Specialties
Pilonidal Sinus Surgery
Pilonidal Sinus Surgery
Consultant Colorectal and General Surgeon in London
Pilonidal sinus disease is a painful condition where hair and debris become embedded in a small pit or sinus in the natal cleft (the skin between the buttocks), leading to infection, abscess formation, and chronic discharge. Traditional wide excision surgery leaves large, open wounds that take months to heal. The EPSiT procedure (Endoscopic Pilonidal Sinus Treatment) is a revolutionary, skin-sparing, minimally invasive technique that treats the sinus from the inside out — preserving healthy skin, reducing pain, and allowing rapid return to normal activities.
Mr Nikhil Pawa is a UK specialist in the EPSiT procedure, offering this advanced treatment to patients across London and beyond.
Benefits of Pilonidal Sinus Surgery
01
Preserves Healthy Skin
Unlike traditional wide excision, EPSiT leaves the natal cleft skin intact — no large wound, no scar deformity, and no need for wound packing.
02
Minimally Invasive
A small 4mm incision allows an endoscope to visualise and ablate all sinus tracts from the inside, treating the disease without cutting through healthy tissue.
03
Very Low Recurrence Rate
EPSiT has reported recurrence rates of only 5-10% at 2-3 years, comparable or superior to traditional surgery, with much better patient satisfaction.
04
Fast Return to Work & Sports
Most patients return to sedentary work within 2-3 days and to full sports/gym within 2-3 weeks — not months.
05
Minimal Post-Operative Pain
Because no skin is excised, pain is significantly less than with open or flap procedures. Most patients require only simple oral painkillers for a few days.
06
No Wound Packing or Dressings
Traditional pilonidal surgery often requires months of daily wound packing. EPSiT uses a small, simple dressing that patients can change easily.
07
Day-Case Procedure
EPSiT is performed as a day-case under general anaesthetic, allowing you to return home the same day.
08
Performed by a Global Expert
Mr. Nikhil Pawa is a recognised specialist in the EPSiT procedure, bringing over 20 years of experience in advanced pilonidal and proctology surgery.
Our Process
Specialist Consultation
Your journey begins with a thorough consultation with Mr Nikhil Pawa, where your symptoms (pain, discharge, recurrent abscesses), previous surgeries, and impact on daily life are carefully reviewed. The natal cleft is examined to assess the number of pits and sinus complexity.
Diagnostic Sinus Assessment
In some cases, an MRI or ultrasound may be arranged to evaluate the depth and direction of sinus tracts, especially for recurrent or complex disease. This ensures the EPSiT procedure can be precisely planned.
Tailored Surgical Planning
If you are a candidate for EPSiT, we create a personalised plan. Most primary and recurrent pilonidal sinuses are suitable. For very extensive disease, a combined approach or alternative flap surgery may be discussed, but EPSiT remains the first-line skin‑sparing option.
EPSiT Procedure & Recovery
Under general anaesthetic, a 4mm endoscope is inserted through the main sinus opening. All side tracts are visualised, cleaned, and ablated using a special probe. The procedure takes 30–45 minutes. You go home the same day with a small dressing. Most patients resume desk work in 2-3 days and full activities in 2-3 weeks.
Locations
FAQs
It is a chronic skin condition where hair and debris collect in a small pit or sinus in the crease between the buttocks, causing infection, pain, and smelly discharge.
EPSiT (Endoscopic Pilonidal Sinus Treatment) is a minimally invasive, skin‑sparing technique where a tiny endoscope is inserted through the sinus opening to visualise and ablate all side tracts from the inside — leaving the overlying healthy skin untouched.
Traditional surgery (wide excision) removes a large ellipse of skin and tissue, leaving an open wound that takes weeks to months to heal, requires daily packing, and has a significant recurrence risk. EPSiT preserves all healthy skin, causes minimal pain, and allows return to work in days.
Most patients with primary or recurrent pilonidal sinus disease are excellent candidates. Even patients who have failed previous traditional surgery can be treated with EPSiT. A consultation with Mr Nikhil Pawa will confirm suitability.
Most patients return to desk work in 2–3 days, driving in 5–7 days, and full sports/gym in 2–3 weeks. There is no wound packing, no activity restrictions beyond comfort, and minimal scarring.
Published studies show healing rates of 90-95% and recurrence rates of 5-10% at 2-3 years — comparable to traditional flap surgery but with dramatically less pain, faster recovery, and better cosmetic outcome.
Skin‑Sparing Pilonidal Surgery (EPSiT) in London
Minimally Invasive, Rapid Recovery, Lasting Cure.