INTRODUCTION: Sinus pilonidalis (SP) is an acquired inflammatory disease, which is relatively common in the paediatric population. Surgery is indicated in symptomatic patients. In 2017, minimally invasive pilonidal sinus treatment (EPSiT) was adapted to the paediatric population. AIM: To evaluate the first experience with minimally invasive endoscopic treatment of SP (PEPSiT) in children and adolescents in the Czech Republic. MATERIAL AND METHODS: A retrospective review of all consecutive paediatric patients who underwent PEPSiT from November 2018 to February 2020. The monitored parameters were demographics, perioperative course of the disease, surgery, length of hospitalisation, postoperative complications, healing, disease recurrence, and follow-up. RESULTS: Seventeen patients were enrolled in the study. The median age at surgery was 17.1 years (range: 12.5-18). The subjects comprised 76% males, and the median body mass index was 25.6 kg/m2 (range: 17-30.3 kg/m2). Thirteen patients underwent previous surgical treatment (76%) under local anaesthesia. The median duration of PEPSiT was 50 min (range: 30-85 min). The subjective evaluation of pain by patients on the VAS scale was 0 on the day of discharge. There were no postoperative complications up to the 30th postoperative day. Two disease recurrences were successfully managed by re-PEPSiT. By the end of follow-up, 14/15 patients had healed. Two patients are still within 3 months of surgery, which is too soon to definitively evaluate possible recurrence of the disease. CONCLUSIONS: These preliminary results show that PEPSiT is a highly promising method. It is safe and well-tolerated by patients (short hospital stay, quick return to normal life, low pain and analgesic consumption). Two recurrences of disease were treated by re-PEPSiT.

Department of Paediatric Surgery 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

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Yücesan S, Dindar H, Olcay I, et al. Prevalence of congenital abnormalities in Turkish school children. Eur J Epidemiol. 1993;9:373–80. PubMed

Søndenaa K, Andersen E, Nesvik I, et al. Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis. 1995;10:39–42. PubMed

Chintapatla S, Safarani N, Kumar S, et al. Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. Tech Coloproctol. 2003;7:3–8. PubMed

Hardy E, Herrod P, Sian T, et al. Fibrin glue obliteration is safe, effective and minimally invasive as first line treatment for pilonidal sinus disease in children. J Pediatr Surg. 2019;54:1668–70. PubMed

Cevik M, Dorterler ME, Abbasoglu L. Is conservative treatment an effective option for pilonidal sinus disease in children? Int Wound J. 2018;15:840–4. PubMed PMC

Hardy EJO, Herrod PJ, Doleman B, et al. Surgical interventions for the treatment of sacrococcygeal pilonidal sinus disease in children: a systematic review and meta-analysis. J Pediatr Surg. 2019;54:2222–33. PubMed

Orhalmi J, Sotona O, Dusek T, et al. Pilonidal sinus – possibilities surgical treatment. Rozhl Chir. 2014;93:491–5. PubMed

Nasr A. A pediatric surgeon’s 35-year experience with pilonidal disease in a Canadian children’s hospital. Can J Surg. 2011;54:39–42. PubMed PMC

Enriquez-Navascues JM, Emparanza JI, Alkorta M, et al. Meta-analysis of randomized controlled trials comparing different techniques with primary closure for chronic pilonidal sinus. Tech Coloproctol. 2014;18:863–72. PubMed

Al-Khamis A, McCallum I, King PM, et al. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev. 2010;2010:CD006213. PubMed PMC

Meinero P, Mori L, Gasloli G. Endoscopic pilonidal sinus treatment (E.P.Si.T.) Tech Coloproctol. 2014;18:389–92. PubMed

Esposito C, Izzo S, Turrà F, et al. Pediatric endoscopic pilonidal sinus treatment, a revolutionary technique to adopt in children with pilonidal sinus fistulas: our preliminary experience. J Laparoendosc Adv Surg Tech A. 2018;28:359–63. PubMed

Esposito C, Turrà F, Cerulo M, et al. Technical standardization of MIS management of children with pilonidal sinus disease using pediatric endoscopic pilonidal sinus treatment (PEPSiT) and laser epilation. J Pediatr Surg. 2020;55:761–6. PubMed

Pappas AF, Christodoulou DK. A new minimally invasive treatment of pilonidal sinus disease with the use of a diode laser: a prospective large series of patients. Colorectal Dis. 2018;20:O207–14. PubMed

Esposito C, Gargiulo F, Izzo S, et al. Pediatric endoscopic pilonidal sinus treatment: an effective procedure for children with recurrent pilonidal sinus disease after failed open surgery. J Laparoendosc Adv Surg Tech A. 2019;29:981–6. PubMed

Horwood J, Hanratty D, Chandran P, et al. Primary closure or rhomboid excision and Limberg flap for the management of primary sacrococcygeal pilonidal disease? A meta-analysis of randomized controlled trials. Colorectal Dis. 2012;14:143–51. PubMed

Fike FB, Mortellaro VE, Juang D, et al. Experience with pilonidal disease in children. J Surg Res. 2011;170:165–8. PubMed

Pini Prato A, Mazzola C, Mattioli G, et al. Preliminary report on endoscopic pilonidal sinus treatment in children: results of a multicentric series. Pediatr Surg Int. 2018;34:687–92. PubMed