Long-term outcomes of endoscopic pilonidal sinus treatment: A single tertiary centre experience

INTRODUCTION: Pilonidal sinus disease commonly affects young adults and presents a clinical challenge due to high recurrence rates. This study aims to evaluate long-term outcomes following Endoscopic Pilonidal Sinus Treatment (EPSIT) performed at a UK district general hospital. PATIENTS AND METHODS: We conducted a retrospective observational study of all adult patients who underwent EPSIT by a single colorectal surgeon between January 2015 and May 2022. Patients with acute abscesses or previous extensive surgery were excluded. Outcomes included healing rate, recurrence and need for further intervention, assessed through structured clinical follow-up and telephone review until March 2024. RESULTS: Eighty-seven patients (62 men, median age: 31 years) underwent EPSIT. Twenty-one procedures were performed under local anaesthesia. The median follow-up was 62 months (range: 24-108). Short-term healing was achieved in 70 patients (84%), with 13 requiring additional intervention (repeat EPSIT or flap). At long-term follow-up, 52 patients were fully evaluated. Of these, 41 (79%) achieved durable healing after a single EPSIT. Six had recurrence and were managed conservatively, and four patients await surgery. Twenty-five patients were lost to follow-up. If assuming the best-case scenario (all healed), the overall long-term success rate would be 76%; worst-case scenario (none healed) gives 47%. Healing was confirmed clinically or through patient self-report of complete resolution of discharge and symptoms. CONCLUSION: EPSIT is a minimally invasive approach with promising long-term results when carefully selected patients are treated by trained surgeons. However, high attrition rates limit interpretation. Larger comparative studies with standardised outcome definitions and inclusion of patient-reported outcomes (pain and cosmesis) are required.