Minimal invasive techniques (Epsit, Silac, etc.)


New Member
Country flag
Hi folks,

I'm 33 and I seem to be starting my unfortunate journey with pilonidal disease having had my first episode in October 2022, which cleared on its own after a few weeks only to reoccur again in February 2023.

Two months later it was mostly gone but this week it flared-up again and I decided to go to the GP for the first time.

The prescription for the moment is a week of antibiotics but he seemed quite sure it was pilonidal sinus but didn't want to go the surgical route before trying some antibiotics first as I haven't tried anything before, apart from applying heat with a hot water bottle and some aloe vera gel. But if clears now and reappears again a referral to a surgery would be the next option.

Since the first episode I have been researching a bit, and read a lot of the stories you all have shared in the forum. So, due to all the difficult ordeals people have had with the traditional techniques, I wonder what has been the experience of people undergoing the newer minimal invasive techniques like EPSIT and SILAC.

For example, where was it done, how easy/difficult was to get the procedure, how was the post-op, any reoccurrence, if done privately was it expensive, etc.

Sorry for the long post, but I think your stories could be a good guide for me and everyone else to understand these newer techniques and gather the pros and cons of real experiences.

Thank you in advance!
I'm facing my first instance of Pilonidal Sinus and would equally welcome more experienced hands chipping in on this. Went to see a leading private surgeon who wants to perform a cleft lift but I can't help but want to explore EPSiT first, although difficult to find real experts with this technique in the UK and yet to find anyone offering the laser-assisted variant.
Amir Darakhshan at London Colorectal Group does a lot of EPSIT procedures. I had a cleft lift done by his colleague, Emin Carapeti, a couple of weeks ago. We discussed EPSIT during my consult -- he said given that I had two sinuses and a relatively long sinus tract, he would not recommend it but would be glad to have Mr Darakhshan assess if I wanted to start more conservatively with EPSIT ... but that in most cases it has about a 30% recurrence rate.

If you've only had a first or second flare-up, you'd probably be a great candidate for EPSIT. I have nothing but good things to say about London Colorectal Group ... they are private, but I think EPSIT is fairly inexpensive so it may not be cost-prohibitive vs. going on the NHS.

Tan Arulampalam in Colchester also seems to do a lot of EPSIT procedures and I believe he is on the NHS.
My son who is 19 has a virtual consultation tomorrow with one of 3-4 colorectal surgeons specializing in pilonidal disease and offering SILAC. I’ve been following the case studies and trials since 2019 and just this month they are starting to offer it. He has had 2 cleft flap repairs that were unsuccessful and only created more pain and chronic problems. We are on our 5th treatment of laser hair removal which has completely eliminated all but a stray hair or two. Wound care Dr was debreding cavity/tract for about 6mo every 2-4wks and mild and temporary improvement was noted but continued to recur and flare. We have used Vashe to irritgate every 48hrs and I keep the top opened so it will prevent abscess. He uses a peri bottle 1-2x daily with hibiclens surgical scrub mixed with hot h20 to keep the surface of the wound and area surrounding as close to sterilize as possible and he’s only had one infection in 2yrs and that was due to no hygiene or wound care performed for 3-4 days after working 3-16hr shifts at work which is labor intensive. Please let us know here if anyone is considering or has recently had the SILAC
treatment, especially with chronic recurrent pilonidal disease. I will keep everyone updated after our virtual visit to determine if he’s even a candidate. Prayers to everyone out there dealing with this