Pediatric Surgery Unit, Federico II University of Naples, Naples, Italy.
Pediatric Surgery Unit, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland.
Updates Surg. 2021 Dec;73(6):2331-2339. doi: 10.1007/s13304-021-01094-4. Epub 2021 May 22.
This paper aimed to report a multi-institutional 3-year experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT) and describe tips and tricks of the technique. We retrospectively reviewed all patients < 18 years, with primary or recurrent pilonidal sinus disease (PSD), undergoing PEPSiT in the period 2017-2020. All patients received pre-operative laser therapy, PEPSiT and post-operative dressing and laser therapy. Success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. A total of 152 patients (98 boys) were included. Median patient's age was 17.1 years. Fifteen/152 patients (9.8%) presented a recurrent PSD. All patients resumed full daily activities 1 day after surgery. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10). Patient satisfaction was excellent (median score 4.8). The median follow-up was 12.8 months (range 1-36). Complete healing in 8 weeks was achieved in 145/152 (95.4%) and the median healing time was 24.6 days (range 16-31). We reported post-operatively immediate Clavien grade 2 complications (3 oedema, 2 burns) in 5/152 (3.3%) and delayed Clavien grade 2 complications (3 granulomas, 8 wound infections) in 11/152 (7.2%). Disease recurrence occurred in 7/152 (4.6%), who were re-operated using PEPSiT. PEPSiT should be considered the standard of care for surgical treatment of PSD in children and teenagers. PEPSiT is technically easy, with short and painless post-operative course and low recurrence rate (4.6%). Standardized treatment protocol, correct patient enrollment and information, and intensive follow-up are key points for the success of the procedure.
本文旨在报告一项多机构 3 年的儿童内镜藏毛窦治疗（PEPSiT）经验，并描述该技术的技巧。我们回顾性分析了 2017-2020 年间接受 PEPSiT 的所有<18 岁、原发性或复发性藏毛窦病（PSD）患者。所有患者均接受术前激光治疗、PEPSiT 和术后敷料及激光治疗。评估成功率、愈合率/时间、术后管理、短期和长期结果和患者满意度。共纳入 152 例患者（98 例男性）。中位患者年龄为 17.1 岁。15/152 例（9.8%）患者出现复发性 PSD。所有患者术后 1 天即可恢复日常活动。100%的患者术后过程无痛（中位数 VAS 疼痛评分<2/10）。患者满意度为优秀（中位数评分为 4.8）。中位随访时间为 12.8 个月（范围 1-36）。152 例中有 145 例（95.4%）在 8 周内完全愈合，愈合时间中位数为 24.6 天（范围 16-31）。我们报告了 5/152（3.3%）例术后即刻出现 Clavien 2 级并发症（3 例水肿，2 例烧伤）和 11/152（7.2%）例延迟出现 Clavien 2 级并发症（3 例肉芽肿，8 例伤口感染）。7/152（4.6%）例患者复发，采用 PEPSiT 再次手术。PEPSiT 应被视为儿童和青少年 PSD 手术治疗的标准。PEPSiT 技术简单，术后过程短暂且无痛，复发率低（4.6%）。标准化治疗方案、正确的患者招募和信息以及强化随访是该手术成功的关键。
