Endoscopic pilonidal sinus treatment (E.P.Si.T.): a minimally invasive approach

Controversy still exists regarding the best surgical technique for the treatment of pilonidal disease in terms of minimizing disease recurrence and patient discomfort. The present study analyzes the results of excision with primary closure and excision with flap reconstruction in the surgical treatment of sacrococcygeal pilonidal disease. From January 2003 to January 2006, 60 consecutive patients with primary pilonidal sinus disease received surgical treatment in the form of either excision and primary closure (group I, n = 20 patients) or excision and flap reconstruction (group II, n = 40 patients; modified Limberg flap n = 20, classic Limberg flap n = 10 and adipo-fasciocutaneous flap n = 10). Times for complete healing and return to work were recorded. To evaluate patient comfort, all patients were asked to complete a questionnaire including visual analog scale, time to sitting on toilet without pain, and time to walking without pain 3 months after surgery. Mean follow-up was 21 months. A significant difference was observed between the two groups in terms of length of hospital stay (P < 0.003), time to complete healing (P < 0.001), time off work (P < 0.001), wound infection (P < 0.01), recurrence rates (P < 0.01), times to sitting on toilet without pain (P < 0.002), and walking without pain (P < 0.001). The mean (standard deviation) postoperative visual analog scale scores were 6.1 (1.2) in the primary closure group vs. 7.4 (1.3) in the flaps groups (P < 0.001). In the modified Limberg flap, no wound infection, wound breakdown, or recurrence of the disease occurred. Flap reconstructions were superior to primary closure after excision of pilonidal sinus and that modified Limberg flap was superior with regard to wound infection and recurrence.

The ideal treatment for pilonidal disease remains controversial with many accepted procedures in current clinical use. This case series is focused on the results of the Bascom procedure for the treatment of sacrococcygeal pilonidal disease. The records of 127 consecutive patients treated by the authors for sacrococcygeal pilonidal disease were reviewed. The Bascom surgical procedure was performed on 127 consecutive patients in a clinical surgical practice. The series included 98 male and 29 female patients. The mean age of the patients reported in this series was 23 years, with a range of 14 to 49 years of age. The lateral incision healed in a mean of 12 days, with a range of 8 to 30 days. Recurrent disease occurred in 3 patients in this series. The Bascom surgical procedure for the treatment of sacrococcygeal pilonidal disease was found in this clinical practice series to have an excellent cure rate with a low recurrence rate. Patient satisfaction was high.