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Resection is not required for mild pilonidal disease: resolution through clinic-based care
Nicole K. Wynne, Nikki M. Check, david p. mooney
Surgery, Boston Children"s Hospital, Boston, Massachusetts, United States

Objective: We report a series of adolescents with mild pilonidal disease and assess the results of a clinic-based approach including improved hygiene, laser epilation, and sinusectomy.

Design: Case series

Setting: Dedicated outpatient pediatric Pilonidal Care Clinic

Patients: Data on patients with mild pilonidal disease (small midline pits, possibly a pocket, and minimal ongoing inflammation) were extracted from a prospectively-collected database.

Main Outcome: Therapies provided, treatment duration, and outcome.

Results: Of 244 patients who presented between August 2017 and September 2020, 102(41.8%) had mild disease. Mean age was 16.3 years, 46(45.1%) were male and 42(41.2%) had undergone prior incision and drainage.

All patients were started on improved hygiene, 92(90.2%) underwent laser epilation, and 83(80.6%) underwent sinusectomy: 80(96.4%) under local anesthesia in clinic and 3(3.6%) under general anesthesia in the OR. Following sinusectomy 19(22.9%) patients were lost to follow up (LTFU). Of the 64(77.1%) not LTFU, 59(92.2%) of them resolved and 5(7.8%) had persistent pits: 2 with active disease and 3 inactive.

19(18.6%) patients did not undergo sinusectomy: 5(4.9%) resolved with improved hygiene, 12(11.7%) were LTFU prior to planned sinusectomy: (6 with active disease, 6 inactive) and 2 are still receiving care.

The mean number of visits was 43, sinusectomies 1.31, and laser epilations 32.5. Mean treatment duration was 67.7 months. Patients experienced no period of disability, most took no pain medication and complications included only 3 difficult suture removals.

Conclusions: Most mild pilonidal disease may be resolved using improved hygiene, laser epilation, and sinusectomy in the clinic. Resection is not required for this skin condition.

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