Endoscopic pilonidal sinus treatment (EPSiT) in the pediatric age group: short-term results [Ulus Travma Acil Cerrahi Derg]
Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-74677 | DOI: 10.14744/tjtes.2020.74677  

Endoscopic pilonidal sinus treatment (EPSiT) in the pediatric age group: short-term results

Zeynep Merve Gokbuget1, Rahsan Ozcan1, Ayse Karagoz1, ayse cigdem tutuncu2, gonca topuzlu tekant1
1Cerrahpasa Medical Faculty, Department of Pediatric Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey
2Cerrahpasa Medical Faculty,Department of Anesthesiology, Istanbul University-Cerrahpasa, Istanbul, Turkey

Background: To evaluate the short term outcomes of endoscopic pilonidal sinus treatment (EPSiT) method in the pediatric age group.

Methods: Pilonidal sinus (PS) cases treated with EPSiT method between June 2018 and July 2019 were investigated retrospectively. Patient characteristics, duration of the procedure, post-operative pain, time of hospital stay, return to normal daily activity, wound healing, recurrence and short term outcome results were evaluated.

Results: Of the twenty-nine patients (20 males, 9 females) the average age was 15,5±2,8years and the average body mass index (BMI) was 25,8±4,2. Eight patients (28%) presented with a history of recurrence following previous surgery. The average number of fistulas present in cases was 1,17 (1-2). The localization of the fistula was midline in twenty-four and lateral in five of the patients. Average time of the EPSiT procedure was 57±13,9 minutes and the average time of hospital stay was 11,4±7,2 hours. Pain score average was 0,86 (range of 0-3) and the duration of analgesic use was 37 hr (12-72 hr). Mean post-operative time of total wound healing was 18,71 days (7-60 days) for primary presenting cases. Early wound healing was seen in twenty-five patients (average of 14 days) while late wound healing was observed in four patients (average of 60 days). Mean time of follow-up was 8,3±3,34 months. Average time of return to full daily activity was 2,1 days (0-30 days) while it was the same day for sixteen (53%) patients. In post-operative follow-up, early (bleeding: 1) and late (formation of granulation tissue: 1, recurrence: 8) complications were seen in a total of nine patients. Of the eight patients (27,5%) which recurrence was detected, seven were primary and one was secondary presenting patients. Average time of presentation for recurrence was 5,8 mo (1-10 mo). Re-EPSiT was applied in two of the eight patients with recurrence and is planned for five, while one of the patients lost to follow-up.

Conclusion: EPSiT is an easily applicable, pain-free minimal invasive procedure with a short period of hospital stay and a fast return to routine daily activity. It provides comfortable and repeatable intervention in cases with recurrences after EPSiT procedure and other methods for PS treatment.

Keywords: pilonidal sinus, EPSiT, fistuloscope, children


Çocuk yaş grubunda endoskopik pilonidal sinüs tedavisi (EPSiT): erken sonuçlar

Zeynep Merve Gokbuget1, Rahsan Ozcan1, Ayse Karagoz1, ayse cigdem tutuncu2, gonca topuzlu tekant1
1İstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, Çocuk Cerrahisi Ana Bilim Dalı, İstanbul
2İstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, Anesteziyoloji Ana Bilim Dalı, İstanbul

Amaç: Pilonidal sinüs (PS) tedavisinde EPSiT yönteminin erken dönem sonuçlarını değerlendirmektir.
Olgular ve Yöntem: Haziran 2018-Temmuz 2019’da EPSiT yöntemiyle tedavi edilen olgular geriye dönük olarak incelendi. Olguların demografik verileri, cerrahi işlem süresi, postoperatif ağrı, hastanede kalış süresi, normal aktiviteye geçiş ve yara iyileşme süresi ve EPSiT işleminin sonuçları değerlendirildi.
Bulgular: Yirmi dokuz olgunun (20 erkek, 9 kız) yaş ortalaması 15,5±2,8 yaş idi. Vücut kitle indeksi (VKİ) ortalaması 25,8±4,2 idi. Sekiz olgu (%28) dış merkezde girişim sonrası nüksle başvurmuştu. Fistül sayısı ortalama 1,17 (1-2) idi. Fistül lokalizasyonu olguların 24’ünde orta hat, 5’inde lateral yerleşimliydi. EPSiT işleminin süresi ortalama 57±13,9 dakika, hastanede kalış süresi ortalama 11,4±7,2 saat idi. Ağrı skoru ortalama 0,86 (0-3 arasında) ve analjezik kullanımı ortalama 37 saat (12-72 saat) olarak bulundu. Tam yara iyileşmesi primer başvuran hastalar için 19 gün (7-60 gün) idi. Olguların 25’inde erken yara iyileşmesi (ortalama 14 gün) ve 4’ünde geç yara iyileşmesi (ortalama 60 gün) görüldü. İzlem süresi 8,3±3,34 ay idi. Tam günlük aktiviteye geçiş 2,1 gün (0-30 gün) iken 16 olguda (% 53) aynı gün idi. Postoperatif izlemde 9 olguda erken(kanama: 1) ve geç (granülasyon dokusu: 1, nüks: 7) komplikasyonlar görüldü. Nüks saptanan 8 olgunun (%27,5) 7’si primer, 1’i nüks sonrası başvurmuştu. Nüks görülme süresi ortalama 5,8±2,8 ay idi. Bu 8 olgunun 2’sine re-EPSiT yapıldı, 1’i takipten çıktı, 5’ine tekrar EPSiT planlanmaktadır.
Sonuç: EPSiT yöntemi kolay uygulanabilir, ağrısız, kısa hastanede kalış süresi olan ve normal günlük aktiviteye hızlı dönüşü sağlayan minimal invaziv bir yöntemdir. EPSiT ve diğer tedavi yöntemleri sonrası görülen nükslerde rahatlıkla ve tekrarlayan uygulamalar yapma olanağı sağlamaktadır.

Anahtar Kelimeler: pilonidal sinüs, EPSiT, fistüloskop, çocuk




Corresponding Author: Rahsan Ozcan, Türkiye


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