Abstract
Introduction:
The traditional open excision of pilonidal sinus disease (PSD) is extremely invasive, with a long and painful postoperative course and a high recurrence rate of PSD (13.3% in our previous series). 1 We recently published our experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT) as an effective treatment option of PSD. 2 We report application of PEPSiT for an effective treatment of PSD recurrence after open repair.
Materials and Methods:
Ten patients (six boys and four girls with an average age 16.8 years [range 14–18]), with a recurrent PSD after open excision, were operated in our unit using PEPSiT over the past 2 years. Most patients (8/10, 80%) with recurrent PSD had already been operated in general surgery units and had undergone an open wide excision of the pilonidal sinus as first-line treatment. Three patients (30%) had undergone open repair twice before coming to our observation. From the technical point of view, a fistuloscope, a monopolar electrode, an endoscopic brush, and an endoscopic grasping forceps were always adopted. 3 All patients received subarachnoid spinal anesthesia and were placed in prone position with buttocks separated by two big plasters. With regard to the operative technique, the fistuloscope was introduced through a fistula hole and a continuous infusion of saline allowed a clear vision. In the operative phase, all the hairs and bulbs were removed under vision using the endoscopic forceps, inserted through the operative channel of the fistuloscope. The cavity was abraded with the endoscopic brush. After this step, a cautery ablation of the sinus granulation tissue was performed using the monopolar electrode, commencing in the main tract and where appropriate traversing secondary tracts. An accurate hemostasis was performed at the end of the procedure. External openings were not closed. Written informed consent was obtained from all subjects participating in the study.
Results and Conclusions:
The average operative time was 27.7 minutes (range 24–43). We did not report intraoperative nor postoperative complications. As for the postoperative course, the average analgesic requirement was 20 hours (range 16–26) and the average hospital stay length was 22.4 hours (range 18–36). The average time to return to full daily activities was 2.3 days (range 1–4) and all patients were highly satisfied with the postoperative outcome and cosmetic results. At 1 month postoperatively, the external openings healed in all patients. No case of recurrence was recorded at a mean follow-up of 18 months (range 1–24). Our preliminary results demonstrate that PEPSiT is an excellent technique for surgical treatment of PSD in children. In fact, it is technically easy and quick to perform, with a short and painless hospital stay and it allows for the operated patients an early return to full daily activities without restrictions as happened for the open technique. In addition, it is also effective for treatment of PSD recurrence after open repair.
No competing financial interests exist.
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