Endoscopic Pilonidal Sinus Surgery


What is Pilonidal Sinus Disease?

Pilonidal Sinus Disease is an inflammatory condition that commonly affects teenagers and young adults, more often males.  It is usually seen in the natal cleft or gluteal fold.  The exact cause is controversial, but the basic elements involved in the condition are hairs, midline pits in the natal cleft, and a foreign body reaction to the hairs in the pits and sinuses.

The hair debri in the pits and sinuses can lead to inflammation and infection, and possibly abscess formation.  The condition care run a waxing and waning course over many years.

What are the treatment options?

Traditionally Pilonidal Sinus Disease has been treated with surgery to drain abscess or excise the affected area, that can result in significant wounds that can take months to heal if left open.  Sometimes to achieve closure of the wound, a skin flap is required to reconstruct the wound off the midline.  Unfortunately, these wounds have a relatively high risk of coming apart if closed due to infection, resulting in an open wound that can take many weeks to months to heal, and can require daily dressings initially, causing significant disruption to daily life.  The disease can also still recur despite radical excision.

A new keyhole surgery technique does not create large wounds that require intensive wound management with dressings,  This is known as Endoscopic Pilonidal Sinus Surgery.

What is Endoscopic Pilonidal Sinus Surgery?

Also known as EPSiT – Endoscopic Pilonidal Sinus Treatment.  This is a NEW minimally-invasive treatment for Pilonidal Sinus Disease.  

It involves using the midline pits that are already present therefore no large wounds that can take months to heal.  A fine rigid endoscope is used to look inside the pits and sinuses and any hair and debris inside are extracted.  Granulation tissue is cauterised and dead tissue removed.  

No packing of wounds is usually required, and there is no requirement for daily dressings of wounds over many months.

Advantages of EPSiT Surgery over Conventional excision?

Less pain, faster return to work and a high rate of healing with minimal wound care required.  If the problem recurs, this minimally invasive technique can be used again.  Patients who undergo excision of pilonidal disease can be left with wounds that can take months to heal, and whilst it is healing it may require dressings that may need changing on a daily basis.

In the largest prospective trial for this treatment from Italy and Switzerland, less than 10% of patients required pain killers after surgery and the average time to return to work was 2 days.  Nearly 95% of patients’ wounds had healed by 2 months. Patients in which disease recurred were able to be treated with repeat EPSiT surgery.

Some patients may still ultimately require excisional surgery after undergoing EPSiT multiple times, but hopefully the extent of excision may not need to be as extensive.

How long will I be in hospital for?

The procedure is performed as day surgery.  You will go home on the same day as surgery and require a carer to stay with you.  The only dressing requirement will be an absorbent pad in your underwear.  A lady's sanitary pad is usually all that is required for a few days.
You will be seen in Outpatient Clinic 6 weeks after surgery.

Use of EPSiT for Emergency Pilonidal Abscess

Traditionally in the setting of an abscess, the abscess is drained, left open and dressings are changed daily until it is healed which can sometimes take a few weeks to heal.

Dr Wong has developed a technique using EPSiT to treat pilonidal abscess which does not require daily dressings and recovery is nearly the same as an elective procedure.  In his experience, healing rates have been equivalent to elective cases.

  1. General anaesthetic procedure
  2. Abscess is drained via a small stab incision.
  3. Rigid scope is used to debride the abscess cavity and wash it out.
  4. Usual EPSiT is performed to clear sinus tracts, remove debri.
  5. Reverse EPSiT is performed from abscess incision to the sinus opening.
  6. Debridement of tract using ribbon gauze and brush.
  7. Irrigation of tract.
  8. Cautery of tract.
  9. Penrose drain is left passing from abscess opening through sinus tract and out sinus opening.
  10. Absorbent pad dressing only.
  11. Drain is pulled out by the patient and discarded after 3 days.
  12. Review in Clinic in 1 week then 6 weeks.