Endoscopic Pilonidal Sinus Treatment (E.P.Si.T): a new minimally invasive technique for the treatment of sacrococcygeal pilonidal sinus

The present study analyzed the results of a new video-assisted minimally invasive technique for the treatment of sacrococcygeal pilonidal disease (E.P.Si.T: endoscopic pilonidal sinus treatment). From May 2013 to June 2015 a total of 85 consecutive patients (68M, 17F), mean age 27.5 years referred to our surgical department. 75 patients had a primary sacrococcygeal pilonidal sinus, 10 patients had a recurrent pilonidal sinus and all underwent to E.P.Si.T. A fistuloscope is introduced through the external opening and the sinus cavity is completely ablated under direct vision. Patients' postoperative complications, wound infection rate, recurrence rate, time until return to work and satisfaction score were recorded during follow-up or at the last interview. Clinical data were obtained at 7 days, 15 days, 30 days, 6 month and 12 months following surgery. RESULT: All patients were followed up. Mean operative time was 18 min (range 12-30 min). The mean hospital stay was 6,5h (range 5-9) and mean time to return to work was 5 days. Mean follow-up was 16,8 (range 4-29) months. Mean healing time was 32,7 days. There were no major complications and infection; 5 recurrences. Overall satisfactory rate 98%. CONCLUSION: The ideal surgical treatment for pilonidal sinus disease must be simple and effective. In our experience, E.P.Si.T can be performed as a day care surgery with early return to work. This technique is also associated with a low recurrence rate and postoperative morbidity rate and a good aesthetic result INTRODUCTION Pilonidal sinus (PS) is a common health problem of the sacrococcygeal region mainly in young men (1), it is associated with obesity, sedentary occupation, local irritation (2) and hirsutism (3). Actually PS is considered an acquired disease due to the obstruction of hair follicles in the natal cleft (4). The symptoms are variable, ranging from asymptomatic pits to acute abscess to chronic cyst. This pathology has an important impact in quality of life causing absenteeism from work and school. The surgical treatment of PS still remains challenging and a lot of surgical treatment have been proposed. Recurrence rates vary with the technique. The aims of treatment of PS are eradication of the sinus tract, complete healing, prevention of recurrence and a good aesthetic result. Open excision and healing by secondary intention is used in the treatment of PS but this technique offers a poor quality of life and close observation as reported in a lot of study (5). Several authors propose excision of PS with primary closure using different technique like midline closure or flap-based procedure (4). These surgical modalities have low rates or efficacy and a prolonged postoperative wound healing. Enriquez-Navascues et al. (6) in a meta-analysis reported recurrence for every surgical approach range from 0 to 40% and concluded that in the treatment of PS “less is more”. In the last years, some authors developed new minimally invasive technique in the treatment of PS: Gupta et al. (7) proposed radio-surgery, Isik et al. (8) used fibrin glue without surgery, Meinero et al. (9), in a small series, proposed the use of a fistuloscope with an operative channel to destroy the sinus cavity and sinus tracts under direct vision, Milone et al. (10) proposed a similar technique using a hysteroscope. The present observational prospective study analyzed the results of E.P.SI.T (Endoscopic Pilonidal Sinus treatment) technique in treating PS.