The EPIC procedure (Endoscopic-assisted Pilonidal Irrigation and Cleaning): a simple and effective treatment for pilonidal disease

Baxter, Jacob; Espinosa, Jairo; Leinwand, Michael

doi:10.1007/s00464-021-08422-0

Cited by 10 publications

(16 citation statements)

References 34 publications

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“…Since the introduction of the techniques, EPSiT and VAAPS, respectively, the interest for this new approach has gained momentum among the surgeon and several studies have been published ( 10 , 13 , 19 – 22 , 24 – 30 , 42 , 44 ).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment of Pilonidal Sinus Disease: State of Art and Review of the Literature

et al. 2022

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Background: Pilonidal sinus disease (PSD) is a chronic troublesome pathology of the natal cleft of the sacrococcygeal region, with an estimated incidence of 26 cases in every 100,000 inhabitants. The aim of this review is to give a snapshot of the current literature on the endoscopic approach to PSD.Methods: A search on endoscopic treatment of pilonidal disease was performed according to PRISMA guidelines, adopting the following search terms: (pilonidal OR sacrococcygeal) and (endoscopic OR VAAPS OR EPSiT OR minimally invasive OR video-assisted OR video assisted).Results: Thirty-four articles were included in the final analysis, among which 23 were on adults and 11 were on pediatric population. The endoscopic approach is associated with painless postoperative pain, good aesthetic results, short time off work, and high patient satisfaction.Despite these advantages in short-term outcomes, results on recurrence rate in a long-term follow up are needed to definitively confirm the importance of this technique.Conclusions: The endoscopic approach is associated with significant postoperative advantages over other standard surgical approaches, and it should be included in the surgical portfolio for the treatment of PSD. According to the Italian guidelines, this technique could be considered as the gold standard for limited PSD. However, the favorable short-term-outcomes and lack of reliable data on long-term follow-up must be a stimulus to perform further high-quality studies to give definitive conclusions on this technique.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment of Pilonidal Sinus Disease: State of Art and Review of the Literature

et al. 2022

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“…Since its introduction, several studies have been published to evaluate the outcomes of endoscopic technique gaining the interest of several surgeons. 2 , 14 , 15 , 16 , 17 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 Most of these studies were non‐comparative or retrospective and were performed on a relatively small population. However, two comparative studies 37 , 38 and a RCT were published 2 to compare endoscopic approaches to PSD with traditional surgical treatments.…”

Section: Discussionmentioning

confidence: 99%

“…The endoscopic technique involves identification of the sinus cavity and its lateral tracks by endoscopic view, identification of hair and its removal, complete resection of sinus cavity and accurate debridement and irrigation of the sinus cavity. Since its introduction, several studies have been published to evaluate the outcomes of endoscopic technique gaining the interest of several surgeons 2,14‐17,26‐36 . Most of these studies were non‐comparative or retrospective and were performed on a relatively small population.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic approach to complex or recurrent pilonidal sinus: A retrospective analysis

Maione

D’Amore

Milone

et al. 2022

International Wound Journal

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Pilonidal Sinus is a benign, chronic disease that affects the hair follicles of the natal cleft of the sacrococcygeal area. Its ideal treatment is controversial, especially in complex or recurrent cases. The aim of this study is to evaluate the use of minimally invasive endoscopic approach in this setting. We enrolled patients affected by complex or recurrent sacrococcygeal pilonidal sinus from January 2015 through December 2020 who underwent Video‐Assisted Ablation of Pilonidal Sinus. All patients enrolled were re‐evaluated once a year with a standard physical examination. The patients included were 38. Recurrence rate at 1‐, 3‐ and 5‐years follow‐ups were 28.9%, 22.2% and 38.1% respectively. Of interest, the mean (SD) distance from the most lateral orifice to the midline was higher in group of patients with recurrence and the multivariate analysis demonstrated that it was the limiting factor, which influences the recurrence rate. In complex or recurrent pilonidal sinus disease with pits off the midline the endoscopic approach should not be the first choice. This makes us think that these cases should have their own classification to be identified and guide surgeons in choosing the appropriate approach.

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“…In 2020, Yuksel et al [33] first described the EPSI-R for removal of PD by means of a bipolar resectoscope. More recently, Baxter et al [34] introduced the EPIC procedure, allowing the removal of hair under direct vision using a small endoscope while flushing normal saline through the cavity via an angio-catheter. Gulcu and Ozturk [27] described the latest kid on the block of MIS procedures for PD, namely LEPSiT, in a case-matched study on 24 patients.…”

Section: Epat Epsi-r Epic and Lepsitmentioning

confidence: 99%

“…TA B L E 4 IDEAL checklists for IDEAL Stages 2a and 2b Milone [28] Milone [52] Milone [22] Esposito [31] Esposito [30] Dotlacil [53] Pérez-Bertólez [64] Gulcu [27] Meinero [29] Chia [40] Gecim [49] Sequeira [21] Pini Prato [55] Khafagy [56] Romaniszyn [23] Gökbuget [39] Giordano [42] Gallo [59] Yuksel [33] Baxter [34] Javed [20] Jain [63] Stage Manigrasso [26] Manigrasso [35] Esposito [32] Esposito [24] Esposito [25] Meinero [37] Giarratano [54] Meinero [38] Mendes [41] Kalaiselvan [57] Azhough [58] Foti [60] Gulcu [61] Hinksman [62] A prospective multicentre trial showed a quick postoperative recovery and a good quality of life after EPSiT [37]. A prospective international multicentre study on 122 patients with recurrent PD showed a complete wound healing in 95% of patients, within a mean time of 29 days.…”

Section: Outcomes Of the Techniquesmentioning

confidence: 99%

Endoscopic sinusectomy: ‘a rose by any other name’. A systematic review of different endoscopic procedures to treat pilonidal disease

et al. 2022

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Aim Pilonidal sinus or Pilonidal Disease (PD) is a relatively common, benign but challenging condition. Although commonly encountered in practice, its ideal treatment is controversial. One of the most validated treatments is video‐assisted surgery. In this context, very similar endoscopic techniques have been published under different names. The aim of this systematic review is to assess the differences among these proposed techniques and their outcomes. Methods The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines were followed during all stages of this systematic review. A systematic search of the English literature was performed on multiple databases from 1 January 2014 to 3 April 2022. The primary outcome measure was the IDEAL framework stage of innovation. The key secondary outcome measures were the adherence to the IDEAL reporting guidelines, the Blencowe framework and the core outcome set (COS) for studies evaluating the introduction and evaluation of novel surgical techniques, the qualitative assessment using appropriate tools, the procedural variations and outcomes of each technique. Results A total of 38 articles were included reporting a very similar technique under eight different acronyms. The number of patients varied from 9 to 250. Mean follow‐up ranged from 1 to 60 months. There was only one published study of IDEAL 3. The majority (58%) were IDEAL 2a studies. Reporting of domains in the IDEAL reporting guidelines and Blencowe framework was poor, with most studies not reporting the component steps of procedures or efforts to standardize them. Half of COS domains were markedly underreported. The quality of the evidence was categorized as having a risk of bias from moderate to critical level in all nine comparative non‐randomized series. Postoperative complications occurred in 0%–6% of cases, including surgical site infection, poor or failed wound healing bleeding, granuloma, haematoma, and pain requiring intervention. The recurrence rate varied from 0% to 22%. Conclusion The study demonstrates that reporting on technical aspects of interventions for PD is poor, thus warranting a better‐quality control of surgical techniques. It is advisable to group all endoscopic procedures under the umbrella term of ‘endoscopic sinusectomy’, thus embracing the two main principles of this technique, that is, video assistance and PD ablation.

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The EPIC procedure (Endoscopic-assisted Pilonidal Irrigation and Cleaning): a simple and effective treatment for pilonidal disease

Cited by 10 publications

References 34 publications

Endoscopic Treatment of Pilonidal Sinus Disease: State of Art and Review of the Literature

Endoscopic Treatment of Pilonidal Sinus Disease: State of Art and Review of the Literature

Endoscopic approach to complex or recurrent pilonidal sinus: A retrospective analysis

Endoscopic sinusectomy: ‘a rose by any other name’. A systematic review of different endoscopic procedures to treat pilonidal disease

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