Endoscopic Pilonidal Sinus Treatment (EPSiT)

Pilonidal sinus (PNS) is a small hole or tunnel in the skin usually filled with fluid or pus that causes a cyst or abscess. It most commonly occurs at the top of the buttocks where they divide (the cleft) and is caused by hair burrowing into the skin.

Pilonidal Sinus affects 26 per 100,000 people and is more common in males. Treatment is required when it becomes infected and causes symptoms.

The exact cause for pilonidal sinus is not known, but the following factors are said to increase risk of the condition:

Hormonal changes during aging
Hair growth that penetrates the skin
Friction from clothes
Being seated for a long time, as in case of taxi drivers, vibration, and prolonged sweating.
Gender: men are more at risk of developing the sinus
Reduced physical activity or obesity at young age
Having a lot of body hair

Commonly observed symptoms include:

Pain felt when sitting or standing
Tailbone pain
Reddened, sore skin around the affected area
Pus or blood oozing from the abscess, accompanied by a foul smell
Hair projecting out from the affected part
Presence of more than one hole in the skin

Prevention

Avoid being seated for a long time
Clean the cleft above the buttocks everyday
Maintain a healthy height-to-weight ratio
Remove hair from region with creams of hair removal treatment.

Treatments for an infected pilonidal sinus

Treatment for an infected pilonidal sinus will depend on:

Your symptoms
The size of the sinus
Whether it’s your first sinus or it keeps coming back

There are a number of treatment options for a recurring pilonidal sinus that is painful, bleeding or leaking discharge. Most people will need a surgical procedure to get rid of ‘pits’ where the hairs get stuck. Your healthcare professional will discuss these options with you individually.

Sometimes the sinus is very small and can be completely removed and then closed with stitches. Nearly a third of these patients experience problem with the wound healing. Sometimes it is necessary to leave an open wound and edges of the wound may be partly closed with stitches.

None of these methods are guaranteed to succeed at the first attempt, and sometimes multiple operations may be needed to fully heal the wound.

Endoscopic Pilonidal Sinus Treatment – EPSiT

Endoscopic Pilonidal Sinus Treatment (EPSiT) is a minimally invasive treatment performed at Forth Valley Royal Hospital using a tiny camera to explore the sinus.

The sinus is initially washed out and any hairs detected at this stage are removed. The internal lining of the sinus is safely burnt (cauterised) and cleaned with a brush.

Some people will need more than one EPSiT for complete healing of sinus.

This procedure is performed as a day-case procedure, most commonly under spinal anaesthesia or local anaesthesia. A brief general anaesthetic may be needed in selected patients.

The benefits of EPSiT compared to traditional surgical removal of the sinus are:

The surgeon can see the sinus (tunnel) using a tiny camera. It helps to identify complex sinus with branching tunnels and abscesses
The natal cleft is not affected
Wounds are quite small and don’t need insertion of packing material
People have less pain after the procedure and can go back to work and daily life much faster
A general anaesthetic can be avoided in most patients

What happens before my surgery?

You will be asked to attend a pre-admission clinic, which is run by specialist nurses. At this clinic, staff will ask about your medical history and carry out any tests or examinations needed.

You may be asked to keep your natal cleft hair-free whilst you are waiting for surgery.

What are the side effects of the EPSiT procedure?

Pain and minor fluid discharge are common after EPSiT.
If you have a high temperature, you might need antibiotics to treat a wound infection.
Fluid is used to wash the sinus tract during EPSiT and rarely (1 in 20 patients) this fluid escapes out of the sinus tract and causes swelling around the natal cleft. This swelling usually goes away by itself after a few days.
Most people have a small amount of bleeding from the wound. You may notice this more after washing and when the dressing has been removed. This is normal and nothing to worry about. It is a good idea to wear a small pad (breast pad) inside your pants to protect your clothes from any staining

After the procedure

After your procedure you will usually be transferred to the recovery area where you will be looked after by specially trained nurses, under the direction of an anaesthetist.

They will monitor your heart rate, blood pressure and oxygen levels too. You will be given oxygen via a facemask, fluids via a drip and pain relief until you are comfortable enough to return to a ward.

A healthcare professional will carry out a review and discuss with you about how the procedure went. You will be given pain killers and wound care advice to take home.

You will go home the same day of the procedure.
You can eat and drink normally after the procedure.

Activity after the procedure

We will help you to become mobile as soon as possible after the procedure. This helps improve your recovery and reduces the risk of forming clots in your legs and lungs. You will be encouraged to get up and walk around as soon as possible after surgery. If you have had a spinal anaesthetic, the nursing team will advise you on when this is safe but is usually about an hour after the procedure.

Your dressings at home

Before you go home a healthcare professional will talk to you about how to look after your dressings at home. The dressing should be laid on the wound flat. You may have some fluid or discharge from the wound while it is healing. A small pant liner or pad will protect your underwear. If hairs start to grow you may need to have these shaved to stop them from growing into the wound.

How long should I stay off work?

The time taken to get back to normal activities varies for different people and will depend on the surgery you have had. Most patients can return to work 24 hours following EPSiT surgery. Do as much as you feel comfortable doing. If you need to take painkillers these may make you drowsy, so you should avoid driving or operating machinery.
Avoid lifting if it causes you any pain or discomfort. You should not go swimming until your wound has healed as the chlorine in the water may affect wound healing and there is a chance of picking up or passing on an infection.
You may find that vigorous exercise is uncomfortable. Start with gentle walking and build up your activity level gradually.