Techniques in Coloproctology (2018) 22:325–331
Outcomes of endoscopic pilonidal sinus treatment (EPSiT):
a systematic review
· R. Athem
· T. Arulampalam
Received: 27 January 2018 / Accepted: 21 May 2018 / Published online: 31 May 2018
© Springer International Publishing AG, part of Springer Nature 2018
Background Pilonidal sinus 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. More
recently minimally invasive approaches have been described. Our aim was to review the current literature on endoscopic
pilonidal sinus treatment (EPSiT) and its outcomes.
Methods A systematic literature review was conducted and reported in accordance to the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of EMBASE, MEDLINE and Cochrane Library was
conducted in November 2017. Full-text studies on the use of endoscopy for the treatment of pilonidal sinus were included
in the review.
Results Initial search results returned 52 articles. Eight studies (eight case series and one randomised control trial) were
included in the ﬁnal qualitative synthesis. These studies demonstrated that EPSiT has good complete healing rates and low
recurrence rates. There was also a high level of patient satisfaction and little time taken oﬀ work. Two studies reported
modiﬁcations to the original technique. The main limitation was the lack of comparative studies.
Conclusions Initial studies on EPSiT have shown promising results. However, there is a need for a standardised technique
and more comparative studies to validate this novel procedure.
Keywords Pilonidal sinus · Endoscopic surgery · Coloproctology · Endoscopy
Pilonidal sinus (PS) is a common disease aﬀecting the natal
cleft with an estimated incidence of 26 per 100,000 people.
PS mainly occurs in young men and is associated with being
overweight, having a sedentary lifestyle and local irritation
. PS usually causes pain and can lead to complications
such as abscess formation and recurrent acute or chronic
The most eﬀective treatment for pilonidal sinus remains
debatable despite various surgical options being available
. Open excision and healing by secondary intention is
painful, and results in large wounds that require frequent
postoperative clinic visits for dressing, all of which result in
poor quality of life . The more favoured approach seems
to be excision of the PS and primary closure with midline
closures or ﬂap-based procedures . An extensive review
on the treatment of pilonidal sinus by Allen-Mersh  was
performed in 1990, which concluded that the choice of sur-
gical approach is dependent on the surgeon’s experience of
the procedure and perceived results in terms of healing speed
and recurrence rate. This still remains true today.
The traditional Bascom’s and Karydakis procedures, in
particular, are known for their complications. For the Bas-
com’s procedure, the midline pit is excised with an addi-
tional lateral incision, which is undermined to allow excision
of a sinus tract or cyst . A primary healing rate of 88% has
been reported for the Bascom’s procedure . The Karyda-
kis procedure excises the entire sinus tract and openings en
bloc followed by primary closure oﬀ midline achieved by
advancement ﬂap . Superﬁcial wound breakdown of 38%
and complete wound breakdown of 8.4% have been reported
for the Karydakis procedure .
The general trend for surgery and procedural interven-
tions to move from open to minimally invasive techniques
* T. Tien
Department of General Surgery, Colchester Hospital
University Foundation Trust, Colchester, UK