Trephination for primary pediatric pilonidal sinus disease: medium term functional and recurrence outcome of a large cohort
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In brief
In brief
This retrospective study of 100 pediatric patients evaluates medium-term outcomes of trephination for primary pilonidal sinus disease over 31 months median follow-up. While functional recovery was excellent with minimal sick days, recurrence rates were notable with 18% requiring reoperation, mostly within two years.
- Trephination offers excellent functional recovery: median 7 sick days and return to full activity in 14 days with minimal analgesic use.
- Recurrence rates are significant: 37% experience recurrent pain, 35% discharge, and 18% require reoperation within medium-term follow-up.
- Most adverse outcomes occur early: 80-85% of recurrences and 95% of reoperations happen within the first 2 postoperative years.
- No demographic or clinical factors predicted recurrence, suggesting current patient selection criteria may need refinement.
- Medium-term efficacy is limited despite good functional outcomes, warranting careful patient counseling about recurrence risk.
Written by the GCMD Library team from the article.
Abstract
Purpose
Minimal incision procedures have been recommended for pediatric pilonidal sinus disease, based on small studies with short follow-up. We aimed to describe medium-term outcomes of trephination in a large cohort.
Methods
Retrospective chart review and additional concluding telephone interviews for all children who underwent primary trephination in our institution over 5.5 years, collecting demographic and clinical data, and updated functional and recurrence outcome data.
Results
100 patients were included. Median follow-up time was 31.4 (16.2–52.8) months. Post-operative analgesics were used for 1.25 (0–4) days, sick days were 7 (3–11), and time to full activity was 14 (14–30) days. Recurrent pain, discharge, and abscess/es were reported by 37%, 35%, and 15% of patients, with 80–85% occurring within the first post-operative year. Reoperation rate was 18%, with 95% occurring within 2 years. No significant associations were found between demographic or clinical characteristics and either functional or recurrence medium-term outcomes.
Conclusion
Trephination carries excellent functional outcome with less favorable medium-term efficacy for the treatment of primary pediatric pilonidal sinus disease. Most adverse outcomes, including reoperations, occur within the first two years.