The application of EPSiT in pilonidal sinus disease: an international Delphi consensus study endorsed by the Association of Laparoscopic Surgeons of Great Britain and Ireland (ALSGBI)
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Background:
Endoscopic Pilonidal Sinus Treatment (EPSiT) is a novel, minimally invasive surgical
technique that has shown promise in the treatment of pilonidal sinus disease. Despite
the apparent benefits and call for increased use, widespread uptake has been slow.
This study aims to gather and understand expert international opinions on EPSiT and
develop recommendations for its application in the surgical community.
Methods:
Expert international panellists were identified and recruited to participate. A three round modified Delphi consensus consisting of forty-three questions regarding the
application of EPSiT was posed. A combination of a 5-point Likert scale, binary
‘Yes/No’ scale and Multiple Choice Questions were used. The consensus threshold
was set at 70% agreement. When consensus was not achieved or further insight was
required, statement questions were posed. The study has been performed in
accordance with ACcurate COnsensus Reporting Document (ACCORD) explanation
and elaboration guidelines.
Results:
Twenty experts from six countries participated in all rounds with a 100% response rate.
Our experts agreed on 28 statements including the absence of absolute
contraindications to EPSiT; Administering intravenous induction antibiotics routinely
but not post-operative oral antibiotics; recommending laser epilation; offering re-EPSiT
to the informed patient after 1st and 2nd procedure failures and that EPSiT should be
incorporated into surgical training programmes.
Conclusion:
This is the first study to provide an international expert consensus on the specific
application of EPSiT in primary and recurrent adult and paediatric patients with
pilonidal sinus disease. The findings of this study contribute to the development of
protocols for EPSiT in pilonidal sinus disease management, addressing key areas of
consensus and controversy and promoting procedure uptake.
Endoscopic Pilonidal Sinus Treatment (EPSiT) is a novel, minimally invasive surgical
technique that has shown promise in the treatment of pilonidal sinus disease. Despite
the apparent benefits and call for increased use, widespread uptake has been slow.
This study aims to gather and understand expert international opinions on EPSiT and
develop recommendations for its application in the surgical community.
Methods:
Expert international panellists were identified and recruited to participate. A three round modified Delphi consensus consisting of forty-three questions regarding the
application of EPSiT was posed. A combination of a 5-point Likert scale, binary
‘Yes/No’ scale and Multiple Choice Questions were used. The consensus threshold
was set at 70% agreement. When consensus was not achieved or further insight was
required, statement questions were posed. The study has been performed in
accordance with ACcurate COnsensus Reporting Document (ACCORD) explanation
and elaboration guidelines.
Results:
Twenty experts from six countries participated in all rounds with a 100% response rate.
Our experts agreed on 28 statements including the absence of absolute
contraindications to EPSiT; Administering intravenous induction antibiotics routinely
but not post-operative oral antibiotics; recommending laser epilation; offering re-EPSiT
to the informed patient after 1st and 2nd procedure failures and that EPSiT should be
incorporated into surgical training programmes.
Conclusion:
This is the first study to provide an international expert consensus on the specific
application of EPSiT in primary and recurrent adult and paediatric patients with
pilonidal sinus disease. The findings of this study contribute to the development of
protocols for EPSiT in pilonidal sinus disease management, addressing key areas of
consensus and controversy and promoting procedure uptake.
Date Acceptance
2025-06-22
Citation
Techniques in Coloproctology
ISSN
1123-6337
Publisher
Springer
Journal / Book Title
Techniques in Coloproctology
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
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Publication Status
Accepted