Evaluating Outcomes in Adolescents With Pilonidal Disease Treated With Pilonidal Sinus Trephination

INTRODUCTION: Pilonidal disease is a common chronic infectious process caused by entrapment of hair follicles in the gluteal cleft that can be managed with conservative therapies or operative intervention, including pilonidal sinus trephination. While trephination has been found to be safe and effective in adults, outcomes in adolescents are limited. This study investigated wound healing and 1-y disease recurrence in adolescents after trephination.

METHODS: We retrospectively reviewed patients aged 10-21 y who underwent trephination at our tertiary care pediatric hospital between November 2019 and November 2022. Patient demographics, treatment history, operative management, and clinical outcomes up to 12 mo postoperatively were collected. We performed Firth penalized logistic regression to identify independent predictors of healing at 60 d and recurrence by 12 mo.

RESULTS: Among 63 patients, the median age at the time of index operation was 16.5 y. Most patients were male (52.4%), and most were White (73.0%). At the time of initial clinic intake, all patients had a current or prior chronic gluteal cleft fistula and/or pilonidal sinus, and 93.7% had experienced ≥1 flare of pilonidal disease. Patients more commonly underwent trephination for a chronic wound than active disease (81.0% versus 19.0%). Nearly half of patients had at least one fistula present (49.2%) and a median of three pits. Wound healing was delayed in 20.5% and was associated with non-White race (odds ratio 7.31, 95% confidence interval 1.68, 31.85) but not Fitzpatrick skin type (P = 0.29) in univariable analysis. Recurrence at 1 y was 25.0% and was also associated with non-White race (odds ratio 8.85, 95% confidence interval 2.02, 38.71) but not Fitzpatrick skin type (P = 0.10) in univariable analysis.

CONCLUSIONS: Pilonidal sinus trephination may be an appropriate surgical option for select adolescents with chronic, fistulous pilonidal disease. Further research is needed to determine if race and ethnicity are associated with healing complications and recurrence of pilonidal disease.