VAAPS Combined With Loose Seton Drainage for Postoperative Self-Care: A Prospective Single-Arm Cohort Study

Description

Pilonidal sinus is a chronic infection of the sacrococcygeal skin that mainly affects young adults. Traditional surgery leaves large wounds requiring weeks of daily dressing changes away from home. Video-Assisted Ablation of Pilonidal Sinus (VAAPS) is a minimally invasive procedure that leaves only a 7-mm wound, but it requires daily saline flushing of the sinus tract and regular follow-up at the operating center. At Peking University People's Hospital, over 60% of VAAPS patients travel from other provinces and cannot return for standardized daily wound care. To address this, we developed a loose glove-edge seton technique: two rubber strips cut from surgical glove edges are loosely tied around the sinus openings during surgery to keep them patent, allowing normal dressing changes at home without flushing. The first strip is removed at 1 week and the second at 3 weeks postoperatively. This is a single-center prospective observational study of 50 out-of-town patients undergoing VAAPS with this seton technique. We will collect pain scores, time off work, wound healing time, complications, and recurrence over 3 years to assess whether self-care after VAAPS with loose seton is safe, effective, and feasible for patients who cannot return to the operating center for routine care.

Interventions

• VAAPS with Loose Seton Drainage (Procedure)
  Video-assisted ablation of pilonidal sinus (VAAPS) is performed through the external sinus opening using a sinusoscope to identify side tracts, remove hair, and ablate the tract wall under direct vision, leaving a wound approximately 5 mm wide. At the completion of the procedure, two thin strips cut from sterile surgical glove edges are loosely looped around the upper and lower sinus openings and secured to the surrounding skin to maintain tract patency. No postoperative saline flushing is required. Patients perform routine dressing changes at a local clinic or at home. The first seton strip is removed at approximately 1 week postoperatively, and the second strip is removed at approximately 3 weeks. This loose seton technique prevents premature wound closure and fluid accumulation while allowing granulation tissue to grow from the tract base.

Eligibility criteria

Conditions

Locations

• Peking University People's Hospital — Beijing, Beijing Municipality, China