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The high success rate (92%) of endoscopic treatment demonstrates that wide local excision (WLE) or even a simple excision is not a mandatory requirement for the cure of pilonidal disease. The same concept has been amply demonstrated by the high cure rate of pilonidal disease by laying open (deroofing) and curettage of pilonidal sinus under local anesthesia (LOCULA).2,3 Extensive meta-analysis of 13 studies (n 1445) published from 1960 through 2014 showed a cure rate of 95.5% with the LOCULA procedure.2 These results reiterate that incision/deroofing is as effective as excision/WLE for treatment of pilonidal disease. This finding is understandable, as pilonidal disease is a localized sepsis or an abscess, not a malignancy. An abscess anywhere else in the body is treated by incision (preferably deroofing), not by excision, and the same principles should hold for pilonidal disease.

journal of the society of laparoendoscopic surgeons

Re: JSLS. 2017 Jul-Sep; 21(3): e2017.00043. DOI: 10.4293/JSLS.2017.00043. Endoscopic Pilonidal Sinus Treatment: Long-Term Results of a Prospective Series