eP546 - Comparison of Minimally Invasive and Excisional Treatment of Pilonidal Disease

Purpose/Background: Pilonidal disease is a chronic condition that negatively impacts quality of life. When surgery is indicated, wide excision is performed with either closure or healing by secondary intention. These treatments can lead to painful and prolonged healing times. A less invasive approach, the Gips procedure, involves removal of the pilonidal pits through punch biopsy and curettage without wide excision. First described in a specialty military clinic in Israel, there has been limited research in the efficacy of this technique in the United States adult civilian population. We hypothesize that the Gips procedure can decrease healing times without significantly increasing recurrence rate or complications.Methods/Interventions: We performed a retrospective review of adult patients (at least 18 years of age) who received surgical treatment for pilonidal disease between 2018 and 2023 at two affiliated tertiary care centers. We defined minimally invasive surgery, the Gips procedure, as removal of pits with punch biopsy and curettage followed by irrigation and debridement of the underlying sinus. Patients whose index surgery involved a combination of excisional and minimally invasive techniques were excluded from the final analysis. Patient demographics, comorbidities, disease characteristics, perioperative data, and postoperative outcomes were collected via chart review and evaluated through summary statistics, chi square analysis, Fisher's exact test, and t-test. The primary outcome was healing time, and secondary outcomes included complications and reoperation rate.Results/Outcomes: Data was collected for 59 patients, 13 of which had the Gips procedure and 42 of which had excisional surgery. We excluded the remaining 4 patients, who had surgery with excisional and minimally invasive components. Follow up time ranged from 1.6 to 15.9 weeks (mean 6.84 weeks) for patients who had the Gips procedure and 1.2 to 69.1 weeks (mean 11.48 weeks) for patients who underwent excisional surgery. Average healing time was shorter for the minimally invasive group (52.64 days) than the excisional group (71.3 days), although not at a statistically significant level (p=0.388, 95% CI -24.42 to 61.74). There was no statistically significant difference (p=0.0764) in complication rates between the minimally invasive group (33%) and excisional group (10.26%). Most complications were related to incomplete drainage. The minimally invasive group had a shorter average operative time (10.75 minutes) than the excisional group (27.77 minutes) and was prescribed less opioids (8 and 16, respectively).Conclusion/

Discussion: In this sample of patients, the Gips procedure has a shorter mean healing time compared to excisional surgery. While the overall reoperation rate is low, the complication rate is higher for the Gips procedure than excisional surgery. Overall, the significance of the study is limited due to the small sample size and lack of statistical significance. Future directions should involve analysis with a larger sample size and longer follow up time."Table 1: Demographics

This table depicts patient characteristics for both the minimally invasive and excisional groups.
Table 2: Outcomes

This table depicts outcome data, operative time, and number of opioids prescribed.
*Indicates statistical significance with alpha=0.05"