Study Design

This was a retrospective single-center study and is reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement for cohort studies (13).

Between June 2017 and January 2021, a total of 32 patients with pilonidal disease underwent EPSiT in our department.

Patient demographics, symptoms, previous surgeries, number and location of external openings, and operative details were prospectively recorded using our PC database.

A visual analog scale (VAS) score was used to assess post-operative pain (minimum score = 0; maximum score = 10).

Pre- and post-operative symptoms after 3 months were assessed using a modified in-house questionnaire based on Meinero et al. (14), in which pain, body temperature, wound secretion, and removal frequency of the dressing were evaluated on a scale from 0 to 20. Each item was rated with a score of 0 to 5 (1 = mild; 2 = moderate; 3 = severe; 4–5 = extremely severe).

Post-operative complications were determined using the Clavien–Dindo classification (15).

Success was defined as the absence of any subjective symptoms, as well as by complete post-operative wound healing. Incomplete wound healing was defined as persistent wound swelling or discharge after 60 days post-operation.

Patients were clinically followed up at 2 and 4 weeks and 1, 3, 6, and 12 months after the procedure. Further follow-up visits were facilitated by telephone, and an eventual follow-up visit was organized according to the needs of the patient.

All the patients were admitted and discharged the day of the procedure, and antibiotic prophylaxis with cephalosporin was administered.

All procedures were performed with the patient in the prone position, with the hips slightly flexed and the buttocks retracted with adhesive tape, under local anesthesia, according to Meinero et al. (7).

We strongly suggest regular and periodic hair removal by shaving or depilatory cream, especially during the first two post-operative years.

Recurrence was defined as the reappearance of the symptoms or PD, as confirmed by both the scores and the findings during the follow-up visit.