Minimally Invasive Pilonidal Procedures

A Smaller Step Before Major Surgery

Not every Pilonidal patient needs a large excision or flap procedure. For many people — especially those with early or localized disease — minimally invasive options such as laser pilonidal surgery, Pit Picking, and others, can offer relief with faster healing and smaller wounds.

These techniques focus on removing pits and sinus tracts through very small openings, often under local anesthesia. Recovery is usually quick, but recurrence rates are somewhat higher than with major off-midline procedures.

Who these are for

• First or second flare-ups
• Small, localized sinus openings
• Patients who want the fastest return to school, work, or daily life
• People who prefer to try the least invasive option first

What to expect

• Usually performed as an outpatient procedure (go home the same day)
• Small incisions or punctures instead of large open wounds
• Local anesthesia or twilight sedation (rarely general anesthesia)
• Most people return to light activity in a few days to a week
• Lower wound care burden compared to large excisions

The trade-off: recurrence is more likely than with more major procedures, especially if your surgeon does not have a lot of experience with these techniques. Finding a surgeon may mean traveling.

Minimally Invasive Surgeries

• Pit picking / Gips (trephination) / Biopsy Punch Excision (BPE) – In these procedures, the surgeon makes small openings in the skin to remove the tiny pits (infected pores) and tunnels just under the surface. Because the cuts are small, recovery is usually quicker.
  • Pit Picking – Dr. John Bascom pioneered this method to treat early pilonidal cases before they became complex.
    • Pit Picking photos, these are post-operative and show open wounds.
  • Gips Procedure – Dr. Moshe Gips improved on Pit Picking by using trephines, but followed the same principle: stop small cases from turning into big ones.
  • Biopsy Punch Excision (BPE)  – Another name for the same type of technique, using small circular instruments.
• Endoscopic Pilonidal Sinus Treatment (EPSiT/VAAPS) – In this approach, the surgeon uses a small camera to look inside the tunnels under your skin. They then clean them out and destroy the infected lining so the tunnels can heal closed.
  • VAAPS (Video Assisted Ablation of Pilonidal Sinus) – Available at some centers in the U.S. It’s less invasive than traditional surgery, but not widely available.
  • EPSiT (Endoscopic Pilonidal Sinus Treatment) – Similar to VAAPS, but not yet available in the U.S. It’s usually done by specialists in pilonidal centers.
• Sinus Laser Ablation (SiLaC/SiLaT) – Here, the surgeon slides a thin laser fiber into the tunnel. The laser burns away the tunnel’s inner lining, causing it to shrink and close up while leaving the healthy skin around it alone. Early results are good, but the success rate is lower for people with larger or more advanced problems.
  • SiLaC, or Sinus Laser-assisted Closure, in which a thin laser probe is inserted into the sinus tract and used to seal the cavity with laser energy, which destroys the lining and causes the tract to shrink and close. The primary goal is to address the infected tract with minimal damage to the surrounding healthy tissue.
  •  SiLAT (Sinus Laser Therapy) refers to the same or a very similar procedure. The names are often used interchangeably by different clinics and publications to describe the use of a laser to close the sinus tract from the inside.
• Crystallized phenol – Instead of surgery, the doctor places a chemical into the tunnel to kill the unhealthy tissue, allowing it to heal shut. Sometimes this needs to be repeated a few times. It’s backed up by research in certain patients, but it’s rarely done in the U.S.

Your options at a glance

Procedure	Good Candidates	Typical Anesthesia	Back to Normal*	Recurrence (typical ranges)**	Where Available
Pit Picking / Gips / Biopsy Punch Excision (BPE)	Few midline pits; limited tracts	Local ± sedation	2–7 days	~10–25% (depends on surgeon skill)	Widely in Europe; some U.S. centers
Endoscopic Pilonidal Sinus Treatment (EPSiT / VAAPS)	Suitable tracts; access to specialized equipment & surgeon	Local or twilight (MAC)	3–10 days	~10–20% (center-dependent)	Italy, Germany, UK, select U.S. centers
Laser Therapy (SiLaC / SiLaT)	Limited–moderate tracts; earlier disease; not very obese	Local or twilight (MAC)	3–10 days	~10–25% short–mid-term; long-term varies	Common in Germany, Italy, Turkey; rare but growing in U.S. centers
Crystallized Phenol	Small/simple sinus tracts; willing to repeat sessions if needed	Local (clinic procedure)	1–3 days	~10–25% in selected studies	Europe, Middle East; limited in U.S.

* “Back to normal” = typical return to routine/light activity; athletes/heavy labor need longer.
** Ranges reflect mixed study designs/follow‑up; ask for your surgeon’s own data.

When to Consider Other Options

Minimally invasive procedures may not be the right choice if:

• You have numerous complex tracts or multiple failed procedures
• Your surgeon doesn’t have significant experience with these techniques
• You want the lowest long-term recurrence rate possible (cleft lift, excision, or other flap procedures may be better

Review the Major Pilonidal Surgeries page for more options

Key Takeaway

Minimally invasive surgery can be a great first step for the right patients: quick healing, small wounds, and a chance to avoid major surgery. But recurrence is more likely than with advanced surgical operations, so the skill and experience of your surgeon — plus your aftercare plan — make all the difference.

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