Early versus delayed endoscopic treatment of acute pilonidal abscess: a propensity score-matched analysis
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ORIGINAL ARTICLE
Early versus delayed endoscopic treatment of acute pilonidal abscess: a propensity score-matched analysis Michele Manigrasso 1 & Nunzio Velotti 1 & Loredana M. Sosa Fernandez 1,2 & Sara Vertaldi 1 & Francesco Maione 3 & Nicola Gennarelli 3 & Pietro Schettino 3 & Mario Musella 1 & Giovanni D. De Palma 3 & Marco Milone 3 Accepted: 30 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background According to the Italian Society of Colorectal Surgery guidelines, the most effective approach to the pilonidal abscess is adequate surgical drainage, concerning incision and drainage of the pilonidal cavity. Few recent studies have demonstrated that endoscopic approach could be a valid treatment option even in the case of acute pilonidal abscess. The aim of our study is to assess if video-assisted ablation of pilonidal sinus (VAAPS) could be an alternative to treat an acute pilonidal abscess and to evaluate if an immediate endoscopic approach to the pilonidal abscess is preferable to a delayed procedure after incision and drainage. Methods All consecutive patients with an acute pilonidal abscess since 1 January 2014 to 31 December 2018 were enrolled in our propensity score-matched analysis and divided into two groups: the early VAAPS group and the delayed VAAPS group. Primary outcomes were recurrence rate at 1-year, 3-year, and 5-year follow-up. Secondary outcomes were time off, time to wound healing, incomplete wound healing, perioperative infection, patients’ satisfaction 1 month after the complete wound healing, and their health status before surgery and 6 months after complete wound healing. Results After the propensity score matching, 82 patients were included in the final analysis (41 in each group). No differences were found in terms of recurrence in the two groups. Early endoscopic approach was associated with a better patients’ satisfaction (8.17 ± 1.2 vs 6.06 ± 1.48, p = 0.001) and a better postoperative health status (86.27 ± 6.54 vs 77.32 ± 5.85, p = 0.001). Conclusions Our results encouraged to perform an immediate endoscopic approach to an acute pilonidal abscess. Keywords Pilonidal . Endoscopic treatment . Video-assisted ablation . Acute abscess
Introduction Pilonidal sinus (PS) is a common disease of the natal cleft of the sacrococcygeal area. Acute abscess is a common surgical presentation with a reported incidence of about 26 per 100,000. According to the Italian Society of Colorectal Surgery guidelines [1], the most effective approach to the pilonidal abscess is adequate surgical drainage of the pilonidal * Michele Manigrasso [email protected] 1
Department of Advanced Biomedical Sciences, “Federico II” University of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy
2
EMBRYOS Fertility Center and Day Surgery, Palazzo Colosseum, Via Fiorignano, 84091 Battipaglia, Salerno, Italy
3
Department of Clinical Medicine and Surgery, “Federico II” University of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy
cavity [2]. However, up to 42% of pati
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