Thématique :
- Colo-proctologie
Originalité :
Très original
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Dans certains cas
Nom du veilleur :
Docteur Vincent DE PARADES
Coup de coeur :
International Journal of Colorectal Disease
  2019 Apr;34(4):561-568.  
  doi: 10.1007/s00384-019-03260-y.  
  Minimally invasive techniques in the management of pilonidal disease.  
  Kalaiselvan R, Bathla S, Allen W, Liyanage A, Rajaganeshan R  



Pilonidal sinus disease (PD) is a chronic condition involved in natal cleft. Excision surgery carries equally morbid course of recovery to that of disease itself. Minimally invasive treatments therefore have been developed to minimise morbidity and improve healing rates. This review looks at the literature on effectiveness of endoscopic pilonidal sinus treatment (EPSiT) and compares that of the other minimally invasive techniques in practice.


MEDLINE, EMBASE, Cochrane and CINAHL databases were searched to look at the peer-reviewed articles on minimally invasive treatments on PD. Primary endpoint was to determine complication rates. Data were pooled using random effect model. Heterogeneity among studies was estimated with χ2 tests. Statistical analysis was performed with Review Manager Version 5.1.2.


Out of 371 papers, ten were retrieved for full appraisal. One randomised clinical trial (RCT) and four case series presented retrospective data on EPSiT. Five RCTs were on alternative minimally invasive treatments. Complication rate, return to work, wound healing rate and pain scores were superior in minimally invasive treatments compared to excision surgery. There was no statistically significant difference in complication rate or return to work in EPSiT compared to that of alternate minimally invasive techniques.


Minimally invasive treatments of pilonidal disease were found to be safe and effective compared to conventional techniques. It is also demonstrated that EPSiT is a safe alternative with a low short-term complication rate. Further randomised controlled trials are required to more accurately define its effectiveness and closely evaluate the side effect profile.


Question posée
Serait-il possible de guérir un sinus pilonidal infecté sans en réaliser l’exérèse chirurgicale ?
Question posée
Cette revue synthétise les résultats publiés confirmant la faisabilité et l’efficacité du traitement endoscopique du sinus pilonidal infecté (EPSiT pour Endoscopic Pilonidal Sinus Treatment).

Les résultats sont intéressants mais cette technique endoscopique nécessite une évaluation plus rigoureuse avant son éventuelle diffusion large.