Abstract Background Endoscopic pilonidal sinus treatment (EPSiT) has emerged as a minimally invasive treatment option for pilonidal disease (PD) in adolescents, yet its adoption has been limited by the need for specialized equipment. We developed a modified EPSiT technique using standard urological instruments, saline irrigation, and lateral positioning, which was introduced in 2019. This study provides a technical description of the modified approach and evaluates the outcomes compared with conventional open excision in a pediatric cohort. Methods We conducted a single-center retrospective cohort study of 113 pediatric patients treated surgically for PD between 2014 and 2023. Patients were divided into two cohorts: EPSiT ( n = 48, 2019–2023) and open excision ( n = 65, 2014–2018). Clinical data were collected from medical records for both groups and structured telephone interviews for patients undergoing EPSiT. Outcomes included operative time, hospital stay, recurrence, pain, and satisfaction. Results Gender distribution was identical in both cohorts (29.2% male, 70.8% female). Operative times were similar between groups (35.8 versus 31.7 min; p = .307). EPSiT was associated with significantly shorter hospital stays (mean difference −2.55 days; 95% CI −3.10 to −2.00; p < .001). Recurrence rates were comparable (16.7% versus 15.4%; p = .808). Patient-reported outcomes were available for the EPSiT cohort only and indicated high cosmetic satisfaction and minimal analgesic use. Among patients undergoing EPSiT, 41.7% returned to school immediately after discharge, and most resumed normal activities within a few days. Conclusions This modified EPSiT approach is feasible and may increase accessibility in resource-limited settings, representing a less invasive treatment option for PD. Further prospective studies are needed to validate these findings and define the role of EPSiT in the treatment of pediatric PD.
Kirsch et al. (Mon,) studied this question.