Young Versus Experienced Surgeons in Endoscopic Treatment of Pilonidal Sinus Disease

Abstract: Background: This study evaluates Endoscopic Sinusectomy procedures performed by young and experienced surgeons to compare outcomes achieved by young surgeons to those obtained by experienced surgeons. Methods: From a prospectively maintained database, patients with chronic non recurrent pilonidal disease who underwent Endoscopic Sinusectomy since 1 September 2011 to 31 December 2021, were enrolled. After the propensity score analysis, 200 patients were involved and divided in the group of procedures performed by young surgeons and the group performed by experienced surgeons. Results: About recurrence rate at 1-year follow up (7% vs. 10%, p=0.45) and 5-years follow-up (12.5% vs. 17.5%, p=0.53) and about time off from work (3.54±1.65 vs. 3.61±1.61, p=0.78) no significant results were found. About operative time (30.44±5.57 vs. 43.43±3.83, p=0.004), infection rate (4% vs. 14%, p = 0.013), time to healing of wound (27.89±11.06 vs. 42.22±13.63, p=0.002) and incomplete healing of wound rate (3% vs. 11%, p=0.027) statistically significant differences were found. The multivariate analysis demonstrated that being young surgeons influences the abovementioned significant results and that the mean distance between lateral orifice and midline impacts on the recurrence rate at 1- and 5-years follow-up for both experienced surgeons’ (p=0.001 and p=0.009) and young surgeons’ procedures (p=0.001 and p=0.003). Conclusions: The recurrence rate doesn’t increase during the training but an adequate training path to perform endoscopic technique is need. A call to perform high-quality randomized controlled studies for establishing how many surgeries are required to be proficient and to outline the ideal endoscopic technique training path. Keywords: endoscopic