Minimally Invasive Pilonidal Sinus Treatment: EPSIT Versus PEBAI Method

Abstract

Purpose: We aimed to compare endoscopic pilonidal sinus treatment (EPSIT) and pit/sinus punch needle excision, brushing, ablation and irrigation (PEBAI) method that was performed with principles similar to EPSIT but without fistuloscope and vision in the treatment of pilonidal sinus disease (PSD). Methods: Patients who underwent EPSIT and PEBAI methods for PSD in a single center between January 2020 and October 2021 were retrospectively analyzed. The primary endpoint was healing, the secondary endpoints were operative time, pain, wound closure, quality of life, cosmetic results, and cost. Results: One hundred 4 patients who underwent EPSIT and 184 patients who underwent PEBAI were included in the study. Age (P=0.871), sex (P=0.669), BMI (P=0.176), number of pits (P=0.99) were similar in both groups. The operative time for PEBAI [20 min (18 to 32)] was shorter than EPSIT [32 min (24 to 44)] (P<0.0000, u value=3096, z-score=-9.459). Postoperative first (P=0.147) and 14th day(P=0.382) pain scores, postoperative analgesic requirements (P=0.609), time to return to daily activities (P=0.747), time to return to work (P=0.345), and wound complications (P=0.816) were similar, whereas the wound closure time was earlier after EPSIT [32 d (24 to 41)] than after PEBAI [37 d (26 to 58)] (P<0.00001, u value=5344, z-score=6.22141). The median follow-up was 24 (12 to 34) months. Complete wound healing (P=0.382), recurrence rate (P=0.533), quality of life at first month and (Wound evaluation scale score at first year (P=0.252) were similar in both groups. However, the cost of PEBAI [54.8 € (50.13 to 64.96)] was significantly lower than cost of EPSIT [147.36 € (132.53 to 169.60)] (P<0.00001, u value=0, z-score=7.210). Conclusions: PEBAI method is a cheaper alternative to EPSIT with similar surgical principles and clinical outcomes.