Surgical treatment of children with pilonidal cysts
- Authors: Smirnov A.N.1,2, Golovanev M.A.1,2, Poverin G.V.1,3
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Affiliations:
- Pirogov Russian National Research Medical University
- Filatov Children’s City Hospital
- Republican Children’s Clinical Hospital
- Issue: Vol 12, No 3 (2022)
- Pages: 327-335
- Section: Original Study Articles
- URL: https://journals.rcsi.science/2219-4061/article/view/123613
- DOI: https://doi.org/10.17816/psaic664
- ID: 123613
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Abstract
BACKGROUND: Pilonidal cyst (other names: pilonidal disease and epithelial coccygeal tract) is a common congenital pathology and most often manifested in adolescence.
AIM: To determine the optimal treatment and diagnostic measures that lead to a reduction in complications and improvement in the quality of life of sick children with pilonidal cysts.
MATERIALS AND METHODS: Case histories of 310 children with pilonidal cysts who were treated at the N.F. Filatov Children’s City Clinical Hospital (Moscow) and Republican Children’s Clinical Disease in Izhevsk in 2013–2018 were analyzed. The patients (95%) were predominantly adolescents. The patients were divided into four groups: group 1 (n = 78), acute inflammation of the cyst; group 2 (n = 75), cyst without signs of inflammation; group 3 (n = 125), cyst with chronic inflammation; group 4 (n = 32), disease relapse. For diagnosis, clinical and ultrasound examination was conducted for uncomplicated cysts. The surgery was performed after fistulography and consisted of cyst excision to the sacral fascia with tight tightening or installation of an aspiration drain. Surgical intervention was preceded by laser treatment in the surgical field.
RESULTS: The severity of infiltration of the surrounding tissues in the postoperative period, depending on the drainage of the wound, was significantly different. More pronounced infiltrative changes were noted in patients with drainage and, accordingly, later terms of wound healing. Following double epilation with a neodymium laser, the frequency of postoperative purulent inflammatory complications was reduced (7.3%). The excision of the pilonidal cyst 1 month after acute inflammation with wound closure and involvement of the sacral fascia without drainage was the most effective.
CONCLUSIONS: Ultrasound examination is a highly informative method that allows for determining the parameters of uncomplicated cysts. Laser epilation in the preoperative period helps reduce purulent inflammatory complications.
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##article.viewOnOriginalSite##About the authors
Aleksei N. Smirnov
Pirogov Russian National Research Medical University; Filatov Children’s City Hospital
Email: smirnov-dgkb13@yandex.ru
ORCID iD: 0000-0002-8646-189X
SPIN-code: 6810-0334
Dr. Sci. (Med.)
Russian Federation, Moscow; MoscowMaxim A. Golovanev
Pirogov Russian National Research Medical University; Filatov Children’s City Hospital
Email: aesculap2001@mail.ru
ORCID iD: 0000-0002-5512-9894
SPIN-code: 4034-4303
Cand. Sci. (Med.)
Russian Federation, Moscow; MoscowGennady V. Poverin
Pirogov Russian National Research Medical University; Republican Children’s Clinical Hospital
Author for correspondence.
Email: poverin982@mail.ru
ORCID iD: 0000-0002-1744-5474
SPIN-code: 9714-2513
Postgraduate Student
Russian Federation, Moscow; IzhevskReferences
- Rivkin VL. Pilonidal cyst, rudimentary rest of the tail, the reason of sacrococcygeal purulence. Science and World. 2015;(9–1):127–128. (In Russ.)
- Lurin IA, Tsema EV. Aetiology and pathogenesis of pilonidal disease (review article). Coloproctology. 2013;(3):35–50. (In Russ.)
- Titov AYu, Kostarev IV, Batishchev AK. Etiopathogenesis and surgical treatment of epithelial pilonidal sinus (review of the literature). Russian Journal of Gastroenterology Hepatology Coloproctology. 2015;25(2):69–78. (In Russ.)
- González-Temprano N, Sánchez-Vázquez M, Ayuso-González L, et al. Are we correctly treating pilonidal disease in children? Therapeutic goals beyond preventing recurrence. Cir Pediatr. 2011;24(3):161–164. (In Spanish.)
- Johnson EK, Vogel JD, Cowan ML, et al. Clinical practice guidelines committee of the American society of colon and rectal surgeons. The American society of colon and rectal surgeons’ clinical practice guidelines for the management of pilonidal disease. Dis Colon Rectum. 2019;62(2):146–157. doi: 10.1097/DCR.0000000000001237
- Barrial MA, Vilanova-Sánchez A, Gortázar S, et al. Pilonidal sinus in pediatric age: primary vs. secondary closure. Cir Pediatr. 2020;33(2):61–64.
- Guerra F, Giuliani G, Amore Bonapasta S, et al. Cleft lift versus standard excision with primary midline closure for the treatment of pilonidal disease. A snapshot of worldwide current practice. Eur Surg. 2016;(48):269–272. doi: 10.1007/s10353-015-0375-z
- Grabowski J, Oyetunji TA, Goldin AB, et al. The management of pilonidal disease: A systematic review. J Pediatr Surg. 2019;54(11):2210–2221. doi: 10.1016/j.jpedsurg.2019.02.055
- Fike FB, Mortellaro VE, Juang D, et al. Experience with pilonidal disease in children. J Surg Res. 2011;170(1):165–168. doi: 10.1016/j.jss.2011.02.016
- Lamdark T, Vuille-Dit-Bille RN, Bielicki IN, et al. Treatment strategies for pilonidal sinus disease in Switzerland and Austria. Medicina (Kaunas). 2020;56(7):341. doi: 10.3390/medicina56070341
- Al-Khamis A, McCallum I, King PM, et al. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database of Syst Rev. 2010(1):CD006213. doi: 10.1002/14651858.CD006213.pub3
- Batishchev AK, Titov AYu, Kostarev IV, Orlova LP. Subcutaneous excision of pilonidal sinus (sinusectomy): first experience. Coloproctology. 2015;(2(52)):11–17. (In Russ.)
- Gips M, Melki Y, Salem L, et al. Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients. Dis Colon Rectum. 2008;51(11):1656–1662. DOI: 10.1007 / s10350-008-9329-x
- Di Castro A, GuerraF, Levi Sandri GB, et al. Minimally invasivesurgery for the treatment of pilonidal disease. The Gips procedure on 2347 patients. Int J Surg. 2016;36(Pt A):201–205. doi: 10.1016/j.ijsu.2016.10.040
- Stepanova NM, Novozhilov VA, Mochalov MN, et al. Minimally invasive treatment of pilonidal cysts in children: the gips procedure. Russian Journal of Pediatric Surgery, Anesthesiology and Intensive Care. 2022;12(1):61–68. doi: 10.17816/psaic1013
- Meinero P, Mori L, Gasloli G. Endoscopic pilonidal sinus treatment (E.P.Si.T.). Tech Coloproctol. 2014;18(4):389–392. doi: 10.1007/s10151-013-1016-9
- Gökbuget ZM, Özcan R, Karagöz A, et al. Endoscopic pilonidal sinus treatment (EPSiT) in the pediatric age group: Short-term results. Ulus Travma Acil Cerrahi Derg. 2021;27(4):443–448. doi: 10.14744/tjtes.2020.74677
- Esposito C, Mendoza-Sagaon M, Del Conte F, et al. Pediatric endoscopic pilonidal sinus treatment (PEPSiT) in children with pilonidal sinus disease: tips and tricks and new structurated protocol. Front Pediatr. 2020;(8):345.
- Sequeira JB, Coelho A, Marinho AS, et al. Endoscopic pilonidal sinus treatment versus total excision with primary closure for sacrococcygeal pilonidal sinus disease in the pediatric population. J Pediatr Surg. 2018;53(10):2003–2007. doi: 10.1016/j.jpedsurg.2018.02.094
- Meinero P, Stazi A, Carbone A, et al. Endoscopic pilonidal sinus treatment: a prospective multicentre trial. Colorectal Dis. 2016;18(5):O164–O170. doi: 10.1111/codi.13322
- Liyanage A, Woods Y, Javed MA, et al. Laser depilation as adjuvant therapy in prevention of recurrence of pilonidal sinus disease: initial experience of a district general hospital in the UK. Ann R Coll Surg Engl. 2020;102(9):685–688. doi: 10.1308/rcsann.2020.0069
- Luijks HG, Luiting-Welkenhuyzen HAL, Greijmans EGE, Bovenschen HJ. Alexandrite (755 nm) laser hair removal therapy reduces recurrence rate of pilonidal sinus after surgery. Indian J Dermatol Venereol Leprol. 2020;86(4):451–453. doi: 10.4103/ijdvl.IJDVL_97_19
- Aleem S, Majid I. Unconventional uses of laser hair removal: A Review. J Cutan Aesthet Surg. 2019;12(1):8–16. doi: 10.4103/JCAS.JCAS_97_18
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