Practice patterns of paediatric surgeons on treating pilonidal sinus disease - a national survey study.

Purpose: Paediatric pilonidal sinus disease is considered a separate entity of disease due to differing recurrence dynamics. However, there are almost no data on real-world surgical care and practice patterns for children and adolescents. We therefore aimed to gather such data surveying a representative sample of German paediatric surgeons.

Methods: Some 101 German paediatric surgical departments and surgeries with inpatient beds were surveyed for their surgical approach to paediatric pilonidal sinus disease. The survey included demographics, information on practice setting, as well as the primary and secondary approach to pilonidal disease and three virtual patient scenarios.

Results: A total of 40 institutions (33 departments and 7 office-based paediatric surgeons) responded (recall rate 40%). Of these, 18/40 reported performing 10-20, and 9/40 perform 5-10 pilonidal sinus operations annually. 17/39 respondents have less than 10% recurrences among their patient cohort and 15/39 operate on 11-20% recurrences among their patients. The most frequently reported surgical approach was excision and secondary closure with 17/39, followed by excision and vacuum-assisted closure (13/39), and pit-picking (12/39). Intraoperative use of blue dyes report 15/39 and 29/39 continue postoperative outpatient care at their institution. Acute pilonidal sinus with abscess is treated with a two-staged approach within four weeks by 15/39 while 11 institutions wait more than four weeks until definitive surgery. In recurrent cases, the majority of 20/39 does not switch their approach, while 13/39 switch to excision and secondary closure, and 11/39 switch to excision and vacuum-assisted closure.

Conclusion: German paediatric surgeons prefer traditional approaches to pilonidal sinus diseases, but pit-picking is frequently used. Neither the adult-based national guideline recommendations nor paediatric treatment algorithms have been widely implemented. The reasons for these deviations from recommendations and favouring traditional approaches remain unclear.