Early versus delayed endoscopic treatment of acute pilonidal abscess: a propensity score-matched analysis

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.

Automated summary

After studying patients with acute pilonidal abscess, we found that immediate endoscopic approach was associated with higher patient satisfaction and better postoperative health status. This suggests that immediate endoscopic approach may be a better treatment option.