Surgical Endoscopy

, Volume 32, Issue 9, pp 3754–3762 | Cite as

Endoscopic pilonidal sinus treatment: a systematic review and meta-analysis

  • Sameh Hany Emile
  • Hossam Elfeki
  • Mostafa Shalaby
  • Ahmad Sakr
  • Valentina Giaccaglia
  • Pierpaolo Sileri
  • Steven D. Wexner



Sacrococcygeal pilonidal disease (SPD) is a common surgical condition for which a multitude of surgical treatments have been described. The present review aimed to evaluate the efficacy and safety of a novel endoscopic procedure for the treatment of SPD.


An organized literature search was conducted. Electronic databases including PubMed/Medline, Scopus, Embase, and Cochrane library were searched for articles that assessed the endoscopic treatment for SPD. The main outcome parameters were failure of the technique including persistence and recurrence of SPD, postoperative complications and pain, time to complete healing, and time to return to work.


Nine studies with a total of 497 patients were included. Mean age of patients was 24.8 years. Mean operation time was 34.7 min. The procedure was performed as day-case surgery in all studies. The mean Visual analogue score of pain within the first week was 1.35. Failure of the technique was recorded in 40 (8.04%) patients, 20 (4.02%) had persistent SPD and 20 (4.02%) developed recurrence. The weighted mean failure rate of the technique was 6.3% (95% CI 3.6–9.1). Mean weighted complication rate was 1.1% (95% CI 0.3–2.4). Mean time to complete healing was 32.9 days and mean time to return to work was 2.9 days.


The endoscopic treatment of pilonidal sinus is a promising and safe method of treatment of SPD. The main advantages of the endoscopic treatment as compared to conventional surgery are the minimal postoperative pain, quick healing, and short time to return to work and daily activities.


Pilonidal sinus Endoscopic Treatment Pilonidal disease Review Meta-analysis 


Author contributions

SHE and MS designed the study. SHE, HE, MS, and AS participated in data collection and analysis, writing and drafting of the manuscript. VG and PS participated in data interpretation, drafting and critical revision of the manuscript. SDW reviewed the collected results on regular basis and participated in drafting and critical revision of the manuscript.

Compliance with ethical standards


Steven D. Wexner, M.D. is a paid consultant and receives royalties from Karl Storz Endoscopy, America. Sameh Emile, Hossam Elfeki, Mostafa Shalaby, Ahmad Sakr, Valentina Giaccaglia, and Pierpaolo Sileri have no conflict of interests or financial ties to disclose.


  1. 1.
    Hull TL, Wu J (2002) Pilonidal disease. Surg Clin N Am 82(6):1169–1185CrossRefPubMedGoogle Scholar
  2. 2.
    da Silva JH (2000) Pilonidal cyst: cause and treatment. Dis Colon Rectum 43(8):1146–1156CrossRefPubMedGoogle Scholar
  3. 3.
    Tokac M, Dumlu EG, Aydin MS, Yalcın A, Kilic M (2015) Comparison of modified Limberg flap and Karydakis flap operations in pilonidal sinus surgery: prospective randomized study. Int Surg 100(5):870–877. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kayaalp C, Aydin C (2009) Review of phenol treatment in sacrococcygeal pilonidal disease. Tech Coloproctol 13(3):189–193. CrossRefPubMedGoogle Scholar
  5. 5.
    Lund J, Tou S, Doleman B, Williams JP (2017) Fibrin glue for pilonidal sinus disease. Cochrane Database Syst Rev 1:CD011923. PubMedCrossRefGoogle Scholar
  6. 6.
    Elbanna HG1, Emile SH, Youssef M, Thabet W, El-Hamed TM, Ghnnam WM (2016) Novel approach of treatment of pilonidal sinus disease with thrombin gelatin matrix as a sealant. Dis Colon Rectum 59(8):775–780. CrossRefPubMedGoogle Scholar
  7. 7.
    Steele SR, Perry WB, Mills S, Buie WD, Standards Practice Task Force of the American Society of Colon and Rectal Surgeons (2013) Practice parameters for the management of pilonidal disease. Dis Colon Rectum 56(9):1021–1027. CrossRefPubMedGoogle Scholar
  8. 8.
    Meinero P, Mori L, Gasloli G (2014) Endoscopic pilonidal sinus treatment (E.P.Si.T.). Tech Coloproctol 18(4):389–392. CrossRefPubMedGoogle Scholar
  9. 9.
    Meinero P, Mori L (2011) Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol 15:417–422CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta analyses of studies that evaluate health care interventions: explanation and elaboration. BMJ 339:b2700. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    National Institute for Health and Clinical Excellence. NICE clinical guidelines, appendix 4 quality of case series form. Accessed 10 Oct 2017
  12. 12.
    Scottish Intercollegiate Guidelines Network (SIGN) Guidelines, methodology checklist 3. Accessed 10 Oct 2017
  13. 13.
    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. PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Gecim IE, Goktug UU, Celasin H (2017) Endoscopic pilonidal sinus treatment combined with crystalized phenol application may prevent recurrence. Dis Colon Rectum 60(4):405–407. CrossRefPubMedGoogle Scholar
  15. 15.
    Javed MA1, Fowler H, Jain Y, Singh S, Scott M, Rajaganeshan R (2016) Comparison of conventional incision and drainage for pilonidal abscess versus novel endoscopic pilonidal abscess treatment (EPAT). Tech Coloproctol 20(12):871–873CrossRefPubMedGoogle Scholar
  16. 16.
    Meinero P, Stazi A, Carbone A, Fasolini F, Regusci L, La Torre M (2016) Endoscopic pilonidal sinus treatment: a prospective multicentre trial. Colorectal Dis 18(5):O164–O170. CrossRefPubMedGoogle Scholar
  17. 17.
    Milone M, Fernandez LM, Musella M, Milone F (2015) Safety and efficacy of minimally invasive video-assisted ablation of pilonidal sinus: a randomized clinical trial. JAMA Surg 151(6):547–553. CrossRefGoogle Scholar
  18. 18.
    Chia CL, Tay VW, Mantoo SK (2015) Endoscopic pilonidal sinus treatment in the Asian population. Surg Laparosc Endosc Percutan Tech 25(3):e95–e97. CrossRefPubMedGoogle Scholar
  19. 19.
    Milone M, Bianco P, Musella M, Milone F (2014) A technical modification of video-assisted ablation for recurrent pilonidal sinus. Colorectal Dis 16(11):O404–O406. CrossRefPubMedGoogle Scholar
  20. 20.
    Milone M, Musella M, Di Spiezio Sardo A, Bifulco G, Salvatore G, Sosa Fernandez LM, Bianco P, Zizolfi B, Nappi C, Milone F (2014) Video-assisted ablation of pilonidal sinus: a new minimally invasive treatment: a pilot study. Surgery 155(3):562–566. CrossRefPubMedGoogle Scholar
  21. 21.
    Bendewald FP, Cima RR (2007) Pilonidal disease. Clin Colon Rectal Surg 20(2):86–95. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Emile SH, Elfeki H, Shalaby M, Sakr A (2017) A Systematic review and meta-analysis of the efficacy and safety of video-assisted anal fistula treatment (VAAFT). Surg Endosc. PubMedCrossRefGoogle Scholar
  23. 23.
    McCallum IJD, King PM, Bruce J (2008) Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis. BMJ 336(7649):868–871. CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Garg P, Menon GR, Gupta V (2016) Laying open (deroofing) and curettage of sinus as treatment of pilonidal disease: a systematic review and meta-analysis. ANZ J Surg 86(1–2):27–33. CrossRefPubMedGoogle Scholar
  25. 25.
    Kayaalp C, Ertugrul I, Tolan K, Sumer F (2016) Fibrin sealant use in pilonidal sinus: systematic review. World J Gastrointest Surg 8(3):266–273. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Elalfy K, Emile S, Lotfy A, Youssef M, Elfeki H (2016) Bilateral gluteal advancement flap for treatment of recurrent sacrococcygeal pilonidal disease: a prospective cohort study. Int J Surg 29:1–8. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Sameh Hany Emile
    • 1
    • 6
  • Hossam Elfeki
    • 1
    • 2
  • Mostafa Shalaby
    • 1
    • 4
  • Ahmad Sakr
    • 1
  • Valentina Giaccaglia
    • 3
  • Pierpaolo Sileri
    • 4
  • Steven D. Wexner
    • 5
  1. 1.Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of MedicineMansoura UniversityMansouraEgypt
  2. 2.Department of SurgeryAarhus University HospitalAarhusDenmark
  3. 3.Colorectal Surgery Unit, General Surgery DepartmentMediclinic City HospitalDubaiUnited Arab Emirates
  4. 4.Department of General Surgery UOC CUniversity of Rome Tor VergataRomeItaly
  5. 5.Department of Colorectal SurgeryCleveland Clinic FloridaWestonUSA
  6. 6.General Surgery Department, Faculty of MedicineMansoura University HospitalsMansouraEgypt

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