REFLECTIONS ON CLASSIFICATION SIGNS OF PILONIDAL DISEASE IN CHILDREN

The history of knowledge about pilonidal disease has been going on for more than 150 years, and so far no single concept has been developed on the cause, modeling and clear single classification, which is the key to a thorough understanding of this pathology. The experience of modern medical science shows that the best treatment results are achieved when it is possible to model the pathological process. Unfortunately, for pi-lonidal disease, there is currently no reproducible exper-imental model. This negatively affects the ability to achieve the desired results in the treatment of this disease in both adults and children. The concept «pilonidal disease» is quite wide and consists of a set of pathological manifestations that are formed under the influence of adverse anatomical - physiological factors (congenital and acquired) and ex-ternal factors. The final morphological substrate for the implementation of pilonidal disease is the formation of pilonidal cysts. The classification pilonidal disease should take into account the development, course and features of clinical forms, due to and on the basis of which a clinical diagnosis is formed. This helps to choose the most opti-mal individual method and treatment plan. Purpose: on the basis of the factual material ac-cumulated over more than 150 years of history to develop clinically oriented classification features of pilonidal disease, taking into account the characteristics of childhood. Materials and methods. The paper deals with all currently available published concepts of the occurrence of pilonidal disease, its variants and proposals for the formation of classifications of pilonidal disease. The most "popular" theories of the development of this dis-ease by both foreign and blighty authors were developed. Results of research. To date, there are a large number of separate classifications of pilonidal disease, which are often formed on the basis of one or two specif-ic features or based on external manifestations of pathol-ogy of the sacrococcygeal region. There are also some classifications based on combinations of some of the features./ On the basis of combination of experience of predecessors, own researches and reflections we offered clinically oriented classification signs of a disease at children on the basis of features of an etiopathogenesis of patients characteristic of this age. First of all, the main differences of the pediatric group of patients from adults were taken into account: impossibility due to age features of the long course of the disease, presence of morphometric features of the external anal sphincter structure, presence of immature mesenchymal tissue in the pilonidal cyst cavity. The classification proposed by us combines all the main aspects of the disease and proposes to classify pilonidal disease: by periods of this pathology, by topographic and anatomical features of the buttock-sacrococcygeal region and the consequences of treatment. Conclusions: 1. In modern pediatric surgery there is an urgent need to develop and implement in clinical practice uni-fied classification features of pilonidal disease. 2. Differences in the classification of pilonidal disease in children should be a number of morphological, etiopathogenetic, anatomical and clinical differences from adults. 3. The use in clinical practice of the developed classification features of pilonidal disease in children will determine the clinical variants of the disease and choose the most optimal tactics of surgical treatment.