Background: Endoscopic technique is being increasingly used for managing pilonidal sinus disease (PSD). The challenge in this technique is to establish complete clearance of all hair and access narrow tracts to avoid recurrence.

Aim: To study the use of ultrasound for adequate clearance of hair and manage all tracts during endoscopic pilonidal sinus treatment.

Procedure: From March 2018 till March 2020, 45 successive patients seeking management for Pilonidal sinus disease of sacrococcygeal region were managed by Endoscopic pilonidal sinus treatment under ultrasound guidance (EPUG). In this, the endoscopic technique was combined with intraoperative sonography to (1) map the tracts prior to introducing scope (2) help in canulation of tracts hence avoiding false tracts and to confirm (3a) adequate clearance of hair and (3b) adequate management of all tracts and their branches. Upon discharge, dressing was continued till closure of external pits. Follow-up was done by monthly outpatient visit or telephonically if patient couldn't visit.

Results: Ultrasound provided additional information (over endoscopic detection) of residual hair in 6/45, additional tract in 5/45 and helped to roadmap the tracts in all patients. 6 months follow-up available for all patients was free of complications and recurrence, with high patient satisfaction rate.

Inference: Sonography is an important, easily available modality for establishing complete clearance and access during pilonidal sinus management by endoscopic technique. Further studies can establish its role in regular surgical practice.