Minimally invasive surgery UK

Discussion in 'Pilonidal Discussions - UK Forum' started by Pete17, Sep 27, 2017.

  1. Pete17

    Pete17 New Member

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    Hi all,

    I saw a post a while back praising Prof. Basso in Italy for his minimally invasive Surgery for sinus removal. the results seem promising - low recurrence rate, low amount of pain and low recovery time. After having a bit of a look into it, I saw a couple articles online from the start of last year, mentioning that there was a similar endoscopic version of the procedure introduced by Mr Tan Arulampalam and Mr Raj Rajaganeshan at Colchester University Hospital. Would be interested to hear if anyone has gone for this, or looked into it themselves?
     
    Last edited: Oct 12, 2017
  2. Pete17

    Pete17 New Member

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    Surprised by the lack of interest in this post, however if anyone is at all interested, I emailed one of the above mentioned surgeons asking for a bit of information, He confirmed he carries out the EPSIT procedures with a success rate of around 85%.

    I’ve gone back asking about recovery time, complication rate etc. But seems like it could potentially be a good alternative option to bigger surgeries.
     
  3. Kelmisty

    Kelmisty New Member

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    This is not a forum with significant traffic, so sometime posts aren't seen as often.

    What is an EPSIT?
     
  4. Pete17

    Pete17 New Member

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    I appreciate that, and if that sounded at all acrimonious it wasn’t intended to, just feel some of these up and coming procedures with promising results should have a bit more coverage if they are to become more widely known/available, as I think most on here are already aware of the majority of surgeries (or at least only need to scroll down one or two threads to find them mentioned again!)

    The EPSiT, is an endoscopic procedure where a small camera is used to locate and track only the infected tissue, from there it is removed and the area scraped clean (almost like a more advanced pit picking).

    I’m no expert on the matter, but as I say, results so far seem promising.

    Here’s the closest I could find on a link to what the procedure entails:

    http://www.piercarlomeinero.it/en/epsit.html

    And a brief study of results (only 77 patients in this trial so obviously won’t reflect results 100% accurately)

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592432/

    I’m sure the results will depend heavily on the surgeon performing, but then again, I think that’s the case with any procedure!
     
    Last edited: Oct 12, 2017
  5. Luke Wade

    Luke Wade Helpful

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    I read this post when you first posted on the 27th of September, but you didn't mention the name of the surgery or any details about the procedure.
     
  6. Pete17

    Pete17 New Member

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    Well I had extremely limited information on it. Literally googled “minimally invasive surgery UK” I’ve just looked into it more since. It is afterall a discussion, not a lecture!
     
  7. Luke Wade

    Luke Wade Helpful

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    Just thought it was slightly ambiguous to comment is all.

    It does look interesting - but I've found if the incision is kept in the midline you're going to most likely have problems. The very midline does not heal wounds well for some reason.

    "The spontaneously draining opening which is normally situated on the midline cleft, must be removed by making a half a centimeter circular incision around the opening."

    That said... it may work for you.
     
    Last edited: Oct 13, 2017
  8. Pete17

    Pete17 New Member

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    I’ve heard the same, however it is very similar to the GIPS procedure, that Luigi Basso in Italy carries out, the results of which were calculated on a much larger number of patients (around 2500) showing results of 80% success rate on patients even after 12 years post op.

    Additionally, if you’re one of the unlucky 15-20%, its a simple procedure to carry out again, and from the trials I read, those who had it carried out again had no further issues.
     
  9. Susan Stanford

    Susan Stanford New Member

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    Pete, I am not familiar with the procedure but agree with Luke. Sternberg and the late Bascom (surgeons who perform/ed cleft lift when less invasive procedures like lancing and draining and pit picking didn't work) emphasis the need to "stay out of the ditch" - don't put any incisions in the cleft where they are extremely difficult, if not impossible to heal. The problem in pilonidal disease is the deep cleft - butt crack. Good if less invasive procedures can work but for my son the 4 prior surgeries all resulted in wounds in the cleft that even professional wound care physicians could not keep healed. For any surgeon operating on pilonidal disease I would want to know what more invasive surgery do they perform. If they are not configuring the cleft with the cleft lift then I would think that they don't really understand the disease and would seek out a surgeon for the less invasive options that does understand the disease.
     
  10. Pete17

    Pete17 New Member

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    Well I can’t speak for the epsit procedure, as again, I’m no expert, but I know that Basso’s procedure specifically references “stay out of the ditch” as a mantra. Of course there’s going to be exceptions, same with any procedure. I’m just going on figures from medical trials I’ve researched.
     
    Last edited: Oct 14, 2017
  11. Susan Stanford

    Susan Stanford New Member

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    If he is using that phrase, "stay out of the ditch" then I would think he does know and agree with Bascom's view because that was his phrase. It is so, so wise of you to do research. I really regret not doing research at the beginning of my son's symptoms when he was in high school. It would saved him a lot of suffering.
     
  12. Luke Wade

    Luke Wade Helpful

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    Susan, I really regret not doing research before my first surgery too (2009), if I would have I would of 100% gone with cleft lift over everything else - hands down! I feel pretty naive to of put complete faith in doctors on their decision for what was best.. But then they are the professionals, the fact I had to do the research and push my GP to get me a referral for the best PD treatment is quite frankly scary. I have really resented them for not initially giving me the best treatment there is; I feel massively let down. It is also kind of empowering that I've taken the role of the Dr (almost?) and procured the best treatment possible. I've definitely learned my lesson from this - Research is key.
     
    Last edited: Oct 14, 2017
  13. Susan Stanford

    Susan Stanford New Member

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    Yes, I agree. It is hard sometimes for me to read other people's stories that did research first because I feel such guilt over handing my son over to a butcher - can't think of any nicer name to call one of his prior surgeons. It took several failed surgeries for me to really wake up and fight for my son and not just naively assume that every doctor understood pilonidal disease because they all talked as if they did. They all talked as if they were experts! Now I am just trying to share our story and help others to avoid our suffering. How are you doing, Luke?
     
  14. Luke Wade

    Luke Wade Helpful

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    Agreed.

    I'm doing ok, nurse today said it looks smaller and flatter, clean. No packing, just a plaster. Using an iodine plaster today instead of aquacel. Which I'm a bit hesitant about, why change something that is working..
    Do you recall what dressing was used on your son?
     
  15. Susan Stanford

    Susan Stanford New Member

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    For the cleft lift my son had multiple layers of gauze, which we changed frequently at the beginning. He wore a hospital disposable underwear that was tight and held them in place - which he hated because they were so tight. What area had the packing that now has the plaster?
     
  16. Susan Stanford

    Susan Stanford New Member

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    And so glad to hear that the nurse says it is looking good and continuing to heal! I have to run to the grocery store now to prepare for a family dinner tonight but will check the forum later. Luke, I have been thinking of you often and praying for your healing.
     
  17. Luke Wade

    Luke Wade Helpful

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    The lower part of the cleft lift scar. She said there's no hole anymore it looks like a graze/surface wound. 2cm

    I guess I should trust they know what is best to apply to the remaining wound? I'm sure you can understand my anxieties for every minor change.
     
  18. Luke Wade

    Luke Wade Helpful

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    Thank you Susan
     
  19. Susan Stanford

    Susan Stanford New Member

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    Yes, I do understand, completely. All of the past failed surgeries left fear, pain, and anxiety that is easily stirred up with a new surgery. I think that it would be good, for your own peace of mind, to ask any question that you are concerned about. I am sure that they have reasons for changing what they are applying to your wound. I think that most medical professionals wouldn't mind having a conversation as they are caring for your wound and answering your questions so that you fully understand. I have had greater peace of mind as my questions have been answered by our surgeon.
     
  20. Luke Wade

    Luke Wade Helpful

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    Today I asked her to switch back to usual as the dressing she put on yesterday, although comfortable whilst on, was so painful when removing it! Felt it could be detrimental to the healing skin. She said the wound was 1cm by 1/2 a cm; no packing, just laid on top. Did your son use a donut whilst sitting at all? She said it might be a good idea for my cleft lift scar in the early stages - that said I am laying on my side a lot instead of sitting.
     

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