Pilonidal Sinus: Open Surgery or PEPSiT? Our Preliminary Experience in Adolescents

Highlights: What are the main findings? Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT) was associated with significantly shorter hospital stay, faster wound healing, and lower overall postoperative complication rates compared with traditional open excision in children and adolescents with pilonidal sinus disease. Recurrence rates were numerically lower after PEPSiT (9.5%) than after open surgery (25%), with comparable operative time between the two techniques. What are the implications of the main findings? PEPSiT represents a safe and feasible minimally invasive alternative to open surgery in the pediatric population, aligning with the need for faster recovery and reduced wound-related morbidity in adolescents. Prospective, controlled, multicenter pediatric studies are needed to confirm long-term outcomes and to establish standardized treatment algorithms for pilonidal sinus disease in children Background: Pilonidal sinus disease (PSD) is a chronic inflammatory condition commonly affecting the sacrococcygeal region, particularly in adolescents and young adults. Traditional open surgical approaches are associated with prolonged recovery, high complication rates, and recurrence. The advent of endoscopic techniques, such as Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT), offers a promising alternative, reducing discomfort and potentially improving outcomes. The aims of the study were to compare the effectiveness and safety of PEPSiT versus traditional open excision in the treatment of PSD in the pediatric population. Methods: A retrospective, non-randomized study was conducted on patients aged 8–18 years who underwent surgery for PSD between 2019 and 2023 at our institution. Patients were divided into two groups: those undergoing traditional open excision (Group A) and those who received PEPSiT (Group B). Data were extracted from electronic medical records, including patient demographics, operative time, length of hospital stay, and post-operative complications such as recurrence and wound dehiscence. A minimum follow-up of 12 months was required. Statistical analysis was performed using the Chi-square test for categorical variables and Mann–Whitney U test for quantitative analysis. Results: A total of 61 patients were included in the study, with 40 undergoing Open surgery and 21 treated with PEPSiT. Mean operative time was shorter in the PEPSiT group (37.95 ± 10.86 min) compared with the Open group (47.85 ± 20.03 min), although this difference did not reach statistical significance (p = 0.052). Length of hospital stay was significantly reduced in the PEPSiT group (5.9 ± 8.73 h) compared with the Open group (15.40 ± 12.54 h) (p < 0.001). Post-operative complications were significantly less frequent following PEPSiT, with no cases of wound dehiscence observed compared with 27.5% in the Open group (p = 0.008). Recurrence rates were lower in the PEPSiT group (9.5%) than in the Open group (25%); however, this difference was not statistically significant (p = 0.149). Conclusions: PEPSiT is a feasible minimally invasive option for pediatric pilonidal sinus disease, associated with shorter hospital stay, faster wound healing, and fewer postoperative complications compared with open surgery, with comparable operative time. These results should nevertheless be interpreted with caution and warrant confirmation in prospective controlled studies.