Room for Improvement: The Trephination Procedure for Pediatric Patients with Pilonidal Disease.

BACKGROUND: Pilonidal disease is common amongst adolescent males and females and often leads to recurrent symptoms and life-altering morbidity. The traditional surgical approach includes wide excision of the involved area and carries a high rate of postoperative morbidity. A minimally invasive surgical approach using trephines was described by Gips in 2008 and has since been widely adopted by many surgeons. The aim of this study was to explore outcomes of the trephination procedure for pediatric and adolescent patients by evaluating postoperative wound healing and disease recurrence. MATERIALS AND METHODS: A retrospective cohort study for patients that underwent the trephination procedure as part of standard of care for the treatment of pilonidal disease from November 1, 2019-November 1, 2020 was performed. Patient demographics, presenting characteristics, and previous treatment history were identified. Outcome measures included healing time, recurrent disease, and need for reoperation. RESULTS: A total of 19 patients underwent the trephination procedure at a mean age of 16.4 years of age. An average of 3.8 pits were excised and there were no reported intraoperative complications. Following trephination, 26.3% of patients were healed at 30-day's, with just over 40% showing complete healing by 6-months. The recurrence rate was 16.1% at 6-months and approximately 15% of patients required a second surgery. CONCLUSION: Early results for trephination at our institution show a high rate of healing complications and frequent reoperation. Future research is needed to establish the role of the trephination procedure in the context of defining the best practices for treating this challenging disease.

Recognizing the Benefit of Telemedicine Before and After COVID-19: A Survey of Pediatric Surgery Providers.

BACKGROUND: Prior to the COVID-19 pandemic, the use of telemedicine to evaluate pediatric surgery patients was uncommon. Due in part to restrictions imposed to mitigate the spread of the virus, the use of telemedicine within pediatric surgery has significantly expanded. METHODS: Prior to the use of telemedicine within surgery divisions at our institution, pediatric surgeons were surveyed to determine their perspectives on the use of telemedicine. Following the expanded use of telemedicine in response to the COVID-19 pandemic, a follow up survey was distributed to determine the impact of telemedicine and the perceived benefits and barriers of continuing its use going forward. RESULTS: The pre-COVID survey was completed by 37 surgeons and the post-COVID survey by 36 surgeons and advanced practice providers across 10 pediatric surgical divisions. General surgeons were the most represented division for both the pre- (25%) and post-COVID (33.3%) survey. Less than 25% of providers reported use of telemedicine at any point in their career prior to COVID-19; but following the expanded use of telemedicine 95% of respondents reported interest in continuing its use. After expansion, 25% of respondents were concerned with the possibility of inaccurate diagnoses when using telemedicine compared to nearly 50% prior to expanded use. CONCLUSION: Following the expanded use of telemedicine within pediatric surgery, there was a decrease in the concern for inaccurate diagnoses and a near uniform desire to continue its use. Going forward, it will be imperative for pediatric surgeons to take an active role in creating a process for implementing telemedicine that best fits their needs and the needs of their patients and patients' families.

The value of telemedicine for the pediatric surgery patient in the time of COVID-19 and beyond.

BACKGROUND: Prior to COVID-19, the use of telemedicine within pediatric surgery was uncommon. To curb the spread of the virus many institutions restricted non-emergent clinic appointments, resulting in an increase in telemedicine use. We examined the value of telemedicine for patients presenting to a pediatric surgery clinic before and after COVID-19 METHODS: Perspectives and the potential value of telemedicine were assessed by surveying patients or caregivers of patients being evaluated by a general pediatric surgeon in-person prior to COVID-19 and by patients or caregivers of patients who completed a telemedicine appointment with a pediatric surgical provider during the COVID-19 period. RESULTS: The pre-COVID survey was completed by 57 respondents and the post-COVID survey by 123. Most respondents were white and were caregivers 31-40 years of age. Prior to COVID-19, only 26% were familiar with telemedicine, 25% reported traveling more than 100 miles and >50% traveled more than 40 miles for their appointment. More than 25% estimated additional travel costs of at least $30 and in 43% of households, at least one adult had to miss time from work. Following a telemedicine appointment during the COVID-19 period, 76% reported the care received as excellent, 86% were very satisfied with their care, 87% reported the appointment was less stressful for their child than an in-person appointment, and 57% would choose a telemedicine appointment in the future. CONCLUSION: For families seeking an alternative to the in-person encounter, telemedicine can provide added value over the traditional in-person encounter by reducing the burden of travel without compromising the quality of care. Telemedicine should be viewed as a viable option for pediatric surgery patients and future research directed toward optimizing the experience for patients and providers. LEVEL OF EVIDENCE: III.