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Endoscopic Pilonidal Sinus Treatment Versus Excisional Surgery: A Retrospective Comparison at an Australian Tertiary
Su Su Hlaing1, Harine Siribaddana1, Harish Iswariah1
1General Surgery Department, The Prince Charles Hospital, Brisbane, Australia.
Insights
Endoscopic pilonidal sinus treatment (EPSiT) offers similar healing and recurrence rates to excisional surgery. EPSiT facilitates same-day discharge and reduces opioid use, but caution is advised for patients with prior abscess drainage.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Procedures
- Surgical Outcomes
Background:
- Pilonidal sinus disease is a common condition requiring surgical intervention.
- Endoscopic pilonidal sinus treatment (EPSiT) is a minimally invasive option with potential recovery benefits.
- Comparative data on EPSiT versus traditional excisional surgery in Australia is limited.
Purpose of the Study:
- To compare the outcomes of EPSiT with contemporary excisional surgical practices for pilonidal sinus disease.
- To evaluate primary healing, recurrence rates, same-day discharge, and opioid prescription following EPSiT and excisional surgery.
Main Methods:
- Retrospective cohort study of 180 elective pilonidal operations in patients aged ≥12 years (January 2018-May 2025).
- Comparison between EPSiT (n=115) and excisional surgery (n=65), including repeat procedures.
- Primary outcomes: primary healing and recurrence. Secondary outcomes: same-day discharge and opioid prescription.
Main Results:
- Primary healing rates were similar between EPSiT (89.6%) and excision (84.6%) (p=0.330).
- Recurrence rates were also similar (EPSiT 29.1% vs. excision 21.8%; p=0.322).
- EPSiT demonstrated significantly higher same-day discharge (86.1% vs. 21.5%; p<0.001) and lower opioid prescribing (2.6% vs. 63.1%; p<0.001).
Conclusions:
- EPSiT provides comparable primary healing and recurrence rates to excisional surgery.
- EPSiT significantly enhances ambulatory care and reduces opioid requirements post-discharge.
- Prior abscess incision and drainage increases recurrence risk after EPSiT, necessitating tailored patient counseling.
Background:
Endoscopic pilonidal sinus treatment (EPSiT) may reduce recovery burden, but comparative data against contemporary excisional practices in Australia are limited.
Methods:
We conducted a retrospective cohort study of consecutive elective pilonidal operations in patients aged ≥ 12 at a tertiary Australian hospital (January 2018-May 2025). Analyses were performed at the operative episode level, including repeat procedures. EPSiT was compared with excisional surgery (off-midline flap closure, lay-open excision or primary closure). The primary outcomes were primary healing and recurrence after healing. Secondary outcomes were same-day discharge and opioid prescription at discharge.
Results:
The cohort included 180 elective operative episodes in 144 patients: 115 EPSiT (63.9%) and 65 excisional (36.1%). Primary healing occurred in 158 episodes (87.8%) and did not differ between EPSiT and excision (89.6% vs. 84.6%; p = 0.330). Recurrence occurred in 26.6% and was similar between groups (29.1% vs. 21.8%; p = 0.322). EPSiT was associated with higher same-day discharge (86.1% vs. 21.5%; p < 0.001) and lower opioid prescribing at discharge (2.6% vs. 63.1%; p < 0.001). In the subgroup with prior emergency I&D (n = 66), primary healing remained similar (89.5% vs. 85.7%; p = 0.644), but recurrence after healing was higher following EPSiT (47.1% vs. 20.8%; p = 0.041).
Conclusions:
EPSiT achieved similar primary healing and recurrence to excisional surgery while enabling ambulatory care and opioid-sparing discharge. Prior abscess I&D was associated with higher recurrence after EPSiT despite comparable primary healing, supporting tailored counselling and selective EPSiT use when long-term durability is prioritised.
