Shavliuk R. Justification of diagnosis and treatment methods and prognosis of pilonidal disease in children (experimental-clinical study)

According to a study, which is based on detailed morphological studies of pilonidal cysts in children and in comparison with adults, we have found the following changes: the presence of mesenchymal tissue, differences in the structure of the coccygeal wall from adults and the lack of clear confirmation of transdermal penetration of the hair shafts into the wall and to the cavity of epithelial coccygeal cysts. These data supports the congenital etiology of the disease. We have also formulated the prognostic signs of a higher risk of recurrence of this disease: increase in body mass index and male gender. We have created a spatially oriented mathematical model for determining a rational operative approach for surgical treatment of pilonidal disease in children, which meets the requirements of minimally invasiveness. To achieve maximum safety we also defined by studying the morphology of the external anal sphincter that it has the shape of an ellipse, displaced caudally with anterior-posterior size of 50.6 ± 1.04 mm and transverse - 36.9 ± 0.42 mm. This proves the necessity of operative margins being no closer than 3.0 cm to the anus access during radical surgery for pilonidal disease in children. We have proven that the created technique of modified cleft-lift operation with lateralization of postoperative wound allowed for the reduction of recurrence of pilonidal disease in children by 30.88% due to modification of the radical removal of inflammation locus and reconstruction of anatomical structures of the sacrococcygeal region and flattening of the gluteal fold from 12 + 0.15 cm to 2.46 + 0.28 cm. There is also a decrease in the term of inpatient treatment of children in comparison with operations according to standard methods. We have developed a diagnostic and treatment algorithm for radical surgical treatment of pilonidal disease in children, which is based on an individual approach to the leading factors in the development of pathological process.