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Minimal Treatment of Pilonidal Disease - APSA Practice Gaps 2019
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Pilonidal Disease 9 items
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Less invasive techniques for pilonidal disease lead to improved outcomes with respect to healing times, recovery times, and decreased need for additional operations and recurrence rates
The minimal pit excision topic was the most rapidly adopted change from all update course topics, with surgeons switching techniques immediately after the presentation
The pits procedure uses trephines or punch biopsies to excise the tract, then cores out everything underneath to clean it out
Hydrogen peroxide is used during the procedure, though its actual benefit is uncertain
Initial cases can be performed in OR under sedation and local anesthesia without requiring general anesthetic as an outpatient procedure
Phenol has been used as a sclerosing agent, with some filling air pockets or sinuses to sclerose granulation tissue
A paper on phenol use was published in the current issue of Journal of Pediatric Surgery
Curettes are used to aggressively scrape out granulation tissue from the cavity
Mosquito clamps or similar instruments are used to pull out hair from the cavity
Unroofing and marsupialization healing time was roughly four to six weeks for complete healing
The area should be kept free of hair during healing with weekly shaving and one-week follow-up visits
If incisions start to close too early, silver nitrate can be applied in clinic to keep the incisions open
Vessel loops or drains left in place caused more pain and developed more granulation tissue along the track
Half of hospitals and half of surgeons in the Midwest Pediatric Surgical Consortium had never done or seen a pits procedure
The Midwest Pediatric Surgical Consortium multi-center cohort study will compare minimally invasive to more invasive procedures with primary outcome of recurrence at one year
Secondary outcomes for the consortium study include time to healing, quality of life, cost, antibiotic use, narcotic use, days of pain, days unable to perform activities, return to school, and return to sports
The consortium pilonidal study received funding in May
Laser hair removal is not covered by insurance and patients often cannot afford it
Antibiotics are not needed for minimally invasive pilonidal surgery unless there is an abscess, because wounds are left open to drain
Vessel loop technique can be used after pits procedure in the setting of abscess to allow better drainage
When draining pilonidal abscess in the emergency department, the incision should be made off midline so the resulting tract will be off midline
Aaron Lipscar presented the pits procedure at a previous session
Nelson Rosen uses sinus endoscopy with a cystoscope after pit excision to identify and remove remaining hair and debris from the cavity
Nationwide Children's Hospital is conducting an NIH-funded study on laser hair removal for pilonidal disease with promising early data
Rock salt works as well as silver nitrate to keep skin open during healing
The initial pits technique paper describes performing pits even in the presence of acute abscess without staging
Tony Sandler in DC uses the vessel loop technique for abscess drainage with pits