Comparison of conventional incision and drainage for pilonidal abscess versus novel endoscopic pilonidal abscess treatment (EPAT)

Excerpt

Acute sacrococcygeal pilonidal abscess is a common surgical presentation with a reported incidence of up to 26/100,000 most commonly treated with incision and drainage and subsequent healing by secondary intention [1]. The reported recurrence rate after conventional I & D varies from 10.9 to 66.6% in cases of recurrent pilonidal abscesses [2]. Further morbidity can result from packing, which is painful and expensive. The cost of one such episode is approximately £159.84, with the average patient requiring 7.4 dressings over 21 days [3]. Endoscopic treatment for pilonidal disease in the elective setting is now recognised as safe and effective technique with better short- and long-term outcomes [4, 5]. Using the described principles of video-assisted surgery, we applied this to the treatment of acute pilonidal abscesses—endoscopic pilonidal abscess treatment (EPAT). The technique involves making a small 1-cm incision over the most fluctuant part of the abscess (Fig. 1a) and then using the fistuloscope (Karl Storz) to directly visualise the cavity, drain its contents, thorough irrigation and washout and subsequent fulguration of the abscess cavity (Fig. 1b) wall alongside any identified tracts. The post-operative wound (Fig. 1c) is small and therefore eliminates the need for formal packing. Patients are counselled and discharged with the advice to irrigate the wound with saline using a 10-ml syringe. We have compared the efficacy of EPAT with conventional incision and drainage of pilonidal abscesses.

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