Surgical treatment of pilonidal sinus in children: opportunities and perspectives.

Abstract

Introduction: Pilonidal Sinus (PS) in children is the severe disease with up to 38% of recurrences. For the treatment of which different surgical techniques are offered. Objectives: To define the optimal surgical methods of treatment of PS in children. Material and Methods: For the period from 2015 to 2021 in surgical department of clinical children`s hospital 95 children with diagnosis of PS, aged 13 to 18 years were operated on. In accordance to type of operation, children were divided into three groups: I group: Limberg flap plastic–35 children, II group: Sewing to the Fascia (SF)–32 children; III group: Primer Closure (PC)–28 children. Sex, age, previous operations of PS abscesses, specimen volume of PS were determined. Body Mass Index (BMI), Duration of Hospitalization (DoH), Duration of Pain (DoP), wound healing were calculated. Observation period was from 1 up to 6 years in all groups. Histological studies of PS specimen were performed in children of 13 and 18 years old. Result: The longest wound healing duration were observed in II group, the shortest in I group, which indicates the effectiveness of Limberg flap plastic in relation to this indicator in children. DoH and DoP (days) were almost the same in I and III group. DoP (days) was higher in II group in relation to I and III group. BMI and age were almost the same for all groups. In postoperative period were observed complications in 57 children of different groups: fluid collection, wound infection, flap edema, hematoma, partial wound dehiscence. When performing histological examinations, were observed some differences in histological structure of PS specimen of 13 years old child and 18 years old child, which indicates of progressing of disease course with age. In our research recurrences of PS were observed in 25% of cases of PC performing, in 18.75% of cases of SF performing and were not observed in cases of Limerg Flap plastic performing. Conclusion: Limberg flap plastic for surgical treatment of PS in children is an optimal method with the least count of complications, absence of recurrences and favorable course of postoperative period according to DoH (days), DoP (days), and wound healing duration (days).