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10.35279/jowm2022.23.01.04SCIENCE, PRACTICE AND EDUCATION terventions; it has a significant negative impact on patient quality of life (QOL). 8 A recent study has identified stark contrasts in the international manage- ment of PSD, with countries such as Germany, Tur- key, Italy and the US using many different techniques and experiencing a wide range of recurrence rates dependant on surgical technique. 8 Classically speak- ing, the surgical technique of excision followed by healing through either primary or secondary inten- tion has been widely used in the UK to treat chronic PSD. 9 Despite multiple surgical techniques being developed, there is no gold-standard treatment, and best practices remain ambiguous. 4 A Cochrane review concluded that each surgical treatment has its own potential benefits and drawbacks, but no consensus has been reached concerning which approach leads to better patient outcomes. 10 Surgical intervention is often complicated by wound infection, recurrence, pain and prolonged hospital stays, which ultimately impact patient outcomes. 11,12 Standard excision and healing by secondary intention has widely reported recurrence rates between 0 and 57%. 13 Wound healing (WH) following this thera- py is generally achieved between 1.5 and 3 months, though follow-up is often poor and leads to the in- cidence of incomplete WH that is not thoroughly reported. 13 A recent systematic review by Grabowski et al. identified a slight trend moving towards mini- mally invasive techniques, due to favourable patient outcomes when compared to excision. 14 One such emerging technique is the use of endoscopic ablation, first described in 2014 by Meinero et al. 15 Under spi- nal or local anaesthetic, endoscopic techniques (ETs) using a fistuloscope is introduced through a small excision (~5mm), allowing a clear visualisation of the inflamed tissues. The hair and debris are removed, tissues are ablated and the tract is left unpacked, but covered with a simple dressing. A series of research trials has subsequently been undertaken to identify the potential benefits and drawbacks associated with ETs versus excision and healing by primary or second- ary closure. The present study examines the potential benefits and drawbacks associated with patients un- dergoing ET for PSD. METHODS The articles included in this work were obtained through a Medline search conducted in November 2021. The search was based on the key themes identi- fied using the PICO search tool. The categories used were ‘pilonidal sinus’, ‘endoscopic’, ‘video-assisted’ or ‘minimally invasive surgical techniques’. Only studies using adults were selected, and only Level I evidence was reviewed. This search returned one randomised controlled trial (RCT). The scope was then widened to include Level 3 evidence, and 19 results were retrieved and reviewed for inclusion. Endoscopic Pilonidal Sinus Treatment (EPSiT) Meinero et al. conducted an initial prospective study using 11 adult patients with PSD. 15 There were no exclusion criteria, and all patients were given a pro- phylactic dose of antibiotics prior to surgery, which may have had consequences for post-surgical infec- tion rates and is not routinely used in excisional tech- niques10; this could have affected the study’s validity. Though the results of the study are difficult to gen- eralise, due to the small sample size, Meinero et al. 15 suggested that EPSiT could allow a surgeon to achieve better visibility, and therefore a more precise removal of infected tissue, alongside the creation of a substantially smaller wound. This was evidenced by a recurrence rate of 0% at six months, indicating that all infected tissue was successfully removed, although there is growing consensus that follow-up should be undertaken for five years in patients with PSD, due to longitudinal recurrence. 16 Complete WH was achieved in all patients at one month; by compari- son, a review by Iesalnieks and Ommer found longer healing times, between 1.5 and 3 months, in patients who underwent excision and secondary healing. 13 Meinero et al. noted that there were no significant complications in this patient group, however no defi- nition of ‘complications’ was provided, therefore this observation is difficult to substantiate. 15 Pain was described as either low or nil up to two weeks post- operatively, and there was no requirement for further antibiotic therapy, indicating no incidence of post- operative infection; however, this was not implicitly stated. Due to the limitations of study, including its sample size, lack of comparative control, short follow- up time and flaws in the study design, the potential harms and benefits of using EPSiT cannot be widely agreed and may have been subject to reporting and selection bias, as is found in studies that have not been randomised. 17 However, this study did provide an interesting basis for a subsequent RCT conducted by Milone et al. 18 Video-assisted ablation of pilonidal sinus In their RCT, Milone et al. 18 explored the safety and JOURNAL OF WOUND MANAGEMENT OFFICIAL JOURNAL OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATION  19Page 1Page 3

iPaper

Endoscopic techniques for the treatment of pilonidal sinus disease - a mini-review
Blake H

This article should be referrenced as: Blake H. Endoscopic techniques for the treatment of pilonidal sinus disease - a mini-review. J Wound Management, 2022,23(1):18-22

ABSTRACT
Background: Pilonidal sinus disease affects many individuals in the UK and is associated with chronicity, pain and recurrence. It has a negative impact on the individual’s quality of life and daily functioning and places a significant burden on the UK’s healthcare service. Traditionally, treatment has involved excision and healing by primary or secondary intention; however, recent advances in surgical techniques have led to the development of endoscopic and video assisted treatments.
Aim: This paper evaluates the current research surrounding the endoscopic treatment of pilonidal sinus disease, with particular reference to patient benefits and harm.
Methods: A Medline search of endoscopic/video-assisted and pilonidal sinus disease in adults was undertaken. There was minimal level 1 evidence, due to the recent nature of the treatment’s development, therefore levels 1–3 were reviewed.
Findings: Patients generally experience less pain and a quicker return to normal functioning following endoscopic treatment; however, this approach does not appear to improve recurrence rates and may only be replicable in uncomplicated pilonidal disease.
Implications for clinical practice: Endoscopic treatments appear to be an interesting new technique for the treatment of simple pilonidal disease; however, further work is required to identify a technique that also addresses recurrence rates.