M. N. Abraham1, S. L. Raymond1, A. Iqbal1, S. D. Larson1, M. M. Mustafa1, J. A. Taylor1, S. Tan1, S. Islam1 1University Of Florida,Pediatric Surgery,Gainesville, FL, USA
Introduction: Pilonidal disease is a chronic and recurring condition which occurs at the natal cleft. For patients initially presenting with symptoms of acute infection with pilonidal sinus, incision and drainage is recommended and has shown to be curative in 60% of patients. However, the remaining 40% of patients experience recurring infections and pain which requires repeated treatment. There are various definitive surgical treatments, including excision with midline primary closure, off-midline primary closure, and secondary healing. These techniques vary on a range of factors such as recurrence rates and wound complications. Due to the wide array of available treatments and the lack of consensus on the best approach, we proposed to study our experience treating pilonidal disease in adolescents and young adults at a large, academic medical center.
Methods: A retrospective review was conducted of all patients between 5 and 24 years of age who underwent management of pilonidal disease at our institution, a 996-bed tertiary medical center, between 2011 and 2016. We utilized ICD 9/10 and CPT codes specific to pilonidal disease and procedures to ensure that all patients were captured. Patients who underwent surgical intervention at an outside facility were excluded. Data including demographics, disease course, surgical management, and outcomes were entered into a specifically designed REDCap database and exported for comparative analysis.
Results: Two hundred forty-five patients were identified with pilonidal disease. The average age was 18.4 years (range 11-24) and 49% were male. One hundred thirty-three patients underwent operative management for pilonidal disease. Prior to surgery, 49% of the operative group had incision and drainage of an abscess compared to 83% of the non-operative group (p<0.0001). Among the operative group, 68 patients underwent primary closure, whereas 65 patients were allowed to heal by secondary intention. There was no significant difference in the recurrence rate of patients who underwent resection with primary closure compared to those who underwent resection with secondary healing (primary 18%, secondary 11%; p=0.3245). However, surgical patients who were allowed to heal by secondary intention had a significantly lower wound complication rate compared to those with primary closure (primary 51%, secondary 23%; p=0.0012). Specifically, patients who underwent resection with off-midline primary closure had the highest percentage of wound complications (off-midline 61%, midline 41%, secondary 23%; p=0.0007).
Conclusion: We compared the outcomes of various surgical approaches for the treatment of pilonidal disease in adolescents and young adults. By comparing common surgical techniques, we hope to understand the most and least efficacious treatments and to implement these recommendations as a prelude to a multicenter study.