Can EPSiT be performed after previous pilonidal surgery?

Yes — recurrent disease after previous excision is one of its strongest indications, because scarred anatomy is exactly where seeing inside the cavity matters most. Where the cleft itself is very deep or badly scarred, a cleft-lift flap procedure may be more durable.

How long until I can drive, fly and return to the gym?

Driving is usually comfortable at three to five days, desk work at two to five days and flying from about a week. Gym, cycling, swimming pools and hot tubs wait until the openings close, typically three to four weeks. Cycling is worth delaying longest because saddle pressure loads the healing area directly.

Should asymptomatic pilonidal pits be treated?

Generally not. Midline pits with no discharge, pain or cavity need hair control and hygiene rather than an operation, and many people carry pits for life without developing disease. Operating on an asymptomatic pit exposes the patient to procedural risk without clear benefit.

Will there be a visible scar after EPSiT?

Only small ones. Access is through the existing pits plus occasionally one small additional opening, leaving a few millimetre-scale marks in the cleft rather than the long midline scar or off-midline flap line left by conventional surgery.

Home/Conditions/Pilonidal Sinus

Pilonidal sinus · Pilonidal disease · الناسور العصعصي

Pilonidal sinus laser treatment in Dubai — no wide excision, no months of packing.

EPSiT lets the surgeon see inside the sinus cavity with a miniature endoscope, remove every hair and fragment of debris under direct vision, and then seal the cavity with a laser fibre (SiLaC). The buttock is not laid open. There is no wound to pack twice a day for four months.

Endoscopic — treated under vision 30–45 minute procedure Day case No open excision wound

Book a pilonidal assessment Ask about pilonidal

EPSiT + SiLaC — what "endoscopic" means here

A miniature camera (fistuloscope) is passed into the sinus cavity through its existing pit
Hair, debris and infected tissue are located and removed under direct vision, not by feel
A laser fibre (SiLaC) then ablates the cavity lining so it closes from the inside out
The skin over the buttock is never widely cut open

The full anatomy and technique diagrams are further down this page.

At a glance

Procedure: LA-EPSiT (endoscopic clearance) + SiLaC (laser cavity ablation)
Access: through the existing pits — typically 5–10 mm total
Theatre time: 30–45 minutes
Dressings: simple, no daily packing
Work: 2–5 days; driving at 3–5 days
Best for: primary and recurrent disease, including after failed excision

Medically reviewed by Dr Kerim Erdem Ulucay, Specialist General & Laparoscopic Surgeon (DHA-licensed) Last reviewed: 25 August 2026 Next review due: August 2027 Reading time: 9 minutes

Understand it, then decide

The condition and the cure, kept separate

Pilonidal disease is the condition where the old operation causes more misery than the disease. Understanding why matters.

Component A · The Disease

What pilonidal disease actually is

Pilonidal means "nest of hair". The disease is a chronic infected cavity in the natal cleft — the groove between the buttocks, just above the tailbone — that contains loose hair, keratin debris and inflammatory tissue.

It is an acquired condition, not something you were born with. Loose hairs shed from the back and scalp collect in the cleft. Friction from walking and sitting, combined with the negative pressure created as the buttocks move, drives those hairs point-first into the skin through enlarged hair follicles known as pits. The hairs have microscopic backward-facing scales, so they can advance but cannot reverse out. Once beneath the skin they behave as foreign bodies: the body walls them off, infection follows, and a cavity forms with one or more tracts draining to the surface.

That mechanism explains the epidemiology precisely. Pilonidal disease favours young adults between fifteen and thirty, men roughly two to three times more than women, people with dense body hair, and anyone who sits for long periods — drivers, office workers, students. It is historically known as "jeep driver's disease" for exactly this reason.

The UAE adds its own risk factors. Heat and humidity mean more sweating and macerated skin in the cleft; long commutes and long office hours mean prolonged sitting; and a young, largely male expatriate working population sits squarely in the peak demographic. This is a condition this clinic sees a great deal of.

Pilonidal sinus disease overview — anatomy, formation and causes, typing and classification, symptoms and diagnostic methods, and management and treatment options including laser ablation

Anatomy & causes, typing, symptoms, and management options at a glance

How it presents — three distinct pictures

Asymptomatic pits

One or more small midline dimples with no symptoms at all, often noticed by chance or by a partner. No treatment is needed — only hair control and hygiene. Operating on an asymptomatic pit is over-treatment.

Chronic discharging sinus

Intermittent or continuous discharge of pus, blood or clear fluid staining underwear. A dull ache when sitting, worse in the car and on long flights. Visible pits, sometimes with a hair protruding. This is the classic presentation and the ideal EPSiT case.

Acute abscess

Rapidly worsening pain over one to three days, a hot tender swelling, fever, and inability to sit or lie flat. This needs drainage within hours, not an elective plan. Definitive laser treatment follows six to eight weeks later.

Symptoms and what drives recurrence

What patients report

Discharge and staining — the most common and the most quietly distressing symptom.
Pain on sitting, particularly on hard chairs, in cars and on flights.
Visible pits in the midline, sometimes with hair emerging.
Recurrent swellings that build up and then discharge, over and over.
Odour and skin irritation from chronic moisture.
Restriction of life — avoiding the gym, swimming, travel and intimacy. Rarely mentioned unless asked, and often the biggest cost.

Why it comes back — the four real reasons

Hair returns to the cleft. The single dominant factor. If hair keeps entering, the disease keeps recurring — whatever operation you had.
A deep, narrow cleft that stays moist and macerated and cannot ventilate.
Incomplete clearance — a residual side tract or a single hair left behind restarts the whole process.
A midline scar. Midline wounds in the cleft heal poorly under constant tension. This is why classic midline closure has such a high failure rate.

Laser hair reduction is part of the treatment, not an optional extra. A course of laser epilation over the cleft is the most evidence-supported way of preventing recurrence after any pilonidal procedure. It is built into the aftercare plan here rather than sold separately as an afterthought.

Severity — matching disease to procedure

Type 1 · Pits only

Asymptomatic midline pits, no cavity, no discharge.

Hygiene & hair control · no surgery

Type 2 · Simple sinus

Single cavity, midline pits, chronic discharge, no lateral extension.

Ideal EPSiT + SiLaC

Type 3 · Complex

Multiple pits, lateral or branching tracts, larger cavity.

EPSiT under vision — its strongest indication

Type 4 · Recurrent

Disease after previous excision, with scarring and distorted anatomy.

EPSiT, or flap surgery if the cleft must be reshaped

Understanding pilonidal disease

Why hair gets in — the mechanism

Loose hair shed nearby is drawn into small pits in the midline natal cleft by everyday movement
Trapped hair acts as a foreign body, triggering a low-grade inflammatory reaction under the skin
A small cavity and tract form as the body tries to wall off the irritation
Friction, sweating and prolonged sitting all make trapping more likely, especially in hairier or heavier patients

This is why hair-control measures are part of every prevention plan, not just treatment.

Why open excision recovery takes so long

Traditional wide excision leaves an open wound that heals by secondary intention — from the base up
This routinely means dressing changes twice a day for 6–12 weeks, sometimes longer
Sitting, exercise and often work are restricted for much of that healing period
EPSiT avoids this because the skin is never widely opened in the first place

This is the single biggest reason patients look for a laser alternative.

Now show me the treatment

Component B · The Laser Treatment

LA-EPSiT and SiLaC, step by step

Two techniques are combined, and each solves a different half of the problem.

EPSiT — Endoscopic Pilonidal Sinus Treatment. A fistuloscope, roughly two millimetres across with its own light and irrigation channel, is introduced through an existing pit. For the first time the surgeon can actually see the cavity: its true extent, every branch, and every hair inside it. Under direct vision the hair nest and inflamed granulation tissue are removed with a miniature brush and forceps, and the cavity is irrigated clean. This matters enormously — the classic reason a pilonidal sinus recurs is a side tract or a single hair that nobody could see and therefore nobody removed.

SiLaC — Sinus Laser Closure. A radial 1470 nm laser fibre is then passed into the emptied cavity and withdrawn slowly, delivering circumferential energy that ablates the epithelial lining and shrinks the cavity walls so they collapse together and fibrose.

Access is through the pits themselves, occasionally with one small additional opening a few millimetres wide for drainage. There is no excision of skin and fat, no large defect, no midline wound under tension, and no packing.

Compare that with the traditional wide excision: a substantial ellipse of skin and subcutaneous tissue removed down to the sacral fascia, left open to heal by secondary intention over two to four months with daily nursing dressings, or closed in the midline with a recurrence rate that made surgeons abandon the approach.

EPSiT and SiLaC technique — endoscopic clearance and laser ablation of a pilonidal sinus cavity

Inside the theatre — the six stages

10–5 minutes
Anaesthesia and positioning

Short general anaesthetic, spinal, or sedation with local infiltration. Prone jack-knife position, cleft gently taped open. Hair around the field is clipped, not shaved.
25–12 minutes
Endoscopic exploration

The fistuloscope enters through an existing pit. The cavity is mapped under vision with continuous irrigation — extent, branches, secondary tracts and the hair burden are all documented before anything is removed.
312–28 minutes
Clearance of the hair nest

Hair, keratin debris and inflamed granulation tissue are removed with an endoscopic brush and micro-forceps. Every branch is followed to its end. This is the longest stage and the one that determines whether the disease returns.
428–38 minutes
Laser ablation of the cavity (SiLaC)

The radial fibre is introduced and withdrawn slowly at controlled power, ablating the lining circumferentially so the walls collapse inward and fibrose.
538–42 minutes
Pit management

The midline pits are excised as tiny discs of skin — millimetres, not centimetres — and left open to drain. Removing the pits closes the door through which hair enters.
642–45 minutes
Simple dressing

A light absorbent dressing. No packing, no drain, no vacuum device. You are awake within minutes and walking within the hour.

Watch it in motion

Animated illustration — no real patients or staff

LA-EPSiT + SiLaC — animated walkthroughSinus tract ablated and sealed from within · silent · 12s loop

Benefits over wide excision

No large open wound

Wide excision leaves a defect that heals by secondary intention over two to four months. EPSiT leaves openings measured in millimetres.

No daily packing

For most patients who have had the open operation, the daily packing — not the surgery — is the memory. There is none here.

Treated under direct vision

The endoscope shows the cavity rather than leaving the surgeon to infer it. Complete clearance is verified, not assumed.

Days, not months

Back to desk work in two to five days and driving at three to five, against weeks off after excision.

Repeatable

If disease persists, EPSiT can be repeated, and open surgery remains fully available afterwards. Nothing has been burnt — literally or figuratively.

Minimal scarring

A significant consideration for young patients, and for the many who have watched a friend's excision scar heal badly.

An honest word on success. Published healing rates for EPSiT with laser closure are broadly comparable to open techniques with dramatically less morbidity, but no pilonidal procedure eliminates recurrence — because the cause is hair, and hair keeps growing. Patients who complete a course of laser epilation and maintain cleft hygiene do substantially better than those who do not, regardless of which operation they had. If someone offers you a permanent cure for pilonidal disease, ask them about hair.

Pain: an honest comparison

EPSiT + SiLaC first 72 hours

Pit picking (Bascom I) first 72 hours

2–3

Flap repair Karydakis / Limberg

Wide excision, open healing ongoing, weeks of packing

7–8

0–10 visual analogue scale. The wide-excision figure reflects sustained discomfort across weeks of dressing changes, not a single post-operative day.

Recovery timeline

Day 0Home the same afternoon. Light dressing. Sit on a cushion; avoid sitting directly on the area for long spells.

Days 1–5Shower normally from day one and dry the cleft thoroughly. Serous discharge is expected. Desk work resumes; driving at 3–5 days.

Weeks 1–3Openings contract steadily. No gym, cycling, swimming pools or hot tubs. Keep the cleft dry and hair-free.

Weeks 4–6Openings closed in most patients. Clinic review. Laser hair reduction begins — this is the recurrence-prevention step.

Months 3–6Epilation course completed. Healing confirmed. Long-term hygiene and hair-control plan handed over in writing.

Contact the clinic if: pain increases after day three rather than easing; discharge becomes thick, foul-smelling or heavier; redness spreads across the buttock; or you develop a fever. Early review deals with all of these easily — a delayed one does not.

The procedure, step by step

EPSiT + SiLaC, in four steps

A fine fistuloscope is passed into the cavity through its existing pit — no new incision is made
Hair and debris are located and washed or grasped out under direct vision
The cavity lining is fulgurated/ablated to remove the source of inflammation
A laser fibre (SiLaC) seals the tract from within so it closes without an open wound

The full illustrated technique diagram is above, in the treatment section.

Patient stories — by consent only

We do not publish stock or invented testimonials on this site
Patients who previously had open excision, and later chose EPSiT, are often willing to describe the difference
Ask us directly and we can put you in touch, where a patient has agreed to be contacted

Ask about patient experiences

Individual results and recovery times vary between patients.

Before you agree to a wide excision, get a second opinion

Many patients are still offered the open operation as though it were the only option. If someone has recommended excision with weeks of packing, it is worth thirty minutes to find out whether an endoscopic approach would work for your anatomy.

Book an assessment Get a second opinion

Every option, not just ours

How EPSiT compares with the alternatives

There is a genuine role for flap surgery. It is a smaller role than it used to be.

Technique	Wound	Off work	Trade-off
Wide excision, healing open	Large open defect	4–8 weeks	Thorough, but months of daily packing and a substantial scar. Increasingly hard to justify as a first option.
Excision with midline closure	Midline suture line	2–4 weeks	Shorter healing, but a high failure rate — a midline wound in the cleft sits under constant tension.
Flap repair (Karydakis / Limberg / Bascom cleft-lift)	Off-midline suture line	2–3 weeks	Low recurrence and the technique of choice for a deep cleft or major recurrent disease — at the cost of a larger operation and scar.
Pit picking (Bascom I)	Tiny excisions	2–5 days	Minimal and effective in simple disease, but the cavity is not treated under vision.
EPSiT + SiLaC	Millimetre openings	2–5 days	Cavity cleared under direct vision and sealed with laser. Not suitable for very extensive disease or a severely distorted cleft.

Pilonidal questions

What patients ask before booking

Do I still need daily wound packing after EPSiT?

No. That is the central difference. Because no large defect is created, there is nothing to pack. A simple absorbent dressing is used for the first few days, you shower normally from day one, and you dry the cleft thoroughly afterwards. For patients who have previously had a wide excision, this single change is usually what they describe as transformative.

Can EPSiT be done if I have already had pilonidal surgery?

Yes — recurrent disease after previous excision is one of its strongest indications. Scarred anatomy is exactly where the ability to see inside the cavity matters most, because previous surgery distorts the tracts and makes blind exploration unreliable. Where the cleft itself is very deep or badly scarred, a cleft-lift flap procedure may be the more durable answer, and you will be told so honestly.

Will pilonidal sinus come back after laser treatment?

It can, after any pilonidal procedure. The disease is caused by hair entering the cleft, and hair keeps growing. Reported recurrence after EPSiT with laser closure is broadly comparable to more invasive techniques, with far less morbidity. The decisive variable is aftercare: patients who complete laser hair reduction over the cleft and keep the area dry do considerably better than those who do not.

Is laser hair removal really necessary afterwards?

It is the most evidence-supported preventive step available, and it is part of the treatment plan here rather than an upsell. Shaving is an alternative but must be repeated indefinitely, and stubble regrowth is sharper and enters the skin more easily — some patients are worse off shaving inconsistently than not at all. A course of laser epilation starting at around four to six weeks post-procedure is strongly recommended.

I have a painful swelling right now — what should I do?

That is likely an acute pilonidal abscess and it needs drainage promptly, not an elective appointment in three weeks. Contact the clinic today or attend an emergency department. Antibiotics alone rarely resolve a collection under pressure. Definitive EPSiT is then performed six to eight weeks later, once the acute inflammation has settled and the anatomy is clear.

How long until I can drive, fly and go back to the gym?

Driving is usually comfortable at three to five days, desk work at two to five days, and flying from about a week — take a cushion for a long-haul seat. The gym, cycling, swimming pools and hot tubs wait until the openings have closed, typically three to four weeks. Cycling in particular is worth delaying, as saddle pressure directly loads the healing area.

Are asymptomatic pits worth treating?

Generally not. Midline pits with no discharge, no pain and no cavity need hair control and hygiene, not an operation. Many people carry pits for life without ever developing disease. Operating on an asymptomatic pit exposes you to the risks of a procedure for no clear benefit, and you will be told that rather than booked in.

Will there be a visible scar?

Only small ones. Access is through the existing pits plus occasionally one small additional opening, so what remains are a few millimetre-scale marks in the cleft rather than the long midline scar or off-midline flap line left by conventional surgery. For younger patients this is frequently a deciding factor, and there is nothing unreasonable about that.