Skip to main content


Log in

The EPIC procedure (Endoscopic-assisted Pilonidal Irrigation and Cleaning): a simple and effective treatment for pilonidal disease

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript



Pilonidal disease (PD) is a common condition of the sacrococcygeal region leading to inflammation and abscess formation. PD is a topic of renewed interest due to the lack of satisfactory management options. Minimally invasive techniques have recently been investigated, with promising results in adult and pediatric populations. Our technique, the “EPIC procedure,” Endoscopic-assisted Pilonidal Irrigation and Cleaning, involves removal of hair under direct visualization using a small endoscope while flushing saline through the cavity via an angiocatheter. We aim to show that the EPIC procedure is a safe and effective operation for the treatment of pilonidal disease in the pediatric population.

Materials and methods

We performed a retrospective chart review including 20 consecutive patients. All had a primary sacrococcygeal pilonidal sinus; all underwent the EPIC procedure. Post-operative care instructions included daily bathing and weekly depilatory application. We evaluated gender, age, weight, disease severity, operative duration, recurrence of PD, and other complications.


In the 20 patients studied, 22 EPIC procedures were performed. The median follow-up duration was 27.95 (range 0.63–45.27) months. The mean operative duration was 28.8 (SD 10.2) min. There was a 15% recurrence rate (95% CI 0.00%, 30.65%).


The EPIC procedure is an endoscopic-assisted operation that simplifies previously published techniques in pursuit of reduced operative complexity, cost, and time, with comparable recurrence and complication rates. All three recurrences occurred in patients that did not follow instructions for post-operative depilatory care. Two of these patients underwent repeat EPIC procedure and had no further complications. The third was lost to follow-up. The EPIC procedure provides a simple, effective, and minimally invasive approach to the treatment of pilonidal disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Khanna A, Rombeau JL (2011) Pilonidal disease. Clin Colon Rectal Surg 24:46–53

    Article  PubMed  PubMed Central  Google Scholar 

  2. de Parades V, Bouchard D, Janier M, Berger A (2013) Pilonidal sinus disease. J Visc Surg 150:237–247

    Article  PubMed  Google Scholar 

  3. Chintapatla S, Safarani N, Kumar S, Haboubi N (2003) Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. Tech Coloproctol 7:3–8

    Article  CAS  PubMed  Google Scholar 

  4. Søndenaa K, Andersen E, Nesvik I, Søreide JA (1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 10:39–42.

    Article  PubMed  Google Scholar 

  5. Lord PH, Millar DM (1965) Pilonidal sinus: a simple treatment. Br J Surg 52:298–300.

    Article  CAS  PubMed  Google Scholar 

  6. Azab ASG, Kamal MS, Saad RA, Abou Al Atta KA, Ali NA (1984) Radical cure of pilonidal sinus by a transposition rhomboid flap. Br J Surg 71:154–155.

    Article  CAS  PubMed  Google Scholar 

  7. Bascom JU (1987) Repeat pilonidal operations. Am J Surg 154:118–122.

    Article  CAS  PubMed  Google Scholar 

  8. Hull TL, Wu J (2002) Pilonidal disease. Surg Clin North Am 82:1169–1185

    Article  PubMed  Google Scholar 

  9. Isik A, Idiz O, Firat D (2016) Novel approaches in pilonidal sinus treatment. Prague Med Rep 117:145–152.

    Article  PubMed  Google Scholar 

  10. Meinero P, Mori L (2011) Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol 15:417–422.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Jain Y, Javed MA, Singh S, Rout S, Joshi H, Rajaganeshan R (2017) Endoscopic pilonidal abscess treatment: a novel approach for the treatment of pilonidal abscess. Ann R Coll Surg Engl 99:134–136.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Meinero P, Stazi A, Carbone A, Fasolini F, Regusci L, La Torre M (2016) Endoscopic pilonidal sinus treatment: a prospective multicentre trial. Color Dis 18:O164–O170.

    Article  CAS  Google Scholar 

  13. Meinero P, Mori L, Gasloli G (2014) Endoscopic pilonidal sinus treatment (E.P.Si.T.). Tech Coloproctol 18:389–392.

    Article  CAS  PubMed  Google Scholar 

  14. Esposito C, Izzo S, Turrà F, Cerulo M, Severino G, Settimi A, Iannazzone M, Masieri L, Cortese G, Escolino M (2018) Pediatric endoscopic pilonidal sinus treatment, a revolutionary technique to adopt in children with pilonidal sinus fistulas: our preliminary experience. J Laparoendosc Adv Surg Tech 28:359–363.

    Article  Google Scholar 

  15. Rao MM, Zawislak W, Kennedy R, Gilliland R (2010) A prospective randomised study comparing two treatment modalities for chronic pilonidal sinus with a 5-year follow-up. Int J Colorectal Dis 25:395–400.

    Article  PubMed  Google Scholar 

  16. Oncel M, Kurt N, Kement M, Colak E, Eser M, Uzun H (2002) Excision and marsupialization versus sinus excision for the treatment of limited chronic pilonidal disease: a prospective, randomized trial. Tech Coloproctol 6:165–169.

    Article  CAS  PubMed  Google Scholar 

  17. Mohamed HA, Kadry I, Adly S (2005) Comparison between three therapeutic modalities for non-complicated pilonidal sinus disease. Surgeon 3:73–77.

    Article  CAS  PubMed  Google Scholar 

  18. McCallum IJD, King PM, Bruce J (2008) Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis. BMJ 336:868–871.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Abramson DJ (1960) A simple marsupialization technic for treatment of pilonidal sinus: long-term follow up. Ann Surg 151:261–267.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Solla JA, Rothenberger DA (1990) Chronic pilonidal disease—an assessment of 150 cases. Dis Colon Rectum 33:758–761.

    Article  CAS  PubMed  Google Scholar 

  21. Monro RS, McDermott FT (1965) The elimination of causal factors in pilonidal sinus: treated by Z-plasty. Br J Surg 52:177–181.

    Article  CAS  PubMed  Google Scholar 

  22. Dýlek ON, Bekereciodlu M (1998) Role of simple V-Y advancement flap in the treatment of complicated pilonidal sinus. Eur J Surg 164:961–964.

    Article  PubMed  Google Scholar 

  23. Özcan B, İlkgül Ö (2019) Contralateral Limberg flap reconstruction for pilonidal disease recurrence. Asian J Surg 42:787–791

    Article  PubMed  Google Scholar 

  24. Dudink R, Veldkamp J, Nienhuijs S, Heemskerk J (2011) Secondary healing versus midline closure and modified bascom natal cleft lift for pilonidal sinus disease. Scand J Surg 100:110–113.

    Article  CAS  PubMed  Google Scholar 

  25. 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 49:1831–1836.

    Article  PubMed  Google Scholar 

  26. Bascom J (1980) Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 87:567–572.

    Article  CAS  PubMed  Google Scholar 

  27. Bascom J (1983) Pilonidal disease: long-term results of follicle removal. Dis Colon Rectum 26:800–807.

    Article  CAS  PubMed  Google Scholar 

  28. Nordon IM, Senapati A, Cripps NPJ (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 197:189–192.

    Article  PubMed  Google Scholar 

  29. Bascom J, Bascom T (2002) Failed pilonidal surgery: new paradigm and new operation leading to cures. Arch Surg 137:1146–1150.

    Article  PubMed  Google Scholar 

  30. Ortega PM, Baixauli J, Arredondo J, Bellver M, Sánchez-Justicia C, Ocaña S, Hernández-Lizoain JL (2014) Is the cleft lift procedure for non-acute sacrococcygeal pilonidal disease a definitive treatment? Long-term outcomes in 74 patients. Surg Today 44:2318–2323.

    Article  CAS  PubMed  Google Scholar 

  31. Meinero P, La Torre M, Lisi G, Stazi A, Carbone A, Regusci L, Fasolini F (2019) Endoscopic pilonidal sinus treatment (EPSiT) in recurrent pilonidal disease: a prospective international multicenter study. Int J Colorectal Dis 34:741–746.

    Article  PubMed  Google Scholar 

  32. Emile SH, Elfeki H, Shalaby M, Sakr A, Giaccaglia V, Sileri P, Wexner SD (2018) Endoscopic pilonidal sinus treatment: a systematic review and meta-analysis. Surg Endosc 32:3754–3762

    Article  PubMed  Google Scholar 

  33. Sequeira JB, Coelho A, Marinho AS, Bonet B, Carvalho F, Moreira-Pinto J (2018) Endoscopic pilonidal sinus treatment versus total excision with primary closure for sacrococcygeal pilonidal sinus disease in the pediatric population. J Pediatr Surg 53:2003–2007.

    Article  PubMed  Google Scholar 

  34. Esposito C, Turrà F, Cerulo M, Del Conte F, Esposito G, Prato AP, Escolino M (2020) Technical standardization of MIS management of children with pilonidal sinus disease using pediatric endoscopic pilonidal sinus treatment (PEPSiT) and laser epilation. J Pediatr Surg 55:761–766.

    Article  PubMed  Google Scholar 

Download references


The authors wish to thank Cuyler Huffman of Western Michigan University Homer Stryker M.D. School of Medicine, Division of Epidemiology and Biostatistics for assistance with statistical analysis.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Michael J. Leinwand.

Ethics declarations


Michael Leinwand is on the advisory board of Virtual Ports Laparoscopic Systems. Jacob Baxter and Jairo Espinosa have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baxter, J., Espinosa, J.A. & Leinwand, M.J. The EPIC procedure (Endoscopic-assisted Pilonidal Irrigation and Cleaning): a simple and effective treatment for pilonidal disease. Surg Endosc 36, 1380–1384 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: