Endoscopic Treatment of Pilonidal Sinus Disease: State of Art and Review of the Literature

Abstract

Background: Pilonidal sinus disease (PSD) is a chronic troublesome pathology of the natal cleft of the sacrococcygeal region, with an estimated incidence of 26 cases in every 100,000 inhabitants. The aim of this review is to give a snapshot of the current literature on the endoscopic approach to PSD.Methods: A search on endoscopic treatment of pilonidal disease was performed according to PRISMA guidelines, adopting the following search terms: (pilonidal OR sacrococcygeal) and (endoscopic OR VAAPS OR EPSiT OR minimally invasive OR video-assisted OR video assisted).Results: Thirty-four articles were included in the final analysis, among which 23 were on adults and 11 were on pediatric population. The endoscopic approach is associated with painless postoperative pain, good aesthetic results, short time off work, and high patient satisfaction.Despite these advantages in short-term outcomes, results on recurrence rate in a long-term follow up are needed to definitively confirm the importance of this technique.Conclusions: The endoscopic approach is associated with significant postoperative advantages over other standard surgical approaches, and it should be included in the surgical portfolio for the treatment of PSD. According to the Italian guidelines, this technique could be considered as the gold standard for limited PSD. However, the favorable short-term-outcomes and lack of reliable data on long-term follow-up must be a stimulus to perform further high-quality studies to give definitive conclusions on this technique.

Outcomes of Sinus Laser Therapy in Sacrococcygeal Pilonidal Sinus Disease: A Single-Center Experience

“…SiLaT is one of the promising techniques of the growing trend toward minimally invasive treatment of SPND, but it needs to be further investigated and validated, which is the main aim of the current study. The demographic characteristics of the patients were similar to those reported in the literature [1,2,[4][5][6]10,12,13].…”

“…Sacrococcygeal pilonidal sinus disease (SPND) is an acquired disease with no precise etiopathogenesis. It is mainly related to the recurrent erosion of hair follicles, resulting in a tract or cavity at the natal cleft (the sacrococcygeal region) [1][2][3]. The most common complaints are pain, discharge, bleeding, and itchiness around the sacrococcygeal region.…”

“…For unknown reasons, SPND incidence has been increasing in the past decades. It is estimated to be 26 cases per 100,000 inhabitants, reaching up to 46 cases/100,000, with a higher prevalence among males and individuals aged between 15 and 30 years [ 1 , 5 ].…”

“…A gold standard definitive treatment for SPND remains controversial despite the variety of available surgical options [ 1 ]. Since there is a significant negative impact of SPND on the quality of life of affected subjects even after surgical management, new management techniques have become need of the hour, such as sinus laser therapy (SiLaT) or sinus laser-assisted closure (SiLaC).…”

An effective and considerable treatment of pilonidal sinus disease by laser ablation

“…Although the cause is not clear, it is believed to be acquired, and it is related to obesity, exuberant hair, and the deep cleft between the buttocks [ 1 ]. The incidence rate is highest among the Caucasian population; in Europe and the USA, its incidence is 26/100,000, most of the patients are aged between 15 and 30 years [ 2 ]. The incidence rate among males is 4 times higher than that among females [ 3 ].…”