Paediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT) in young people – information for teenagers

What is a pilonidal sinus?

A pilonidal sinus is a small pit, or tunnel, at the top of your bottom, between your buttocks (bum cheeks), in which hairs can get trapped leading to infection. The infection can turn into a collection of pus called an abscess, which can cause a painful swelling and lead to regular discharge of blood or pus onto underwear.

What causes pilonidal sinus?

The cause of pilonidal sinuses is not known but it results from hairs growing between the buttocks or loose hairs gathering in the groove which separates the buttocks (called the ‘natal cleft’) being pushed inwards into the skin and forming a tunnel where increasing numbers of hairs get trapped. This causes an infection.

The hairs may be pushed into the skin due to wearing tight clothing, cycling and prolonged periods of sitting. Pilonidal sinus’ most commonly occur in teenagers who have had other family members who have also had this problem, those with a lot of body hair or those who are overweight. Pilonidal sinus is more common in males but is also often seen in females.

Treating a pilonidal sinus

A pilonidal abscess can burst by itself, or it can be treated with antibiotics or by making a cut (called an ‘incision’) and draining the abscess. However, surgery is often the only way to effectively remove all of the sinuses to prevent it coming back.

Ways of treating different health problems change and improve over time. Until quite recently most young people needed to have an operation that involved making a cut, draining the abscess and having the wound filled with special dressings and healing took place over the following weeks and months. During that healing time young people needed to restrict their activities for up to 2-3 months.

Paediatric endoscopic pilonidal sinus treatment (PEPSiT) is a newer way of performing the operation and is less invasive. PEPSiT treatment has a high success rates of 90% with healing taking, on average, four weeks.

Before admission to hospital

Prevent progression of infection

After you meet your surgeon in the clinic you will be advised that achieving hair removal is essential to avoid the infection getting worse while you wait for your operation. As a priority, hair removal with shaving of the buttocks and also use of a tweezer to pull out the hairs within the pits needs to start. If there are signs of skin infection you will also be advised to use a soap called ‘Octenisan wash.’

Preoperative assessment

When a decision is made that an operation is needed, you will be asked, with your parent or carer, to complete a ‘health screening questionnaire.’ This questionnaire helps us understand if you have any other health problems or if you take any medicines for any other problems and helps us gain information about your, and your families, experiences of operations. Often this questionnaire is completed over the telephone. You can answer the questions with your mum, dad or carer or they can answer them for you.

Purchasing suitable painkillers

It is important that you have some children’s pain killers such as Paracetamol (e.g. Calpol) and Ibuprofen at home for use after your operation.

If you become unwell before your operation

If you become unwell with a cold, cough or illness such as chicken pox the operation will need to be postponed until you are better. Your parent or carer will need to tell us about this (the telephone number is provided at the end of this leaflet) before you come to hospital.

Starvation times

You will not be able to eat and drink on the morning of the day of your operation. Specific advice about this will be given on the booking letter once a date for surgery is confirmed.

What happens when I am admitted to hospital?

You will come to one of our children’s wards, usually early in the morning on the day of surgery. When you arrive you will be seen by the nursing staff plus a surgeon (who performs the operation) and an anaesthetist (who gives you the medicine that makes you go to sleep for the operation and who looks after you while you are asleep).

Your parent or your carer can be with you when you are given the anaesthetic medicine and when you go to sleep for the operation and also be present in the recovery area where you wake up.

What happens during the operation?

The area will be shaved and cleaned.

The surgeon will use a thin keyhole camera called a ‘fistuloscope’ to look inside the pilonidal sinus cavity.

The surgeon will then use small instruments through the fistuloscope to remove all hairs and infected tissue to help to heal the pilonidal sinus cavity from within.

The wounds made during this operation are small and should heal relatively quickly, allowing for a much quicker return to school and normal activities than the older methods of surgery.

What happens after the operation?

When you wake up from your operation you will in a room next to the operating room, called the recovery room. You will have a dressing over the wound. Your mum, dad or carer will be called to be with you in the recovery room.

A member of the nurse specialist team will visit you on the ward and will discuss with you and your parent/carer how you will need to care for the wound at home, and how to change the dressings.

How long will I need to stay in hospital after the operation?

Most young people go home on the same day, a few hours after surgery.

What are the complications or risks?

The risks of surgery include:

• Infection which can be treated with antibiotics
• Bleeding or a blood clot (called a haematoma). This does not usually cause problems, but may occasionally require another operation to drain the blood
• Excess scar tissue called granulation tissue that can mean it takes longer to heal.
• There is a small (10% risk) that the pilonidal sinus and symptoms can come back after surgery. We advise long term hair removal to minimise this risk. In this case, further surgery would likely be required.

What are the alternatives?

Treatment with antibiotics can be tried, but ultimately if the infection keeps reoccurring, then surgery is the only option.

An alternative to PEPSIT is the more traditional open surgery that has been shown to have a longer recovery time but similar risks of recurrence.

Discharge advice

Pain relief

During the operation the surgeon will put some numbing gel inside the sinus tract. After surgery pain killing medicines such as Ibuprofen and Paracetamol will be needed.

Wound care

You will have a dressing in place over the wound. The nurse specialist team will explain to you how to change this on a daily basis. The purpose of the dressing is to keep the wound dry – once there is no longer any discharge, dressings can stop.

Bathing

• 1st 5 days: You will not be able to have a bath, but will have a pink treatment spray called Chlorhexidine that will need to be applied to the wound daily
• After day 5: You will have a special body wash called Octenisan which you will need to use every day along with the pink spray.

Hair removal

Really careful and precise hair removal is required following surgery. The nurse specialist team will explain how to do this safely. This will initially be carried out by shaving, hair removal cream and plucking with tweezers.

Once full healing has been achieved, then long term laser hair removal may be something that you and your parents/carer decide to try.

Follow-up

You will come back to the hospital, to one of the children’s clinics, to see one of the clinical nurse specialist team on approximately day 5 after surgery.

You will then come back to see the nurse specialist team weekly until the wound has fully healed. This is usually 2-4 weeks, but can take much longer in some cases if the cavity was found to be very large at surgery.

You will be seen by your surgeon approximately 4 weeks after your wound has fully healed, and then at regular intervals over the next year.

Chaperoning

During your hospital visits you will need to be examined to help diagnose and to plan care. Examination may take place before, during and after treatment, is performed by trained members of staff and will always be explained to you beforehand. A chaperone is a separate member of staff who is present during the examination. The role of the chaperone is to provide practical assistance with the examination and to provide support to you, your family member/carer and to the person examining.

Who shall I contact if I have any queries, concerns or questions?

For further information/queries please contact:

Your nurse specialist (Monday to Friday 08:00 to 18:00)…01223 586973………………...

The ward your child was on …………………………….

Reference

1. Mentessidou A, Mirilas P, Maravilla V, Malakounides G. Outcomes of Pediatric Endoscopic Pilonidal Sinus Treatment: A Systematic Review. Eur J Pediatr Surg. 2023 Jul 26. doi: 10.1055/s-0043-1771224. Epub ahead of print. PMID: 37494954.

Useful contact numbers

Paediatric surgery clinical nurse specialist team Office: 01223 586973

(Mon to Fri 08:00 to 18:00 except bank holidays) For emergency queries call 01223 245151 and ask for the Clinical Nurse Specialist in Paediatric Surgery (Mon to Fri 08:00 to 18:00 excluding public holidays) Addenbrooke’s contact centre 01223 245151

Your children’s community nurse .............