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Endoscopic pilonidal sinus treatment (EPSiT) in recurrent pilonidal disease: a prospective international multicenter study

  • Piercarlo Meinero
  • Marco La Torre
  • Giorgio LisiEmail author
  • Alessandro Stazi
  • Antonella Carbone
  • Luca Regusci
  • Fabrizio Fasolini
Original Article

Abstract

Background

Pilonidal disease (PD) is a common disease of the natal cleft, which can lead to complications including infection and abscess formation. Various operative management options are available, but the ideal technique is still debatable. Recurrent PD after surgical treatment is frequent event for the 25–30% of cases. The present study evaluated endoscopic pilonidal sinus treatment (EPSiT) in recurrent and multi-recurrent PD.

Methods

Of the consecutive prospective patients with recurrent PD, 122 were enrolled in a prospective international multicenter study conducted at a secondary and tertiary colorectal surgery centers. Primary endpoint was to evaluate short- and long-term outcomes: healing rate/time, morbidity rate, re-recurrence rate, and patient’s quality of life (QoL).

Results

Complete wound healing rate was occurred in 95% of the patient, with a mean complete wound healing time of 29 ± 12 days. The incomplete healing rate (5%) was significantly related to the number of external openings (p = 0.008), and recurrence was reported in six cases (5.1%). Normal daily activity was established on the first postoperative day, and the mean duration before patients returned to work was 3 days. QoL significantly increased between the preoperative stage and 30 days after the EPSiT procedure (45.3 vs. 7.9; p < 0.0001).

Conclusions

The EPSiT procedure seems to be a safe and effective technique in treating even complex recurrent PD. It enables excellent short- and long-term outcomes than various other techniques that are more invasive.

Keywords

Pilonidal disease Recurrent pilonidal sinus Minimally invasive treatment Endoscopic treatment VAAFT 

Notes

Authors’ contributions

Substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data: PM, GL, AS, AC, FF, LR, MLaT. Drafting the article or revising it critically for important intellectual content: PM, GL, AS, AC, FF, LR, MLaT. Final approval of the version to be published: PM, GL, AS, AC, FF, LR, MLaT.

Compliance with ethical standards

Conflicts of interest

Professor Piercarlo Meinero declares to receive financial grants from Karl Storz. The remaining authors declare no potential financial conflict of interest related to this study.

References

  1. 1.
    McCallum I, King PM, Bruce J (2007) Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev (4):CD006213 Review. Update in: Cochrane Database Syst Rev. 2010;(1):CD006213Google Scholar
  2. 2.
    Iesalnieks I, Deimel S, Schlitt HJ (2013) Karydakis flap for recurrent pilonidal disease. World J Surg 37(5):1115–1120CrossRefGoogle Scholar
  3. 3.
    Bascom J (1980) Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 87:567–572Google Scholar
  4. 4.
    Bascom J (1983) Pilonidal disease: long-term results of follicle removal. Dis Colon Rectum 26:800–807CrossRefGoogle Scholar
  5. 5.
    Tejirian T, Lee JJ, Abbas MA (2007) Is wide local excision for pilonidal disease still justified? Am Surg 73(10):1075–1078Google Scholar
  6. 6.
    Karydakis GE (1973) New approach to the problem of pilonidal sinus. Lancet 2(7843):1414–1415CrossRefGoogle Scholar
  7. 7.
    Gips M, Melki Y, Salem L, Weil R, Sulkes J (2008) Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients. Dis Colon Rectum 51(11):1656–1662CrossRefGoogle Scholar
  8. 8.
    Kepenekci I, Demirkan A, Celasin H, Gecim IE (2010) Unroofing and curettage for the treatment of acute and chronic pilonidal disease. World J Surg 34(1):153–157CrossRefGoogle Scholar
  9. 9.
    Meinero P, Mori L, Gasloli G (2014) Endoscopic pilonidal sinus treatment (E.P.Si.T.). Tech Coloproctol 18(4):389–392CrossRefGoogle Scholar
  10. 10.
    Meinero P, Mori L (2011) Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol 15:417–422CrossRefGoogle Scholar
  11. 11.
    Steele SR, Perry BW, Mills S, Buie WD (2013) Practice parameters for the management of pilonidal disease. Dis Colon Rectum 56:1021–1027CrossRefGoogle Scholar
  12. 12.
    Karakayali F, Karagulle E, Karabulut Z, Oksuz E, Moray G, Haberal M (2009) Unroofing and marsupialization vs. rhomboid excision and Limberg flap in pilonidal disease: a prospective, randomized, clinical trial. Dis Colon Rectum 52:496–502CrossRefGoogle Scholar
  13. 13.
    Horwood J, Hanratty D, Chandran P, Billings P (2012) Primary closure or rhomboid excision and Limberg flap for the management of primary sacrococcygeal pilonidal disease? A meta-analysis of randomized controlled trials. Color Dis 14(2):143–151CrossRefGoogle Scholar
  14. 14.
    Bali İ, Aziret M, Sözen S, Emir S, Erdem H, Çetinkünar S, İrkörücü O (2015) Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease. Clinics (Sao Paulo) 70(5):350–355CrossRefGoogle Scholar
  15. 15.
    Nordon IM, Senapati A, Cripps NP (2009) A prospective randomized controlled trial of simple Bascom's technique versus Bascom's cleft closure for the treatment of chronic pilonidal disease. Am J Surg 197(2):189–192CrossRefGoogle Scholar
  16. 16.
    Tien T, Athem R, Arulampalam T (2018) Outcomes of endoscopic pilonidal sinus treatment (EPSiT): a systematic review. Tech Coloproctol 22(5):325–331CrossRefGoogle Scholar
  17. 17.
    Gecim IE, Goktug UU, Celasin H (2017) Endoscopic pilonidal sinus treatment combined with crystalized phenol application may prevent recurrence. Dis Colon Rectum 60(4):405–407CrossRefGoogle Scholar
  18. 18.
    Milone M, Fernandez LMS, Musella M, Milone F (2016) Safety and efficacy of minimally invasive video-assisted ablation of pilonidal sinus. JAMA Surg 151(6):547–553CrossRefGoogle Scholar
  19. 19.
    Chia CLK, Tay VWY, Mantoo SK (2015) Endoscopic pilonidal sinus treatment in the Asian population. Surg Laparosc Endosc Percutan Tech 25(3):e95–e97CrossRefGoogle Scholar
  20. 20.
    Meinero P, Stazi A, Carbone A, Fasolini F, Regusci L, La Torre M (2016) Endoscopic pilonidal sinus treatment: a prospective multicentre trial. Color Dis 18(5):O164–O170CrossRefGoogle Scholar
  21. 21.
    Milone M, Musella M, Di Spiezio Sardo A, Bifulco G, Salvatore G, Sosa Fernandez LM et al (2014) Video-assisted ablation of pilonidal sinus: a new minimally invasive treatment—a pilot study. Surgery 155(3):562–566CrossRefGoogle Scholar
  22. 22.
    Giarratano G, Toscana C, Shalaby M, Buonomo O, Petrella G, Sileri P (2017) Endoscopic pilonidal sinus treatment: long-term results of a prospective series. JSLS J Soc Laparoendosc Surg 21(3):e2017.00043CrossRefGoogle Scholar
  23. 23.
    Emile SH, Elfeki H, Shalaby M, Sakr A (2018 Apr) A systematic review and meta-analysis of the efficacy and safety of video-assisted anal fistula treatment (VAAFT). Surg Endosc 32(4):2084–2093CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Colorectal Unit Sanatrix ClinicRomeItaly
  2. 2.Department of SurgeryEOC HospitalMendrisioSwitzerland
  3. 3.General Surgery and ProctologyUniversity Pittsburgh Medical Center - Salvator Mundi International HospitalRomeItaly
  4. 4.Department of SurgerySant’Eugenio HospitalRomeItaly
  5. 5.Department of General SurgerySant’Eugenio HospitalRomeItaly
  6. 6.Pelvic Care CenterMadonna delle Grazie HospitalRomeItaly
  7. 7.Policlinico Umberto I HospitalSapienza University of RomeRomeItaly

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