Minimally invasive treatment of pilonidal cysts in children: the Gips procedure

Abstract

BACKGROUND: Pilonidal disease (pilonidal cyst, epithelial coccygeal passage) is a chronic inflammatory disease of the sacrococcygeal region, common among young people, including adolescents, to a certain extent worsens the quality of life. Until now, the etiopathogenesis and surgical treatment methods of the disease have been the subject of wide discussion.

AIM: The aim of the study was to evaluate the effectiveness of Gips operations in children with pilonidal disease.

MATERIALS AND METHODS: A comparative analysis of 41 patients with pilonidal disease was conducted in the surgical department of the City Ivano-Matryoninsk Children's Clinical Hospital in Irkutsk from January 2020 to August 2021. Planned surgical treatment was performed in 22 patients with primary or recurrent pilonidal cysts, including 15 children using the M. Gips procedure. The comparison group consisted of patients who underwent wide excision of a complex of soft tissues bearing a pilonidal cyst, primary and secondary fistulous passages, followed by wound restoration with a storey suture.

RESULTS: The patients comprised 72.7% boys and 27.3% girls with an average age of 15.6 ± 1.5 years and average disease duration of 5.1 ± 2.2 months. The average operation time was 12 ± 4.2 minutes. The motor regime was resumed on the first day after the operation. Patient pain was relieved by administering non-steroidal anti-inflammatory drugs for the first two postoperative days. There were no early postoperative complications. The average hospital stay was 3.8 ± 1.9 days. Complete healing by secondary intention was achieved after an average of 3.9 ± 1.8 weeks. The average follow-up was 7 ± 3.8 months, and 6.7% had early relapses.

CONCLUSIONS: Minimally invasive sinusectomy according to the Gips procedure for treating pilonidal disease in adolescents is safe and effective, has a low recurrence rate, allows an early return to daily activities, and provides a good cosmetic result. However, the small number of observations requires further research.

Keywords

pilonidal cyst / epithelial coccygeal passage / sinusectomy / surgery / children

References

[1] Dul’tsev YuV, Rivkin VL. Ehpitelial’nyi kopchikovyi khod. Moscow: Meditsina, 1988. 128 p. (In Russ.)

[2] Дульцев Ю.В., Ривкин В.Л. Эпителиальный копчиковый ход. Москва: Медицина, 1988. 128 c.

[3] Rivkin VL. Pilonidal cyst, rudimentary rest of the tail, the reason of sacrococcygeal purulence. Science and world. 2015;(9-1):127–128. (In Russ.)

[4] Ривкин В.Л. Эпителиальный копчиковый ход — рудиментарный остаток хвоста, причина крестцово-копчиковых нагноений // Наука и мир. 2015. № 9-1. С. 127–128.

[5] Lurin IA, Tsema IeV. Aetiology and pathogenesis of pilonidal disease (review article). Koloproktologia. 2013;(3):35–50. (In Russ.)

[6] Лурин И.А., Цема Е.В. Этиология и патогенез пилонидальной болезни // Колопроктология. 2013. № 3. С. 35–50.

[7] Titov AYu, Kostarev IV, Batischev AK. Etiopathogenesis and surgical treatment of epithelial pilonidal sinus (review of the literature). Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2015;25(2):69–78. (In Russ.)

[8] Титов А.Ю., Костарев И.В., Батищев А.К. Этиопатогенез и хирургическое лечение эпителиального копчикового хода // Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2015. Т. 25, № 2. С. 69–78.

[9] Bascom J. Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery. 1980;87(5):567–572.

[10] Bascom J. Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment // Surgery. 1980. Vol. 87. No. 5. Р. 567–572.

[11] McCallum IJ, King PM, Bruce J. Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis. Br Med J. 2008;336:868–871. DOI: 10.1136/bmj.39517.808160.BE

[12] McCallum I.J., King P.M., Bruce J. Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis // Br Med J. 2008. Vol. 336. P. 868–871. DOI: 10.1136/bmj.39517.808160.BE

[13] Thompson MR, Senapati A, Kitchen P. Simple day-case surgery for pilonidal sinus disease. Br J Surg. 2011;98(2):198–209. DOI: 10.1002/bjs.7292

[14] Thompson M.R., Senapati A., Kitchen P. Simple day-case surgery for pilonidal sinus disease // Br J Surg. 2011. Vol. 98. No. 2. P. 198–209. DOI: 10.1002/bjs.7292

[15] Senapati A, Cripps NP, Flashman K, Thompson MR. Cleft closure for the treatment of pilonidal sinus disease. Colorectal Disease. 2011;13(3):333–336. DOI: 10.1111/j.1463-1318.2009.02148.x

[16] Senapati A., Cripps N.P., Flashman K., Thompson M.R. Cleft closure for the treatment of pilonidal sinus disease // Colorectal Disease. 2011. Vol. 13. No. 3. P. 333–336. DOI: 10.1111/j.1463-1318.2009.02148.x

[17] Guerra F, Giuliani G, Amore Bonapasta S, et al. Cleft lift versus standard excision with primary midline closure for the treatment of pilonidal disease. A snapshot of worldwide current practice. Eur Surg. 2016;48:269–272. DOI 10.1007/s10353-015-0375-z

[18] Guerra F., Giuliani G., Amore Bonapasta S., et al. Cleft lift versus standard excision with primary midline closure for the treatment of pilonidal disease. A snapshot of worldwide current practice // Eur Surg. 2016. Vol. 48. P. 269–272. DOI: 10.1007/s10353-015-0375-z

[19] Gips M, Melki Y, Salem L, et al. Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients. Diseases of the Colon & Rectum. 2008;51(11):1656–1662. DOI: 10.1007/s10350-008-9329-x

[20] Gips M., Melki Y., Salem L., et al. Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients // Diseases of the Colon & Rectum. 2008. Vol. 51. No. 11. P. 1656–1662. DOI: 10.1007/s10350-008-9329-x

[21] Di Castro A, Guerra F, Levi Sandri GB, Maria Ettorrea G. Minimally invasivesurgery for the treatment of pilonidal disease. The Gips procedure on 2347 patients. Int J Surg. 2016;36(A):201–205. DOI: 10.1016/j.ijsu.2016.10.040

[22] Di Castro A., Guerra F., Levi Sandri G.B., Maria Ettorrea G. Minimally invasivesurgery for the treatment of pilonidal disease. The Gips procedure on 2347 patients // Int J Surg. 2016. Vol. 36. No. A. P. 201–205. DOI: 10.1016/j.ijsu.2016.10.040

[23] Al-Khamis A, McCallum I, King PM, Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database of Syst Rev. 2010;1:CD006213. DOI: 10.1002/14651858.CD006213.pub3

[24] Al-Khamis A., McCallum I., King P.M., Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus // Cochrane Database of Syst Rev. 2010. Vol. 1. ID CD006213. DOI: 10.1002/14651858.CD006213.pub3

[25] Sevinç B, Karahan Ö, Okuş A, et al. Randomized prospective comparison of midline and off-midline closure techniques in pilonidal sinus surgery. Surgery. 2016;159(3):749–754. DOI: 10.1016/j.surg.2015.09.024

[26] Sevinç B., Karahan Ö., Okuş A., et al. Randomized prospective comparison of midline and off-midline closure techniques in pilonidal sinus surgery // Surgery. 2016. Vol. 159. No. 3. P. 749–754. DOI: 10.1016/j.surg.2015.09.024

[27] Enriquez-Navascues JM, Emparanza JI, Alkorta M, Placer C. Meta-analysis of randomized controlled trials comparing different techniques with primary closure of chronic pilonidal sinus. Techniques in Coloproctology. 2014;18:863–872. DOI: 10.1007/s10151-014-1149-5

[28] Enriquez-Navascues J.M., Emparanza J.I., Alkorta M., Placer C. Meta-analysis of randomized controlled trials comparing different techniques with primary closure of chronic pilonidal sinus // Techniques in Coloproctology. 2014. Vol. 18. P. 863–872. DOI: 10.1007/s10151-014-1149-5

[29] Steele SR, Perry BW, Mills S, Buie WD. Practice parameters for the management of pilonidal disease. Diseases of the Colon & Rectum. 2013;56(9):1021–1027. DOI: 10.1097/DCR.0b013e31829d2616

[30] Steele S.R., Perry B.W., Mills S., Buie W.D. Practice parameters for the management of pilonidal disease // Diseases of the Colon & Rectum. 2013. Vol. 56. No. 9. P. 1021–1027. DOI: 10.1097/DCR.0b013e31829d2616

[31] Kаser SA, Zengaffinen R, Uhlmann M, et al. Primary wound closure with a Limberg flap vs. secondary wound healing after excision of a pilonidal sinus: a multicentre randomised controlled study. Int J Colorectal Dis. 2015;30:97–103. DOI: 10.1007/s00384-014-2057-x

[32] Kаser S.A., Zengaffinen R., Uhlmann M., et al. Primary wound closure with a Limberg flap vs. secondary wound healing after excision of a pilonidal sinus: a multicentre randomised controlled study // Int J Colorectal Dis. 2015. Vol. 30. P. 97–103. DOI: 10.1007/s00384-014-2057-x

[33] Guner A, Boz A, Ozkan OF, et al. Limberg flap versus Bascom cleft lift techniques for sacrococcygeal pilonidal sinus: prospective, randomized trial. World J Surg. 2013;37:2074–2080. DOI: 10.1007/s00268-013-2111-9

[34] Guner A., Boz A., Ozkan O.F., et al. Limberg flap versus Bascom cleft lift techniques for sacrococcygeal pilonidal sinus: prospective, randomized trial // World J Surg. 2013. Vol. 37. P. 207–208. DOI: 10.1007/s00268-013-2111-9

[35] Karaca T, Yoldaş O, Bilgin BC, et al. Comparison of short-term results of modified Karydakis flap and modified Limberg flap for pilonidal sinus surgery. Int J Surg. 2012;10(10):601–606. DOI: 10.1016/j.ijsu.2012.10.001

[36] Karaca T., Yoldaş O., Bilgin B.C., et al. Comparison of short-term results of modified Karydakis flap and modified Limberg flap for pilonidal sinus surgery // Int J Surg. 2012. Vol. 10. No. 10. P. 601–606. DOI: 10.1016/j.ijsu.2012.10.001

[37] Tavassoli A, Noorshafiee S, Nazarzadeh R. Comparison of excision with primary repair versus Limberg flap. Int J Surg. 2011;9(4):343–346. DOI: 10.1016/j.ijsu.2011.02.009

[38] Tavassoli A., Noorshafiee S., Nazarzadeh R. Comparison of excision with primary repair versus Limberg flap // Int J Surg. 2011. Vol. 9. No. 4. P. 343–346. DOI: 10.1016/j.ijsu.2011.02.009

[39] Muzi MG, Milito G, Cadeddu F, et al. Randomized comparison of Limberg flap versus modified primary closure for the treatment of pilonidal disease. Am J Surg. 2010;200(1):9–14. DOI: 10.1016/j.amjsurg.2009.05.036

[40] Muzi M.G., Milito G., Cadeddu F., et al. Randomized comparison of Limberg flap versus modified primary closure for the treatment of pilonidal disease // Am J Surg. 2010. Vol. 200. No. 1. P. 9–14. DOI: 10.1016/j.amjsurg.2009.05.036

[41] Sondenaa K, Diab R, Nesvik I, et al. Influence of failure of primary wound healing on subsequent recurrence of pilonidal sinus. Combined prospective study and randomised controlled trial. Eur J Surg. 2002;168(11):614–618. DOI: 10.1080/11024150201680007

[42] Sondenaa K., Diab R., Nesvik I., et al. Influence of failure of primary wound healing on subsequent recurrence of pilonidal sinus. Combined prospective study and randomised controlled trial // Eur J Surg. 2002. Vol. 168. No. 11. P. 614–618. DOI: 10.1080/11024150201680007

[43] Oram Y, Kahraman F, Karincaoğlu Y, Koyuncu E. Еvaluation of 60 patients with pilonidal sinus treated with laser epilation after surgery. American Society for Dermatologic Surgery. 2010;36(1):88–91. DOI: 10.1111/j.1524-4725.2009.01387.x

[44] Oram Y., Kahraman F., Karincaoğlu Y., Koyuncu E. Еvaluation of 60 patients with pilonidal sinus treated with laser epilation after surgery // American Society for Dermatologic Surgery. 2010. Vol. 36. No. 1. P. 88–91. DOI: 10.1111/j.1524-4725.2009.01387.x

[45] Levinson T, Sela T, Chencinski S, et al. Pilonidal sinus disease: a 10-year review reveals occupational risk factors and the superiority of the minimal surgery trephine technique. Military Medicine. 2016;181(4):389–394. DOI: 10.7205/MILMED-D-14-00729

[46] Levinson T., Sela T., Chencinski S., et al. pilonidal sinus disease: a 10-year review reveals occupational risk factors and the superiority of the minimal surgery trephine technique // Military Medicine. 2016. Vol. 181. No. 4. P. 389–394. DOI: 10.7205/MILMED-D-14-00729

[47] Milone M, Fernandez LM, Musella M, Milone F. Safety and efficacy of minimally invasive video-assisted ablation of pilonidal sinus: a randomized clinical trial. JAMA Surgery. 2016;151(6):547–553. DOI: 10.1001/jamasurg.2015.5233

[48] Milone M., Fernandez L.M., Musella M., Milone F. safety and efficacy of minimally invasive video-assisted ablation of pilonidal sinus: a randomized clinical trial // JAMA Surgery. 2016. Vol. 151. No. 6. P. 547–553. DOI: 10.1001/jamasurg.2015.5233

[49] Soll C, Dindo D, Steinemann D, et al. Sinusectomy for primary pilonidal sinus: less is more. Surgery. 2011;150(5):996–1001. DOI: 10.1016/j.surg.2011.06.019

[50] Soll C., Dindo D., Steinemann D., et al. Sinusectomy for primary pilonidal sinus: less is more // Surgery. 2011. Vol. 150. No. 5. P. 996–1001. DOI: 10.1016/j.surg.2011.06.019

[51] Iesalnieks I, Ommer A, Petersen S, et al. German national guideline on the management of pilonidal disease. Langenbeck’sArchives of Surgery. 2016;401:599–609. DOI: 10.1007/s00423-016-1463-7

[52] Iesalnieks I., Ommer A., Petersen S., et al. German national guideline on the management of pilonidal disease. // Langenbeck’s Archives of Surgery. 2016. Vol. 401. P. 599–609. DOI: 10.1007/s00423-016-1463-7

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Stepanova N.M., Novozhilov V.A., Mochalov M.N., Zvonkov D.A., Voropaeva A.V., Petrov E.M., Moroz S.V., Khaltanova D.Y., Namkhanov V.V.