Endoscopic pilonidal sinus treatment versus excision with wound closure: a systematic review of the literature.

Introduction: The aim of this systematic review was to compare minimally invasive procedures versus excision and wound closure for the treatment of pilonidal disease (PD) in terms of perioperative outcomes.

Evidence Acquisition: Search was performed in PubMed, Embase and Web of Science, founding 581 articles.

Evidence Synthesis: Six articles published between 2018 and 2023, including 595 patients were included in the present systematic review. All of these studies presented endoscopic pilonidal sinus treatment (EPSIT) as the minimally invasive surgical technique for the treatment of pilonidal disease, while no articles meeting the inclusion and exclusion criteria addressed video-assisted ablation of pilonidal sinus. One hundred eighty-two patients (30.6%) underwent EPSIT (Group A), whereas 413 (69.4%) underwent excision and wound closure (Group B). Patients in Group A experienced shorter operative times (42.1±16 minutes) and hospital stay (0.5±0.3 days) in comparison to Groups B (59.3±19 minutes and 2.4±1 days, respectively). Group A had lower complication rate (12.5%) compared to Group B (35.2%) and recurrence rate (17.9% versus 14.8%). Wound dehiscence rate was 12.8% in Group B. Mean time to complete healing was longer in Group A than Group B (47.9±26.1 days and 39.1±22.3 days, respectively).

Conclusions: EPSIT requires approximately 9 additional days to fully heal, but it avoids the risk of wound dehiscence, and had fewer complications, along with a shorter hospital stay, compared to those treated with excision and wound closure. The choice of treatment should be personalized, considering the individual needs and specific risk factors for wound dehiscence.