Esposito Ciro, Gargiulo Francesca, Izzo Serena, Cerulo Mariapina, Del Conte Fulvia, Severino Giovanni, Escolino Maria
Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.
J Laparoendosc Adv Surg Tech A. 2019 Jul;29(7):981-986. doi: 10.1089/lap.2019.0031. Epub 2019 Apr 13.
The traditional open excision of pilonidal sinus disease (PSD) is associated with a painful postoperative course and high recurrence rates. We recently published our technique of pediatric endoscopic pilonidal sinus treatment (PEPSiT). We aimed to report our long-term outcome including using PEPSiT for recurrent PSD after failed open repair. All patients with recurrent PSD after open excision who underwent PEPSiT in our unit over the past 2 years were included in the study. During surgery a fistuloscope was introduced through the fistula's orifice. All identifiable hairs were removed using endoscopic forceps. Thereafter, the cavity was debrided with endobrush and ablated with monopolar electrode. External openings were not closed. In the past 2 years, 40 patients with PSD underwent PEPSiT. Ten of 40 patients (6 boys and 4 girls with an average age of 16.8 years [range = 14-18]) had recurrent PSD after open surgery and were included in the study. The average operative time was 27.7 minutes (range = 24-43). No perioperative complications occurred. The average analgesic requirement was 20 hours (range = 16-26) and the average hospitalization was 22.4 hours (range = 18-36). The average time to return to full daily activities was 2.3 days (range = 1-5) and all patients were highly satisfied of postoperative course. At 1 month postoperatively, the external openings were completely healed. No recurrence was recorded at a mean follow-up of 18 months (range = 6-24). Our results demonstrated that PEPSiT is an excellent technique for surgical treatment of PSD in children and teenagers. In fact, it is technically easy and fast to perform, with a short and painless hospital stay and it allows to the operated patients an early return to full daily activities without any physical limitations compared with open repair. In addition, it is also effective for treatment of recurrent PSD after failed open repair.
藏毛窦疾病（PSD）的传统开放性切除术后疼痛明显且复发率高。我们最近发表了小儿内镜下藏毛窦治疗技术（PEPSiT）。我们旨在报告其长期疗效，包括PEPSiT用于开放性修复失败后的复发性PSD的情况。本研究纳入了过去2年在我科接受PEPSiT治疗的所有开放性切除术后复发性PSD患者。手术过程中，通过瘘口插入瘘管镜。使用内镜钳清除所有可见毛发。之后，用内镜刷清理腔隙，并用单极电极进行消融。外部开口不封闭。在过去2年中，40例PSD患者接受了PEPSiT治疗。40例患者中有10例（6例男孩和4例女孩，平均年龄16.8岁[范围=14 - 18岁]）开放性手术后出现复发性PSD并纳入研究。平均手术时间为27.7分钟（范围=24 - 43分钟）。未发生围手术期并发症。平均镇痛需求为20小时（范围=16 - 26小时），平均住院时间为22.4小时（范围=18 - 36小时）。恢复日常全部活动的平均时间为2.3天（范围=1 - 5天），所有患者对术后过程高度满意。术后1个月，外部开口完全愈合。平均随访18个月（范围=6 - 24个月）未记录到复发。我们的结果表明，PEPSiT是治疗儿童和青少年PSD的优秀手术技术。事实上，该技术操作简便快捷，住院时间短且无痛，与开放性修复相比，接受手术的患者能够早期恢复日常全部活动且无任何身体限制。此外，它对开放性修复失败后的复发性PSD治疗也有效。
