SRS155 - 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)

Background Endoscopic Pilonidal Sinus Treatment (EPSiT) is a novel, minimally invasive surgical technique that has shown promise in the treatment of pilonidal sinus disease (PSD). 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 panellists were 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. 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. A protocol for the application of EPSiT was generated with these results. Conclusions 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 PSD. The findings address key areas of consensus and controversy and promote procedure uptake.