gms | German Medical Science

Introduction: Pilonidal sinus is a disease affecting predominantly young people. Standard treatment techniques (wide excision, marsupialization, different kinds of flaps) are often characterized by postoperative pain, huge wounds, bad aesthetic result and long recovery time.

The mini-invasive treatment using the Meinero’s fistuloscope, called EPSiT (Endoscopic Pilonidal Sinus Treatment) allows the destruction of the pilonidal cyst under endoscopic direct vision and the complete removal of all hairs.

Material and methods: Between November 2012 and September 2014 EPSiT was performed on 15 patients, one with multiple recurrences, four with complex fistolization (multiple orifices). Mean age was 27.5 years and the percentage of male was 80%. We included all patients referred to surgery with fistula in pilonidal disease and excluded the acute abscesses. Surgery was performed initially under spinal anaesthesia, then, progressively, under local anaesthesia with endovenous analgesia-sedation. The post-operative home wound care consisted of daily self-application of water (jet-wash like) of the wound with a 20 ml syringe.

EPSiT procedure is divided in two steps: firstly a diagnostic fistuloscopy to retrieve hairs and further occult incomplete fistulous tract and then a therapeutic removal of all hairs and the destruction of all inflammatory fistula wall tracts by under-vision electrocauterization and mechanical curettage.

Results: Hair were found in all cysts operated. No major or minor complications were observed. Post-operative mean maximum pain experienced was 2.9/10 on a VAS scale. All patients were discharged in the same or next day after the operation. The average return to work time was 4.8 days. We haven’t observed recurrences at a median follow-up of 3 months. Aesthetic result was rated very good by all the patients.

Conclusion: EPSIT revealed to be a valid mini-invasive method to treat the pilonidal sinus disease, with promising low recurrence rate (none in our short term experience), a low post-operative pain, a low complication rate (none in our short term experience) allowing a short return to work time and a very good aesthetic result.