EP233 - Clinical Efficacy of Video-Assisted Endoscopy Treatment for Pilonidal Sinus Disease In the Infectious Stage

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Purpose/Background: For patients with pilonidal sinus (PS) in the infectious stage, characterized by abscess, simple incision and drainage surgery is the main treatment method. However, its therapeutic efficacy rate is low, with a recurrence rate close to 100%. Patients who undergo simple incision and drainage surgery need secondary or even multiple surgical treatments. Video-assisted endoscopy treatment for PS is an emerging minimally invasive method, characterized by minimal surgical wounds, short operation time, mild pain, and high cure rate. The author's team conducted a retrospective study to evaluate the clinical efficacy of video-assisted endoscopy treatment in patients with PS accompanied by acute swelling and pain.

Methods/Interventions: Patients with PS in infectious stage who underwent video-assisted endoscopy treatment between November 2022 to June 2023 were enrolled in this study. The specific surgical method was as follows: (1) Make a small incision at the highest protrusion of the abscess or the breach sites according to the scope of infection; (2) Make auxiliary incisions at the farthest end of the abscess cavity and remove the pits of the buttock sulcus; (3) Endoscopy was inserted through incisions to clearly explore the sinus tract and hairs; (4) Monopolar electrocoagulation and curettage were used repeatedly for cauterization and debridement to remove necrotic tissue, hair follicles, and keratin fragments; (5) Loose rubes between incisions can be placed to fully drain the pus. Follow up weekly after surgery until 1 year after complete wound healing or when further intervention was needed. We observed and recorded the wound healing time and complications.

Results/Outcomes: A total of 26 patients were included in this study. The male to female ratio of the patients was 3.33:1, with an average age of 27.23 years and an average BMI of 26.77. The average body temperature of the patient upon admission was 36.7 ℃, the average white blood cell count was 10.25 × 109/L, and the average CRP level was 7.20mg/L. The average surgical duration was 50.54 minutes, and the probability of discovering hair inside the wound cavity was 23.08% (6/26). All patients engaged in simple activities 4 hours after surgery and resumed daily activities on the first day after surgery. The average healing time of the wound is 52.17 ± 15.35 days, with the shortest healing time being 29 days and the longest healing time being 76 days. The complete healing rate of the first stage wound within 3 months was 100%. After a one-year follow-up, one patient experienced a recurrence in the second month after complete wound healing. The recurrence rate was 3.85% (1/26). Through Pearson correlation analysis, it was found that the number of breaches (r=0.652, P=0.016), the number of incisions (r=0.591, P=0.033), and the duration of surgery (r=0.603, P=0.029) were positively correlated with healing time. It indicated that the size of the abscess cavity may affect the wound healing time.

Conclusion/Discussion: Video-assisted endoscopy treatment is a minimally invasive, safe and effective surgical method for PS in the infectious stage. Compared with simple incision and drainage surgery, this method has the characteristics of high therapeutic efficacy rate, low recurrence rate, and mild pain.