Pérez-Bertólez S, Casal-Beloy I, Pasten A, Martín-Solé O, Salcedo P, Tapia L, Tarrado X
Department of Pediatric Surgery, Hospital Sant Joan de Déu, Universitat de Barcelona, Passeig de Sant Joan de Déu, 2. 08950, Barcelona, Spain.
Faculty of Medicine, University of Concepcion, Concepcion, Chile.
Tech Coloproctol. 2024 Dec 10;29(1):14. doi: 10.1007/s10151-024-03049-4.
Pediatric endoscopic pilonidal sinus treatment (PEPSiT) has favorable short-term-outcomes, but there is a lack of reliable data on medium and long-term follow-up. The objective of our study was to evaluate the effectiveness and advantages of PEPSiT versus conventional surgery of pilonidal sinus in the pediatric population.
A quasi-experimental study was carried out in pediatric patients undergoing pilonidal sinus surgery at a single institution from 2019 to 2022. Excision and healing by secondary intention (EHSI), excision and primary closure (EPC), and PEPSiT were compared. The surgical technique chosen was surgeon-dependent.
In total, 149 patients were studied-100 undergoing PEPSiT, 28 undergoing EHSI, and 21 undergoing EPC. Median full healing process was 4 weeks [interquartile range (IQR): 3-8] in PEPSiT, 16 weeks in EHSI (IQR: 12-26.5), and 7 weeks (IQR: 4-10) in ECP (p < 0.01). Pain on the visual analogue scale (VAS) and need for analgesics were lower in the PEPSiT group (p < 0.01). Mean time to return to normal life was shorter with PEPSiT-177 days earlier than EHSI (95% CI 124.7-230.2; p < 0,01) and 7.2 days earlier tan EPC (95% CI 20.2-138.6; p < 0,009). Complications with PEPSiT were 9.3 times lower tan EHSI [odds ratio (OR) 9.3; 95% confidence interval (CI) 3.5-24.7] and 8.5 times lower than ECP (OR = 8.5; 95% CI 2.9-24.4). EHSI had 5.3 times more probability of recurrence than PEPSiT (OR = 5.3; 95% CI 1.3-22.7), and ECP 15.2 times more (OR = 15.2; 95% CI 3.2-71.7).
Endoscopic pilonidal sinus treatment is effective in medium-term follow-up, with fewer complications than classic techniques. It allows for an early return to normal life without restrictions.
小儿内镜下藏毛窦治疗（PEPSiT）具有良好的短期疗效，但缺乏关于中长期随访的可靠数据。我们研究的目的是评估PEPSiT与小儿藏毛窦传统手术相比的有效性和优势。
对2019年至2022年在单一机构接受藏毛窦手术的小儿患者进行了一项准实验研究。比较了二期切除缝合（EHSI）、一期切除缝合（EPC）和PEPSiT。所选择的手术技术取决于外科医生。
总共研究了149例患者，100例接受PEPSiT，28例接受EHSI，21例接受EPC。PEPSiT的中位完全愈合过程为4周[四分位间距（IQR）：3 - 8]，EHSI为16周（IQR：12 - 26.5），ECP为7周（IQR：4 - 10）（p < 0.01）。PEPSiT组视觉模拟量表（VAS）疼痛评分和镇痛药需求较低（p < 0.01）。PEPSiT组恢复正常生活的平均时间较短，比EHSI早177天（95%置信区间124.7 - 230.2；p < 0.01），比EPC早7.2天（95%置信区间20.2 - 138.6；p < 0.009）。PEPSiT的并发症比EHSI低9.3倍[比值比（OR）9.3；95%置信区间（CI）3.5 - 24.7]，比EPC低8.5倍（OR = 8.5；95% CI 2.9 - 24.4）。EHSI复发的可能性比PEPSiT高5.3倍（OR = 5.3；95% CI 1.3 - 22.7），EPC高15.2倍（OR = 15.2；95% CI 3.2 - 71.7）。
内镜下藏毛窦治疗在中期随访中有效，并发症比传统技术少。它允许早期不受限制地恢复正常生活。
