Surgical treatment of children with pilonidal cysts

Abstract

BACKGROUND: Pilonidal cyst (other names: pilonidal disease and epithelial coccygeal tract) is a common congenital pathology and most often manifested in adolescence.

AIM: To determine the optimal treatment and diagnostic measures that lead to a reduction in complications and improvement in the quality of life of sick children with pilonidal cysts.

MATERIALS AND METHODS: Case histories of 310 children with pilonidal cysts who were treated at the N.F. Filatov Children’s City Clinical Hospital (Moscow) and Republican Children’s Clinical Disease in Izhevsk in 2013–2018 were analyzed. The patients (95%) were predominantly adolescents. The patients were divided into four groups: group 1 (n = 78), acute inflammation of the cyst; group 2 (n = 75), cyst without signs of inflammation; group 3 (n = 125), cyst with chronic inflammation; group 4 (n = 32), disease relapse. For diagnosis, clinical and ultrasound examination was conducted for uncomplicated cysts. The surgery was performed after fistulography and consisted of cyst excision to the sacral fascia with tight tightening or installation of an aspiration drain. Surgical intervention was preceded by laser treatment in the surgical field.

RESULTS: The severity of infiltration of the surrounding tissues in the postoperative period, depending on the drainage of the wound, was significantly different. More pronounced infiltrative changes were noted in patients with drainage and, accordingly, later terms of wound healing. Following double epilation with a neodymium laser, the frequency of postoperative purulent inflammatory complications was reduced (7.3%). The excision of the pilonidal cyst 1 month after acute inflammation with wound closure and involvement of the sacral fascia without drainage was the most effective.

CONCLUSIONS: Ultrasound examination is a highly informative method that allows for determining the parameters of uncomplicated cysts. Laser epilation in the preoperative period helps reduce purulent inflammatory complications.

Keywords

coloproctology / pilonidal cyst / diagnosis / surgical treatment / laser treatment / children

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