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).
H K Sekhon Inderjit Singh, P Meinero, F C Campanile, A Quddus, R Rajaganeshan, J Warusavitarne, V Dotlacil, A Bhargava, P Giordano, A Pini Prato, V Shatkar, P Jalali, V C Halahakoon, G Gallo, M Milone, S Mantoo, C A Leo, C Esposito, M Farghaly, T Arulampalam, N Pawa
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Abstract
Background: Endoscopic pilonidal sinus treatment (EPSiT) is a novel, minimally invasive surgical technique that has shown promise in the treatment of pilonidal sinus disease. 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 international panellists were identified and recruited to participate. A three-round modified Delphi consensus consisting of 43 questions regarding the application of EPSiT was posed. A combination of a five-point Likert scale, binary 'yes/no' scale and multiple-choice questions was used. The consensus threshold was set at 70% agreement. When consensus was not achieved or further insight was required, statement questions were posed. 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 first and second procedure failures; and that EPSiT should be incorporated into surgical training programmes.
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 pilonidal sinus disease. The findings of this study contribute to the development of protocols for EPSiT in pilonidal sinus disease management, addressing key areas of consensus and controversy and promoting procedure uptake.
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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