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Updated: May 6, 2026
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Published on: April 28, 2026
Endoscopic treatment versus open excision for pediatric pilonidal disease: technical description of a modified
J Kirsch1, S Drossard2, K Schriek3
1Wilhelmstift Children's Hospital, Liliencronstrasse 130, 22149, Hamburg, Germany.
Background:
Endoscopic pilonidal sinus treatment (EPSiT) has emerged as a minimally invasive treatment option for pilonidal disease (PD) in adolescents, yet its adoption has been limited by the need for specialized equipment. We developed a modified EPSiT technique using standard urological instruments, saline irrigation, and lateral positioning, which was introduced in 2019. This study provides a technical description of the modified approach and evaluates the outcomes compared with conventional open excision in a pediatric cohort.
Methods:
We conducted a single-center retrospective cohort study of 113 pediatric patients treated surgically for PD between 2014 and 2023. Patients were divided into two cohorts: EPSiT (n = 48, 2019-2023) and open excision (n = 65, 2014-2018). Clinical data were collected from medical records for both groups and structured telephone interviews for patients undergoing EPSiT. Outcomes included operative time, hospital stay, recurrence, pain, and satisfaction.
Results:
Gender distribution was identical in both cohorts (29.2% male, 70.8% female). Operative times were similar between groups (35.8 versus 31.7 min; p = .307). EPSiT was associated with significantly shorter hospital stays (mean difference -2.55 days; 95% CI -3.10 to -2.00; p < .001). Recurrence rates were comparable (16.7% versus 15.4%; p = .808). Patient-reported outcomes were available for the EPSiT cohort only and indicated high cosmetic satisfaction and minimal analgesic use. Among patients undergoing EPSiT, 41.7% returned to school immediately after discharge, and most resumed normal activities within a few days.
Conclusions:
This modified EPSiT approach is feasible and may increase accessibility in resource-limited settings, representing a less invasive treatment option for PD. Further prospective studies are needed to validate these findings and define the role of EPSiT in the treatment of pediatric PD.
