Abstract
Purpose
The purpose of this study was to evaluate the resource utilization and outcome of
a minimally invasive pilonidal protocol (MIPP) versus surgical excision (SE) in adolescents
with pilonidal disease.
Methods
Improved hygiene, laser epilation (LE), and sinusectomy were implemented as a minimally
invasive pilonidal protocol (MIPP) in March 2016. Following IRB approval, 34 consecutive
MIPP patients with moderate and severe disease were compared with a random sample
of 17 SE patients treated prior to MIPP implementation. Number of visits, laser epilation
(LE) treatments, care duration, operations, operating room (OR) time, charges, and
condition at last visit were analyzed. Charges were standardized for 2018.
Results
No differences were found in age or body mass index between groups. SE patients underwent
an average 1.6 excisions/patient (cumulative 2598 OR minutes) and no LE. MIPP patients
underwent an average 1.4 sinusectomies and 3.5 LEs/patient. Six sinusectomies (0.17/patient)
were performed in OR (cumulative 258 OR minutes). No differences in number of visits
or care duration were found between groups. At last follow-up, 82% of MIPP and 18%
of SE patients were healed or asymptomatic (p < 0.01). Average charges were $29,098
for SE versus $8440 for MIPP (p < 0.01).
Conclusion
A minimally invasive pilonidal protocol reduces charges and improves outcome compared
with surgical excision in adolescents.
Level of evidence
III.
Type of study
Retrospective comparative study.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Evaluation and management of pilonidal disease.Surg Clin North Am. 2010; 90: 113-124https://doi.org/10.1016/j.suc.2009.09.006
- Pilonidal disease.Surg Clin North Am. 2002; 82: 1169-1185
- Management of recurrent pilonidal disease.Semin Colon Rectal Surg. 2003; 14: 173-185https://doi.org/10.1053/j.scrs.2004.03.002
- Easy and successful treatment of pilonidal sinus after explanation of its causative process.Aust N Z J Surg. 1992; 62: 385-389
- Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment.Surgery. 1980; 87: 567-572
- Pilonidal sinus disease.Adv Skin Wound Care. 2016; 29: 469-478https://doi.org/10.1097/01.ASW.0000491324.29246.96
López JJ, Cooper JN, Halleran DR, Deans KJ, Minneci PC. High rate of major morbidity after surgical excision for pilonidal disease. Surg Infect (Larchmt) 2018:sur.2018.020. doi:https://doi.org/10.1089/sur.2018.020.
- Prognosis after simple incision and drainage for a first-episode acute pilonidal abscess.Br J Surg. 1988; 75: 60-61https://doi.org/10.1002/bjs.1800750122
Milone M, Velotti N, Manigrasso M, Anoldo P, Milone F, De Palma GD. Long-term follow-up for pilonidal sinus surgery: a review of literature with metanalysis. Surg 2018;16:315–20. doi:https://doi.org/10.1016/j.surge.2018.03.009.
- The psychological wellbeing of patients following excision of a pilonidal sinus.J Wound Care. 2012; 21: 595-600https://doi.org/10.12968/jowc.2012.21.12.595
- Management of pilonidal disease.Curr Opin Pediatr. 2018; 30: 411-416https://doi.org/10.1097/MOP.0000000000000628
- Minimal excision and primary suture is a cost-efficient definitive treatment for pilonidal disease with low morbidity: a population-based interventional and a cross-sectional cohort study.World J Surg. 2017; 41: 1295-1302https://doi.org/10.1007/s00268-016-3828-z
- Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients.Dis Colon Rectum. 2008; 51 (discussion 1662-3): 1656-1662
- Minimally invasive surgery for the treatment of pilonidal disease. The Gips procedure on 2347 patients.Int J Surg. 2016; 36: 201-205https://doi.org/10.1016/j.ijsu.2016.10.040
- Pilonidal sinus disease: a 10-year review reveals occupational risk factors and the superiority of the minimal surgery trephine technique.Mil Med. 2016; 181: 389-394https://doi.org/10.7205/MILMED-D-14-00729
Palesty JA, Zahir KS, Dudrick SJ, Ferri S, Tripodi G, Doll KM, et al. Evaluation of 60 patients with pilonidal sinus treated with laser epilation after surgery. Dermatologic Surg 2016;31:260–1. doi:https://doi.org/10.1007/s00384-008-0476-2.
- Laser epilation is a safe and effective therapy for teenagers with pilonidal disease.J Pediatr Surg. 2009; 44: 282-285https://doi.org/10.1016/j.jpedsurg.2008.10.057
- Karincaog̀lu Y, Koyuncu E, Karncaoğlu Y, Koyuncu E, et al. Evaluation of 60 patients with pilonidal sinus treated with laser epilation after surgery.Dermatol Surg. 2010; 36: 88-91https://doi.org/10.1111/j.1524-4725.2009.01387.x
- Laser hair removal as adjunct to surgery for pilonidal sinus: our initial experience.J Cutan Aesthet Surg. 2011; 4: 192-195https://doi.org/10.4103/0974-2077.91251
- Pit-picking resolves pilonidal disease in adolescents.J Pediatr Surg. 2019; 54https://doi.org/10.1016/j.jpedsurg.2018.10.021
- Pilonidal sinus: a simple treatment.Br J Surg. 1965; 52: 298-300
- Short convalescence and minimal pain after out-patient Bascom's pit-pick operation.Dan Med Bull. 2011; 58: A4348
- Treatment options for pilonidal disease.Am Surg. 2017; 83: 453-457
- Minimal incision as a promising technique for resection of pilonidal sinus in children.J Pediatr Surg. 2017; 52: 1484-1487https://doi.org/10.1016/j.jpedsurg.2017.03.040
- Laser hair depilation in the treatment of pilonidal disease: a systematic review.Surg Infect (Larchmt). 2018; 19: 566-572https://doi.org/10.1089/sur.2018.099
- Tolerability of laser hair depilation in pilonidal disease: a pilot study.Surg Infect (Larchmt). 2017; 18: 890-893https://doi.org/10.1089/sur.2017.153
- Treatment of pilonidal disease with laser epilation.Am Surg. 2006; 72: 534-537
- Control of hair growth using long-pulsed alexandrite laser is an efficient and cost effective therapy for patients suffering from recurrent pilonidal disease.Lasers Med Sci. 2016; 31: 857-862https://doi.org/10.1007/s10103-016-1920-0
- Patient characteristics and symptoms in chronic pilonidal sinus disease.Int J Colorectal Dis. 1995; 10: 39-42
- Pilonidal sinus.N Engl J Med. 1953; 249: 926-930https://doi.org/10.1056/NEJM195312032492303
- The management of pilonidal sinus.Dtsch Aerzteblatt Online. 2019; 116: 12-21https://doi.org/10.3238/arztebl.2019.0012
Article info
Publication history
Published online: October 30, 2019
Accepted:
September 29,
2019
Received:
September 12,
2019
Footnotes
☆How this paper will improve care: Compared to surgical excision, a minimally invasive pilonidal protocol (improved hygiene, outpatient sinusectomy, laser epilation, and close clinical follow-up) reduces charges and increases the percentage of patients who enjoy symptom resolution, thus improving resource utilization and clinical outcomes.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
