Endoscopic Pilonidal Sinus Treatment (EPSiT) at Parkside Hospital

What is endoscopic pilonidal sinus treatment?

Endoscopic pilonidal sinus treatment (EPSiT) is a minimally invasive operation to treat a pilonidal sinus, a small tunnel under the skin at the top of your buttocks. Your surgeon uses a tiny camera to see inside the tunnel, then cleans and seals it from within, without needing to cut the area open.

What conditions does it treat?

EPSiT is used for a pilonidal sinus, a small tunnel in the skin at the top of your buttocks where they divide (the cleft), often caused by hair burrowing into the skin. It affects around 26 in 100,000 people, more commonly men in their teens to thirties, though women can be affected too.

A pilonidal sinus doesn’t always cause symptoms and only needs treatment once it becomes infected. Infection can cause:

• pain when sitting or standing, and tailbone pain
• redness and soreness around the area
• pus or blood, sometimes with an unpleasant smell
• hair visible poking out of the affected area
• more than one opening in the skin

EPSiT can be used whether this is your first pilonidal sinus or one that keeps coming back after previous treatment.

What are the benefits of EPSiT?

Compared with traditional surgery to remove a pilonidal sinus, EPSiT can offer:

• a clear view inside the tunnel with a tiny camera, helping your surgeon spot complex, branching sinuses or abscesses
• a wound that’s small and doesn’t need packing material
• less pain, and a faster return to work and daily life
• avoiding a general anaesthetic in most cases
• fewer complications, such as wound infection or breakdown, compared with conventional surgery.

Even for a pilonidal sinus that has come back after previous treatment, one study found EPSiT achieved complete healing in around 95% of people.

Are there different types of EPSiT?

There are a few variations on the standard EPSiT technique.

Standard EPSiT

The lining of the sinus is burnt (cauterised) using an electrode, then cleaned with a brush.

Cautery-phenol EPSiT

This adds a chemical called phenol into the tract alongside cautery, which some surgeons use to try to reduce the chance of the sinus coming back.

Laser-assisted EPSiT

A laser is used instead of, or alongside, cautery to treat the lining of the sinus.

Some surgeons also apply a negative pressure dressing at the end of the procedure, instead of standard wound care, which may help reduce the chance of the sinus returning. Evidence directly comparing these variations is still limited, so your surgeon will recommend whichever approach suits your circumstances best.

What happens before the procedure?

You’ll usually attend a pre-admission clinic run by specialist nurses, where staff will ask about your medical history and carry out any tests or examinations needed. You may be asked to keep the area hair-free while you wait for your surgery.

There’s no particular group of people who can’t have EPSiT: having a complex or recurrent sinus, or having tried previous treatments, doesn’t rule it out. The main exception is a very short tract, under 1cm, which may not be suitable for this approach. Occasionally, a scan such as an MRI may be used beforehand if there’s uncertainty about the diagnosis.

You’ll be given a single dose of antibiotics through a drip as you go off to sleep, to help prevent infection.

What happens during the procedure?

1. You’re given your anaesthetic, most commonly a spinal or local anaesthetic, though a brief general anaesthetic is sometimes needed.
2. You lie on your front for the operation.
3. Your surgeon makes a small opening and passes a tiny camera into the sinus to examine the tunnel and any branching tracts.
4. The sinus is washed out, and any hairs found inside are removed.
5. The lining of the sinus is cauterised to encourage it to heal, then cleaned with a brush.
6. A small dressing is applied; the wound is left without packing material.

Some people need more than one EPSiT procedure to fully heal the sinus.

What does recovery look like?

In hospital

After your procedure, you’ll be looked after in a recovery area, where nurses monitor your heart rate, blood pressure and oxygen levels, and give you oxygen, fluids and pain relief until you’re comfortable. A healthcare professional will review how the procedure went with you before you go home.

You’ll usually go home the same day and can eat and drink normally straight away. You’ll be encouraged to get up and walk around as soon as possible, which helps your recovery and lowers the risk of blood clots. If you’ve had a spinal anaesthetic, this is usually safe about an hour after your procedure.

At home

Your dressing should be laid flat on the wound. Some fluid or discharge is normal while it heals, so a pad or liner can help protect your underwear. If hair starts to regrow, you may need to shave it to stop it growing into the wound.

Most people can return to work around 24 hours after EPSiT, building up their activity gradually. Painkillers may make you drowsy, so avoid driving or operating machinery if you’ve taken them and avoid lifting if it causes pain. You should not go swimming until your wound has fully healed as chlorine can affect healing and there’s a chance of picking up or passing on an infection. Start with gentle walking and build up to more vigorous exercise gradually.

Complete healing typically takes around 4 weeks, though this varies between individuals.

What are the risks and complications?

EPSiT is generally safe, but as with any procedure, there are some risks and side effects to be aware of.

Common

• pain and minor fluid discharge from the wound
• a small amount of bleeding, which is more noticeable after washing or when the dressing is removed. This is normal.

Less common

• a wound infection, which may cause a high temperature and need treating with antibiotics
• the fluid used to wash the sinus tract escaping and causing swelling around the area, in around 1 in 20 people; this usually settles on its own within a few days
• the sinus not fully healing, or coming back, which may mean you need a further EPSiT procedure. In one study of people with a recurrent sinus, around 5% did not achieve complete healing after a single EPSiT.