Modified Endoscopic Pilonidal Sinus Treatment (mEPSiT): a prospective study of mid to long term results in an Asian population

Introduction: Surgical treatment of pilonidal sinus disease (PSD) is debated. Endoscopic pilonidal sinus treatment is a new minimally invasive technique with early outcomes reported by the first author and other investigators. Mid to long term results have not been investigated and reported in the Asian population. A modified technique of mEPSiT will be discussed and demonstrated in the form of a video. Methods: A prospective data collection of 20 consecutive patients, with PSD, who had mEPSiT performed from February 2014 to June 2016, at Khoo Teck Puat Hospital, Singapore, was done. Patients with pilonidal abscess were excluded and were managed with incision and drainage or saucerisation. The primary outcome measure for this study was complete wound healing, defined as complete healing of the sinus opening with no discharge and healthy scar. Secondary outcome measures were time taken for complete healing, persistence of sinus, recurrence of PSD and failure of EPSiT. Other surgical outcomes such as operation time, post-operative pain, and use of analgesia were also analyzed. Results: All patients had a good postoperative recovery with no immediate complications. Patients were followed-up for a median period of 71 days (range 26-167days). Complete wound healing was achieved in 80% patients (n=16) and of these 16 patients, 75% (n=12) had complete wound healing in less than two months. No patients were lost to follow-up before complete wound healing. Two patients (10%) had persistence of external opening of pilonidal sinus disease but had no discharge. 2 patients (10%) had recurrence of symptoms after apparent healing. Conclusion: EPSiT is gaining popularity with encouraging results published over the last one or two years. Effectiveness and modifications of this procedure need to be further evaluated in the setting of different population groups and races and in comparison to other treatment modalities of pilonidal sinus disease.