Pediatric endoscopic pilonidal sinus treatment (PEPSiT) as standard of care results over 10 years' experience in 507 patients.

Pilonidal sinus disease (PSD) is an acquired inflammatory condition of the gluteal cleft predominantly affecting teenagers. We report our 10-year experience adopting this minimally invasive approach, pediatric endoscopic pilonidal sinus treatment (PEPSiT). We retrospectively reviewed all patients, with primary or recurrent PSD, undergoing PEPSiT in the 2016-2025 period. We operated 507 patients (313 boys and 194 girls) with a median age of 15.5 years (IQR 12-18 years). All patients received our postoperative management. Data regarding success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10, IQR 1-2). Patient satisfaction was excellent (median score 4.8/5, IQR 4-5). Dressing after surgery was performed with ozone oil products in every patient and in the last 18 months Platelet-Rich Plasma (PRP) has been added to the intra and post-operative care too. Disease recurrence occurred in 53/507 patients (10.4%), mostly within 3 months (range 2 months-23 months), and all were successfully re-operated with PEPSiT with no further recurrence. This study demonstrates that a standardized perioperative protocol, including tailored pre- and post-operative management and structured long-term follow-up, is effective in ensuring favorable clinical outcomes, with negligible pain, high patient satisfaction and a low rate of recurrence.