International Journal of Colorectal Disease

, Volume 34, Issue 4, pp 561–568 | Cite as

Minimally invasive techniques in the management of pilonidal disease

  • Ramya Kalaiselvan
  • Sonia Bathla
  • William Allen
  • Aloka LiyanageEmail author
  • Rajasundaram Rajaganeshan



Pilonidal sinus disease (PD) is a chronic condition involved in natal cleft. Excision surgery carries equally morbid course of recovery to that of disease itself. Minimally invasive treatments therefore have been developed to minimise morbidity and improve healing rates. This review looks at the literature on effectiveness of endoscopic pilonidal sinus treatment (EPSiT) and compares that of the other minimally invasive techniques in practice.


MEDLINE, EMBASE, Cochrane and CINAHL databases were searched to look at the peer-reviewed articles on minimally invasive treatments on PD. Primary endpoint was to determine complication rates. Data were pooled using random effect model. Heterogeneity among studies was estimated with χ2 tests. Statistical analysis was performed with Review Manager Version 5.1.2.


Out of 371 papers, ten were retrieved for full appraisal. One randomised clinical trial (RCT) and four case series presented retrospective data on EPSiT. Five RCTs were on alternative minimally invasive treatments. Complication rate, return to work, wound healing rate and pain scores were superior in minimally invasive treatments compared to excision surgery. There was no statistically significant difference in complication rate or return to work in EPSiT compared to that of alternate minimally invasive techniques.


Minimally invasive treatments of pilonidal disease were found to be safe and effective compared to conventional techniques. It is also demonstrated that EPSiT is a safe alternative with a low short-term complication rate. Further randomised controlled trials are required to more accurately define its effectiveness and closely evaluate the side effect profile.


Pilonidal sinus Pilonidal disease Abscess 


Compliance with ethical standard

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Sondenaa K, Andersen E, Nesvik I, Soreide JA (1995) Patient characteristics and symptoms in chronic pilonidal disease. Int J Color Dis 10:39–42CrossRefGoogle Scholar
  2. 2.
    Al-Khamis A, McCallum I, King PM, Bruce J (2010) Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev 20:CD006213Google Scholar
  3. 3.
    Mayo OH (1833) Observation on injuries and diseases of the rectum. Burgess and Hill 4:45–46Google Scholar
  4. 4.
    Anderson AW (1847) Hair extracted from an ulcer. Boston Med Surg J 36:74–76Google Scholar
  5. 5.
    Hodges RM (1880) Pilonidal sinus. Boston Med Surg J 103:485–486CrossRefGoogle Scholar
  6. 6.
    Chintapatla S, Safarani N, Kumar S, Haboubi N (2003) Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. Tech Coloproctol 7(1):3–8CrossRefGoogle Scholar
  7. 7.
    Thompson MR, Senapati A, Kitchen P (2011) Simple day-case surgery for pilonidal sinus disease. Br J Surg 98:198–209CrossRefGoogle Scholar
  8. 8.
    Lord PH, Millar DM (1965) Pilonidal sinus: a simple treatment. Br J Surg 52:298–300CrossRefGoogle Scholar
  9. 9.
    Millar DM, Lord PH (1967) The treatment of acute postanal pilonidal abscess. Br J Surg 54:598–599CrossRefGoogle Scholar
  10. 10.
    Bascom J (1983) Pilonidal disease: long term results of follicle removal. Dis Colon Rectum 26:800–807CrossRefGoogle Scholar
  11. 11.
    Karydakis GE (1992) Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg 62:385–389CrossRefGoogle Scholar
  12. 12.
    Girgin M, Kanat BH, Ayten R, Cetinkaya Z, Kanat Z, Bozdağ A, Turkoglu A, Ilhan YS (2012) Minimally invasive treatment of pilonidal disease: crystallized phenol and laser depilation. Int Surg 97(4):288–292CrossRefGoogle Scholar
  13. 13.
    Meinero P, Mori L, Gasloli G (2014) Endoscopic pilonidal sinus treatment (E.P.Si.T.). Tech Coloproctol 18(4):389–392CrossRefGoogle Scholar
  14. 14.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2010) PRISMA group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336–341CrossRefGoogle Scholar
  15. 15.
    Milone M, Bianco P, Musella M, Milone F (2014) A technical modification of video-assisted ablation for recurrent pilonidal sinus. Color Dis 16(11):404–406CrossRefGoogle Scholar
  16. 16.
    Milone M, Musella M, Di Spiezio Sardo A, Bifulco G, Salvatore G, Sosa Fernandez LM, Bianco P, Zizolfi B, Nappi C, Milone F (2014) Video-assisted ablation of pilonidal sinus: a new minimally invasive treatment - a pilot study. Surgery 155(3):562–566CrossRefGoogle Scholar
  17. 17.
    Chia CLK, Tay VWY, Mantoo SK (2015) Endoscopic pilonidal sinus treatment in the Asian population. Surg Laparosc Endosc Percutan Tech 25(3):e95–e97CrossRefGoogle Scholar
  18. 18.
    Gaslioli G, Regusci L, Poli G, Meinero P, Pasolini F (2015) EPSiT (endoscopic pilonidal sinus treatment) described by Meinero: a well-tolerated mini-invasive approach to the pilonidal sinus disease. Feasibility in a community hospital. Br J Surg 102(S6):1–22CrossRefGoogle Scholar
  19. 19.
    Milone M, Fernandez LM, Musella M, Milone F (2016) Safety and efficacy of minimally invasive video-assisted ablation of pilonidal sinus: a randomized clinical trial. JAMA Surg 151(6):547–553CrossRefGoogle Scholar
  20. 20.
    Gencosmanoglu R, Inceoglu R (2005) Modified lay-open (incision, curettage, partial lateral wall excision and marsupialization) versus total excision with primary closure in the treatment of chronic sacrococcygeal pilonidal sinus. A prospective, randomized clinical trial with a complete two-year follow-up. Int J Color Dis 20:415–422CrossRefGoogle Scholar
  21. 21.
    Karakayali F, Karagulle E, Karabulut Z, Oksuz E, Moray G, Haberal M (2009) Unroofing and marsupialization vs. rhomboid excision and Limberg flap in pilonidal disease: a prospective, randomized, clinical trial. Dis Colon Rectum 52(3):496–502CrossRefGoogle Scholar
  22. 22.
    Lorant T, Ribbe I, Mahteme H, Gustafsson UM, Graf W (2011) Sinus excision and primary closure versus laying open in pilonidal disease: a prospective randomized trial. Dis Colon Rectum 54(3):300–305CrossRefGoogle Scholar
  23. 23.
    Mohamed HA, Kadry I, Adly S (2005) Comparison between three therapeutic modalities for non-complicated pilonidal sinus disease. Surgeon 3(2):73–77CrossRefGoogle Scholar
  24. 24.
    Nordon IM, Senapati A, Cripps NP (2009) A prospective randomized controlled trial of simple Bascom's technique versus Bascom's cleft closure for the treatment of chronic pilonidal disease. Am J Surg 197(2):189–192CrossRefGoogle Scholar
  25. 25.
    Testini M, Piccinni G, Miniello S, Di Venere B, Lissidini G, Nicolardi V, Bonomo GM (2001) Treatment of chronic pilonidal sinus with local anaesthesia: a randomized trial of closed compared with open technique. Color Dis 3(6):427–430CrossRefGoogle Scholar
  26. 26.
    Fazeli MS, Adel MG, Lebaschi AH (2006) Comparison of outcomes in Z-Plasty and delayed healing by secondary intention of the wound after excision of the sacral pilonidal sinus: results of a randomized, clinical trial. Dis Colon Rectum 49(12):1831–1836CrossRefGoogle Scholar
  27. 27.
    McCallum IJ, King PM, Bruce J (2008) Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis. BMJ 336(7649):868–871CrossRefGoogle Scholar
  28. 28.
    Ozkan Z, Aksoy N, Emir S, Kanat BH, Gonen AN, Yazar FM, Cimen AR (2014) Investigation of the relationship between serum hormones and pilonidal sinus disease: a cross-sectional study. Color Dis 16(4):311–314CrossRefGoogle Scholar
  29. 29.
    Segre D, Pozzo M, Perinotti R, Roche B (2015) The treatment of pilonidal disease: guidelines of the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol 19:607–613CrossRefGoogle Scholar
  30. 30.
    Gips M, Melki Y, Salem L, Weil R, Sulkes J (2008) Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients. Dis Colon Rectum 51(11):1656–1662CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.St Helens and Knowsley NHS Foundation TrustWhiston HospitalPrescotEngland

Personalised recommendations