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 4±3, sinusectomies 1.3±1, and laser epilations 3±2.5. Mean treatment duration was 6±7.7 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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