P1.040: Minimally Invasive Pilonidal Excision for the Treatment of Pilonidal Disease- A Multi-center Prospective Study

Background: Pilonidal disease is a common condition with multiple surgical options for treatment, depending on severity of disease as well as surgeon and patient preference. Recently, minimally invasive pilonidal excision (MIPE) has gained traction as a less invasive procedure in adults. We aimed to assess uptake of MIPE and surgical outcomes across children’s hospitals. We hypothesized that uptake would be high, with favorable outcomes and acceptable recurrence rates.

Methods: Six children’s hospitals with surgeons participating in the Pediatric Surgery Research Collaborative, enrolled patients in a prospective observational study from 1/2019-6/2022, with follow up through 12/2024. Surgeons, patients, and their families were free to proceed with the operative intervention they preferred. Patients were followed longitudinally to assess outcomes, including disease recurrence.

Results: 150 children from 6 children’s hospitals were followed for a median 186 days (IQR 27-660). Median age was 16 years (IQR 15-17). Patients had a median of 1 occurrence of pilonidal disease prior to enrollment (range 0-4). 10 (7%) patients had undergone surgery for pilonidal disease prior to enrollment.

Most patients, 124 (83%) underwent MIPE while 25 (17%) patients had a modification including concomitant incision and drainage or other debridement. 1 patient (1%) underwent complex excision of pilonidal disease. At follow up, 92% of respondents stated that they would recommend their procedure to a friend.

A total of 40 (27%) patients ultimately underwent a second procedure for their pilonidal disease, with 18 (45%) of the recurrences within the first 6 months of their index procedure. 33 (83%) patients underwent MIPE or modified MIPE as their second procedure.

Of the 12% of patients who underwent a second procedure for pilonidal disease within 6 months, those patients with hair diameter that was rated as more thick had 1.8 times the risk of needing a second procedure (95%CI 1.00-3.30, p=0.05, Table 1). Those patients discharged home to complete a course of antibiotics had 3.9 times higher risk for need for recurrent surgery (95% CI 1.56-9.93, p=0.004), even while active infection identified at surgery was not a predictor of recurrence.

Of patients who underwent a second procedure at any time during the study period, on multivariate analysis, those patients who were discharged home to complete a course of antibiotics had 3.1 times higher risk for need for recurrent surgery (95% CI 1.3-7.2, p=0.01).

Conclusion: Among participating centers and surgeons, the MIPE was the preferred procedure for pilonidal disease both as an initial procedure and for recurrence. Although many surgeons varied their operative procedure from initial reports, there was a strong preference for minimal procedures. Consistent with prior reports in adults, 27% of patients needed an additional procedure during the first 2 years following MIPE. Most patients would recommend MIPE to a friend.