title: Improving outcomes in pilonidal sinus disease.
abstract: BACKGROUND
  Optimal surgical treatment for pilonidal sinus disease remains controversial. Studies in children are uncommon with overall high postoperative recurrence and infection rates (20%). Our unit adopted a technique for excision of the pilonidal sinus with primary midline closure using a full-thickness flap. We present our results of this technique in the pediatric age group.
  
  
  METHODS
  Single-center retrospective review and telephone follow-up was performed, including all children undergoing pilonidal sinus excision from 2005 to 2014 using the same operative technique and preoperative/postoperative care.
  
  
  RESULTS
  19 children were identified. Median age was 15years, and 47% were male. All had previously infected sinuses, with 5 requiring abscess drainage. Median follow-up was 13months (3.5-67months). Histology confirmed pilonidal sinus in 18/19 cases (one developmental malformation excluded from subsequent analysis). Recurrence requiring further surgery occurred in 4/18 (22%) patients at a median of 9months (range 8-36), wound dehiscence in 8/18 (44%), and wound infection in 5/18 (28%) cases. Laser hair removal of the natal cleft was performed in 7/18 (39%) patients with no further recurrence.
  
  
  CONCLUSIONS
  This is the first report of this technique in children which showed a higher incidence of complications than a comparable adult study. Our study underlines the importance of accurate long-term outcomes when introducing new techniques to evaluate operation-associated morbidity. Our preliminary results of laser hair removal are promising but need to be evaluated with a prospective study.
authors.affiliation: Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Braungart
authors.affiliation: Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Powis
authors.affiliation: Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, UK.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Sutcliffe
authors.affiliation: Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, UK. Electronic address: ian.sugarman@nhs.net.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Sugarman
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010864:Pilonidal Sinus / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome
keywords: Operative technique; Pilonidal sinus