Clinical Scorecard: Utilization of EPSiT for Pilonidal Sinus Disease: An International Delphi Consensus Study Supported by the Association of Laparoscopic Surgeons of Great Britain and Ireland (ALSGBI)

At a Glance

Key Highlights

• EPSiT and VAAPS are minimally invasive alternatives to traditional surgery with reduced complications, pain, hospital stay, and faster recovery.
• Despite benefits, EPSiT uptake remains low in the UK due to evolving evidence, lack of guidelines, training gaps, and technique modifications.
• Delphi consensus study aims to standardise EPSiT technique and improve adoption, endorsed by ALSGBI with expert international surgeon participation.

Guideline-Based Recommendations

Diagnosis

• Perform diagnostic phase using fistuloscope to identify sinus cavity and fistula tracts under direct vision.

Management

• Administer single-dose antibiotic prophylaxis pre-operatively.
• Make a 5-mm incision around the discharging sinus for fistuloscope introduction.
• Remove all hairs inside the sinus with forceps.
• Cauterise fistula cavity and tracts with electrode.
• Remove epithelial and granulation tissue with endobrush or Volkmann spoon.
• Infuse glycine/mannitol 1% solution during EPSiT procedure.
• Post-operative wound care with light dressing, no packing, and once-daily saline wound washing for at least 2 weeks.

Monitoring & Follow-up

• Monitor for wound infection, wound dehiscence, seroma, and haematoma, noting reduced incidence compared to conventional surgery.
• Assess for disease recurrence, acknowledging no significant difference in recurrence rates compared to traditional surgery.

Risks

• Potential for disease recurrence similar to conventional surgery.
• Possible complications include wound infection, wound breakdown, seroma, and haematoma, though rates are reduced.

Patient & Prescribing Data

Patients with limited or recurrent pilonidal sinus disease undergoing EPSiT.

EPSiT offers reduced post-operative pain, shorter hospital stay, and faster return to daily activities compared to conventional surgery, but recurrence risk remains similar.

Clinical Best Practices

• Standardise EPSiT technique to improve uptake and outcomes.
• Use prone positioning and single-dose antibiotic prophylaxis during procedure.
• Employ direct vision endoscopic approach with appropriate irrigation solution (glycine/mannitol 1%).
• Avoid wound packing post-operatively; use light dressing and daily saline irrigation.
• Incorporate EPSiT training into surgical education to address current uptake barriers.
• Consider EPSiT as treatment of choice for limited disease and apply same approach for recurrent disease.

References

• Endoscopic Pilonidal Sinus Treatment (EPSiT) Introduction
• Video-Assisted Ablation of Pilonidal Sinus (VAAPS) Introduction
• Italian Society of Colorectal Surgery Consensus on PD Management
• UK PITSTOP Cohort Study on EPSiT Uptake
• Delphi Method in Healthcare Research