excision with fibrin...
INTRODUCTION
Pilonidal sinus disease (PSD) arises in the hair follicles of the gluteal cleft with many cases occurring during adolescence. Early studies of pit excision with fibrin glue closure (PEF), a minimally invasive procedure for the management of chronic PSD, suggest it is safe and effective with similar results to traditional lateralizing flap procedures (LFP), without the need for extensive tissue excision and associated complications. However, these studies lack large sample sizes and prolonged follow-up.
METHODOLOGY
All children undergoing primary operative procedures for chronic PSD from May 2009 to February 2022 received either a PEF or a LFP. Recurrence and complications rates alongside their demographic and disease severity data were compared using statistical and Kaplan-Meier analyses.
RESULTS
Seventy-eight children had 33 primary PEF and 45 primary LFP procedures with a median follow-up of 2.21 and 2.52 years, respectively. Demographic and disease severity indicators were similar between groups (p > 0.05). The overall recurrence rate in each cohort was 3% for PEF and 11% for LFP, respectively (p = 0.2346). The all-cause repeat intervention rate was 12% and 49% in the PEF and LFP cohorts, respectively (p = 0.0007). Kaplan-Meier analysis showed a reduction in the requirement of re-operation in the PEF cohort (p = 0.0340). Operative time was significantly decreased in the PEF cohort compared to the LFP cohort (p < 0.0001). Wound dehiscence was significantly decreased in the PEF cohort compared to the LFP cohort (3% vs 31%; p = 0.0026).
CONCLUSION
This 14-year study is the largest pediatric-focused cohort utilizing PEF to manage PSD and demonstrated clinically relevant decreases in symptom recurrence alongside significantly decreased rates of complications and further surgical intervention compared to traditional LFP techniques. We conclude that PEF is a viable minimally invasive technique in the management of pediatric PSD.
Topics: Humans; Adolescent; Child; Fibrin Tissue Adhesive; Cohort Studies; Pilonidal Sinus; Postoperative Complications; Reoperation; Skin Diseases; Recurrence; Treatment Outcome
PubMed: 38512592
DOI: 10.1007/s00383-024-05668-2 -
The British Journal of Surgery Mar 2024Numerous surgical approaches exist for the treatment of pilonidal disease. Current literature on treatment is of poor quality, limiting the ability to define optimal...
BACKGROUND
Numerous surgical approaches exist for the treatment of pilonidal disease. Current literature on treatment is of poor quality, limiting the ability to define optimal intervention. The aim of this study was to provide real-world data on current surgical practice and report patient and risk-adjusted outcomes, informing future trial design.
METHODS
This UK-wide multicentre prospective cohort study, including patients (aged over 16 years) who had definitive treatment for symptomatic pilonidal disease, was conducted between May 2019 and March 2022. Patient and disease characteristics, and intervention details were analysed. Data on patient-reported outcomes, including pain, complications, treatment failure, wound issues, and quality of life, were gathered at various time points up to 6 months after surgery. Strategies were implemented to adjust for risk influencing different treatment choices and outcomes.
RESULTS
Of the 667 participants consenting, 574 (86.1%) were followed up to the study end. Twelve interventions were observed. Broadly, 59.5% underwent major excisional surgery and 40.5% minimally invasive surgery. Complications occurred in 45.1% of the cohort. Those who had minimally invasive procedures had better quality of life and, after risk adjustment, less pain (score on day 1: mean difference 1.58, 95% c.i. 1.14 to 2.01), fewer complications (difference 17.5 (95% c.i. 9.1 to 25.9)%), more rapid return to normal activities (mean difference 25.9 (18.4 to 33.4) days) but a rate of higher treatment failure (difference 9.6 (95% c.i. 17.3 to 1.9)%). At study end, 25% reported an unhealed wound and 10% had not returned to normal activities.
CONCLUSION
The burden after surgery for pilonidal disease is high and treatment failure is common. Minimally invasive techniques may improve outcomes at the expense of a 10% higher risk of treatment failure.
Topics: Humans; Aged; Treatment Outcome; Prospective Studies; Pilonidal Sinus; Quality of Life; Neoplasm Recurrence, Local; Pain; Recurrence
PubMed: 38488204
DOI: 10.1093/bjs/znae009 -
British Journal of Community Nursing Mar 2024Pilonidal sinus disease (PSD) manifests as an inflammatory skin condition typically emerging within the anal cleft. The prevalence of this disease varies in high income...
Pilonidal sinus disease (PSD) manifests as an inflammatory skin condition typically emerging within the anal cleft. The prevalence of this disease varies in high income countries. This disease is associated with significant physical and psychosocial distress. Surgery is an option for managing PSD; yet, surgical methods vary, and a universally accepted gold standard approach is lacking, leading to current practices that are diverse and subject to ongoing debate. One such point of contention revolves around the decision to use packing or opt for a non-packing approach following surgery. Mohamedahmed et al (2021) conducted a systematic review to evaluate the comparative outcomes of packing versus non-packing of an abscess cavity following incision and drainage of cutaneous abscess on any part of the body. This commentary aims to critically appraise the methods used within the review by Mohamedahmed et al (2021) and expand upon the findings in the context of treatment and management of PSD.
Topics: Humans; Pilonidal Sinus; Abscess; Drainage; Surgical Wound; Skin Diseases
PubMed: 38478417
DOI: 10.12968/bjcn.2024.29.Sup3.S26 -
Langenbeck's Archives of Surgery Mar 2024Pilonidal disease (PD) significantly impacts patients' quality of life and requires regular maintenance behaviors to achieve cure. Health mindset is a psychological...
PURPOSE
Pilonidal disease (PD) significantly impacts patients' quality of life and requires regular maintenance behaviors to achieve cure. Health mindset is a psychological construct which can influence health behaviors and outcomes, with a growth mindset being associated with better outcomes than a fixed. We propose that participation in a standardized treatment protocol can affect the health mindset for adolescents with pilonidal disease.
METHODS
PD patients' demographics, recurrence, and comorbidities were prospectively collected from 2019 to 2022. We assessed patients' mindset score at initial presentation using the validated Three-Item Mindset Scale (1-6) then reassessed during follow-up. t-test was used to compare baseline and follow-up mindset scores and stratified by recurrence or comorbidities. p ≤ 0.05 was considered significant.
RESULTS
A total of 207 PD patients (108 males, 99 females) with mean age 18.2 ± 3.7 years were followed for 351 ± 327 days. Mean baseline mindset score (4.76 ± 1.27) was significantly lower than mean follow-up mindset score (5.03 ± 1.18, p = 0.049). Baseline mindset score was significantly lower among patients with PD recurrence (4.00 ± 0.66) compared to those without recurrence (4.8 ± 1.29, p = 0.05). Among patients with PD recurrence, mean baseline mindset score (4.00 ± 0.66) was significantly lower than mean follow-up mindset score (5.27 ± 0.93, p = 0.0038). Patient comorbidity did not affect the baseline or follow-up mindset score.
CONCLUSIONS
Participation in a standardized treatment protocol is associated with the development of a stronger growth mindset over time for patients with PD. Furthermore, a growth mindset was linked to lower recurrence rate than a fixed mindset. Further investigations into how treatment approaches can work in concert with health mindset are proposed.
Topics: Male; Female; Humans; Adolescent; Young Adult; Adult; Treatment Outcome; Quality of Life; Pilonidal Sinus; Neoplasm Recurrence, Local; Clinical Protocols; Recurrence
PubMed: 38467936
DOI: 10.1007/s00423-024-03282-3 -
Indian Journal of Otolaryngology and... Feb 2024We report a patient with recurrent discharging sinus over the nasal bridge which was finally diagnosed as pilonidal sinus over the nasal bridge. Nasal pilonidal sinus is...
We report a patient with recurrent discharging sinus over the nasal bridge which was finally diagnosed as pilonidal sinus over the nasal bridge. Nasal pilonidal sinus is a rare condition that presents as a chronic and recurrent inflammation of the hair follicles and surrounding tissues of the nose, leading to the formation of abscesses and sinus tracts. The following report deals the dilemma of diagnosing and management of the patient. Though rare, nasal pilonidal sinus should be included as a differential diagnosis to aid in management as well as to improve awareness and inclusion of this condition. This report provides an overview of the clinical presentation, diagnosis and management of nasal pilonidal sinus.
PubMed: 38440473
DOI: 10.1007/s12070-023-04191-5 -
International Journal of Surgery Case... Mar 2024Pilonidal sinus is a condition that causes inflammation and abscesses in the sacral region and affects adolescents and young adults. The etiology of this condition...
INTRODUCTION
Pilonidal sinus is a condition that causes inflammation and abscesses in the sacral region and affects adolescents and young adults. The etiology of this condition remains controversial.
CASE PRESENTATION
A six year old boy was observed to have an orifice in the frontonasal region which contained hair. He had two previous infections which were treated with antibiotics. Magnetic Resonance Imaging showed no cranial malformations. Surgery was performed under general anesthesia and the pilonidal sinus was completely excised. At follow-up the child was in good health.
CLINICAL DISCUSSION
This case in a child with a frontonasal skin anomaly highlights that skin anomalies may be a cause of pilonidal sinus.
CONCLUSION
Skin malformations can be the underlying cause of pilonidal sinus in some cases.
PubMed: 38430899
DOI: 10.1016/j.ijscr.2024.109444 -
Pediatric Dermatology Feb 2024Pilonidal sinus disease is typically located in the sacrococcygeal area, although it has been described in other locations. We present a rare case of pilonidal sinus on...
Pilonidal sinus disease is typically located in the sacrococcygeal area, although it has been described in other locations. We present a rare case of pilonidal sinus on the scalp and its management.
PubMed: 38413127
DOI: 10.1111/pde.15562 -
Colorectal Disease : the Official... Apr 2024
Topics: Humans; Pilonidal Sinus
PubMed: 38403811
DOI: 10.1111/codi.16919 -
Polski Przeglad Chirurgiczny Oct 2023<b><br>Aim:</b> The aim of this retrospective study was to evaluate our treatment for pilonidal disease in adolescent patients, which uses...
<b><br>Aim:</b> The aim of this retrospective study was to evaluate our treatment for pilonidal disease in adolescent patients, which uses ultrasonography, minimally invasive pit-picking, and Nd:YAG laser therapy.</br> <b><br>Material and methods:</b> We included 52 of 147 patients treated between June 2017 and December 2020. The patients underwent pit-picking procedures and 6-10 Nd:YAG treatments. The remnants of the cysts were removed by laser therapy, which provided easy epilation. Each patient underwent multiple ultrasound examinations during the therapy to uncover any potential newly formed asymptomatic sinuses. When such issues were identified, the pit-picking procedure was repeated on those sinuses.</br> <b><br>Results:</b> A total of 52 patients were included in this study with a 1-year follow-up following the procedure. There were 49 symptom-free patients (96%). One patient underwent surgery in another hospital because of a recurrence and 1 had a pilonidal disease relapse (4%). In the follow-up period, asymptomatic cysts were found in 2 other patients by ultrasound examination. They were all treated with a pit-picking procedure in the outpatient department with good results.</br> <b><br>Conclusions:</b> Combining sequentially repeated pit-picking procedures and Nd:YAG laser therapy is an effective treatment method for adolescent pilonidal disease. Simultaneous Nd:YAG laser therapy enables efficacious epilation of the intergluteal cleft. Repeatable ultrasonography examinations allow for early diagnosis of possible pilonidal sinus relapse.</br>.
Topics: Adolescent; Humans; Hair Removal; Lasers, Solid-State; Retrospective Studies; Neoplasm Recurrence, Local; Pilonidal Sinus; Ultrasonography; Recurrence; Ultrasonography, Interventional
PubMed: 38348985
DOI: 10.5604/01.3001.0053.9305 -
Pediatric Surgery International Jan 2024Pilonidal disease (PD) is marked by chronic inflammation and frequent recurrence which can decrease quality of life. However, debate remains regarding the optimal...
PURPOSE
Pilonidal disease (PD) is marked by chronic inflammation and frequent recurrence which can decrease quality of life. However, debate remains regarding the optimal treatment for PD in the pediatric population. This study compares two recommended treatment approaches-excision with off-midline flap reconstruction (OMF: Bascom cleft lift flap, modified Limberg flap) and minimally invasive endoscopic pilonidal sinus treatment (EPSiT).
METHODS
Single-center retrospective evaluation of patients 1-21 years of age with PD who underwent either excision with OMF reconstruction or EPSiT between 10/1/2011 and 10/31/2021. Outcomes included were disease recurrence, reoperation, and wound complication rates. Comparisons were performed using Chi-square and Mann-Whitney U tests.
RESULTS
18 patients underwent excision/OMF reconstruction and 45 patients underwent EPSiT. The excision/OMF reconstruction cohort was predominantly male (44.4% vs 17.8% p = 0.028), with history of prior pilonidal infection (33.3% vs 6.7%; p = 0.006), and longer median operative time (60 min vs 17 min; p < 0.001). The excision/OMF reconstruction cohort had a higher rate of wound complications (22.2% vs 0%; p = 0.001), but lower rates of disease recurrence (5.6% vs 33.3%; p = 0.022) and reoperation (5.6% vs 31.1%; p = 0.031).
CONCLUSION
In pediatric patients with PD, excision with OMF reconstruction may decrease recurrence and reoperation rates with increased operative times and wound complication rates, compared to EPSiT.
Topics: Humans; Child; Male; Female; Pilonidal Sinus; Quality of Life; Retrospective Studies; Endoscopy; Reoperation; Skin Diseases
PubMed: 38294551
DOI: 10.1007/s00383-023-05629-1