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Pilonidal sinus disease in children
1950
Correspondence Shawn D. St. Peter Kuojen Tsao Troy L. Spilde George W. Holcomb Susan W. Sharp J. Patrick Murphy Charles L. Snyder Ronald J. Sharp Walter S. Andrews Daniel J. Ostlie Center for Prospective Clinical Trials The Children's Mercy Hospital Kansas City, MO 64108, USA
the other children of the same ages. I wonder whether the patients presented by Lee et al [1] in whom postoperative complications developed were overweight, obese, or not? If they indeed had high BMI values, it would suggest this factor should be taken into consideration when evaluating these patients and selecting operative management. Sincerely, I. Serdar Arda Department of Pediatric Surgery Baskent University Faculty of Medicine Fevzi Cakmak caddesi 10. sokak No: 45 06490 Bahcelievler Ankara, Turkey E-mail address: [email protected]
doi:10.1016/j.jpedsurg.2008.08.010 doi:10.1016/j.jpedsurg.2008.08.007
Pilonidal sinus disease in children To the Editor, I have read the article entitled as “Current management of adolescent pilonidal disease” written by Lee et al [1] in the latest issue of Journal of Pediatric Surgery (J Pediatr Surg 2008;43:1124-27). In their elegant study, the authors compare 2 operative techniques, called wide local excision and unroofing and marsupialization with regard to the postoperative complications, median time to final healing, need for reoperation, complete healing, and recurrent disease. They conclude that unroofing and marsupialization is a simple technique with a lower complication rate that can be easily performed in children who do not need creation of lateral flaps during the repair. We recently published a study pointing out the effect of high body mass index (BMI) on the development of pilonidal sinus disease (PSD) in children [2]. To our knowledge, it is a unique study concerning the relationship of BMI and PSD in the English literature. We have used the technique of en bloc excision of the sinus or sinuses with the surrounding healthy tissue down to the presacral fascia and primary closure of the wound. This was a surgical method similar to the wide local excision described by the authors. In 5 of 14 patients, minor complications such as mild wound infection and superficial wound dehiscence occurred. The disease recurred in only one patient 3 months after the procedure. All of these patients had high BMI values. Cosmesis was acceptable in all of our patients without any significant scar tissue formation. Our results showed that a high BMI also influenced the outcome of the disease. In the report by Lee et al [1], the authors did not present any data concerning the BMI of their patients. Previous reports have supported the concept that high BMI increases the risk for both the development of PSD and postoperative complications [3,4]. My personal experience with pilonidal sinus disease in children also suggests that the disease occurs more frequently in overweight patients when compared to
References [1] Lee SL, Tejirian T, Abbas MA. Current management of adolescent pilonidal disease. J Pediatr Surg 2008;43:1124-7. [2] Arda IS, Güney LH, Sevmiş S, et al. High body mass index as a possible risk factor for pilonidal sinus disease in adolescents. World J Surg 2005;29:469-71. [3] Cubukçu A, Gönüllü NN, Paksoy M, et al. The role of obesity on the recurrence of pilonidal sinus disease in patients, who were treated by excision and Limberg flap transposition. Int J Colorectal Dis 2000;15:173-5. [4] Sakr M, El-Hammadi H, Moussa M, et al. The effect of obesity on the results of Karydakis technique for the management of chronic pilonidal sinus. Int J Colorectal Dis 2003;18:36-9.
Reply To the Editor, We thank Dr Arda for the comments regarding our recent article on managing adolescent pilonidal disease [1]. We also congratulate the study of Dr Arda relating high body mass index (BMI) with complications after wide local excision (WLE) of pilonidal disease [2]. This unique study showed complications occurred in 5 of 8 overweight or obese patients (based on BMI) and none in normal weight adolescents. We reviewed our data, and BMI was available for 13 of the 17 patients treated with unroofing and marsupialization (UM) and for 6 of the 9 patient treated with WLE. There was a trend toward a lower BMI in the UM group compared to the WLE group (26.7 ± 4.5 vs 31.1 ± 4.9, respectively, P = .09). The patients in the WLE group did have a higher complication rate and longer time to heal compared to the UM group. However, patients were treated based on surgeon's preference and experience not based on BMI. Furthermore, the 2 patients without complications after WLE had a mean BMI of 33 ± 5.2 compared to a mean BMI of 30.2 ± 4.5 in patients with complications after WLE. Finally, 8 of the 13 patients in the UM group were overweight or obese and did not have postoperative complications.
Correspondence Shawn D. St. Peter Kuojen Tsao Troy L. Spilde George W. Holcomb Susan W. Sharp J. Patrick Murphy Charles L. Snyder Ronald J. Sharp Walter S. Andrews Daniel J. Ostlie Center for Prospective Clinical Trials The Children's Mercy Hospital Kansas City, MO 64108, USA
the other children of the same ages. I wonder whether the patients presented by Lee et al [1] in whom postoperative complications developed were overweight, obese, or not? If they indeed had high BMI values, it would suggest this factor should be taken into consideration when evaluating these patients and selecting operative management. Sincerely, I. Serdar Arda Department of Pediatric Surgery Baskent University Faculty of Medicine Fevzi Cakmak caddesi 10. sokak No: 45 06490 Bahcelievler Ankara, Turkey E-mail address: [email protected]
doi:10.1016/j.jpedsurg.2008.08.010 doi:10.1016/j.jpedsurg.2008.08.007
Pilonidal sinus disease in children To the Editor, I have read the article entitled as “Current management of adolescent pilonidal disease” written by Lee et al [1] in the latest issue of Journal of Pediatric Surgery (J Pediatr Surg 2008;43:1124-27). In their elegant study, the authors compare 2 operative techniques, called wide local excision and unroofing and marsupialization with regard to the postoperative complications, median time to final healing, need for reoperation, complete healing, and recurrent disease. They conclude that unroofing and marsupialization is a simple technique with a lower complication rate that can be easily performed in children who do not need creation of lateral flaps during the repair. We recently published a study pointing out the effect of high body mass index (BMI) on the development of pilonidal sinus disease (PSD) in children [2]. To our knowledge, it is a unique study concerning the relationship of BMI and PSD in the English literature. We have used the technique of en bloc excision of the sinus or sinuses with the surrounding healthy tissue down to the presacral fascia and primary closure of the wound. This was a surgical method similar to the wide local excision described by the authors. In 5 of 14 patients, minor complications such as mild wound infection and superficial wound dehiscence occurred. The disease recurred in only one patient 3 months after the procedure. All of these patients had high BMI values. Cosmesis was acceptable in all of our patients without any significant scar tissue formation. Our results showed that a high BMI also influenced the outcome of the disease. In the report by Lee et al [1], the authors did not present any data concerning the BMI of their patients. Previous reports have supported the concept that high BMI increases the risk for both the development of PSD and postoperative complications [3,4]. My personal experience with pilonidal sinus disease in children also suggests that the disease occurs more frequently in overweight patients when compared to
References [1] Lee SL, Tejirian T, Abbas MA. Current management of adolescent pilonidal disease. J Pediatr Surg 2008;43:1124-7. [2] Arda IS, Güney LH, Sevmiş S, et al. High body mass index as a possible risk factor for pilonidal sinus disease in adolescents. World J Surg 2005;29:469-71. [3] Cubukçu A, Gönüllü NN, Paksoy M, et al. The role of obesity on the recurrence of pilonidal sinus disease in patients, who were treated by excision and Limberg flap transposition. Int J Colorectal Dis 2000;15:173-5. [4] Sakr M, El-Hammadi H, Moussa M, et al. The effect of obesity on the results of Karydakis technique for the management of chronic pilonidal sinus. Int J Colorectal Dis 2003;18:36-9.
Reply To the Editor, We thank Dr Arda for the comments regarding our recent article on managing adolescent pilonidal disease [1]. We also congratulate the study of Dr Arda relating high body mass index (BMI) with complications after wide local excision (WLE) of pilonidal disease [2]. This unique study showed complications occurred in 5 of 8 overweight or obese patients (based on BMI) and none in normal weight adolescents. We reviewed our data, and BMI was available for 13 of the 17 patients treated with unroofing and marsupialization (UM) and for 6 of the 9 patient treated with WLE. There was a trend toward a lower BMI in the UM group compared to the WLE group (26.7 ± 4.5 vs 31.1 ± 4.9, respectively, P = .09). The patients in the WLE group did have a higher complication rate and longer time to heal compared to the UM group. However, patients were treated based on surgeon's preference and experience not based on BMI. Furthermore, the 2 patients without complications after WLE had a mean BMI of 33 ± 5.2 compared to a mean BMI of 30.2 ± 4.5 in patients with complications after WLE. Finally, 8 of the 13 patients in the UM group were overweight or obese and did not have postoperative complications.