How long does a pilonidal cyst flare-up last?

This hasn't been directly studied. The closest figures available describe how long it took specific treatments to heal a flare-up — for example, one phenol treatment took around 18 days on average, and laser treatments healed in roughly 10 to 15 days in some studies — but none of this tells you how long an untreated flare-up would last on its own.

How long does pilonidal cyst pain last?

No study tracked pain duration without treatment. One case series of laser treatment found pain could persist for up to a year in some patients afterward, but this describes pain after a procedure, not the natural course of untreated pain.

Should I just wait it out instead of seeing a doctor?

The evidence doesn't support waiting indefinitely. Disease that lingered for more than three years was linked to a small increased risk of a rare skin cancer in one study. Some mild cases did improve with simple measures like better hygiene and hair removal, so see a clinician who can guide safe conservative care rather than ignoring it for years.

Does a pilonidal cyst go away without surgery?

It can for some people. In one study, almost all teenagers with mild disease improved using hygiene, hair removal, and minor pit removal, without needing the cyst cut out. In another small study, laser hair removal alone resolved the problem in about 4 of 10 patients. But no study tested doing absolutely nothing.

How long does a pilonidal cyst last?

Name: How long does a pilonidal cyst last?
Published: 2026-10-13
Keywords: how long does a pilonidal cyst last, how long does a pilonidal cyst flare up last, how long do pilonidal cyst flare ups last, how long does pilonidal cyst pain last

In people with pilonidal disease (cyst, abscess, or sinus), including acute flare-ups, what is the typical duration of symptoms and the natural course over time without or before surgical treatment?

How people search for this, in their own words

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Evidence review in plain language · compiled 2026-10-13 · checked 2026-10-13 · next 2026-11-13 · automated review, how it works

Bottom line

No study has tracked how long a pilonidal cyst or flare-up lasts if left alone — the research instead measures how fast different treatments heal it.

One randomised trial compared two active treatments (cutting the sinus out vs. a chemical called phenol) for disease that was already present; it did not test leaving the cyst untreated. A separate study found that most teenagers with mild disease got better using simple steps like better hygiene and hair removal, without needing the cyst cut out — but that is still treatment, not doing nothing. A tissue-lab study found that disease present for more than three years was linked to a small, rare increase in cancerous change, which is a reason not to simply wait indefinitely.

How certain

Moderate

One well-conducted randomised trial addresses this question directly.

What it shows

Signal of harm

2 studies reported harm or tissue damage, including laboratory evidence.

studies found: 134studies found
randomised trials: 13randomised trials
people studied: 566,568people studied
reviews of trials: 18reviews of trials
years covered: 2021–2026years covered

Read this first

One study that examined removed tissue under a microscope found a small number of cancers (squamous cell carcinoma) in sinuses, and this was more likely when the disease had been present for more than three years.
One comparison found a much higher rate of the disease coming back with laser treatment than with open flap surgery.
One analysis found women had higher recurrence rates than men after the same types of surgery.

What the research shows

Duration of an acute flare-up (pain, swelling, drainage) in days
No study in this set timed how many days an untreated flare-up lasts. Every duration figure reported is for how long it took a specific treatment (surgery, phenol, laser) to heal, not how long symptoms last on their own.
Not studied
Time to spontaneous resolution without any treatment
No trial left a group completely untreated. The closest evidence is from people given simple non-surgical care (hygiene, hair removal, minor pit removal), where most improved — but this still involved active steps, not true inaction.[1,2]
Insufficient evidence
Recurrence after symptoms subside, without surgery
Recurrence numbers in this body of research almost all describe disease coming back after a surgical or chemical procedure. None tracked whether symptoms return after settling down on their own, with no treatment at all.
Not studied
Progression from acute abscess to chronic sinus
A single case report described swelling that lasted about a year before turning into a draining sinus 11 months in. One case cannot tell us how often or how fast this progression typically happens.[1]
Insufficient evidence
Time to healing with conservative (non-surgical) management
One study found healing was slow with conservative management, and not clearly faster or slower than surgery in a small comparison — but exact typical healing time without any treatment was not established.[1]
Insufficient evidence
Need for eventual surgical intervention
In studies of mild disease, many people avoided the cyst being cut out by using hygiene, hair removal, or minor in-clinic pit removal instead, though a share still went on to need surgery.[1,2,3]
Possible improvement

What it may help with

In one study of teenagers and young adults with mild pilonidal disease, almost all who stuck with simple non-surgical care — better hygiene, hair removal, and sometimes removing just the small pits under local numbing medicine — got better without having the cyst cut out.[1]
In a small pilot study of 22 patients with moderate to severe pilonidal disease, 6 of 15 (40%) who completed laser hair removal treatment had resolution without needing surgery; among those who went on to have surgery, 6 of 9 (67%) resolved after a single operation.[1]
In people without symptoms, regular hair removal alone worked about as well at keeping the disease from coming back as hair removal combined with a minor pit-removal procedure.[1]

Important limitations

These studies measured how quickly treatments like phenol, Karydakis flap surgery, and endoscopic surgery (PEPSiT) healed the wound after treatment - they did not measure how long a flare-up or cyst lasts if left untreated.[1,2,3,4]
'Recurrence' in this research almost always means the disease returning after a procedure. It does not tell us how often symptoms come back after resolving naturally without treatment.[1,2,3]
Follow-up time in published pilonidal studies has been shrinking for decades — from about 6.7 years on average in the 1980s to about 2.6 years now — so researchers increasingly watch people for shorter periods, limiting what we know about the long-term course.[1]
Some of the only evidence that speaks directly to disease duration comes from a single case report, which is too limited to say what is typical.[1]

What the studies found

Found a benefit58 · 43%
Found no clear effect12 · 9%
Mixed or unclear62 · 46%
Found possible harm2 · 1%

What kind of studies

Retrospective69 · 51%
Prospective cohort18 · 13%
Case series13 · 10%
Randomised trial13 · 10%
Systematic review10 · 7%
Meta-analysis8 · 6%
Narrative review3 · 2%

The studies that decided it

Singh et al. 2026
Intermammary pilonidal sinus in an adolescent female: a case report
Symptoms lasted about a year.Case seriesVery low qualityRelated question
1 people2026
swelling lasted 1 year before becoming a draining sinus after 11 months; surgery led to full recovery with no recurrence at follow-up
Who was studied
14-year-old girl with a pilonidal sinus between the breasts
What they received
complete surgical removal of the sinus tract with stitching it closed
Compared with
none
Main outcome
recovery and recurrence after surgery
Quality
this is a single patient case report, so it cannot show how long pilonidal cysts last in general or how reliable surgery is for others.
Limitations
single case report from an unusual location (intermammary, not the typical sacrococcygeal area), so findings may not generalize to typical pilonidal cysts.
Taken word for word from the abstract
- population A 14-year-old Asian female presented with 1-year history of intermammary swelling that evolved into a discharging sinus after 11 months.
- intervention Complete excision of the sinus tract with primary closure was performed under general anesthesia.
- comparator Complete excision of the sinus tract with primary closure was performed under general anesthesia.
- primaryOutcome The patient had an uncomplicated recovery with no recurrence at follow-up.
- result A 14-year-old Asian female presented with 1-year history of intermammary swelling that evolved into a discharging sinus after 11 months.
- result The patient had an uncomplicated recovery with no recurrence at follow-up.
- n A 14-year-old Asian female
J Med Case Rep · PMID 42057099 · Read it on PubMed ↗
Donnelly et al. 2026
Minimally Invasive, Maximally Effective: Outpatient Strategies for Paediatric Pilonidal Disease
Healing took a long time overall.RetrospectiveLow qualityRelated question
69 people2026
Recurrence was higher after operative treatment (26.1%) than non-operative treatment (2.2%); time to healing was prolonged in both groups and did not differ significantly between them
Who was studied
children and teenagers (up to 18 years old) with pilonidal sinus disease
What they received
operative treatment (trephination or limited excision) for severe or refractory disease
Compared with
non-operative/conservative management (structured conservative care or in-clinic debridement)
Main outcome
recurrence of pilonidal disease after healing, and time to healing
Quality
This is a small, single-centre, retrospective study where the group having surgery likely had more severe disease to begin with, making the comparison unreliable.
Limitations
Retrospective single-centre design; operative group likely represented a more severe subgroup, confounding comparisons; no significant difference in time to healing reported between groups.
Taken word for word from the abstract
- population patients aged ≤ 18 years treated for PNS between February 2023 and August 2024
- n 69 patients were included
- intervention operative intervention (trephination or limited excision) for refractory or severe disease
- comparator structured conservative care, in-clinic debridement
- primaryOutcome Primary outcome was recurrence after documented healing.
- result Recurrence occurred in 6/23 (26.1%) in the operative group and 1/46 (2.2%) in the non-operative group (Fisher's exact p = 0.0045).
- result Time to healing was prolonged in both groups and did not differ significantly.
Int Wound J · PMID 42020338 · Read it on PubMed ↗
Janek et al. 2025
Laser Hair Removal May Be a Primary Treatment of Pilonidal Disease: A Pilot Study
Laser hair removal helped some cysts heal.Prospective cohortLow qualityRelated question
22 people18 months
40% of patients resolved without surgery, and 67% of those who had surgery resolved after one operation
Who was studied
patients ages 13-35 with moderate to severe pilonidal disease referred for surgical excision
What they received
laser hair removal (long-pulsed Alexandrite 755 nm laser) as primary treatment
Compared with
no control group; outcomes compared before and after laser treatment, with some patients later needing surgery
Main outcome
resolution rates without surgical intervention and recurrence rates after surgery
Quality
This was a small, single-arm pilot study without a comparison group, so it can't prove the laser caused the improvement.
Limitations
small sample size, no control group, some patients withdrew, single-center design
Taken word for word from the abstract
- n Twenty-two patients were enrolled
- population Patients ages 13-35 with moderate to severe disease who were referred for surgical excision were recruited.
- intervention Participants underwent 3-8 treatment sessions with the long-pulsed--Alexandrite (755 nm) laser by a dermatologist until hair removal endpoints were met.
- comparator Patients with persistent symptoms after LHR underwent subsequent excision.
- primaryOutcome Primary outcomes included resolution rates without surgical intervention and recurrence rates following surgical resection.
- result Six of 15 (40 %) who completed laser treatments had resolution without surgical intervention. Nine patients underwent surgery, of which 6 (67 %) resolved after one surgery, with 18 months of follow up to evaluate for recurrence.
- followUp Patients were subsequently followed in the pediatric surgery clinic at 6, 9, 12 and 18 months following LHR to evaluate for disease recurrence.
J Pediatr Surg · PMID 39893840 · Read it on PubMed ↗
Kudaş et al. 2025
Pathological Examination in Pilonidal Sinus Surgery: Evaluating Necessity and Cost-Effectiveness: A 10-Year Retrospective Analysis
Longer-lasting cysts linked to slightly higher cancer risk.RetrospectiveLow qualityRelated question
1,505 people2-year follow-up
Two cases (0.13%) of squamous cell carcinoma were found; risk was higher in patients over 40 and in those with disease lasting more than 3 years
Who was studied
patients who had surgery to remove a pilonidal sinus
What they received
routine pathological (microscopic) examination of the removed tissue
Compared with
examination based only on patients' risk factors (age, disease duration)
Main outcome
rate of cancer (malignancy) found in the removed pilonidal tissue
Quality
It is a retrospective chart review with only two cancer cases, giving very wide confidence intervals and limited ability to draw firm conclusions.
Limitations
Retrospective design, very small number of malignant cases, missing data excluded without imputation, and it studies cancer risk rather than typical cyst duration.
Taken word for word from the abstract
- n A retrospective analysis was conducted on 1505 patients who underwent surgical excision of PSD between January 1, 2014, and December 31, 2023.
- population 1505 patients who underwent surgical excision of PSD
- intervention All specimens underwent histopathological examination to detect malignancies.
- comparator Selective pathological examination based on these risk factors could enhance cost-effectiveness by reducing unnecessary routine examinations.
- primaryOutcome This study aims to assess the incidence of malignancy in PSD and identify risk factors to guide more targeted pathological examination strategies.
- result Two cases (0.13%) of SCC were identified, both in males aged 50 and 58 years without a history of Crohn's disease, HIV, prior radiation, or other cancers. Significant risk factors for malignancy included age over 40 years (OR 3.2, 95% CI 1.1-9.5) and disease duration over 3 years (OR 2.8, 95% CI 1.0-7.6).
Am Surg · PMID 39544170 · Read it on PubMed ↗
Adams et al. 2023
Regular epilation alone is an acceptable treatment for symptom-free pilonidal patients
Epilation alone worked as well as surgery.Prospective cohortLow qualityRelated question
255 people612.5days
Recurrence was similar between groups (9.4% with surgery plus epilation vs 12.6% with epilation alone, p>0.05)
Who was studied
Symptom-free (asymptomatic) pediatric and young adult pilonidal disease patients, median age 17.3 years
What they received
Regular hair removal (epilation) alone
Compared with
Surgical pit excision plus regular epilation
Main outcome
Recurrence/failure rate of pilonidal disease after treatment
Quality
This was a non-randomized, prospectively collected cohort comparing two treatment approaches, so it cannot say how long a cyst naturally lasts and may be affected by unmeasured differences between groups.
Limitations
Not randomized; patients were assigned to treatment based on time period and symptom status rather than randomization, and comparisons controlled only for select variables.
Taken word for word from the abstract
- population symptom-free/asymptomatic pilonidal patients
- intervention regular epilation only
- comparator surgical excision and regular epilation
- primaryOutcome Recurrence rates were statistically analyzed.
- result The failure rate between patients who received surgical excision initially and recurred (9.4%) and patients who received epilation only and recurred (12.6%) was similar
- n 255 patients (male:54.4%, female:45.6%)
- followUp followed for median 612.5days (IQR:367.5-847)
Pediatr Surg Int · PMID 37906293 · Read it on PubMed ↗
Pronk et al. 2022
Long-term Outcome of Radical Excision Versus Phenolization of the Sinus Tract in Primary Sacrococcygeal Pilonidal Sinus Disease: A Randomized Controlled Trial
Similar long-term recurrence and quality of lifeRandomised trialModerate quality
100 people48.4 (±12.8) months for the phenolization group and 47.8 (±13.5) months for the excision group
no significant difference in quality of life or recurrence rate between phenolization and excision, but treatment impact was lower with phenolization
Who was studied
patients with primary pilonidal sinus disease
What they received
pit excision with phenolization of the sinus tract
Compared with
radical excision with primary wound closure
Main outcome
recurrence, quality of life, and patient satisfaction after long-term follow-up
Quality
This was a randomized trial but patients and assessors were not blinded, nearly a quarter of patients were lost to follow-up, and recurrence numbers were small.
Limitations
The response rate was almost 80% in this young patient population, patients and assessors were not blinded for the type of surgery, and the results are only applicable to primary pilonidal sinus disease.
Taken word for word from the abstract
- n A total of 100 patients were randomized.
- population The study population included patients with primary pilonidal sinus disease presented between 2013 and 2017.
- intervention pit excision with phenolization of the sinus tract(s)
- comparator excision with primary off-midline wound closure
- primaryOutcome The main outcomes included recurrence, quality of life (Short-Form 36), and patient's satisfaction.
- result No significant difference was found between both groups regarding quality of life. Two patients in the phenolization group (5.6%) and 1 in the excision group (2.6%) developed a recurrence ( p = 0.604). The impact of the whole treatment was significantly less after phenolization ( p = 0.010).
- followUp The mean (±SD) time to follow-up was 48.4 (±12.8) months for the phenolization group and 47.8 (±13.5) months for the excision group.
Dis Colon Rectum · PMID 36102853 · Read it on PubMed ↗
Check et al. 2022
Resolution of Mild Pilonidal Disease in Adolescents Without Resection
Resolved without surgery for most.Case seriesLow quality
102 people30 ± 19 weeks
77 of 78 patients who continued treatment had their pilonidal disease resolve
Who was studied
adolescents and young adults with mild pilonidal disease
What they received
improved hygiene, excision of midline pits under local anesthesia, and laser hair removal
Compared with
no surgical removal of the cyst (resection)
Main outcome
resolution of pilonidal disease
Quality
This was a single-arm case series from one clinic with no comparison group and nearly a quarter of patients lost to follow-up, so it can't prove the approach is better than other options.
Limitations
24 of 102 patients were lost to follow up; no control group for comparison; single clinic experience.
Taken word for word from the abstract
- population Pilonidal disease is a common condition of the gluteal crease, affecting around 1 in 2,000 adolescents and young adults.
- intervention improved hygiene to limit debris in the gluteal crease, excision of midline pilonidal pits under local anesthesia to prevent intrusion of debris with drainage of any nidus present, and laser ablation of midline follicles to prevent new pits from forming
- comparator nidus resection is often recommended, even for patients with mild pilonidal disease, despite significant postoperative morbidity
- primaryOutcome resolution of their pilonidal disease
- result Twenty-four were lost to follow up, and 77 of the 78 who continued care had resolution of their pilonidal disease after a mean of 3 ± 2.5 laser epilations and 1.3 ± 1 pit excisions during 4 ± 2 clinic visits over a treatment duration of 30 ± 19 weeks.
- n One hundred two patients presented
J Am Coll Surg · PMID 36102566 · Read it on PubMed ↗

What actually helps, on this site

More about the condition:

Pilonidal Disease

All 134 studiesEvery study that answered the question, with its design, size and result.

The other 128 studiesEverything else the search returned, including anything retracted.

Çolak et al. 2026
Comparison of Phenol Application and Endoscopic Pilonidal Sinus Treatment in Pediatric Pilonidal Sinus Disease
Endoscopic treatment worked better than phenol.RetrospectiveLow qualityRelated question
61 people2026
EPSiT had less pain, faster return to activities, fewer complications, and fewer recurrences than phenol
Who was studied
children with pilonidal sinus disease
What they received
endoscopic pilonidal sinus treatment (EPSiT)
Compared with
phenol application
Main outcome
pain, recovery time, complications, and recurrence after treatment
Quality
This was a retrospective comparison of two treatments without randomization, so differences could be due to other factors besides the treatment itself.
Limitations
Retrospective study design; not randomized; does not address natural duration or course of untreated pilonidal cysts.
Taken word for word from the abstract
- population pediatric pilonidal sinus disease
- intervention endoscopic pilonidal sinus treatment (EPSiT)
- comparator phenol application
- primaryOutcome VAS) pain scores at postoperative 3 h, length of hospital stay, time to return to daily activities, early postoperative complications, and recurrence
- result EPSiT was more advantageous than phenol treatment in terms of postoperative pain, time to return to daily routine, early complications, and recurrence.
- n A total of 61 patients were included in the study
Pediatr Int · PMID 42717603 · Read it on PubMed ↗
Osmanov et al. 2026
Comparative outcomes of phenol therapy and Karydakis flap in pilonidal sinus disease: A retrospective cohort study with 1-year follow-up
Faster healing with phenol; recurrence similar.RetrospectiveLow qualityRelated question
125 people1 year
Phenol therapy healed faster and allowed quicker return to work, but recurrence rates at 1 year were similar between groups
Who was studied
adults with primary sacrococcygeal pilonidal sinus disease
What they received
phenol therapy (chemical ablation)
Compared with
Karydakis flap surgery
Main outcome
wound healing time, return-to-work time, and recurrence rate at 1 year
Quality
It is a retrospective, non-randomized comparison of two treatments without a true untreated or natural-history group, so it cannot show how long a cyst lasts on its own.
Limitations
Retrospective design, no randomization, and comparison is between two active treatments rather than against no treatment or natural course
Taken word for word from the abstract
- n This retrospective cohort study included 125 consecutive patients treated between January 2024 and January 2025.
- population patients with primary sacrococcygeal PSD
- intervention phenol therapy (PT)
- comparator the Karydakis flap (KF) procedure
- primaryOutcome Demographic characteristics, wound healing time, return-to-work time, postoperative complications, and recurrence rates were evaluated.
- result Wound healing time was significantly shorter in the phenol group than in the KF group (15.4 ± 8.4 vs 36.1 ± 7.6 days, P < .005).
- result recurrence occurred in 6 patients (12.5%) in the phenol group and 7 patients (9.1%) in the KF group, with no statistically significant difference between the groups (P = .09).
Medicine (Baltimore) · PMID 42700095 · Read it on PubMed ↗
Tokocin et al. 2026
Surgical Treatment Outcomes for Primary Pilonidal Sinus Disease: A Single-Centre Retrospective Study of 2222 Patients (2006-2020)
After surgery, most recurrences happen within 2 years.RetrospectiveModerate qualityRelated question
2,222 peopleminimum follow-up of 5 years
5-year recurrence was 7.9% and infection 6.9%; overall recurrence was 10.2%, with most recurrences happening within the first 2 years (median 20 months); off-midline flap techniques like Karydakis and Bascom cleft lift had much lower recurrence than lay-open treatment
Who was studied
adults with a first-time (primary) pilonidal sinus who had surgery, followed for at least 5 years
What they received
various surgical techniques for pilonidal sinus (including Karydakis flap, Bascom cleft lift, Limberg flap, Dufourmentel flap)
Compared with
lay-open (open wound healing) surgical technique
Main outcome
recurrence of pilonidal sinus and postoperative infection over time
Quality
it is a large single-center study with long follow-up, but it is retrospective and not randomized, so differences between techniques could be influenced by other factors.
Limitations
Retrospective design, single center, no randomization between surgical techniques, and it studies recurrence after surgery rather than the natural course of an untreated cyst.
Taken word for word from the abstract
- n We retrospectively analysed 2222 patients with primary PSD
- population 2222 patients with primary PSD who underwent surgery between January 2006 and December 2020 at a single tertiary referral centre in Turkey and had a minimum follow-up of 5 years
- intervention Nine surgical techniques were evaluated.
- comparator Compared with lay-open treatment, the Karydakis flap (HR 0.19, 95% CI 0.12-0.30)
- primaryOutcome We compared long-term recurrence and postoperative infection among nine surgical techniques
- result The 5-year cumulative recurrence was 7.9% (175/2222) and postoperative infection 6.9% (154/2222); overall recurrence was 10.2% (226/2222).
- result Most recurrences occurred within the first 2 years, with a median time to recurrence of 20 months (IQR 12-36).
- followUp had a minimum follow-up of 5 years
Int Wound J · PMID 42633928 · Read it on PubMed ↗
Başar et al. 2026
Outcomes of minimally invasive pit-picking treatment in adolescents with uncomplicated pilonidal disease: a retrospective single-center study
Most healed, some recurred by 10 monthsRetrospectiveLow qualityRelated question
42 people15 months
14.3% of patients had recurrence, with a median time to recurrence of 10 months
Who was studied
adolescents aged 12-18 with uncomplicated pilonidal disease
What they received
minimally invasive pit-picking surgery
Compared with
none (single group, no comparator treatment)
Main outcome
recurrence of pilonidal disease after treatment
Quality
This is a small, retrospective single-center study with no comparison group, so it can't reliably show how the condition behaves without this specific treatment.
Limitations
Retrospective design, single center, no control/comparator group, and the question asked is about natural disease duration while this study reports treatment recurrence after a procedure.
Taken word for word from the abstract
- n A total of 42 patients were included
- population adolescents aged 12-18 years who underwent pit-picking for pilonidal disease
- intervention pit-picking procedure
- comparator A retrospective single-center study was conducted including adolescents aged 12-18 years who underwent pit-picking for pilonidal disease between September 2020 and December 2022.
- primaryOutcome recurrence rates, and need for reintervention were analyzed
- result Recurrence occurred in six patients (14.3%), with a median time to recurrence of 10 months.
- followUp The median follow-up duration was 15 months.
Pediatr Surg Int · PMID 42593573 · Read it on PubMed ↗
Türker Çolak et al. 2026
Laser-assisted endoscopic treatment of pilonidal sinus disease in children: a first pediatric series
High cure rate after laser treatment.RetrospectiveLow qualityRelated question
45 people32.4 ± 11.3 months
91.1% of patients were cured after one procedure, and all patients eventually improved after up to two procedures
Who was studied
children under 18 years old with pilonidal sinus disease
What they received
laser-assisted endoscopic treatment of pilonidal sinus (LEPSIT)
Compared with
none - single group, repeat procedure after recurrence
Main outcome
successful cure of pilonidal sinus disease after treatment
Quality
This is a retrospective study of one treatment with no comparison group, so it cannot show whether this method works better than other treatments or no treatment.
Limitations
Retrospective design, no control or comparator group, single center, relatively small number of patients.
Taken word for word from the abstract
- population Clinical data of children under 18 years of age who underwent LEPSIT for PSD
- intervention laser-assisted endoscopic pilonidal sinus treatment (LEPSIT)
- comparator 4 patients (8.9%) had recurrence, all of whom achieved cure after a second LEPSIT
- primaryOutcome Successful treatment was achieved in 41 patients (91.1%) after a single procedure
- result Successful treatment was achieved in 41 patients (91.1%) after a single procedure; 4 patients (8.9%) had recurrence, all of whom achieved cure after a second LEPSIT. Improvement was ultimately achieved in all 45 patients.
- n Of the 45 patients included, 19 (42.2%) were female, and 26 (57.8%) were male
Pediatr Surg Int · PMID 42560577 · Read it on PubMed ↗
Komiyama et al. 2026
Minimally Invasive Phenol Treatment for Pilonidal Sinus: A Single-Center Case Series From Japan
No recurrence after phenol treatment.Case seriesLow qualityRelated question
11 people331 days
no recurrence was seen during follow-up, with two cases of bleeding managed without further surgery
Who was studied
patients with pilonidal sinus, median age 27, mostly male
What they received
phenol injection into the sinus cavity after excision of pits and curettage
Compared with
none mentioned
Main outcome
recurrence and complications after treatment
Quality
This was a small, single-center case series with no comparison group and only short-term follow-up.
Limitations
small sample size, retrospective design, no control group, short follow-up period
Taken word for word from the abstract
- n A total of 11 patients were included in the study.
- population The median age was 27 years (range, 13-50), and 10 patients were male.
- intervention undiluted phenol was injected into the cavity and subsequently neutralized with ethanol
- comparator We retrospectively reviewed patients with pilonidal sinus who underwent phenol treatment at our institution between 2020 and 2025.
- primaryOutcome Clinical data, including patient characteristics, number of pits, operative time, postoperative hospital stay, complications, and recurrence, were analyzed.
- result No recurrence was observed during the follow-up period (median, 331 days; range, 100-979).
- followUp the follow-up period (median, 331 days; range, 100-979)
J Dermatol · PMID 42304603 · Read it on PubMed ↗
Esposito et al. 2026
Pediatric endoscopic pilonidal sinus treatment (PEPSiT) as standard of care results over 10 years' experience in 507 patients
Low recurrence after keyhole surgery.Case seriesLow qualityRelated question
507 people2026
10.4% of patients had the disease come back, mostly within 3 months, with painless recovery and high satisfaction
Who was studied
children and teenagers with pilonidal sinus disease (primary or recurrent)
What they received
minimally invasive keyhole surgery (PEPSiT) with ozone oil and later platelet-rich plasma dressings
Compared with
none reported
Main outcome
disease recurrence, healing, pain, and patient satisfaction after surgery
Quality
This is a retrospective single-group case series with no comparison group, so it cannot show how long the condition lasts without treatment.
Limitations
Retrospective design, no control/comparator group, and focuses on surgical outcomes rather than natural disease duration.
Taken word for word from the abstract
- n We operated 507 patients
- population Pilonidal sinus disease (PSD) is an acquired inflammatory condition of the gluteal cleft predominantly affecting teenagers.
- intervention pediatric endoscopic pilonidal sinus treatment (PEPSiT)
- result Disease recurrence occurred in 53/507 patients (10.4%), mostly within 3 months (range 2 months-23 months)
- primaryOutcome Data regarding success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed.
- comparator We retrospectively reviewed all patients, with primary or recurrent PSD, undergoing PEPSiT in the 2016-2025 period.
Sci Rep · PMID 42168379 · Read it on PubMed ↗
Acar et al. 2026
Treatment Outcomes of Presacral Pilonidal Sinus Disease Using Crystallised Phenol: A Single-Centre Clinical Series
Treatment took about 18 days total.Case seriesLow qualityRelated question
40 people3 months
Overall treatment duration was 18.2 ± 7.58 days; 42.5% needed two sessions and 57.5% needed three sessions; recurrence occurred in 12.5% by 3 months, all in the three-session group
Who was studied
patients with presacral pilonidal sinus disease
What they received
crystallised phenol treatment given in two or three sessions
Compared with
two-session versus three-session phenol treatment groups
Main outcome
treatment duration, session requirement and recurrence after phenol treatment
Quality
This is a small, single-centre case series without a control group or randomisation, so it cannot reliably show cause and effect.
Limitations
Single-centre series, short follow-up of only 3 months, no control group, and the comparison between session groups was not statistically significant for abscess or recurrence (p = 0.061).
Taken word for word from the abstract
- n Consecutive patients treated with crystallised phenol were analysed (n = 40).
- population patients with presacral pilonidal sinus disease managed with crystallised phenol
- intervention crystallised phenol
- comparator Comparisons between the two-session and three-session groups were performed with the Mann-Whitney U test
- primaryOutcome To evaluate short-term treatment outcomes and treatment burden in patients with presacral pilonidal sinus disease managed with crystallised phenol
- result overall treatment duration was 18.2 ± 7.58 days
- result Two sessions were sufficient in 42.5% (17/40), whereas 57.5% (23/40) required three sessions.
- result recurrence during the 3-month follow-up was observed in 12.5% (5/40)
- followUp All patients completed scheduled clinical reassessment at 5 weeks and 3 months.
Int Wound J · PMID 42165106 · Read it on PubMed ↗
Arslan et al. 2026
Does laser treatment affect outcome in pilonidal sinus disease? Long-term multicenter retrospective analysis of pit-picking alone vs. pit-picking with laser
Most healed within about two weeks.RetrospectiveLow qualityRelated question
306 people5 years
Complete healing was achieved in 97.4% of patients, with a median time of 14 days, and recurrence rates at 5 years were similar between groups
Who was studied
patients with pilonidal sinus disease who had pit-picking surgery
What they received
pit-picking surgery combined with laser treatment
Compared with
pit-picking surgery alone
Main outcome
recurrence rate at 5 years
Quality
It's a retrospective, non-randomized comparison across multiple centers, so bias and confounding limit how much it can be trusted.
Limitations
Retrospective design, not randomized, authors call for further randomized trials
Taken word for word from the abstract
- n Of 306 patients, 109 (35.6%) underwent pit-picking alone, and 197 (64.4%) received pit-picking with LT.
- population Patients who underwent pit-picking surgery for PSD between June 2017 and March 2025 were included.
- intervention pit-picking combined with LT
- comparator Pit-picking surgeries performed with or without LT were compared.
- primaryOutcome The primary measure was the recurrence rate at 5 years.
- result Complete healing was achieved in 97.4% of patients, with a median time of 14 days. Recurrence rates at 5 years were similar (pit-picking: 13.8%, pit-picking + LT: 12.7%, p = 0.460).
Tech Coloproctol · PMID 42128975 · Read it on PubMed ↗
Hlaing et al. 2026
Endoscopic Pilonidal Sinus Treatment Versus Excisional Surgery: A Retrospective Comparison at an Australian Tertiary Centre
Similar healing and recurrence between surgery types.RetrospectiveLow qualityRelated question
180 people2026
primary healing and recurrence were similar between the two surgery types overall, but recurrence was higher after EPSiT in patients who had previously had an abscess drained
Who was studied
patients aged 12 and older having elective surgery for pilonidal sinus
What they received
endoscopic pilonidal sinus treatment (EPSiT)
Compared with
excisional surgery (flap closure, lay-open excision, or primary closure)
Main outcome
whether the wound healed completely and whether the cyst came back after healing
Quality
it is a retrospective study at a single hospital comparing two treatments, which cannot show how long a cyst lasts without surgery and is prone to selection bias.
Limitations
retrospective design, single tertiary centre, operative episode-level analysis including repeat procedures, and a small subgroup analysis
Taken word for word from the abstract
- n The cohort included 180 elective operative episodes in 144 patients: 115 EPSiT (63.9%) and 65 excisional (36.1%).
- population a retrospective cohort study of consecutive elective pilonidal operations in patients aged ≥ 12 at a tertiary Australian hospital
- intervention EPSiT was compared with excisional surgery (off-midline flap closure, lay-open excision or primary closure).
- comparator EPSiT was compared with excisional surgery (off-midline flap closure, lay-open excision or primary closure).
- primaryOutcome The primary outcomes were primary healing and recurrence after healing.
- result Primary healing occurred in 158 episodes (87.8%) and did not differ between EPSiT and excision (89.6% vs. 84.6%; p = 0.330). Recurrence occurred in 26.6% and was similar between groups (29.1% vs. 21.8%; p = 0.322).
- result recurrence after healing was higher following EPSiT (47.1% vs. 20.8%; p = 0.041).
ANZ J Surg · PMID 42112873 · Read it on PubMed ↗
Jarrin Lopez et al. 2026
Outcomes of Pilonidal Surgery Performed in the Setting of Standard Adjunct Laser Hair Removal: A Retrospective Cohort Study
Fewer repeat surgeries with flap closureRetrospectiveLow qualityRelated question
168 people2026
Bascom flap closure had fewer repeat procedures and fewer unplanned visits than pilocystectomy, with similar infection rates
Who was studied
patients aged 14-89 years who underwent operative treatment of PSD with adjunctive LHR
What they received
surgery for pilonidal sinus disease using Bascom flap closure, with adjunct laser hair removal
Compared with
surgery using pilocystectomy, with adjunct laser hair removal
Main outcome
repeat procedures, 30-day surgical site infection, and unplanned clinic visits after surgery
Quality
This was a retrospective study without a non-laser comparison group, with low event counts that made more detailed statistical analysis unreliable.
Limitations
Retrospective descriptive design, no comparison group without laser hair removal, multivariable modeling not performed because of low event counts and sparse covariate distributions, which resulted in unstable models
Taken word for word from the abstract
- n Among 168 patients
- population patients aged 14-89 years who underwent operative treatment of PSD with adjunctive LHR
- intervention Patients treated with Bascom flap closure had fewer repeat procedures
- comparator than those undergoing pilocystectomy
- primaryOutcome Outcomes included repeat procedures, 30-day surgical site infection (SSI), and unplanned clinic visits
- result Patients treated with Bascom flap closure had fewer repeat procedures (10.4% vs. 20.8%) and fewer unplanned visits (33.8% vs. 43.6%) than those undergoing pilocystectomy, with similar SSI rates (14.9% vs. 14.0%)
Int Wound J · PMID 42089833 · Read it on PubMed ↗
Doll et al. 2026
[Are there any male-to-female disparities in recurrence rates after surgery for Pilonidal Disease? A meta-analysis comparing differing mixed-gender cohorts]
Higher recurrence in women after surgery.Meta-analysisModerate qualityRelated question
113,021 people5-year and 10-year
Women had higher recurrence rates than men after all types of surgery studied, and mixed-gender cohorts with more women had higher recurrence than cohorts with fewer women
Who was studied
adults with pilonidal sinus disease who had surgery, grouped by whether the study cohort was male-only, female-only, or mixed-gender
What they received
surgical treatment for pilonidal sinus disease (e.g., midline closure, open healing, Karydakis/Bascom procedures)
Compared with
male-only patient cohorts versus female-only or mixed-gender cohorts with varying proportions of women
Main outcome
recurrence of the cyst/disease after surgery at 5 and 10 years
Quality
It pools a huge number of very different studies (RCTs and observational) with widely differing designs and a large gender imbalance in available data, which limits how much confidence can be placed in the comparison.
Limitations
The abstract notes the female-only cohort was very small, precluding further subgroup analyses, and calls for confirmation using individual patient data.
Taken word for word from the abstract
- n 880 studies encompassing 113, 021 patients were surveyed
- population Studies were segregated into male-only (Mo), female-only (Fo), or male-female mixed cohorts (mixG)
- intervention Recurrence rates at 5-year and 10-year follow-up following various surgical interventions were compared.
- comparator studies were stratified based on the proportion of females above or below the mean of 19.87%
- primaryOutcome In this study we aimed to assess the postoperative recurrence rate in women with PSD.
- result Females with PSD seem to have a higher RR as compared to men for all therapies tested.
Khirurgiia (Mosk) · PMID 42027172 · Read it on PubMed ↗
Saleem et al. 2026
Surgical management of pilonidal sinus disease in pediatric population: An updated systematic review and meta-analysis
Healing time varies a lot by surgery type.Meta-analysisLow qualityRelated question
5,075 people2026
Healing time after surgery varied widely depending on technique, from as short as 8 days with off-midline closure to up to 98 days with open healing
Who was studied
children and teenagers (18 years or younger) with pilonidal disease
What they received
various surgical techniques for pilonidal disease (open healing, midline closure, off-midline closure, minimally invasive surgery)
Compared with
different surgical techniques compared against each other
Main outcome
recurrence, wound complications, and recovery time after surgery
Quality
This pools results from 59 mostly observational pediatric studies with high variability, so it is not a strong direct measure of how long an untreated or typical cyst lasts.
Limitations
The abstract notes pediatric-specific evidence is limited, studies were heterogeneous, and quality was mixed as assessed by the Newcastle-Ottawa Scale and ROB-2
Taken word for word from the abstract
- n identified 59 studies (N = 5075)
- population patients ≤18 years with PD
- intervention Despite various surgical approaches, no consensus exists on the optimal technique
- comparator compare recurrence, wound complications, and recovery outcomes across surgical techniques
- primaryOutcome Data on recurrence, wound complications, healing time, operative time, hospital stay, return to daily activities (ADL), pain scores, and reoperation rates were extracted.
- result Open healing showed the highest recurrence (20.1%) and moderate wound complication rates (16.2%), with healing times up to 98 days.
- result Off-midline closures had the lowest recurrence (10.2%) and moderate complications (19.5%), with healing times as short as 8 days.
J Pediatr Surg · PMID 41999968 · Read it on PubMed ↗
Arslan et al. 2026
Shrinking follow-up duration in pilonidal sinus surgery, 1970-2020: a patient-weighted longitudinal analysis of 2,285 studies
Studies don't track patients long enough.Systematic reviewLow qualityRelated question
2,285 people2026
Follow-up time in published studies has shrunk a lot over the decades, from about 6.7 years average in the 1980s down to about 2.6 years in the 2020s; only 14% of studies followed patients 5 years or more, and under 3% followed them 10 years or more
Who was studied
People who had surgery for pilonidal sinus/cyst, studied across 2,285 published surgical series from 1850 to the present
What they received
Pilonidal sinus surgery (various types), as reported in the studies analyzed
Compared with
No treatment comparator; this study compares follow-up reporting practices across different decades of publication rather than comparing treatments
Main outcome
How long patients were followed up after surgery in published studies, and whether this was long enough to catch recurrences
Quality
This is a study about how long other studies followed patients, not a study of how long the cyst itself lasts or how often it comes back, so it doesn't directly answer the duration question.
Limitations
The abstract reports trends in published follow-up duration, not actual recurrence rates or how long symptoms/cysts persist in patients; it does not report clinical outcomes.
Taken word for word from the abstract
- population 2,285 pilonidal surgery series (1850–present)
- intervention pilonidal sinus surgery
- comparator decade-wise patient-weighted mean FUP
- primaryOutcome Reliable estimation of recurrence after pilonidal sinus surgery requires sufficient follow-up (FUP).
- result Median FUP was 1.67 years; mean 2.50 years.
- result Patient-weighted mean FUP peaked in the 1980s at 6.69 years, declining to 5.26 (1990s), 4.26 (2000s), 3.14 (2010s), and 2.55 years (2020s).
- n 2,285 pilonidal surgery series (1850–present)
Langenbecks Arch Surg · PMID 41904336 · Read it on PubMed ↗
Alsalaumy 2026
Comparative study of the Karydakis flap versus conventional surgical techniques for pilonidal sinus disease: a systematic review and meta-analysis
Karydakis flap lowers recurrence, faster recoveryMeta-analysisModerate qualityRelated question
3,108 people2026
Karydakis flap had lower recurrence and fewer infections than the other techniques, and faster return to work
Who was studied
people having surgery for pilonidal sinus disease
What they received
Karydakis flap surgery
Compared with
midline closure or excision left to heal naturally
Main outcome
cyst coming back (recurrence) and infection after surgery
Quality
it pools many studies but mixes randomised trials with non-randomised comparisons, which can bias results.
Limitations
combines randomized and non-randomized comparative cohort studies, with some heterogeneity between studies
Taken word for word from the abstract
- n Fifteen studies (n = 3,108) were identified for inclusion
- intervention The Karydakis flap (KF) was compared with midline closure (MC) and excision with healing by secondary intention (EHSI).
- comparator The Karydakis flap (KF) was compared with midline closure (MC) and excision with healing by secondary intention (EHSI).
- primaryOutcome The primary outcomes included recurrence and infection
- result KF was associated with a significant reduction in recurrence compared to MC (OR 0.30, 95% CI 0.16-0.59; p < 0.001; I2 = 34%) and EHSI (OR 0.29, 95% CI 0.12-0.71; p = 0.006; I2 = 11%). KF had fewer infections than EHSI
- population pilonidal sinus disease (PSD)
Updates Surg · PMID 41854814 · Read it on PubMed ↗
van Kempen et al. 2026
Long-Term Outcomes of Sinus Laser-Assisted Closure in Primary Versus Recurrent Sacrococcygeal Pilonidal Sinus Disease: A Retrospective Cohort Study
Healing took 6-8 weeks; recurrence common.RetrospectiveModerate qualityRelated question
267 peoplea median of 4.0 years (IQR: 3.6-5.0 years)
Recurrent disease had higher recurrence rates and took longer to heal than primary disease, though initial healing rates were similar.
Who was studied
patients with primary or recurrent sacrococcygeal pilonidal sinus disease treated with laser surgery
What they received
sinus laser-assisted closure (SiLaC) surgery for pilonidal sinus
Compared with
primary disease versus recurrent disease status
Main outcome
whether the pilonidal sinus came back (recurrence) after treatment
Quality
It is a single-center retrospective study without a control group getting a different treatment, so results could be affected by unmeasured differences between patients.
Limitations
Retrospective design, single center, no comparison to no treatment or other therapies, and follow-up relied partly on telephone interviews.
Taken word for word from the abstract
- n This retrospective cohort study analyzed 267 consecutive patients undergoing SiLaC at a single center
- population stratified by disease status: primary (n = 214) versus recurrent (n = 53)
- intervention Sinus laser-assisted closure (SiLaC) demonstrates favorable outcomes for primary sacrococcygeal pilonidal sinus disease (SPSD)
- comparator compared long-term outcomes following SiLaC in primary versus recurrent SPSD
- primaryOutcome The primary outcome, disease recurrence, was assessed using Kaplan-Meier analysis
- result Despite comparable initial healing rates (75.4% primary, 68.0% recurrent), recurrent disease required 10 additional days for complete healing (56 vs. 46 days, p < 0.001).
- result Recurrence rates were significantly higher in recurrent versus primary disease (RR 1.76, 95%CI: 1.30-2.40, p = 0.001), with 12-month rates of 34.8% versus 16.8% respectively.
World J Surg · PMID 41834241 · Read it on PubMed ↗
Tekin et al. 2026
Localization-Based Surgical Approaches in Pilonidal Sinus Treatment: A Comparative Study of Laser Therapy and Alternative Techniques
Recurrence rates vary by treatment and cyst location.Prospective cohortLow qualityRelated question
size not givena minimum of two years
laser therapy had the lowest overall recurrence (15.6%) but the highest recurrence (83.3%) in cases with disease in mixed locations
Who was studied
patients with pilonidal sinus disease treated surgically
What they received
laser therapy
Compared with
microsinusectomy, phenol application after surgical resection, and platelet-rich plasma (PRP) treatment
Main outcome
rate of disease coming back after treatment (postoperative recurrence)
Quality
this is a non-randomized comparison of different surgical techniques without numbers of patients given, so the recurrence results are not very reliable.
Limitations
abstract does not report patient numbers, randomization, or how groups were matched beyond 'comparable sociodemographic characteristics'
Taken word for word from the abstract
- primaryOutcome Treatment outcomes were assessed primarily in terms of postoperative recurrence.
- intervention laser therapy
- comparator microsinusectomy, surgical resection followed by phenol application, platelet-rich plasma (PRP), and laser therapy
- population Patients with comparable sociodemographic characteristics were allocated into four treatment groups
- result laser therapy demonstrated the lowest overall recurrence rate (15.6%). However, in cases of mixed-location PSD, laser treatment was associated with the highest recurrence rate (83.3%).
- followUp All patients were followed for a minimum of two years.
Photobiomodul Photomed Laser Surg · PMID 41804956 · Read it on PubMed ↗
Darbandi et al. 2026
Advancing pilonidal disease care through pediatric endoscopic treatment (PEPSiT): early insights
Healed in about 3 months after surgeryRetrospectiveLow qualityRelated question
32 people9 months
median healing time was 3 months, with 3 recurrences out of 32 patients
Who was studied
adolescents and young adults with pilonidal sinus disease, median age 15
What they received
endoscopic surgery for pilonidal sinus (PEPSiT)
Main outcome
time to healing, complications, and recurrence after surgery
Quality
This was a small, retrospective study without a comparison group, so it can't reliably show how the condition behaves on its own or against other treatments.
Limitations
Retrospective design, small sample size, no comparator group, and the study authors call for larger prospective studies.
Taken word for word from the abstract
- n Thirty-two patients (18 males) underwent PEPSiT
- population median age 15 years (11-18)
- intervention Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT)
- primaryOutcome surgical time, anesthesia, hospital stay, complications, healing, recurrence, and follow-up
- result Median healing was 3 months (1-24).
- result Three recurrences were successfully treated with redo-PEPSiT.
- followUp Median follow-up was 9 months (1-52).
Pediatr Surg Int · PMID 41758282 · Read it on PubMed ↗
Maak et al. 2026
The Use of Methylene Blue in Pilonidal Sinus Surgery Reduces the Risk of Recurrence: A Systematic Review and Meta-Analysis
Dye marking may cut recurrence after cyst surgery.Meta-analysisLow qualityRelated question
130,677 people2026
methylene blue staining was linked to a lower recurrence rate for most surgical techniques, but a higher recurrence rate for one flap technique
Who was studied
patients with pilonidal sinus disease having surgery
What they received
staining the sinus with methylene blue dye during surgery
Compared with
surgery without methylene blue staining
Main outcome
rate of the cyst coming back after surgery (recurrence)
Quality
This review pooled many different studies and surgery types, and some of the key comparisons had a lot of missing follow-up data, which weakens how much the results can be trusted.
Limitations
The abstract notes a 'notable loss of follow-up data' for the Bascom/Karydakis-Flap and Other Flaps groups, which the authors say diminishes the meaning of those results.
Taken word for word from the abstract
- n A total of 1192 studies involving 130,677 patients were eligible for analysis
- population Pilonidal Sinus Disease shows an increasing incidence
- intervention the usage of methylene blue (MB) for staining the PSD fistulas for better visualization during surgery
- comparator 929 studies without MB (77.9%, n = 105,075 patients)
- primaryOutcome recurrence rates were analyzed using Kaplan-Meier-survival curves
- result Primary open approach, primary midline closure, primary asymmetric closure, and Limberg/Dufourmentel all showed a significantly lower RR when MB was used (p < 0.0001). The use of MB in Bascom/Karydakis-Flap showed a statistically significant disadvantage concerning RR (p < 0.0001)
- limitations both groups showed a notable loss of follow-up data, diminishing the meaning of these p values
Medicina (Kaunas) · PMID 41752637 · Read it on PubMed ↗
Oruc et al. 2026
Limberg flap reconstruction for recurrent pilonidal sinus disease: A single-center U.S. Cohort
No recurrence after flap surgeryRetrospectiveLow qualityRelated question
37 people4.5 years
no recurrence observed during median follow-up of 4.5 years, with an 11% complication rate mainly wound dehiscence
Who was studied
patients with recurrent pilonidal sinus disease who had multiple previous surgeries
What they received
Limberg flap reconstruction surgery
Compared with
none - no comparison group, all patients received the same surgery
Main outcome
disease recurrence after surgery
Quality
This is a small, single-center retrospective study with no comparison group, so it cannot reliably establish how long disease lasts or how outcomes compare to other treatments.
Limitations
Retrospective design, single center, no control or comparator group, small sample size of 37 patients.
Taken word for word from the abstract
- n Thirty-seven patients were included.
- population patients who underwent LF for recurrent PSD between 2014 and 2023
- intervention Limberg flap (LF) reconstruction
- comparator A retrospective analysis was conducted of patients who underwent LF for recurrent PSD
- primaryOutcome Long-term follow-up, including assessment for recurrence, was obtained via structured telephone interviews and chart reviews.
- result No recurrence was observed during the median follow-up of 4.5 years.
- followUp median follow-up of 4.5 years
Langenbecks Arch Surg · PMID 41680360 · Read it on PubMed ↗
Sahakyan et al. 2026
[Clinical experience of using modified Limberg plastic surgery using a polymer hydrogel for recurrent and complex pilonidal sinus]
Lower recurrence with hydrogel-assisted surgery.RetrospectiveLow qualityRelated question
97 people2026
recurrence was 10.9% with traditional surgery, 4.9% with modified surgery, and 2.5% with modified surgery plus hydrogel; no significant difference in early complications between groups
Who was studied
patients with recurrent or complex pilonidal sinus disease
What they received
modified Limberg flap surgery combined with polymer hydrogel
Compared with
traditional Limberg flap surgery and modified Limberg flap without hydrogel
Main outcome
rate of disease recurrence and postoperative complications
Quality
This is a retrospective comparison of surgical techniques with no statistical test reported for the recurrence rate differences and the authors themselves say further studies are needed.
Limitations
No statistical significance reported for recurrence rate differences between groups; authors state further studies are required to confirm results.
Taken word for word from the abstract
- n 97 patients were included in the study
- population 97 patients with a diagnosis of recurrent or complex PSD (Pilonidal sinus disease)
- intervention modified Limberg flap and polymer hydrogel
- comparator traditional Limberg flap, modified Limberg flap
- primaryOutcome The incidence of complications in the early postoperative period and the frequency of relapses in the late period were assessed
- result The recurrence of the disease in patients who underwent traditional plastic surgery was 10.9%. In the group with modified plastic surgery, recurrence was detected in 2 patients (4.9%). In the group with the use of polymer hydrogel, 1 case of recurrence (2.5%) was recorded.
Khirurgiia (Mosk) · PMID 41590391 · Read it on PubMed ↗
Stoeckel et al. 2026
In-Office Pit Excision for Pilonidal Disease Using Needle-Free Local Anesthesia: A Minimally Invasive, Non-Operative Treatment Approach
Most healed with simple office procedure.Case seriesLow qualityRelated question
100 people6 to 8 weeks
60% of patients had all pits healed at follow-up, and ultimately 88% healed all of their pits
Who was studied
patients with gluteal crease pits (pilonidal disease), mean age 18.1 years
What they received
in-office pit excision using needle-free pneumatic lidocaine anesthesia, laser follicle ablation, and punch excision
Main outcome
healing of pilonidal pits (resolution of pits)
Quality
This was a single-arm study with no comparison group, and a quarter of patients were lost to follow-up, so it can't say how long the disease would last without this treatment.
Limitations
25 of 125 eligible patients were lost to follow-up; no control group; short follow-up period of 6 to 8 weeks for initial assessment.
Taken word for word from the abstract
- n 100 were included in the analysis
- population Patients with gluteal crease pits at our Pilonidal Care Clinic
- intervention patients received 1% buffered lidocaine via pneumatic injection. Laser follicle ablation was followed by punch excision
- primaryOutcome 60% patients healed all pits, resolving their condition, with 64% (144/224) of all pits healed
- result Ultimately, 88% of patients healed all of their pits.
Eur J Pediatr Surg · PMID 41461191 · Read it on PubMed ↗
Öztaş et al. 2026
Artificial Intelligence-Based Prediction of Recurrence and Personalized Treatment Planning in Pediatric Pilonidal Sinus Disease
Low recurrence; healing time varies by factors.RetrospectiveLow qualityRelated question
242 people2026
Overall recurrence rate was 5.7%, with no significant differences among treatment modalities; longer healing time, larger lesion, higher BMI, and more sinus tracts linked to higher recurrence risk
Who was studied
children with pilonidal sinus disease
What they received
AI models predicting recurrence and guiding treatment choice (surgical excision, crystallized phenol, or silver nitrate)
Compared with
different treatment modalities compared to each other; actual outcomes vs AI predictions
Main outcome
recurrence of pilonidal sinus disease after treatment
Quality
This is a retrospective study using AI modeling without a control group or prospective validation, so it cannot reliably show how long a cyst lasts or what helps.
Limitations
Retrospective design; authors state further multicenter, prospective studies are warranted to validate findings.
Taken word for word from the abstract
- population Clinical data from 242 pediatric PSD patients were retrospectively analyzed.
- n Clinical data from 242 pediatric PSD patients were retrospectively analyzed.
- intervention Two machine learning (ML) models were developed: (1) a binary classifier for recurrence prediction and (2) a multiclass classifier for treatment modality selection.
- comparator 59.1% underwent surgical excision (unroofing with secondary healing), 33.1% received crystallized phenol, and 7.8% were treated with silver nitrate.
- primaryOutcome a binary classifier for recurrence prediction
- result The overall recurrence rate was 5.7%, with no significant differences among treatment modalities. Longer healing duration, larger lesion size, higher body mass index (BMI), and an increased number of sinus tracts were associated with higher recurrence risk.
- limitations Further multicenter, prospective studies are warranted to validate these findings and support clinical integration of AI-assisted decision systems.
Surg Innov · PMID 41432023 · Read it on PubMed ↗
Chen et al. 2025
[Treatment options for different types of sacrococcygeal pilonidal disease]
No duration data reported.Narrative reviewVery low qualityRelated question
size not given2025
article summarizes which treatment fits which disease presentation, not how long the disease lasts
Who was studied
people with sacrococcygeal pilonidal disease
What they received
various treatments depending on disease type (non-surgical care, drainage, minimally invasive procedures, excision with or without flap)
Compared with
different treatment types compared to each other based on disease presentation
Main outcome
best treatment strategy for different types of pilonidal disease
Quality
this is a narrative summary of treatment strategies based on clinical experience and literature, with no patient numbers or outcome data reported.
Limitations
no original data, no numbers of patients, and no information on disease duration or natural course is given.
Taken word for word from the abstract
- population sacrococcygeal pilonidal disease (SPD)
- intervention Non-surgical treatment is suitable for asymptomatic SPD patients. For patients in the acute abscess phase, drainage is the primary therapeutic goal, with avoidance of midline incisions. Minimally invasive procedures may be considered for patients with localized lesions
- comparator For recurrent SPD or cases with extensive lesions, excision followed by secondary healing or combined with flap techniques is required to pursue a lower recurrence risk.
- primaryOutcome this article summarizes the treatment strategies for different types of SPD, providing a reference for clinicians in formulating diagnosis and treatment plans.
- result Based on clinical experience and literature review, this article summarizes the treatment strategies for different types of SPD
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 41397831 · Read it on PubMed ↗
Li et al. 2025
[Clinical efficacy of laser ablation and closure in the treatment of sacrococcygeal pilonidal disease and analysis of risk factors for postoperative recurrence in male patients]
Healed in about five weeks after surgery.RetrospectiveLow qualityRelated question
369 people2025
All wounds healed (100% healing rate), with a median healing time of 35 days; recurrence occurred in 5.1% of patients, mainly young males or those with prior pilonidal surgery
Who was studied
Patients with sacrococcygeal pilonidal disease who underwent laser ablation and closure surgery (mostly male)
What they received
Laser ablation and closure surgery for pilonidal disease
Compared with
No comparison group reported; all patients received the same laser treatment
Main outcome
Clinical efficacy and safety of laser ablation and closure, including wound healing and recurrence after surgery
Quality
This was a single-center retrospective study with no comparison group, which limits how much confidence can be placed in the results.
Limitations
Retrospective design, single center, no control or comparator group, and recurrence risk-factor analysis limited mainly to male patients.
Taken word for word from the abstract
- n 369 patients with SPD who underwent laser ablation and closure
- population 369 patients with SPD who underwent laser ablation and closure in the Anorectal Department of Yueyang Hospital
- intervention laser ablation and closure
- comparator A retrospective observational study was conducted to collect clinical data of 369 patients with SPD who underwent laser ablation and closure
- primaryOutcome To investigate the clinical efficacy and safety of laser ablation and closure for the treatment of sacrococcygeal pilonidal disease (SPD) and to analyze risk factors for postoperative recurrence in male patients.
- result The wound healing rate was 100%, with a median wound healing time of 35 (IQR: 30, 42) days. Postoperative recurrence occurred in 19 patients (5.1%), all of whom were male.
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 41397828 · Read it on PubMed ↗
Turpin et al. 2026
Identifying Predictors of Recurrent Pilonidal Disease in Adolescents and Young Adults: A Secondary Analysis of a Randomized Controlled Trial
Laser treatment reduced recurrence, mainly if privately insured.Randomised trialModerate qualityRelated question
200 people1 year
Laser hair treatment lowered the odds of recurrence overall, but the benefit was seen only in privately insured patients, not publicly insured patients
Who was studied
patients 11 to 21 years old with at least one prior episode of pilonidal disease
What they received
laser hair removal (depilation) added to standard treatment
Compared with
standard treatment alone
Main outcome
pilonidal disease recurrence within 1 year
Quality
It's a planned secondary analysis of a randomized trial with adjusted statistical modeling, but subgroup interaction findings and recurrence self-report limit certainty.
Limitations
Findings are based on multivariable regression with potential confounding by unmeasured social factors, and the interaction by insurance status needs further investigation.
Taken word for word from the abstract
- n Complete 1-y follow-up data to be included in the multivariable analysis were available for 200 patients in the trial.
- population Inclusion criteria were patients 11 to 21 y of age with a history of at least 1 episode of pilonidal disease, without active disease.
- intervention laser depilation as an adjunct to standard care versus standard care alone
- comparator standard treatment alone
- primaryOutcome laser hair treatment was strongly associated with decreased odds of disease recurrence within 1 y
- result Laser hair treatment was significantly associated with lower odds of disease recurrence in patients who were privately insured (OR, 0.29 [95% CI, 0.16-0.55], P < 0.001) but was not associated with lower disease recurrence in those who were publicly insured (OR, 1.20 [95% CI, 0.63-2.28], P = 0.58).
J Surg Res · PMID 41365098 · Read it on PubMed ↗
Canturk et al. 2025
Combined laser ablation and pit excision for pilonidal sinus: effectiveness, quality of recovery, and patient-reported outcomes
High success, some recurrence after laser treatment.RetrospectiveLow qualityRelated question
39 people13.6 ± 3.6 months
Treatment success in 84.6% (33/39) and recurrence in 15.4% (6/39) over a mean follow-up of 13.6 months
Who was studied
Adults treated for pilonidal sinus disease
What they received
Diode laser ablation combined with pit excision
Compared with
No comparison group (single-arm cohort)
Main outcome
Recurrence and treatment success after surgery
Quality
It is a small, retrospective, single-center study without a comparison group, so the results may not be reliable.
Limitations
Findings should be interpreted cautiously given the retrospective design and modest sample size; prospective, adequately powered studies are needed to validate the prognostic performance and comparative effectiveness.
Taken word for word from the abstract
- n the primary analysis included 39 patients who 6month patientreported outcomes
- population Fifty-four adults were treated consecutively
- intervention diode laser ablation combined with pit excision for pilonidal sinus disease
- comparator Fifty-four adults were treated consecutively
- primaryOutcome The primary endpoints were recurrence and treatment success (no recurrence without re-intervention).
- result Mean followup was 13.6 ± 3.6 months; treatment success 84.6% (33/39), recurrence 15.4% (6/39), and delayed healing 20.5% (8/39).
BMC Surg · PMID 41316137 · Read it on PubMed ↗
Chiu et al. 2026
Adding gauze sweep technique to pit-picking procedure increases hair removal and lowers recurrence rate of pilonidal disease
Fewer recurrences with added hair-removal step.RetrospectiveLow qualityRelated question
175 people425.5 ± 244.8 days
adding gauze sweep increased hair removal (84% vs 62%) and lowered recurrence (1.1% vs 11.6%) compared to pit-picking alone
Who was studied
patients with pilonidal disease
What they received
pit-picking procedure plus gauze sweep technique
Compared with
pit-picking procedure alone
Main outcome
hair removal during procedure and recurrence of pilonidal disease
Quality
This was a non-randomized comparison of two time periods with low level of evidence (Level IV), so other factors over time could explain the difference.
Limitations
Level IV evidence; not randomized; compares two sequential time periods rather than concurrent groups; does not address natural duration or course of untreated pilonidal cysts.
Taken word for word from the abstract
- n 175 total patients were included.
- population Consecutive pilonidal patients who underwent PP 2/2021-9/2024 were selected.
- intervention the GS technique was added during PP
- comparator 86 patients underwent PP only
- primaryOutcome any hair removed during PP, pilonidal disease recurrence, and follow-up period were recorded
- result 53 patients (62 %) in cohort PP and 75 patients (84 %) in cohort PP + GS had hair removed during the procedure (p < 0.001). The recurrence rate was 11.6 % (10/86) for cohort PP and 1.1 % (1/89) for cohort PP + GS (p = 0.01).
- followUp followed for a mean of 425.5 ± 244.8 days
J Pediatr Surg · PMID 41274599 · Read it on PubMed ↗
O'Guinn et al. 2026
Pilonidal Disease
Review of treatments, not duration.Narrative reviewVery low qualityRelated question
size not given2026
flap-based closures had fewer recurrences but more complications; deroofing at drainage reduced recurrence
Who was studied
young people with pilonidal disease, a skin condition near the tailbone
What they received
various treatments including incision and drainage, deroofing, marsupialization, and flap-based surgery
Compared with
different treatment approaches compared to each other
Main outcome
disease recurrence and complications
Quality
this is a general review describing management approaches without original data on how long the disease lasts.
Limitations
abstract does not report study methodology, numbers of patients, or natural duration of the disease without treatment.
Taken word for word from the abstract
- population Pilonidal disease, common in adolescents and young adults
- intervention Acute disease is primarily managed by incision and drainage; the addition of deroofing identified pits at the time of drainage can reduce recurrence.
- comparator Closures with flap-based techniques, such as Karydakis and Bascom's cleft lift, offer a lower recurrence rate but higher complication risks.
- primaryOutcome offer a lower recurrence rate but higher complication risks
- result Closures with flap-based techniques, such as Karydakis and Bascom's cleft lift, offer a lower recurrence rate but higher complication risks.
Surg Clin North Am · PMID 41241452 · Read it on PubMed ↗
Bilgin et al. 2025
Comparison of short- and long-term outcomes of diode laser vs. crystallized phenol treatment for pilonidal sinus disease: A propensity score-matched multicentre study
Laser heals faster; phenol lets you return soonerRetrospectiveLow qualityRelated question
644 people45 months (laser), 40 months (phenol)
laser healed faster and needed fewer sessions, phenol allowed shorter procedures and quicker return to daily life, with similar recurrence rates
Who was studied
patients with pilonidal sinus disease treated with laser or phenol
What they received
diode laser ablation of the pilonidal sinus
Compared with
crystallized phenol application to the pilonidal sinus
Main outcome
time to complete healing, return to daily activities, and recurrence
Quality
This was a retrospective study comparing two treatments, so it cannot directly show how long an untreated cyst would last and may be biased by how patients were selected.
Limitations
retrospective design, propensity-score matching cannot remove all bias, complication rates differed between groups
Taken word for word from the abstract
- n 644 were included
- population patients treated with laser or phenol were included
- intervention patients treated with laser or phenol were included
- comparator patients treated with laser or phenol were included
- primaryOutcome Return to daily activities was delayed in the laser group, whereas complete healing was slower in the phenol group.
- result Laser favoured faster healing and fewer sessions, whereas phenol allowed for shorter procedures and earlier return to daily life.
- followUp Median follow-up was 45 months (laser) and 40 months (phenol).
Colorectal Dis · PMID 41146596 · Read it on PubMed ↗
Jazi et al. 2025
Future of pilonidal cyst surgery: a comparative review of traditional and laser techniques
Laser surgery heals faster, fewer complications.Systematic reviewLow qualityRelated question
size not given2025
laser techniques reduced hospital stay, pain, and recurrence, with healing rates up to 97%, but were less effective in severe cases and cost more
Who was studied
people with pilonidal cysts or sinuses near the tailbone
What they received
laser ablation treatment
Compared with
traditional surgical excision and flap reconstruction techniques
Main outcome
effectiveness, recovery time, recurrence rates, complications, cosmetics and cost of treatment
Quality
This is a narrative comparison of existing studies without pooled statistics, and the authors themselves say more research is needed on long-term outcomes.
Limitations
Abstract notes laser methods may be less effective in severe or complicated cases and that long-term outcomes still need to be established.
Taken word for word from the abstract
- population Pilonidal disease is a common sacrococcygeal cyst or sinus
- intervention minimally invasive procedures focusing on laser-assisted
- comparator traditional surgical techniques including traditional excision with open and closed healing, flap reconstructions
- primaryOutcome focusing on each method's effectiveness, recovery time, recurrence rates, complications, cosmetics, and costs
- result Laser techniques showed promising results in reducing hospital stays (for at most 3 h vs. days), postoperative pain, and recurrence rates, with healing rates up to 97%. However, laser methods may be less effective in severe or complicated cases, and they have higher costs.
BMC Surg · PMID 41094667 · Read it on PubMed ↗
Nyandoro et al. 2026
Sacrococcygeal Pilonidal Sinus Disease: A Decade-In-Review of Patient-Reported Outcome Measures
Flap surgery heals faster than open wound.RetrospectiveLow qualityRelated question
136 people2026
flap repairs let people return to work sooner (14-21 days) than leaving the wound open (60 days), and open healing had the highest rates of the cyst coming back (52.2%) and wound infection (30.4%), while modified flap techniques gave low recurrence with good patient satisfaction
Who was studied
adults who had surgery for a long-term pilonidal cyst (pilonidal sinus disease) in Western Australia
What they received
different surgical repair techniques, including flap procedures (Karydakis flap, modified Karydakis flap, Limberg flap, modified Limberg flap, other flaps)
Compared with
wound left open to heal on its own (secondary intention healing)
Main outcome
patient-reported outcomes such as body image, cosmetic appearance, confidence, return to normal activity and overall satisfaction
Quality
This was a retrospective survey-based study with results split across six small surgical-technique subgroups, so chance and selection bias could easily affect the findings.
Limitations
Retrospective, mixed-methods design relying on mailed questionnaires and phone interviews, with patients split into six small technique subgroups.
Taken word for word from the abstract
- n A total of 136 patients met the inclusion criteria.
- population definitive SPD surgery participants from Western Australia
- intervention Six surgical technique groups were analysed: Karydakis flap (KF), modified Karydakis flap (MKF), Limberg flap (LF), modified Limberg flap (MLF), other flap techniques (OFT) and secondary intention healing techniques (SIT).
- comparator secondary intention healing techniques (SIT)
- primaryOutcome PROMs assessed included body image, cosmesis, confidence, functional recovery and overall satisfaction-secondary outcomes examined recurrence, SSI and other complications.
- result MLF and OFT achieved the fastest functional recovery, with median return-to-work times of 14 and 21 days, respectively, compared to 60 days for SIT (p = 0.007).
- result SIT was associated with the highest recurrence rate (52.2%) and SSI rates (30.4%), while MLF and MKF combined had low recurrence rates with favourable PROMs.
ANZ J Surg · PMID 41074563 · Read it on PubMed ↗
Gallo et al. 2025
Intra-operative ultrasound in the surgical treatment of complex and recurrent pilonidal disease: a retrospective, observational, single-center study
Most healed; some recurrences treated successfully.RetrospectiveLow qualityRelated question
19 people36 months
At 36-month follow-up, disease persistence (recurrence or incomplete healing) was observed in 5 patients (26.3%); recurrent cases achieved 100% healing after additional surgery.
Who was studied
patients with complex or recurrent pilonidal disease treated surgically
What they received
intraoperative ultrasound combined with endoscopic pilonidal sinus treatment (EPSiT)
Compared with
none (single-arm study, no comparison group)
Main outcome
disease persistence (recurrence or incomplete wound healing) at 36 months
Quality
This was a small, single-center, retrospective study with no comparison group, so its findings carry limited weight.
Limitations
Retrospective design, single center, small sample size (19 patients), no control group for comparison.
Taken word for word from the abstract
- n Nineteen patients were included
- population patients with recurrent and complex PD treated between 2018 and 2021
- intervention Intraoperative ultrasound (IUS) offers real-time visualization of subcutaneous structures and may aid in detecting hidden tracts during surgery.
- comparator A retrospective cohort, single-center study was conducted on patients with recurrent and complex PD treated between 2018 and 2021 using IUS in conjunction with EPSiT.
- primaryOutcome recurrence rate, time to wound healing, and incidence of incomplete wound healing
- result At 36-month follow-up, disease persistence (recurrence or incomplete healing) was observed in 5 patients (26.3%). Recurrent cases were successfully managed with additional procedures, achieving 100% healing after reintervention.
- followUp All patients had a minimum follow-up of 36 months.
Int J Colorectal Dis · PMID 40974390 · Read it on PubMed ↗
Ertekin et al. 2026
Comparing Square Excision and Transposition Flap Versus Modified Limberg Flap in Sacrococcygeal Pilonidal Sinus Disease Surgery: A New Technique With Fewer Wound Issues
Faster healing, fewer wound problems with one flap.RetrospectiveLow qualityRelated question
102 people6-month follow-up
SF group had shorter healing time (11 days) and quicker return to work (13 days), lower infection rate, less wound dehiscence, and lower recurrence than LF group
Who was studied
patients who had surgery for pilonidal sinus disease (sacrococcygeal) between 2016 and 2022
What they received
square excision and transposition flap (SF) surgical technique
Compared with
modified Limberg flap (LF) surgical technique
Main outcome
healing time, wound infection/dehiscence, return to work, recurrence
Quality
This is a retrospective comparison of two surgical techniques, not a randomized trial, so differences between groups could be due to factors other than the technique itself.
Limitations
Retrospective design, not randomized, and the abstract does not report numeric recurrence rates or statistical significance for recurrence or cosmetic satisfaction.
Taken word for word from the abstract
- n the SF (53 patients) and LF (49 patients) groups
- population Patients who underwent surgical intervention for PSD utilizing SF and LF techniques between January 2016 and January 2022 were evaluated.
- intervention square excision and transposition flap (SF) technique
- comparator modified Limberg flap (LF)
- primaryOutcome hospital stay duration, healing time, time to return to work, and recurrence status
- result Patients in the SF group experienced shorter healing times of 11 days and quicker returns to work at 13 days compared with patients in the LF group ( P <.001).
- result A lower incidence of wound infection was observed in the SF group (3.8%) compared with the LF group (16.3%) ( P =.035).
- followUp Regarding cosmetic satisfaction at the 6-month follow-up, the SF group reported higher satisfaction rates.
Adv Skin Wound Care · PMID 40956974 · Read it on PubMed ↗
Yalcinkaya et al. 2025
Investigating recurrence in pilonidal sinus disease: results of a nationwide, multicenter study in Turkey (PISI TURKEY)
6% recurrence after surgery, 1 year.RetrospectiveModerate qualityRelated question
1,662 people12 months
Recurrence occurred in 6.26% of patients within 12 months after surgery
Who was studied
Patients who had surgery for pilonidal sinus disease in Turkey
What they received
Surgical treatment of pilonidal sinus disease (index operation)
Compared with
None (observational comparison of patients with vs without recurrence)
Main outcome
Recurrence of pilonidal sinus disease within 12 months after surgery
Quality
Large multicenter sample but it's a retrospective database review without a control group, so it can't show how long an untreated cyst lasts, only how often it comes back after surgery.
Limitations
Retrospective database review; no information on natural history or duration of untreated cysts; focused on surgical recurrence only.
Taken word for word from the abstract
- n The data of 1662 patients from 41 centers were analyzed.
- population included recipients of PSD surgery in 41 select hospitals in Turkey
- intervention index PSD intervention
- comparator Age (p = 0.594) and sex distribution (p = 0.441) were similar in patients with and without recurrence.
- primaryOutcome recurrence, and complications were collected from baseline to postoperative 12 months
- result The recurrence rate following index operations was 6.26% in the 12-month period.
Int J Colorectal Dis · PMID 40931185 · Read it on PubMed ↗
Bahadir et al. 2025
Comparison of Endoscopic Pilonidal Sinus Treatment Combined With Platelet-Rich Plasma and Excision With Primary Closure in Pediatric Patients: A Retrospective Comparative Cohort Study on Short-Term Outcomes
No difference in recurrence, faster recovery.RetrospectiveLow qualityRelated question
104 peoplepostoperative 1st year follow-up
Hospital stay was shorter with EPSIT + PRP, recurrence rates were not significantly different between groups, and cosmetic satisfaction favored EPSIT + PRP
Who was studied
children and adolescents with pilonidal sinus disease
What they received
endoscopic pilonidal sinus treatment combined with platelet-rich plasma (EPSIT + PRP)
Compared with
excision with primary closure (EPC)
Main outcome
recurrence rate, hospital stay, and recovery/cosmetic outcomes
Quality
This was a retrospective comparison of two historical, non-randomized patient groups treated in different time periods, which makes the results less reliable.
Limitations
Retrospective design comparing two different time-period cohorts (one retrospective, one prospective), not randomized, with differing follow-up durations between groups.
Taken word for word from the abstract
- n A total of 104 patients under 18 years of age were included.
- population pediatric patients with pilonidal sinus disease
- intervention endoscopic pilonidal sinus treatment combined with platelet-rich plasma application (EPSIT + PRP)
- comparator excision with primary closure (EPC)
- primaryOutcome Patients were evaluated based on demographic features, length of hospital stay, recurrence and complication rates, analgesic use, return to daily life, cosmetic outcomes, and satisfaction.
- result Hospital stay was significantly shorter in the EPSIT + PRP group (same-day discharge vs. mean 2.79 days; p < 0.05). In the postoperative 1st year follow-up, recurrence rates were 13.7 % (EPC) and 9.7 % (EPSIT + PRP), not statistically significant (p = 0.750). Cosmetic satisfaction and return to social life favored the EPSIT + PRP group (p = 0.031).
J Pediatr Surg · PMID 40921262 · Read it on PubMed ↗
de Kort et al. 2025
Minimal Invasive Surgical Treatment in Primary Sacrococcygeal Pilonidal Sinus Disease: Phenolization of the Sinus Tract Versus Sinus Laser Assisted Closure; Long-Term Follow-Up of a Comparative Cohort Study
No clear winner between two surgeries.RetrospectiveLow qualityRelated question
72 people47 months
additional surgery needed in 19.4% of phenolization patients versus 30.6% of SiLaC patients; most quality of life measures did not differ significantly, though phenolization patients reported less pain and better general health
Who was studied
adults with primary sacrococcygeal pilonidal sinus disease
What they received
phenolization of the sinus tract
Compared with
sinus laser-assisted closure (SiLaC)
Main outcome
need for additional surgery and quality of life/symptom scores
Quality
this is a non-randomized, matched cohort study comparing two treatments, so it cannot reliably show one is better and does not address how long a cyst lasts untreated.
Limitations
not randomized; comparative cohort design with matching rather than randomization
Taken word for word from the abstract
- population primary, chronic sacrococcygeal pilonidal sinus disease
- intervention phenolization of the sinus tract
- comparator sinus laser-assisted closure
- primaryOutcome Patient records were examined for additional surgeries, and quality of life and symptoms were assessed with a questionnaire.
- result seven patients (19.4%) in the phenolization group (n = 36) required additional surgery and 11 patients (30.6%) in the SiLaC group (n = 36) underwent additional surgery
- result other quality of life outcomes, such as the VAS score and the SF-36, did not differ significantly between phenolization and SiLaC
- n phenolization group (n = 36)
- n SiLaC group (n = 36)
- followUp After a mean follow-up of 47 months
World J Surg · PMID 40769774 · Read it on PubMed ↗
Doll et al. 2025
Unveiling Observation Bias in Pilonidal Sinus Disease Studies: A Comparative Analysis of Study Designs and Follow-Up Protocols
How follow-up is done changes reported recurrenceMeta-analysisLow qualityRelated question
135,349 peoplefive-year
Randomized trials showed significantly higher recurrence rates than return-on-recurrence or non-randomized studies at 10-year follow-up, and return-on-recurrence studies appeared to underreport recurrence by three to fourfold
Who was studied
patients treated for pilonidal sinus disease across many published studies
What they received
studies using scheduled follow-up versus studies where patients only returned if their disease came back
Compared with
non-randomized studies without a return-on-recurrence design (N trials)
Main outcome
recurrence rate at 5 and 10 years after treatment
Quality
This is a comparison of pooled studies with very different designs and follow-up completeness, so it cannot reliably establish the true natural duration of a pilonidal cyst.
Limitations
Relies on pooling data from studies of differing designs and follow-up methods, with likely underreporting of recurrence in studies lacking structured follow-up
Taken word for word from the abstract
- n 135.349 patients treated
- population 1.222 PSD studies with 135.349 patients treated
- intervention patients returning in case of recurrent disease (return on recurrence; ROR)
- comparator 1,029 were non-RCT non-ROR (N) trials
- primaryOutcome Recurrence rates were compared between groups
- result RCTs show significantly higher recurrence rates than N or ROR at 10-year follow-ups (p<0.001, p<0.001)
Pol Przegl Chir · PMID 40679024 · Read it on PubMed ↗
Yalçın et al. 2025
Our Experience With Four or More Crystallised Phenol Applications in Pilonidal Sinus Disease
High success with phenol treatment.RetrospectiveLow qualityRelated question
53 people3-year follow-up
92.45% of patients achieved treatment success, with recurrence in 1.9% and surgery needed in 5.7% due to failure
Who was studied
adults aged 18 or older with pilonidal sinus disease
What they received
crystallised phenol applications (4-9 sessions) given in an outpatient clinic
Compared with
no comparison group reported
Main outcome
treatment success rate after phenol therapy
Quality
This was a small, retrospective study without a control group, so it can't reliably show how the condition compares to other treatments or its natural course.
Limitations
Retrospective design, no comparator group, small single-center sample.
Taken word for word from the abstract
- n We retrospectively evaluated 53 patients (43 male, 10 female) aged ≥ 18 years
- population patients with pilonidal sinus who underwent daily phenol treatment
- intervention received 4-9 crystallised phenol applications for pilonidal sinus disease
- comparator Phenol treatment is an effective and simple procedure compared to surgical methods
- primaryOutcome Treatment success was achieved in 92.45% of patients, with a 3-year follow-up.
- result Treatment success was achieved in 92.45% of patients, with a 3-year follow-up. Recurrence occurred in one patient (1.9%), while three patients (5.7%) required surgery due to treatment failure.
Int Wound J · PMID 40524141 · Read it on PubMed ↗
Emral et al. 2025
Evaluation of laser ablation for recurrent pilonidal sinus disease: treatment success, recurrence rates, and patient outcomes
Most healed without recurrence.RetrospectiveLow qualityRelated question
37 people9.6 months
70.3% of patients healed completely without recurrence, while 21.6% had recurrence over a mean follow-up of 9.6 months
Who was studied
patients with recurrent pilonidal sinus disease
What they received
laser ablation
Main outcome
complete healing without recurrence of pilonidal sinus disease
Quality
This was a small retrospective study with no comparison group, so it can't reliably show how the disease would progress without treatment.
Limitations
Retrospective design, small sample size, no control group, and short follow-up.
Taken word for word from the abstract
- n A retrospective analysis of 37 patients with recurrent pilonidal sinus disease treated with laser ablation between January 2022 and January 2025 was conducted.
- population patients with recurrent pilonidal sinus disease
- intervention treated with laser ablation between January 2022 and January 2025
- primaryOutcome 70.3% of patients achieved complete healing without recurrence
- result The results showed that 70.3% of patients achieved complete healing without recurrence, while 21.6% experienced recurrence within a mean follow-up of 9.6 months.
- followUp mean follow-up of 9.6 months
Lasers Med Sci · PMID 40522552 · Read it on PubMed ↗
König et al. 2025
Long term results and quality of life after primary excision followed by Limberg plasty in pilonidal sinus disease
Low recurrence after surgery, better quality of life.RetrospectiveLow qualityRelated question
47 people86 months
only one recurrence (2.4%) and significant improvement in quality of life
Who was studied
adults with pilonidal sinus disease who had surgery
What they received
primary excision followed by Limberg plasty
Compared with
no comparison group (single treatment group)
Main outcome
rate of disease recurrence and quality of life after surgery
Quality
This is a small retrospective study of one surgery type with no comparison group, so it mainly shows what happens after this operation, not how long an untreated cyst lasts.
Limitations
Retrospective design, no control group, patients recalled by phone or written survey, single center.
Taken word for word from the abstract
- n The study enrolled forty-seven patients who presented with PSD
- population forty-seven patients who presented with PSD from August 2010 until June 2019 and underwent primary excision and LP
- intervention underwent primary excision and LP at the Department of General, Visceral, and Vascular Surgery
- comparator Forty- one of these patients were questioned retrospectively in writing or by telephone interviews
- primaryOutcome Only one recurrence (2.4%) was reported.
- result Only one recurrence (2.4%) was reported. While the participants' BMIs remained unchanged, they reported significant improvements in QoL
- followUp The median follow-up for all patients was 86 months (range, 23-140 months).
Langenbecks Arch Surg · PMID 40515949 · Read it on PubMed ↗
Huurman et al. 2025
Prospective nationwide audit of short-term outcomes after surgery for chronic pilonidal sinus disease in the Netherlands
Minimally invasive surgery healed faster.Prospective cohortLow qualityRelated question
405 people42 days
minimally invasive surgery had a higher wound healing rate and healed faster than excision with open healing
Who was studied
adults with chronic pilonidal sinus disease having surgery in Dutch hospitals
What they received
minimally invasive surgical techniques
Compared with
excision with secondary wound healing
Main outcome
type of pilonidal disease and which surgical approach was used
Quality
this is an observational audit with only 42 days of follow-up, so it cannot show how long untreated cysts last or long-term healing
Limitations
short median follow-up of 42 days, observational design without randomization, and it studies surgical healing time rather than natural disease duration
Taken word for word from the abstract
- n 405 patients had chronic disease
- population All patients with PSD and who underwent surgery were included
- intervention Minimally invasive techniques were used the most (61.2%)
- comparator compared to excision with secondary healing
- primaryOutcome Primary endpoints were PSD classification and type and frequency of surgical approach.
- result Minimally invasive techniques showed a significantly higher wound healing rate (41.1% vs 28.6%) and a shorter median time to closure (41 vs 78 days) compared to excision with secondary healing.
- followUp The median follow-up period was 42 days.
Tech Coloproctol · PMID 40498166 · Read it on PubMed ↗
Doll et al. 2025
Impact of surgical case load on recurrence rates in pilonidal sinus disease: a cross-study data synthesis
More surgeon experience, fewer recurrences (mostly).Meta-analysisLow qualityRelated question
130,599 people5 years
Higher-volume centers had lower recurrence rates for most surgery types, but midline closure surgery stayed high regardless of volume
Who was studied
people with pilonidal sinus disease who had surgery
What they received
surgery done at centers with higher annual case volume (10 or more, especially 30+ operations per year)
Compared with
surgery done at centers with lower annual case volume (fewer than 10 operations per year)
Main outcome
rate of pilonidal disease coming back after surgery over 5 years
Quality
It combines many different studies of mixed design and quality rather than being a single controlled trial, so the comparison across caseload groups is indirect and open to bias.
Limitations
Combines over a thousand studies of varying design (RCT and non-RCT), with inconsistent results depending on surgery type and caseload group definitions.
Taken word for word from the abstract
- n 130,599 patients
- population Pilonidal Sinus Disease (PSD)
- intervention annual PSD surgery volumes
- comparator fewer than 10 operations per year (group 1), 10-30 operations per year (group 2), and 30 or more operations per year (group 3)
- primaryOutcome recurrence rates (RR)
- result higher surgical caseloads significantly reduce PSD recurrence rates, with notable benefits observed for centers treating 30 or more patients annually
- result midline closure surgery continues to show persistently high recurrence rates, regardless of caseload
- followUp 5-year recurrence rate
Int J Colorectal Dis · PMID 40407900 · Read it on PubMed ↗
Chiu et al. 2025
Standardized Classification System for Pilonidal Disease and Recurrence Rate after Treatment
Higher stage, more recurrence after treatment.Prospective cohortModerate qualityRelated question
411 people1- and 2-year follow-up
recurrence rates rose with higher disease stage: at 1 year 0.0%, 2.3%, 8.3%, and 20.8% for stages 0, I, II, III; at 2 years 0.0%, 4.8%, 12.7%, and 27.5%
Who was studied
patients presenting with pilonidal disease at a specialized care center
What they received
pilonidal disease severity (PDS) staging assigned at initial presentation
Compared with
different PDS stages (0, I, II, III) and presence of open wound or prior surgery
Main outcome
pilonidal disease recurrence at 1 and 2 years after treatment
Quality
This was a sizable prospective study but single-center, and roughly half the patients were lost before the 1- and 2-year follow-up points.
Limitations
Only about half of the 411 patients completed 1- and 2-year follow-up, and the study looked at recurrence after treatment rather than how long an untreated cyst lasts.
Taken word for word from the abstract
- n A total of 411 patients met criteria
- population All patients presenting with pilonidal disease were included.
- intervention The main effector under study was PDS stage assigned at initial presentation.
- comparator recurrence occurred in 0.0%, 2.3%, 8.3%, and 20.8% of patients with PDS stage 0, I, II, and III disease at initial presentation
- primaryOutcome The primary outcome was pilonidal disease recurrence at 1- and 2-year follow-up.
- result At 2 years, recurrence was noted in 0.0%, 4.8%, 12.7%, and 27.5% of patients with PDS stage 0, I, II, and III disease, respectively (log-rank test, p = 0.010).
J Am Coll Surg · PMID 40401769 · Read it on PubMed ↗
Demir et al. 2025
Efficacy of crystallized and liquid form phenol application in pilonidal sinus disease: a single-center retrospective study
Not about untreated cyst duration.RetrospectiveLow qualityRelated question
80 people1st year
Both phenol forms led to similar recovery (90% vs 95%) and recurrence rates at 1 year, but the liquid form caused more early complications
Who was studied
young adults with pilonidal sinus disease
What they received
crystallized phenol application
Compared with
liquid phenol application
Main outcome
recovery rate, complication rate, and recurrence after treatment
Quality
This is a small retrospective study comparing two treatments without a surgical or untreated comparison group, so it cannot show how long a cyst lasts without treatment.
Limitations
Retrospective design, no untreated comparison group, small sample size
Taken word for word from the abstract
- population Pilonidal sinus is a frequently observed disease in young adult male patients.
- n Eighty patients were included in the study: 40 treated with crystallized phenol and 40 with liquid phenol.
- intervention 40 treated with crystallized phenol
- comparator 40 with liquid phenol
- primaryOutcome the recovery rates, complication rates, persistence of complaints, and recurrence at the end of the 1st year were compared between the groups
- result At the end of the 1st year, 90% improvement was detected in group 1 and 95% in group 2. However, there was no significant difference between the recovery and recurrence rates between the groups.
Tech Coloproctol · PMID 40329097 · Read it on PubMed ↗
Morais et al. 2025
What is the Impact of Negative Pressure Wound Therapy on Healing in Patients Post Excision of Pilonidal Sinus? A Systematic Review and Meta-Analysis
Uncertain benefit of vacuum dressing after surgery.Systematic reviewVery low qualityRelated question
size not given2025
some reduction in healing time, recurrence and pain with higher satisfaction, but evidence was very uncertain and it is unclear if NPWT makes a real difference
Who was studied
patients who had surgery to remove a pilonidal sinus (cyst)
What they received
negative pressure wound therapy (vacuum dressing) on the wound after surgery
Compared with
other types of wound dressings
Main outcome
time to healing, recurrence, pain and patient satisfaction after surgery
Quality
The review itself rated the evidence as very low certainty due to small, mixed-quality studies.
Limitations
Very low certainty of evidence; small sample sizes; mix of study designs including retrospective and non-randomised studies.
Taken word for word from the abstract
- population patients with pilonidal sinus following surgical excision
- intervention negative pressure wound therapy
- comparator any other dressings
- primaryOutcome time to healing, recurrence, pain or patient's experience
- result Studies showed reduction in healing time, recurrence rates and postoperative pain, as well as higher patients' satisfaction with the use negative pressure wound therapy, however, the certainty of the evidence was very low.
- result it is unclear whether NPWT makes any difference when compared to any other dressings, on time to healing, recurrence, pain or patient's experience
- n Ten studies were included with a mean sample size of 61 (SD: 33).
Int Wound J · PMID 40288765 · Read it on PubMed ↗
Agnesi et al. 2025
Endoscopic pilonidal sinus treatment versus excision with wound closure: a systematic review of the literature
Slower healing but fewer complications with minimally invasive surgery.Systematic reviewLow qualityRelated question
595 people2025
EPSIT had shorter operative time and hospital stay, lower complication and wound dehiscence rates, but longer healing time and slightly higher recurrence than excision with wound closure
Who was studied
adults with pilonidal disease undergoing surgery
What they received
endoscopic pilonidal sinus treatment (EPSIT), a minimally invasive procedure
Compared with
excision of the cyst with wound closure
Main outcome
perioperative outcomes including operative time, hospital stay, complications, recurrence, and healing time
Quality
This is a systematic review of only six studies with no mention of risk-of-bias assessment or randomization, so the comparison between techniques is not strongly controlled.
Limitations
Review combines only six studies from 2018-2023; no mention of randomization or bias assessment; abstract does not address untreated or natural course of pilonidal cysts.
Taken word for word from the abstract
- n including 595 patients were included in the present systematic review
- population treatment of pilonidal disease (PD)
- intervention All of these studies presented endoscopic pilonidal sinus treatment (EPSIT) as the minimally invasive surgical technique for the treatment of pilonidal disease
- comparator excision and wound closure (Group B)
- primaryOutcome to compare minimally invasive procedures versus excision and wound closure for the treatment of pilonidal disease (PD) in terms of perioperative outcomes
- result Patients in Group A experienced shorter operative times (42.1±16 minutes) and hospital stay (0.5±0.3 days) in comparison to Groups B (59.3±19 minutes and 2.4±1 days, respectively). Group A had lower complication rate (12.5%) compared to Group B (35.2%) and recurrence rate (17.9% versus 14.8%). Wound dehiscence rate was 12.8% in Group B. Mean time to complete healing was longer in Group A than Group B (47.9±26.1 days and 39.1±22.3 days, respectively)
Minerva Surg · PMID 40178497 · Read it on PubMed ↗
El Deen et al. 2025
A Comparitive Study Between Early Outcomes of Laser and Lay-Open Technique in Management of Simple Pilonidal Sinus
Faster healing with laser, similar recurrence.Randomised trialLow qualityRelated question
40 people2025
Laser treatment healed wounds faster (10.1 days vs 34.1 days), with less pain, shorter hospital stay, and shorter operative time; recurrence and infection rates were similar between groups
Who was studied
patients with simple/chronic pilonidal sinus disease
What they received
laser therapy (SiLaT) for pilonidal sinus
Compared with
lay-open technique (sinotomy) for pilonidal sinus
Main outcome
healing time, pain, hospital stay, operative time, recurrence
Quality
Small randomized trial with only 40 patients and short-term follow-up, so results may not be reliable or lasting.
Limitations
Small sample size; only early postoperative outcomes assessed; authors call for long-term studies to evaluate effectiveness
Taken word for word from the abstract
- n including 40 patients, divided into two equal groups
- population treatment of chronic pilonidal sinus disease
- intervention PS treated with diode laser therapy (SiLaT)
- comparator the lay-open group: PS treated with lay-open (sinotomy)
- primaryOutcome Postoperative outcomes such as operative time, hospital stay, pain scores, healing time, complications, and recurrence rates were analyzed.
- result Wound healing was significantly faster in the SiLaT group (10.1 ± 2.7 days vs. 34.1 ± 15.1 days, p < 0.0001). Recurrence rates (p = 0.998) and surgical site infection (p = 1.00) were comparable among both groups.
Lasers Surg Med · PMID 40108765 · Read it on PubMed ↗
Demir et al. 2025
Is it beneficial to add laser ablation to curettage in the treatment of pilonidal sinus disease?
No difference between the two surgeries.Randomised trialLow qualityRelated question
80 people6 months
no significant difference between the two treatments for wound healing or recurrence
Who was studied
adults with pilonidal sinus disease having surgery
What they received
laser ablation plus sinus curettage
Compared with
sinus curettage alone
Main outcome
wound healing problems and recurrence after surgery
Quality
small randomized trial with only non-significant differences, so it may be too small to detect a real benefit
Limitations
Small sample size (40 per group); only non-significant differences found in any outcome; study compares two surgical treatments rather than addressing how long a cyst lasts without treatment.
Taken word for word from the abstract
- n the laser + curettage (L/C; n = 40) group or the curettage-only (C; n = 40) group
- population This study included patients diagnosed with PSD between February 2019, and September 2022.
- intervention laser application with sinus curettage
- comparator only sinus curettage
- primaryOutcome postoperative complications, wound healing, and recurrence
- result The groups had similar results for postoperative pain, discharge, bleeding, wound healing problems at 30 days, and recurrence at 6 months.
Lasers Med Sci · PMID 40100423 · Read it on PubMed ↗
Gojayev et al. 2025
Comparative Outcomes of Surgical Techniques for Pilonidal Sinus: A Turkish Retrospective Study
Surgery removes it; technique affects recovery, not duration.RetrospectiveLow qualityRelated question
476 people2025
Primary midline closure had more complications and recurrence; laser pilonidotomy had shorter hospital stay, faster recovery, and higher satisfaction; Karydakis flap had lower recurrence
Who was studied
adults with pilonidal sinus disease who had surgery
What they received
different surgical techniques: primary midline closure, Karydakis flap, Limberg flap, laser pilonidotomy
Compared with
the four surgical techniques compared against each other
Main outcome
surgical complications, recurrence, recovery time, and quality of life after surgery
Quality
This was a retrospective study without randomization, so differences between groups could be due to other factors, not just the surgery type.
Limitations
Retrospective design; abstract itself calls for studies with larger samples and longer follow-up.
Taken word for word from the abstract
- n The data of 476 patients who underwent surgery for pilonidal sinus disease in our clinic between January 2011 and September 2022 were retrospectively evaluated.
- population adult patients with pilonidal sinus disease
- intervention primary midline closure (PMC), Karydakis flap (KF), Limberg flap (LF), and laser pilonidotomy (LP)
- comparator compares outcomes of primary midline closure (PMC), Karydakis flap (KF), Limberg flap (LF), and laser pilonidotomy (LP) in adult patients with pilonidal sinus disease
- primaryOutcome Patient characteristics, surgical findings, and quality of life outcomes were compared between the groups.
- result Seroma (P=0.006), wound dehiscence (P<0.001), and postoperative recurrence (P=0.017) rates were significantly higher in the PMC group.
- result Pain-free toilet sitting time, pain-free walking time, and return to work time were statistically significantly shorter in the LP group (all P<0.001).
Med Sci Monit · PMID 39995244 · Read it on PubMed ↗
Alwadees et al. 2025
Laser versus rhomboid flap for sacrococcygeal pilonidal sinus: multi-centre comparative study
Laser had more recurrences than surgery.RetrospectiveLow qualityRelated question
374 people4 weeks or 3 months
the laser group had a much higher recurrence rate than the open surgery group
Who was studied
people aged 16 to 70 with a first-time pilonidal sinus (cyst near the tailbone)
What they received
laser ablation treatment
Compared with
open rhomboid flap surgery
Main outcome
rate of the cyst coming back (recurrence)
Quality
it compares two surgical groups without describing randomization or blinding, so bias cannot be ruled out.
Limitations
abstract does not describe randomization, blinding, or how patients were assigned to each group
Taken word for word from the abstract
- n 190 and 184 patients were selected for the laser and open groups, respectively.
- population Patients are included if they are diagnosed with pilonidal sinus, between the ages of 16 and 70, and have never had surgery before.
- intervention laser ablation
- comparator open rhomboid flap technique
- primaryOutcome This study aims to assess the recurrence rate after both techniques.
- result There is a significantly higher recurrence rate in the laser group value: <0.00001.
- followUp Patients are seen for 4 weeks or 3 months and discharged if there are no complications.
Lasers Med Sci · PMID 39953215 · Read it on PubMed ↗
Doll et al. 2025
Evaluation of Outcomes for Karydakis Operation for Pilonidal Sinus Disease-Comparison of Original Reports With Later Results
Surgery recurrence higher than first reported.Systematic reviewLow qualityRelated question
9,878 people5- and 10-year follow-ups
recurrence rates in later studies were much higher than in the original report
Who was studied
patients who had pilonidal sinus disease treated with Karydakis flap surgery
What they received
Karydakis advancement flap surgery for pilonidal sinus disease
Compared with
the original 1992 Karydakis report's recurrence results
Main outcome
rate of pilonidal sinus recurrence after surgery at 5 and 10 years
Quality
it combines many different studies of varying quality rather than a single controlled comparison, so the pooled recurrence numbers are less reliable.
Limitations
compares a single historic report to a mix of later RCTs and non-RCTs, which may differ in surgical technique, follow-up, and patient selection
Taken word for word from the abstract
- n 113 other studies encompassing 9878 patients undergoing the Karydakis advancement flap surgery
- population 113 other studies encompassing 9878 patients undergoing the Karydakis advancement flap surgery
- intervention patients undergoing the Karydakis advancement flap surgery
- comparator Recurrence rates at 5- and 10-year follow-ups were compared to the data presented in the Karydakis 1992 paper.
- primaryOutcome Recurrence rates at 5- and 10-year follow-ups were compared to the data presented in the Karydakis 1992 paper.
- result In the global literature, the 10-year recurrence rate is 8.8% in RCTs and 14.6% in nonRCTs which is 11.6- and 19.2-fold higher.
World J Surg · PMID 39900551 · Read it on PubMed ↗
Faurschou et al. 2025
Gender-specific outcomes in pilonidal sinus disease: Female outcomes after cleft lift surgery in a large prospective Danish cohort
Women healed slower after surgery.Prospective cohortLow qualityRelated question
560 people2025
women had a 30% higher risk of recurrence (not statistically significant) and a 46% higher risk of prolonged healing than men
Who was studied
people with pilonidal sinus disease who had cleft lift surgery, comparing women and men
What they received
Bascom's cleft lift surgery in female patients
Compared with
Bascom's cleft lift surgery in male patients
Main outcome
risk of disease recurrence and prolonged wound healing after surgery
Quality
it is an observational cohort without randomization, and one of the two key differences (recurrence) was not statistically significant.
Limitations
observational design, no randomization, small subgroup of women (88 patients), focuses on surgical outcomes rather than natural disease duration
Taken word for word from the abstract
- population we evaluate the surgical outcomes in a female population following Bascom's cleft lift (BCL) surgery
- intervention Bascom's cleft lift (BCL) surgery
- comparator Risk of recurrence in female patients was 30% higher than in male patients
- primaryOutcome Risk of recurrence in female patients was 30% higher than in male patients (risk ratio 1.30, 95% CI 0.79-2.09) and the risk of prolonged healing after BCL surgery was 46% higher in women compared to men
- result risk ratio 1.30, 95% CI 0.79-2.09) and the risk of prolonged healing after BCL surgery was 46% higher in women compared to men (risk ratio 1.46, 95% CI 1.02-2.14)
- n In all, 560 patients underwent BCL surgery at our centre during this period.
Colorectal Dis · PMID 39871414 · Read it on PubMed ↗
Aljarrah et al. 2024
Limberg flap for previously recurrent complex sacrococcygeal pilonidal sinus surgeries
No recurrence after flap surgeryCase seriesVery low qualityRelated question
10 people3 months
no recurrences during about 3 months of follow-up, with mild to moderate pain, 1 wound infection, and 5 patients with flap swelling that healed in 2-3 weeks
Who was studied
patients with complex or recurrent pilonidal sinus disease near the tailbone
What they received
Limberg flap surgery (a rotational skin flap procedure)
Compared with
no comparison group within this study (only mentioned vs open procedures in general)
Main outcome
wound infection, seroma, pain, recurrence, return to work, cosmetic result and satisfaction after surgery
Quality
This was a very small study of only 10 patients with no comparison group and just 3 months of follow-up, so it cannot reliably show how the disease or recovery unfolds over time.
Limitations
Very small sample size (10 patients), no control group, short follow-up of about 3 months, and the study focuses on surgical outcomes rather than the natural course of pilonidal disease.
Taken word for word from the abstract
- n A total of 10 patients were operated from January 2022 to March 2023.
- population patients selected were classified as complex and at least of a second recurrence of the disease
- intervention Limberg flap, is a rotational rhomboid flap
- comparator in comparison to the open procedures
- primaryOutcome regarding the wound infection rate, seroma formation, postoperative pain relief, recurrence rates, return to work, its cosmetic final result and patients' satisfaction
- result there were no recurrences so far for an average follow-up time of about 3 months
- followUp an average follow-up time of about 3 months
Acta Chir Plast · PMID 39800555 · Read it on PubMed ↗
Breidung et al. 2024
Evaluation of Clinical Outcomes and Quality of Life following the Karydakis Flap Procedure for Pilonidal Sinus Treatment
Surgical wounds healed in about 3 weeks.RetrospectiveLow qualityRelated question
103 people59 months
average wound healing time was 21.4 days after surgery, with a 6.8% recurrence rate within 59 months
Who was studied
patients with pilonidal sinus who had surgery
What they received
Karydakis flap surgical procedure for pilonidal sinus
Compared with
none reported (single-arm study)
Main outcome
postoperative complications, recurrence rate, wound healing time, and return to daily life
Quality
This was a retrospective single-surgeon study with no comparison group, so it cannot show whether the procedure is better than other options.
Limitations
Retrospective design, single surgeon, no control/comparator group, follow-up partly done by telephone.
Taken word for word from the abstract
- n A total of 103 patients were enrolled in the study.
- population patients who underwent reconstruction of pilonidal sinus using the Karydakis technique
- intervention the Karydakis flap procedure performed by a single surgeon for the treatment of pilonidal sinus
- primaryOutcome focusing on postoperative complications, recurrence rate, wound healing time, and return to daily life
- result Wound healing time was on average 21.4 days postoperatively. A total of seven patients (6.8%) had a recurrence within 59 months postoperatively.
- comparator Authors performed a retrospective data analysis of patients who underwent reconstruction of pilonidal sinus using the Karydakis technique
Adv Skin Wound Care · PMID 39792517 · Read it on PubMed ↗
Akyol 2024
Sinus laser therapy versus Karydakis flap procedure in the management of pilonidal sinus disease: a comparative analysis of intraoperative parameters and postoperative outcome
Laser surgery: faster, less painful recovery.RetrospectiveLow qualityRelated question
106 people2024
Laser therapy had shorter operating time, less pain, and faster return to work, with similar complication and recurrence rates to flap surgery
Who was studied
adults with pilonidal sinus disease treated surgically
What they received
minimally invasive sinus laser therapy (SiLaT)
Compared with
Karydakis flap surgery
Main outcome
operative time, pain, return-to-work time, complications and recurrence after surgery
Quality
This was a retrospective, non-randomized comparison of two surgeries, so differences could be due to patient selection rather than the treatments themselves.
Limitations
Retrospective design without randomization; abstract does not report length of follow-up for recurrence.
Taken word for word from the abstract
- n A total of 106 patients with PSD
- population patients with pilonidal sinus disease (PSD)
- intervention sinus laser therapy (SiLaT)
- comparator Karydakis flap procedure
- primaryOutcome operative characteristics (number of openings, length of sinus tract, and operative time), and postoperative outcome including postoperative (day 1) pain intensity-visual analog scale (VAS) scores, time to return to work after surgery (days), complication rate, and recurrence rate
- result The SiLaT versus KF procedure was associated with significantly shorter operative time [median (min-max) 17 (12-28) versus 27 (20-44) min, p = 0.001], lower pain scores [3 (1-4) versus 5 (3-7), p = 0.001], and earlier return to work [1 (1-3) versus 10 (5-20) days, p = 0.001].
- result Although no significant difference was noted in complication and recurrence rates between the KF and SiLaT groups
Tech Coloproctol · PMID 39699772 · Read it on PubMed ↗
Pérez-Bertólez et al. 2024
Pediatric endoscopic pilonidal sinus treatment: lessons learned after 100 consecutive cases
Faster healing with endoscopic surgery.RetrospectiveLow qualityRelated question
149 people2024
endoscopic surgery healed faster (4 weeks) than standard open healing (16 weeks) or stitched closure (7 weeks), with less pain, fewer complications, and lower chance of it coming back
Who was studied
children and teens with a pilonidal sinus (cyst) needing surgery
What they received
endoscopic pilonidal sinus surgery (PEPSiT)
Compared with
standard surgery - cutting it out and letting it heal naturally (EHSI) or cutting it out and stitching it closed (EPC)
Main outcome
how long it took to fully heal, pain, complications, and return to normal activity
Quality
patients were not randomly assigned to a treatment group, and the surgeon chose which technique to use, so other factors could explain the difference.
Limitations
not randomized, surgical technique was chosen by the surgeon rather than assigned, single institution
Taken word for word from the abstract
- population A quasi-experimental study was carried out in pediatric patients undergoing pilonidal sinus surgery at a single institution from 2019 to 2022.
- intervention Pediatric endoscopic pilonidal sinus treatment (PEPSiT) has favorable short-term-outcomes, but there is a lack of reliable data on medium and long-term follow-up.
- comparator Excision and healing by secondary intention (EHSI), excision and primary closure (EPC), and PEPSiT were compared.
- primaryOutcome Median full healing process was 4 weeks [interquartile range (IQR): 3-8] in PEPSiT, 16 weeks in EHSI (IQR: 12-26.5), and 7 weeks (IQR: 4-10) in ECP (p < 0.01).
- result Median full healing process was 4 weeks [interquartile range (IQR): 3-8] in PEPSiT, 16 weeks in EHSI (IQR: 12-26.5), and 7 weeks (IQR: 4-10) in ECP (p < 0.01).
- n In total, 149 patients were studied-100 undergoing PEPSiT, 28 undergoing EHSI, and 21 undergoing EPC.
Tech Coloproctol · PMID 39656288 · Read it on PubMed ↗
Darnis et al. 2024
Does the holmium laser have a place in the treatment of pilonidal cysts? (Pilolas study)
Similar healing but more pain.RetrospectiveLow qualityRelated question
size not givenup to a year
Healing rate at 1 month was 90.7%, similar to SiLaT, but pain occurred in 44.9% of patients and could persist up to a year, with higher complication rates
Who was studied
patients treated for pilonidal cysts
What they received
holmium laser treatment
Compared with
SiLaT laser treatment
Main outcome
healing (cure) rate at one month after treatment
Quality
It's a retrospective study without a concurrent control group, comparing to past results, which makes the findings less reliable.
Limitations
Retrospective design; comparison to SiLaT laser is indirect, not a randomized head-to-head trial; higher complication rates noted.
Taken word for word from the abstract
- population treatment of pilonidal cysts
- intervention holmium laser
- comparator SiLaT laser
- primaryOutcome the primary endpoint being the cure rate one month after treatment
- result healing rate at 1 month was 90.7%
- result 102 patients (44.9%) experienced pain in the coccygeal region often exacerbated by sitting
- result pain that can persist for up to a year after the procedure
- result Holmium laser does not differ from SiLaT laser in the healing rate of pilonidal cysts after treatment
Lasers Med Sci · PMID 39578271 · Read it on PubMed ↗
Pedersen et al. 2025
Distinct recurrence patterns according to disease manifestation in pilonidal sinus disease treated with cleft lift surgery at 5 years' follow-up in a large prospective Danish cohort
Most healed by 3 months; some recurred later.Prospective cohortModerate qualityRelated question
392 people60 months
87% healed within 3 months overall; 17% had recurrence by a median of 60 months, with recurrence higher in nonhealing-wound patients (20%) and recurrent-disease patients (17%) than in primary extensive disease (13%)
Who was studied
adults with pilonidal sinus disease, including new extensive disease, wounds that didn't heal after prior surgery, and recurrent disease
What they received
Bascom's cleft lift surgery
Compared with
disease manifestation type (newly diagnosed extensive disease vs nonhealing wounds vs recurrent disease)
Main outcome
wound healing and recurrence rates after surgery
Quality
Large prospective single-center cohort with long follow-up, but it has no untreated comparison group and does not address the natural course of an untreated cyst.
Limitations
Single high-volume center, no comparator arm without surgery, and findings may not generalize to other settings.
Taken word for word from the abstract
- n Three hundred and ninety two patients (326 men/66 women) underwent BCL surgery over a 4-year period.
- population Of these, 127 (32.4%) presented with primary extensive PSD, 136 (34.7%) with nonhealing wounds and 129 (33.9%) with recurrent PSD.
- intervention following Bascom's cleft lift (BCL) in primary extensive disease, nonhealing wounds after previous surgery and recurrence
- comparator the risk of recurrence was higher among patients with nonhealing wounds (20%) and recurrence (17%) compared with primary extensive manifestation (13%)
- primaryOutcome Overall, 87% healed uneventfully within the first 3 months, and 17% had recurrence at a median follow-up of 60 months (45-73 months).
- result Overall, 87% healed uneventfully within the first 3 months, and 17% had recurrence at a median follow-up of 60 months (45-73 months). However, the risk of recurrence was higher among patients with nonhealing wounds (20%) and recurrence (17%) compared with primary extensive manifestation (13%).
Colorectal Dis · PMID 39551964 · Read it on PubMed ↗
Baños et al. 2025
Short-term results of unroofing and marsupialization compared to the Karydakis technique in the treatment of pilonidal sinus. A randomized prospective study
Fewer complications but more recurrences.Randomised trialModerate qualityRelated question
122 people90-day
unroofing and marsupialization had fewer complications at 15 and 30 days, shorter surgery time, and faster return to daily activity, but 3 recurrences within 90 days versus 0 with Karydakis
Who was studied
adults with a symptomatic pilonidal sinus with no abscess, having surgery for the first time
What they received
unroofing and marsupialization surgery
Compared with
Karydakis flap surgery
Main outcome
complications in the first 30 days after surgery
Quality
it was a randomized trial but came from a single center with only 90 days of follow-up, which is too short to judge recurrence or long-term healing.
Limitations
single-center study, short 90-day follow-up, and the question asked here is about how long a cyst/sinus lasts rather than which surgery works better
Taken word for word from the abstract
- n 122 patients with symptomatic primary PS were randomized: 60 in the K group and 62 in the UM group
- population patients who underwent surgery for primary PS with no abscess
- intervention unroofing and marsupialization (UM)
- comparator Karydakis (K) technique
- primaryOutcome To evaluate early postoperative complications (EPC) 30 days after UM surgery compared to the K technique.
- result There were statistically significant differences between surgery and postoperative complications at 15 and 30 days in favor of UM. There were also differences in favor of UM in surgical time and return to daily activity. During the 90-day follow-up, there were 3 recurrences in the UM group and 0 in the K group.
Cir Esp (Engl Ed) · PMID 39427709 · Read it on PubMed ↗
de Kort et al. 2024
Phenolization of the sinus tract in recurrent sacrococcygeal pilonidal sinus disease: long-term results of a prospective cohort study
Low recurrence, improved symptoms long-termProspective cohortLow qualityRelated question
47 people76 (SD 21.7) months
Recurrence needing further surgery developed in 7 patients (14.9%) after a mean follow-up of 76 (SD 21.7) months.
Who was studied
patients with recurrent SPSD
What they received
phenolization technique for recurrent SPSD
Compared with
preoperative levels
Main outcome
The primary endpoint was recurrence.
Quality
this is a single-arm study without a comparison treatment group, and almost a fifth of patients were lost to long-term follow-up.
Limitations
no control group, loss to follow-up of 17.5%, relies on patient questionnaire for long-term data
Taken word for word from the abstract
- n A total of 47 patients (82.5%) were available for long-term follow-up.
- population patients with recurrent SPSD
- intervention phenolization technique for recurrent SPSD
- comparator there was improvement in the quality of life compared to preoperative levels
- primaryOutcome The primary endpoint was recurrence.
- result Recurrence needing further surgery developed in 7 patients (14.9%) after a mean follow-up of 76 (SD 21.7) months.
- followUp mean follow-up of 76 (SD 21.7) months
Int J Colorectal Dis · PMID 39422799 · Read it on PubMed ↗
Azizoglu et al. 2025
Platelet-rich Plasma as an Adjuvant Therapy to Crystallized Phenol in the Treatment of Pediatric Pilonidal Sinus Disease: A Prospective Randomized Controlled Trial
Faster healing with added PRPRandomised trialModerate qualityRelated question
87 people2025
healing time was shorter with PRP added (19.4 days vs 30.7 days)
Who was studied
children with pilonidal sinus disease
What they received
crystallized phenol plus platelet-rich plasma injection
Compared with
crystallized phenol alone
Main outcome
healing time after treatment
Quality
it was a randomized trial but single-center with modest size and the abstract does not mention blinding of outcome assessors.
Limitations
single-center study, no mention of blinding, population is children undergoing a specific chemical treatment rather than studying natural duration of untreated cysts
Taken word for word from the abstract
- n Eighty-seven patients aged 0-18 were randomly assigned to two groups: the CP group (n = 42) and the CP + PRP group (n = 45).
- population pediatric pilonidal sinus disease (PSD)
- intervention In CP + PRP group, PRP injections were also administered.
- comparator the CP group (n = 42)
- primaryOutcome The CP + PRP group demonstrated significantly shorter healing times (19.4 ± 7.88 days) compared to the CP group (30.7 ± 12.9 days) (p < 0.001).
- result The CP + PRP group demonstrated significantly shorter healing times (19.4 ± 7.88 days) compared to the CP group (30.7 ± 12.9 days) (p < 0.001).
J Pediatr Surg · PMID 39307596 · Read it on PubMed ↗
Karita et al. 2024
Long-term follow-up of pilonidal sinus disease treated by radial laser surgery
About 15% recurred after laser surgery.RetrospectiveLow qualityRelated question
83 peoplemedian of 5.2 years, range 1.5 to 7.4 years
recurrence rate of 14.5%, with some needing repeat surgery
Who was studied
patients with pilonidal sinus disease
What they received
radial laser surgery
Compared with
none (single group, followed over time)
Main outcome
recurrence of pilonidal sinus disease after treatment
Quality
This is a retrospective review of one group's records without a comparison treatment, so it can't show if laser surgery is better than other options.
Limitations
Retrospective design, no comparator group, single center likely, relies on medical records.
Taken word for word from the abstract
- n We retrospectively studied the medical records of 83 patients who underwent the radial laser procedure for PSD
- population 83 patients who underwent the radial laser procedure for PSD between January 2017 and September 2019
- intervention radial laser procedure for PSD
- comparator The aim of this study was to retrospectively report long-term follow-up results for PSD treatment by radial laser surgery.
- primaryOutcome Twelve patients had a PSD recurrence after their laser procedure, which gives a recurrence rate of 14.5%
- result recurrence rate of 14.5% (95% CI 8.2%-23.2%)
- followUp Our follow-up time was a median of 5.2 years, range 1.5 to 7.4 years.
Langenbecks Arch Surg · PMID 39174833 · Read it on PubMed ↗
Liang et al. 2024
Management and outcomes of pilonidal patients with secondary sinuses-a cohort study
Most healed, some had recurring drainage.Prospective cohortLow qualityRelated question
105 people367.0 days
most patients did not have recurrent disease; a small number had recurrent drainage that often resolved without more surgery
Who was studied
young people (median age 17) with pilonidal disease and a secondary draining sinus
What they received
surgical excision of pilonidal disease and secondary sinus (Gips procedure)
Compared with
regular hair removal (epilation) versus no regular epilation after surgery
Main outcome
recurrence of pilonidal disease or recurrent drainage from the sinus site
Quality
this is a single-center cohort without a comparison group, so it describes outcomes after surgery but can't prove what causes recurrence.
Limitations
not randomized, no untreated comparison group, single surgical approach, so it does not describe the natural course of an untreated cyst.
Taken word for word from the abstract
- n One hundred and five patients (seventy-one males) with a median age of 17.2 years
- population Patients with PD and concurrent secondary sinus who underwent Gips procedure with secondary sinus excision from 2019 to 2023 were prospectively followed.
- intervention underwent Gips procedure with secondary sinus excision
- comparator Without regular epilation, six patients (5.7%, five males, one female) had recurrent PD. With regular epilation, three patients (2.8%, three males) had recurrent PD.
- primaryOutcome drainage recurrence, symptom resolution, treatment, and follow-up period were recorded
- result Recurrent secondary sinus site drainage was treated with antibiotics, silver nitrate, debridement, or no treatment.
- followUp followed for a median of 367.0 days (IQR: 173.2-658.8)
Pediatr Surg Int · PMID 39145895 · Read it on PubMed ↗
Romanova et al. 2024
Adolescent pilonidal disease laser treatment (a-PiLaT): a pilot study
Laser treatment had modest recurrence rate.Case seriesLow qualityRelated question
17 people24.5 ± 16.8 months
24% had complications, 18% had recurrence, with average follow-up of about 24.5 months
Who was studied
adolescents aged 10 to 17 years with pilonidal disease
What they received
pilonidal disease laser treatment (PiLaT)
Compared with
none - single group, no comparison treatment
Main outcome
complication rate, recurrence rate, and scar appearance after laser treatment
Quality
This was a small, retrospective case series of only 17 patients with no comparison group, so it can't say how the condition behaves on its own.
Limitations
Retrospective analysis, small sample size, no control group, single-center pilot study.
Taken word for word from the abstract
- n A total of 17 consecutive patients (n = 12 female, 71%) underwent a-PiLaT.
- population PiLaT performed in adolescents aged 10-17 years at our tertiary paediatric surgical hospital
- intervention pilonidal disease laser treatment (PiLaT)
- comparator Data on perioperative characteristics and clinical outcomes at follow-up were retrospectively analysed.
- primaryOutcome complication rate of 24% (n = 4) and recurrence rate of 18% (n = 3)
- result complication rate of 24% (n = 4) and recurrence rate of 18% (n = 3)
- followUp the mean follow-up period was 24.5 ± 16.8 months
Tech Coloproctol · PMID 39141158 · Read it on PubMed ↗
Emengo et al. 2024
Standardized pilonidal protocol as rescue therapy for excision-refractory pilonidal disease
Healed in about 52 days with treatment.Prospective cohortLow qualityRelated question
34 people405 days
All patients achieved complete resolution after a median of 52 days, with 14.7% recurring
Who was studied
patients with pilonidal disease that came back after previous surgery
What they received
a standardized minimally invasive protocol (regular hair removal, wound care, and selective debridement/pit removal)
Compared with
no comparison group; outcomes tracked within the same patients after treatment
Main outcome
time to complete healing of the pilonidal disease
Quality
This was a small study of only 34 patients with no comparison group, so it can't reliably show how long a cyst lasts without this specific treatment.
Limitations
No control group, small sample size, all patients had already failed prior surgery so results may not reflect typical pilonidal disease course.
Taken word for word from the abstract
- n We treated 34 refractory patients (23 males)
- population symptomatic patients who underwent ≥ 1 pilonidal excision prior to presentation at our clinic
- intervention standardized protocol incorporating local wound care, regular manual/laser epilation, and selective debridement/pit trephination
- comparator We treated 34 refractory patients
- primaryOutcome All patients achieved complete resolution after median 52 days
- result All patients achieved complete resolution after median 52 days. Five (14.7%) recurred
- followUp median follow-up 405 days
Pediatr Surg Int · PMID 39141128 · Read it on PubMed ↗
Yildirim et al. 2024
Results of Laser-assisted Closure (SiLaC) Surgery in Pilonidal Sinus Disease: Factors Associated With Success
Laser surgery cured most cases.RetrospectiveLow qualityRelated question
64 people17.0±8.06 months (range: 3 to 36)
85.9% recovery rate, with higher BMI and advanced disease linked to treatment failure
Who was studied
adults with pilonidal sinus disease treated with laser surgery
What they received
laser-assisted closure (SiLaC) surgery for pilonidal sinus
Compared with
none (single group, compared recovered vs non-recovered patients)
Main outcome
recovery and recurrence rates after surgery
Quality
this is a single-center study without a comparison group, so it only shows surgery outcomes, not the natural course or duration of the condition without treatment.
Limitations
No control group; retrospective design; single institution; does not address untreated disease duration.
Taken word for word from the abstract
- n The study cohort consisted of 64 patients.
- population All adult patients treated with this procedure between March 2020 and December 2023 were included in the study.
- intervention Pilonidal sinus treatment with sinus laser-assisted closure (SiLaC) method
- comparator Univariate analysis was performed between recovered and non-recovered patients to find the factors influencing successful treatment.
- primaryOutcome Demographic and clinical data, complications, and recurrence rates of the patients were compared.
- result Our recovery rate was 85.9%.
- followUp The mean follow-up period was 17.0±8.06 months (range: 3 to 36)
Surg Laparosc Endosc Percutan Tech · PMID 39140695 · Read it on PubMed ↗
Ram et al. 2024
Efficacy and safety of RD2 Ver.02, a whole blood clot therapy, coupled with a minimally invasive procedure in pilonidal sinus: a phase II study
Most healed by 12 months after treatment.Prospective cohortLow qualityRelated question
51 people12 months
82.4% healed at 3 months, 90.2% at 6 months, 82.4% at 12 months, with recurrence in 11.8% of patients
Who was studied
adults with pilonidal sinus disease
What they received
minimally invasive trephine procedure plus RD2 Ver.02 whole blood clot instillation
Compared with
none (single-arm study, no comparison group)
Main outcome
complete wound healing at 3, 6, and 12 months
Quality
This was a small, single-arm, open-label trial with no comparison group, so it can't show how this treatment compares to other options or to no treatment.
Limitations
Open-label, single-arm pilot study with no control group; authors state further comparative studies are needed.
Taken word for word from the abstract
- n Overall, 51 patients participated in the study.
- population Patients with PNS underwent a minimally invasive trephine procedure under local anesthesia
- intervention a minimally invasive trephine procedure under local anesthesia followed by RD2 Ver.02 instillation into the cavity
- comparator A Phase II open-label, pilot, single-arm prospective study
- primaryOutcome Primary healing was assessed at 3, 6, and 12 months.
- result At 6 and 12 months, 46/51 (90.2%) and 42/51 (82.4%) achieved complete healing, respectively. At 6 months, two PNSs recurred after initial healing and an additional four instances of PNS recurrence observed in 12 months, so a total of recurrence in six patients (11.8%).
Tech Coloproctol · PMID 39136828 · Read it on PubMed ↗
Huurman et al. 2024
Postoperative Outcomes of Bascom Cleft Lift Versus Excision With Secondary Wound Healing for Pilonidal Sinus Disease: A Multicenter Retrospective Analysis
Faster healing with cleft lift surgeryRetrospectiveLow quality
272 people12 months
Bascom cleft lift had higher healing rate (84.4% vs 32.6%) and faster healing (55 vs 101 days), but more complications (28.9% vs 13.2%); recurrence not significantly different (6.3% vs 11.8%)
Who was studied
patients with pilonidal sinus disease
What they received
Bascom cleft lift surgery
Compared with
excision with secondary wound healing
Main outcome
rate of successful wound healing and time to heal
Quality
This was a retrospective study with selection bias risk and a short follow-up period, as the authors themselves note.
Limitations
Retrospective design prone to selection bias and residual confounding; short follow-up period; no patient satisfaction data collected.
Taken word for word from the abstract
- n Of 272 patients, 128 underwent Bascom cleft lift and 144 patients underwent excision and secondary wound healing.
- population Patients who underwent excision with secondary wound healing or Bascom cleft lift between July 2015 and August 2021 were included.
- intervention Bascom cleft lift
- comparator excision with secondary wound healing
- primaryOutcome Primary end points included the rate of successful wound healing and the time to achieve healing.
- result The wound healing rate was 84.4% after Bascom cleft lift versus 32.6% after excision and secondary wound healing ( p < 0.001), with a median time to wound healing of 55 and 101 days, respectively ( p < 0.001). Complications were 28.9% for Bascom cleft lift versus 13.2% for excision and secondary wound healing ( p = 0.003). The rate of recurrent disease was 6.3% after Bascom cleft lift and 11.8% after excision and secondary wound healing ( p = 0.113).
- limitations This study used a retrospective design, which makes it prone to selection bias and residual confounding. In addition, the short follow-up period adds to these limitations because a longer follow-up period may better identify true recurrence rates. The absence of collected patient satisfaction data, which is currently a common scientific issue, is also a deficiency.
- followUp recurrence rate within 12 months after surgery
Dis Colon Rectum · PMID 39115207 · Read it on PubMed ↗
Amir et al. 2024
Endoscopic pilonidal sinus treatment (EPSiT) for sacrococcygeal pilonidal sinus disease: A prospective long-term study
Most healed after keyhole surgery.Prospective cohortLow qualityRelated question
67 people1-7 years
89.6% of patients had complete wound healing, while 10.4% had recurrence; median time off work was 2.5 days
Who was studied
people with pilonidal sinus disease (a cyst/tunnel near the tailbone)
What they received
endoscopic pilonidal sinus treatment (a minimally invasive surgery)
Compared with
none; all patients received the same procedure
Main outcome
how long the wound took to heal, complications, ongoing discharge, and recurrence over 1 to 7 years
Quality
This was a single-team, single-center study with no comparison group, so it can't say how the condition would go without this specific surgery.
Limitations
No control/comparator group, single surgical team, and some patients had prior recurrent disease which may affect generalisability.
Taken word for word from the abstract
- n Of the 67 patients, 55(82%) were males and 12(18%) were females.
- population comprised all pilonidal sinus cases undergoing minimal invasive endoscopic pilonidal sinus treatment
- intervention Endoscopic pilonidal sinus treatment appeared to be a good minimally invasive surgical technique
- comparator who were treated by a single surgical team
- primaryOutcome The primary outcomes were duration of healing, post-operative morbidities, persistence of discharge and recurrence at 1-7 years.
- result Complete wound healing was achieved in 60(89.6%) patients, while recurrence was seen in 7(10.4%).
J Pak Med Assoc · PMID 38948976 · Read it on PubMed ↗
Towfighi et al. 2024
Propeller Flap Reconstruction Following Pilonidal Cyst Excision: A Single-Center Experience With Same-Day Discharge
Flap surgery worked well, low recurrence.RetrospectiveLow qualityRelated question
26 people4.1 ± 5.4 months
all flaps survived (100%), 17.9% had minor wound problems, one patient needed a return trip to the operating room, and pilonidal disease came back in 11.5% of patients over an average follow‑up of about 4 months
Who was studied
patients with pilonidal cyst disease who had propeller flap reconstruction after cyst removal
What they received
propeller flap reconstruction performed right after surgical removal of the pilonidal cyst
Main outcome
flap survival, flap complications, and recurrence of pilonidal disease
Quality
it is a small, single-center retrospective case series without a comparison group, so results may not generalize.
Limitations
retrospective design, small sample size, short average follow-up, and no control group for comparison
Taken word for word from the abstract
- n Twenty-eight outpatient propeller flap reconstructions following pilonidal cyst resections were identified in 26 patients
- population Twenty-eight outpatient propeller flap reconstructions following pilonidal cyst resections were identified in 26 patients
- intervention Propeller flap reconstruction following pilonidal cyst resection
- primaryOutcome Primary outcomes included flap survival, flap complications, and pilonidal disease recurrence.
- result Flap survival was 100% (n = 28), with five flaps (17.9%) experiencing minor wound complications and one patient (3.8%) requiring return to the operating room.
- result Pilonidal disease recurrence occurred in three patients (11.5%).
- followUp Mean follow-up was 4.1 ± 5.4 months.
Ann Plast Surg · PMID 38885167 · Read it on PubMed ↗
Tas et al. 2024
A new midline closure technique without skin sutures: Long-term outcomes of primary repair of pilonidal sinus disease
New stitch-free surgery had fewer recurrencesRandomised trialModerate qualityRelated question
160 peoplefive-year mean follow-up
the stitch-free midline closure had fewer complications and no recurrences, while the standard closure had a 6.2% recurrence rate
Who was studied
male patients with pilonidal sinus disease having surgery
What they received
excision with midline closure without skin sutures
Compared with
excision and primary closure (standard stitched closure)
Main outcome
postoperative complications and recurrence of the cyst after surgery
Quality
it was a randomized multicenter trial but included only male patients and did not address how long an untreated cyst lasts, only surgical outcomes.
Limitations
study only includes male patients, excludes recurrent/complicated cases, and focuses on surgical technique rather than natural disease course
Taken word for word from the abstract
- population male patients with pilonidal sinus disease attended at two general surgery outpatient centers
- intervention excision and midline closure without skin sutures
- comparator excision and primary closure
- primaryOutcome postoperative long-term complications and recurrence of two surgical techniques
- result five patients (6.2%) in Group 1 had recurrence compared to none in Group 2 (p = 0.023)
- n Group 1 (n=80; excision and primary closure) or Group 2 (n=80; excision and midline closure without skin sutures)
- followUp five-year mean follow-up
An Sist Sanit Navar · PMID 38725367 · Read it on PubMed ↗
Paz Oliveira et al. 2024
Minimum energy laser pilonidotomy (MELPi): a multicenter study of a novel method in pilonidal disease
Average disease lasted about 3 years before treatment.RetrospectiveLow qualityRelated question
47 people12 months
median healing time was 15 days, recurrence occurred in 10% of cases, and average disease duration before treatment was 3 years
Who was studied
adults with pilonidal disease treated at four centers in Brazil
What they received
minimum energy laser pilonidotomy
Compared with
none (single-arm case series, no control group)
Main outcome
healing time, complications and recurrence after laser pilonidotomy
Quality
This is a small retrospective case series without a comparison group, so it can't reliably show whether the treatment works better than other options.
Limitations
Retrospective design, no control group, small sample size, multiple centers may vary in technique and follow-up.
Taken word for word from the abstract
- n We included 47 consecutive patients who underwent 50 "minimal energy pilonidotomies (MELPi)"
- population 47 consecutive patients who underwent 50 "minimal energy pilonidotomies (MELPi)" between 2019 and 2023 in four centers in Brazil
- intervention This study aims to describe a new pilonidotomy method using minimal laser energy and evaluate its initial results.
- comparator This is a retrospective multicenter study.
- primaryOutcome Age, BMI, gender, smoking, diabetes, Guner classification, duration of illness, energy, hospitalization time, complications, recurrence, wound closure, pain, and return to activities were analyzed.
- result The average duration of the disease was 3 years.
- result the median healing time was 15 days
- result recurrence occurred in 5 (10%)
Updates Surg · PMID 38704463 · Read it on PubMed ↗
Dreznik et al. 2024
Recurrence rates of pilonidal sinus disease in the pediatric population following trephine surgery
Low recurrence after cyst surgery.RetrospectiveLow qualityRelated question
565 people2024
8.1% of patients had recurrence, and a second operation using the same method cured nearly all of them
Who was studied
children and teens with pilonidal sinus disease who had surgery
What they received
Gips procedure (a minimally invasive trephine surgery) for pilonidal sinus
Compared with
same surgical method used again for recurrence
Main outcome
rate of disease coming back after surgery
Quality
This is a single-center retrospective chart review without a comparison group, so it can show patterns but not prove cause and effect.
Limitations
Retrospective single-center design; no control group; focuses on surgical recurrence rather than natural course of the disease.
Taken word for word from the abstract
- n 565 pediatric patients underwent an elective surgery for PSD in the study period
- population pediatric patients that underwent Gips procedure due to PSD between the years 2012-2022
- intervention minimally invasive methods such as the Gips procedure
- comparator re-operation took place on average 9 months following the first surgery and using the same surgical method
- primaryOutcome assess recurrence rates following the Gips procedure
- result Recurrence rate was 8.1% (n = 46)
- result Following the second surgery, only 8 patients (1%) had multiple recurrences
World J Surg · PMID 38554245 · Read it on PubMed ↗
Gratiashvili et al. 2024
Efficacy of laser obliteration with limited excision of pilonidal sinus
Faster healing with laser surgery.Prospective cohortLow qualityRelated question
152 people2024
Healing was faster with laser obliteration (6.5 weeks) than wide excision (14.5 weeks), with no significant difference in recurrence
Who was studied
patients with chronic pilonidal sinus disease
What they received
laser obliteration with limited excision
Compared with
wide excision of the pilonidal sinus
Main outcome
complete wound healing, recurrence, and complication rate
Quality
This was an observational study without randomization, so other factors could explain the difference in healing time.
Limitations
Observational, non-randomized, cross-sectional design comparing two surgical techniques rather than tracking natural disease duration.
Taken word for word from the abstract
- n 152 patients with chronic pilonidal sinus disease
- population 152 patients with chronic pilonidal sinus disease
- intervention laser obliteration with limited excision (LOLE)
- comparator wide excision (WE) of the pilonidal sinus
- primaryOutcome complete wound healing, recurrence, and the complication rate
- result The duration of wound healing was significantly shorter in the LOLE group than in the WE group (6.5 ± 2.4 vs. 14.5 ± 2.6 weeks, respectively)
- result Recurrence developed in six (7.9%) patients in the LOLE group and one (1.3%) patient in the WE group, with no significant difference
J Int Med Res · PMID 38530042 · Read it on PubMed ↗
Giles et al. 2024
Pit excision with fibrin glue closure versus lateralizing flap procedures in the management of pilonidal sinus disease in adolescents: a 14-year cohort study
Less recurrence after glue surgery.RetrospectiveLow qualityRelated question
78 people2.21 and 2.52 years
lower recurrence, less repeat surgery, less wound breakdown with fibrin glue closure than flap surgery
Who was studied
adolescents with chronic pilonidal sinus disease needing surgery
What they received
pit excision with fibrin glue closure
Compared with
lateralizing flap surgery
Main outcome
disease recurrence and need for repeat surgery
Quality
this is a retrospective comparison of surgical techniques, not a randomized trial, so it cannot directly answer how long an untreated cyst lasts and may be biased by how patients were chosen for each surgery.
Limitations
Retrospective design, not randomized, and median follow-up only about 2 to 2.5 years.
Taken word for word from the abstract
- n Seventy-eight children had 33 primary PEF and 45 primary LFP procedures
- population All children undergoing primary operative procedures for chronic PSD from May 2009 to February 2022
- intervention pit excision with fibrin glue closure (PEF)
- comparator traditional lateralizing flap procedures (LFP)
- primaryOutcome Recurrence and complications rates alongside their demographic and disease severity data were compared
- result The overall recurrence rate in each cohort was 3% for PEF and 11% for LFP, respectively (p = 0.2346). The all-cause repeat intervention rate was 12% and 49% in the PEF and LFP cohorts, respectively (p = 0.0007).
- followUp median follow-up of 2.21 and 2.52 years, respectively
Pediatr Surg Int · PMID 38512592 · Read it on PubMed ↗
Mueller et al. 2024
A standardized treatment protocol for pilonidal disease can influence the health mindset of adolescents
Mindset improved during treatment, not duration.Prospective cohortLow qualityRelated question
207 people351 ± 327 days
mindset score was higher at follow-up than at baseline
Who was studied
adolescents with pilonidal disease
What they received
standardized treatment protocol for pilonidal disease
Compared with
none; baseline mindset score compared with follow-up mindset score in the same patients
Main outcome
change in health mindset score over time
Quality
This study has no comparison group and relies on a self-reported psychological score with highly variable follow-up time, so it carries little weight.
Limitations
No control group, follow-up time varied widely (351 ± 327 days), and the study measures psychological mindset rather than disease duration or resolution.
Taken word for word from the abstract
- n A total of 207 PD patients (108 males, 99 females) with mean age 18.2 ± 3.7 years were followed for 351 ± 327 days.
- population We propose that participation in a standardized treatment protocol can affect the health mindset for adolescents with pilonidal disease.
- intervention participation in a standardized treatment protocol can affect the health mindset for adolescents with pilonidal disease
- comparator t-test was used to compare baseline and follow-up mindset scores
- primaryOutcome We assessed patients' mindset score at initial presentation using the validated Three-Item Mindset Scale (1-6) then reassessed during follow-up.
- result Mean baseline mindset score (4.76 ± 1.27) was significantly lower than mean follow-up mindset score (5.03 ± 1.18, p = 0.049).
- followUp followed for 351 ± 327 days
Langenbecks Arch Surg · PMID 38467936 · Read it on PubMed ↗
Tumer et al. 2023
Comparison of crystallized phenol and Karidakis flap treatment in pilonidal sinus disease
Faster recovery with phenol, fewer recurrences with surgery.RetrospectiveLow qualityRelated question
216 people13.44 (11-16) months in the KFR group and 13.67 (11-16) months in the phenol group
Phenol group had faster return to work (2.79 vs 15.35 days) but 5.4% treatment failure; KFR had lower recurrence (4.22%) but higher complications
Who was studied
patients treated for pilonidal sinus disease
What they received
crystallized phenol treatment
Compared with
Karidakis flap reconstruction (KFR) surgery
Main outcome
treatment success, recurrence, hospital stay, and return to work time
Quality
This was a retrospective comparison without randomization, so differences between groups could be due to factors other than the treatment itself.
Limitations
Retrospective design; no mention of randomization or blinding; patient selection criteria for each treatment not detailed.
Taken word for word from the abstract
- n 216 patients treated for pilonidal sinus disease with the researched methods between June 2016 and July 2019 were included in the study.
- population patients treated for pilonidal sinus disease
- intervention crystallized phenol method
- comparator Karidakis flap reconstruction with crystallized phenol in pilonidal sinus treatment
- primaryOutcome The mean time to return to work was 2.79 (± 1.03) days in the phenol group and 15.35 (± 3.39) days in the KFR group.
- result In 4 (5.4%) patients, the improvement could not be achieved despite multiple sessions of phenol administration, and the procedure was considered unsuccessful. Recurrence occurred in 6 patients (4.22%) in the KFR group.
- followUp The mean follow-up period was 13.44 (11-16) months in the KFR group and 13.67 (11-16) months in the phenol group.
Ann Ital Chir · PMID 38051512 · Read it on PubMed ↗
Gulcu et al. 2024
Minimally Invasive Pilonidal Sinus Treatment: EPSIT Versus PEBAI Method
Faster wound closure with one method, similar healing overall.RetrospectiveLow qualityRelated question
288 people24 (12 to 34) months
wound closure time was earlier after EPSIT than PEBAI, but complete healing and recurrence rates were similar
Who was studied
patients with pilonidal sinus disease
What they received
endoscopic pilonidal sinus treatment (EPSIT)
Compared with
pit/sinus punch needle excision, brushing, ablation and irrigation (PEBAI)
Main outcome
wound healing
Quality
This was a retrospective comparison of two surgical techniques without a no-treatment group, so it cannot show how long a cyst lasts without treatment.
Limitations
Retrospective design comparing two active treatments, no untreated or placebo comparison group, so natural disease duration cannot be determined.
Taken word for word from the abstract
- n One hundred 4 patients who underwent EPSIT and 184 patients who underwent PEBAI were included in the study.
- population Patients who underwent EPSIT and PEBAI methods for PSD in a single center between January 2020 and October 2021 were retrospectively analyzed.
- intervention endoscopic pilonidal sinus treatment (EPSIT)
- comparator pit/sinus punch needle excision, brushing, ablation and irrigation (PEBAI) method
- primaryOutcome The primary endpoint was healing
- result the wound closure time was earlier after EPSIT [32 d (24 to 41)] than after PEBAI [37 d (26 to 58)] ( P <0.00001
- result Complete wound healing ( P =0.382), recurrence rate ( P =0.533), quality of life at first month and (Wound evaluation scale score at first year ( P =0.252) were similar in both groups.
Surg Laparosc Endosc Percutan Tech · PMID 37971236 · Read it on PubMed ↗
Şahin et al. 2023
Use of the laser in the pilonidal sinus alone or in combination with phenol
No significant difference between treatments.RetrospectiveLow qualityRelated question
size not givenfourth month
laser-phenol group had lower recurrence and higher healing but difference was not statistically significant
Who was studied
patients with pilonidal sinus disease
What they received
laser treatment combined with phenol
Compared with
laser treatment alone
Main outcome
recurrence and complete healing rates
Quality
This was a small retrospective study where the treatment groups did not differ by a statistically meaningful amount.
Limitations
Retrospective design and no statistically significant difference reported; abstract does not give exact total number of patients.
Taken word for word from the abstract
- population patients with pilonidal sinus disease
- intervention laser-phenol treatment group
- comparator laser treatment group
- primaryOutcome Recurrence was observed in three patients (13.6%) in the laser treatment group and one patient (4.8%) in the laser-phenol treatment group after the fourth month.
- result Although not statistically significant, the laser-phenol treatment group exhibited a lower recurrence rate and a higher complete healing rate.
- followUp after the fourth month
Rev Assoc Med Bras (1992) · PMID 37971129 · Read it on PubMed ↗
Minneci et al. 2024
Laser Epilation as an Adjunct to Standard Care in Reducing Pilonidal Disease Recurrence in Adolescents and Young Adults: A Randomized Clinical Trial
Laser hair removal cut recurrence.Randomised trialModerate qualityRelated question
302 people1 year
recurrence was significantly less common with laser hair removal added to standard care
Who was studied
adolescents and young adults aged 11 to 21 with pilonidal disease
What they received
laser hair removal plus standard care (improved hygiene and hair removal)
Compared with
standard care alone (improved hygiene and mechanical or chemical hair removal)
Main outcome
rate of pilonidal disease coming back within 1 year
Quality
it was a randomized trial but many patients were lost to follow-up, especially in the laser group, which could bias the results.
Limitations
Only 63.6% of the laser group and 88.7% of the standard care group had 1-year follow-up data available.
Taken word for word from the abstract
- n A total of 302 participants
- population Patients aged 11 to 21 years with pilonidal disease were recruited from a single tertiary children's hospital.
- intervention LE and standard care (improved hygiene and mechanical or chemical depilation)
- comparator standard care alone
- primaryOutcome The primary outcome was the rate of recurrence of pilonidal disease at 1 year.
- result The proportion of patients who experienced a recurrence within 1 year was significantly lower in the LE treatment arm than in the standard care arm (-23.2%; 95% CI, -33.2 to -13.1; P < .001).
JAMA Surg · PMID 37938854 · Read it on PubMed ↗
Huurman et al. 2023
Non-excisional techniques for the treatment of intergluteal pilonidal sinus disease: a systematic review
Fast recovery but recurrence common.Systematic reviewModerate qualityRelated question
8,100 people2023
healing rates ranged from 67 to 100%, recurrence ranged from 0 to 29% depending on technique and follow-up, wound healing took 3 to 47 days, and return to daily activities took 1 to 9 days
Who was studied
people with pilonidal sinus disease (both new and recurrent cases)
What they received
non-excisional treatments such as pit picking, laser or phenol, unroofing, endoscopic techniques, and gelatin matrix application
Compared with
different non-excisional techniques compared with each other, and primary versus recurrent disease
Main outcome
how often the sinus came back, how often it healed, complications, healing time, and time to return to daily activities
Quality
it pools many different studies and techniques without statistical combination, so the range of results is wide and hard to compare directly.
Limitations
wide variation in recurrence and healing depending on technique and follow-up time, and the review does not describe the natural course of untreated pilonidal cysts.
Taken word for word from the abstract
- n 31 studies comprising 8100 patients were included
- population Recurrence rates do not differ between primary and recurrent disease.
- intervention pit picking techniques with or without additional laser or phenol treatment, unroofing, endoscopic techniques and thrombin gelatin matrix application
- comparator the difference between primary and recurrent PSD
- primaryOutcome Outcomes were recurrence rates, healing rates, complication rates, wound healing times and time taken to return to daily activities.
- result Non-excisional techniques had overall healing rates ranging from 67 to 100%. Recurrence rates for pit picking, unroofing and gelatin matrix application varied from 0 to 16% depending on the follow-up time. Recurrence rates after additional laser, phenol and endoscopic techniques varied from 0 to 29%. Complication rates ranged from 0 to 16%, and the wound healing time was between three and forty-seven days.
Tech Coloproctol · PMID 37930579 · Read it on PubMed ↗
Erdoğrul 2024
Postoperative results of modified Karydakis flap method for primary sacrococcygeal pilonidal sinus disease: short and long-term analysis
No recurrence after flap surgery.RetrospectiveLow qualityRelated question
175 people39.21 ± 17.58 months
no recurrence and low complication rate after surgery
Who was studied
patients with sacrococcygeal pilonidal sinus disease
What they received
modified Karydakis flap surgery
Compared with
none (single-arm case series)
Main outcome
complications and recurrence after surgery
Quality
This is a retrospective single-surgeon case series with no comparison group, so it cannot reliably show how the surgery compares to other options or to no treatment.
Limitations
Retrospective design, single surgeon, no control group for comparison.
Taken word for word from the abstract
- n A retrospective analysis was conducted on 175 patients
- population patients with sacrococcygeal pilonidal sinus
- intervention modified Karydakis flap method
- comparator A retrospective analysis was conducted on 175 patients who underwent the modified Karydakis flap method for sacrococcygeal pilonidal sinus by a single surgeon
- primaryOutcome Complications were observed in 12 (6.85%) patients
- result with no observed cases of flap necrosis or recurrence
- followUp the follow-up time was 39.21 ± 17.58 months
ANZ J Surg · PMID 37837259 · Read it on PubMed ↗
Retracted by the journal — not counted
Xu et al. 2024
Simplified and modified Limberg flap plus vacuum-assisted closure for treatment of sacrococcygeal pilonidal sinus disease
Surgery removed cysts, no recurrence seen.Case seriesVery low qualityRelated question
96 people2024
No recurrence, wound infection, seroma or hematoma occurred; 6.3% had wound dehiscence; average time to resume daily activities was 26.3 days
Who was studied
Young adults (ages 15-34) with sacrococcygeal pilonidal sinus disease
What they received
Simplified modified Limberg flap surgery combined with vacuum-assisted wound closure
Compared with
None - single-arm study with no comparison group
Main outcome
Recurrence rate, wound complications, and time to return to normal activities after surgery
Quality
This is a small single-arm study with no comparison group, and the publication itself has been retracted, so its findings cannot be trusted.
Limitations
No control group, single-center, publication retracted, and no mention of blinding or comparator; study addresses surgical outcomes, not the natural duration of untreated cysts.
Taken word for word from the abstract
- n The 96 patients ranged in age from 15 to 34 years
- population 88 male patients (91.7%) and 8 female patients (8.3%)
- population The 96 patients ranged in age from 15 to 34 years (mean ± SD, 23 ± 4.4).
- intervention all patients underwent simplified modified Limberg flap reconstruction with vacuum-assisted closure
- comparator This prospective study was conducted from 1 June 2017 to 31 March 2022
- primaryOutcome wound infection, wound dehiscence and recurrence rate were recorded
- result None of the patients experienced post-operative recurrence, wound infection, seroma or hematoma.
- result Six patients (6.3%) experienced wound dehiscence at the flap tip around the natal cleft.
- result The mean time to the resumption of daily activities was 26.3 days.
Int Wound J · PMID 37691134 · Read it on PubMed ↗
Manigrasso et al. 2023
Five-year recurrence after endoscopic approach to pilonidal sinus disease: A multicentre experience
About 1 in 4 recurred by 5 years.RetrospectiveLow qualityRelated question
290 people5-year
25.2% of patients had recurrence by 5 years; recurrence risk was much higher (63.2%) when the lateral opening was more than 2cm from the midline versus lower (6.7%) when closer than 2cm
Who was studied
patients with pilonidal sinus disease treated at referral centres
What they received
endoscopic sinusectomy
Main outcome
recurrence of pilonidal sinus disease at 5 years
Quality
this is a retrospective, non-randomised study of one treatment without a comparison group, so it cannot show how long untreated or differently-treated cysts last.
Limitations
retrospective design, no control group, single intervention only, from a prospectively maintained database analysed retrospectively
Taken word for word from the abstract
- n Out of 290 patients (185 males versus 105 female, with a mean age of 25.5±6.9)
- population All consecutive patients from September 2011 through December 2017 who underwent endoscopic sinusectomy at seven referral centres for pilonidal sinus treatment were retrospectively analysed from a prospectively maintained database.
- intervention endoscopic sinusectomy
- primaryOutcome The aim of this study was to evaluate the 5-year recurrence rate of pilonidal sinus disease (PSD) after endoscopic sinusectomy and identify risk factors for recurrence.
- result 73 presented recurrence at 5-year follow-up with a recurrence rate of 25.2%.
- result Out of 95 cases with the most lateral orifice more than 2 cm from midline, 60 showed recurrence at 5-year follow-up with a recurrence rate of 63.2%.
Tech Coloproctol · PMID 37597082 · Read it on PubMed ↗
Ojo et al. 2023
Cleft closure (the Bascom cleft lift) for 714 patients-treatment of choice for complex and recurrent pilonidal disease (a cohort study)
Most healed within 16 weeks after surgery.RetrospectiveLow qualityRelated question
714 peoplea median of 12 months
60.7% healed initially, rising to 88.5% by 12 weeks and 91.8% by 16 weeks; 97% healed overall without further surgery; 5.3% recurrence at a median of 12 months
Who was studied
patients with extensive, complex, or recurrent pilonidal disease
What they received
cleft closure (Bascom cleft lift) surgery
Main outcome
rate of primary healing, time to complete healing, and recurrence rate
Quality
This was a single-surgeon, single-arm retrospective series without a comparison group, so it can't show how the disease behaves without this specific surgery.
Limitations
No control group; single surgeon series; some patients lacked documented follow-up (714 enrolled vs 656 followed).
Taken word for word from the abstract
- n Some 714 patients had a cleft closure of whom 656 had documented follow-up.
- population extensive, complex or recurrent pilonidal disease
- intervention cleft closure (or cleft lift) described by Bascom and Bascom
- primaryOutcome Primary study outcomes that were measured included rate of primary healing, time to complete healing and rate of recurrence.
- result Primary healing occurred in 60.7% (n = 398) rising to 88.5% by 12 weeks (n = 562) and 91.8% by 16 weeks.
- result After complete healing 5.3% of patients developed recurrent disease at a median of 12 months.
- followUp After complete healing 5.3% of patients developed recurrent disease at a median of 12 months.
Colorectal Dis · PMID 37553846 · Read it on PubMed ↗
Mentessidou et al. 2024
Outcomes of Pediatric Endoscopic Pilonidal Sinus Treatment: A Systematic Review
Healed in about a month.Systematic reviewLow qualityRelated question
320 people13.5 months
treatment succeeded in most patients with healing averaging about 4 weeks, and recurrence in about 9% after an average of 4.6 months
Who was studied
children and teenagers with pilonidal sinus disease (under 18 years)
What they received
endoscopic pilonidal sinus treatment (PEPSiT)
Compared with
no direct control group; different endoscopic approaches compared with each other
Main outcome
time to healing and recurrence after treatment
Quality
it pools results from small case series without a comparison group, so the findings can't be fully trusted.
Limitations
Comparison with conventional techniques, particularly off-midline flap and semi-closure procedures, is, however, lacking.
Taken word for word from the abstract
- n A total of 320 patients (9 studies, 2018-2022) with a weighted mean age of 15.7 years and follow-up duration of 13.5 months were included.
- population Systematic search was performed for all studies on PEPSiT in patients younger than 18 years
- intervention Endoscopic pilonidal sinus treatment (EPSiT) is gaining increasing popularity.
- comparator Fisher's test was used to assess the associations between success/recurrence rates and different approaches (fistuloscope vs. cystoscope, different wound care protocols).
- primaryOutcome PEPSiT was successful in 290 patients (90.9%) with weighted mean time to healing of 4.1 weeks.
- result Recurrence was reported in 29 patients (9.1%) with weighted mean time to recurrence of 4.6 months.
- followUp follow-up duration of 13.5 months
Eur J Pediatr Surg · PMID 37494954 · Read it on PubMed ↗
Taşkin et al. 2023
Comparison of the effectiveness of laser and crystallized phenol in the treatment of sacrococcygeal pilonidal sinus
Similar recurrence, less pain with laser.RetrospectiveLow qualityRelated question
80 people2023
no significant difference in recurrence and patient satisfaction between the groups, but laser had significantly lower pain scores and fewer complications
Who was studied
patients with sacrococcygeal pilonidal sinus disease
What they received
crystallized phenol treatment
Compared with
laser treatment
Main outcome
recurrence, pain, and patient satisfaction after treatment
Quality
The study compares two treatments without mention of randomization and has a small sample size, so it carries limited weight.
Limitations
Abstract does not mention randomization, blinding, or exact follow-up duration.
Taken word for word from the abstract
- n A total of 80 patients (40 crystallized phenol, 40 laser) were included in the study.
- population The aim of this study was to compare the effectiveness of crystallized phenol and laser in the treatment of sacrococcygeal pilonidal sinus (SPS) disease.
- intervention The aim of this study was to compare the effectiveness of crystallized phenol and laser in the treatment of sacrococcygeal pilonidal sinus (SPS) disease.
- comparator The aim of this study was to compare the effectiveness of crystallized phenol and laser in the treatment of sacrococcygeal pilonidal sinus (SPS) disease.
- result While there was no significant difference in recurrence and patient satisfaction between the groups (p > 0.05), the visual pain scale pain score and post-procedural complications were significantly lower in the laser group (p < 0.05).
- primaryOutcome While there was no significant difference in recurrence and patient satisfaction between the groups (p > 0.05), the visual pain scale pain score and post-procedural complications were significantly lower in the laser group (p < 0.05).
Cir Cir · PMID 37440707 · Read it on PubMed ↗
Gan et al. 2024
A meta-analysis comparing phenol treatment with surgical excision for pilonidal sinus
Phenol heals faster, fewer complications.Meta-analysisLow qualityRelated question
size not given2024
Recurrence rates were similar between phenol and surgery, but phenol had fewer wound complications, shorter operating time, faster return to work, and faster healing
Who was studied
people with pilonidal sinus disease (chronic cyst/inflammation near the tailbone)
What they received
phenol injection treatment
Compared with
surgical excision
Main outcome
rate of disease coming back (recurrence) and wound complications
Quality
It pools both randomized and non-randomized studies, which can introduce bias and makes the combined results less reliable.
Limitations
Included both RCTs and non-RCTs; abstract does not report risk of bias assessment or overall patient numbers.
Taken word for word from the abstract
- population Pilonidal sinus is a chronic condition characterized by inflammation, swelling, and pain in the sacrococcygeal region.
- intervention phenol treatment
- comparator surgical excision treatment for PSD
- primaryOutcome The phenol group had a slightly higher rate of disease recurrence than the surgical group (RR = 1.12, 95% CI [0.77,1.63]), but the difference was not statistically significant (P = 0.55 > 0.05).
- result wound complications were considerably less common (RR = 0.40, 95% CI [0.27,0.59]). Phenol treatment resulted in a significantly shorter operating time than surgery treatment (weighted mean difference -22.76, 95% CI [-31.13,-14.39]). The time to return to daily work was considerably shorter than in the surgical group (weighted mean difference -10.11, 95% CI [-14.58,-5.65]). Postoperative complete healing time was significantly shorter than surgical healing time (weighted mean difference -17.11, 95% CI [-32.18,-2.03]).
Asian J Surg · PMID 37419810 · Read it on PubMed ↗
Bilgin et al. 2023
Short- and mid-term results of diode laser treatment in pilonidal sinus disease and the role of endoscopic camera use on outcomes
Most healed within about a monthRetrospectiveLow qualityRelated question
106 peopleminimum of 1 year
mean complete recovery time was 27.4 days, recurrence rate was 11.0%, and camera use made no difference to outcomes
Who was studied
patients with pilonidal sinus disease
What they received
diode laser treatment for pilonidal sinus, with or without use of an endoscopic camera
Compared with
laser treatment with endoscopic camera versus without camera use
Main outcome
time to complete recovery, postoperative pain, complications, patient satisfaction, and recurrence
Quality
This was a retrospective study without a comparison group for the laser treatment itself, only comparing camera use within the same procedure.
Limitations
Retrospective design with no control group for laser versus standard surgical treatment; p-value reporting appears inconsistent (p<0.05 stated for 'no effect' findings).
Taken word for word from the abstract
- n A total of 106 patients with PSD who underwent laser treatment between November 2017 and September 2021 were included in this study.
- population A total of 106 patients with PSD who underwent laser treatment
- intervention All patients were treated with a 1470-nm diode laser. Endoscopic camera was used in 73 patients and results of these were compared with those in whom camera was not used.
- comparator Endoscopic camera was used in 73 patients and results of these were compared with those in whom camera was not used.
- primaryOutcome Eighty-six (87.8%) patients completely recovered and the mean complete recovery time was 27.4 ± 15.9 days.
- result The mean time to return to daily life was 4.5 ± 5.5 (median 2, range 1-30) days. The complication rate was 10.4%. Eighty-six (87.8%) patients completely recovered and the mean complete recovery time was 27.4 ± 15.9 days. The patient satisfaction rate was 99.0%. The recurrence rate was 11.0%.
- result Use of an endoscopic camera had no effect on postoperative pain, complete recovery, complications, patient satisfaction, and recurrence (p < 0.05).
- followUp Follow-up period was determined as a minimum of 1 year.
Tech Coloproctol · PMID 37356014 · Read it on PubMed ↗
Spindler et al. 2023
[Pilonidal disease: The revolution in minimally invasive surgery]
Newer surgeries heal fast, recurrence unclear.Narrative reviewLow qualityRelated question
size not given1 year
newer minimally invasive techniques had failure rates under 10% at one year with low complication rates, but traditional excision has lower recurrence though longer healing and sick leave
Who was studied
people with pilonidal disease (cysts near the tailbone)
What they received
minimally invasive techniques such as endoscopic and laser treatment
Compared with
traditional lay-open excision and flap-based surgical repair
Main outcome
treatment failure/recurrence and healing time
Quality
this is a narrative review of treatment approaches, not a study of disease duration, and the authors themselves say results need confirmation by better quality studies with longer follow-up.
Limitations
abstract states results need confirmation by better quality studies with longer follow-up; this discusses surgical treatment outcomes, not the natural duration of untreated pilonidal cysts.
Taken word for word from the abstract
- population Pilonidal disease is a common suppurative condition and affects 0.7% of the population.
- intervention Endoscopic and laser treatment of pilonidal disease have shown promising results
- comparator the most common procedure is lay-open excision with healing by secondary intention
- primaryOutcome failure rates of less than 10% at 1 year, few complications and low morbidity
- result Endoscopic and laser treatment of pilonidal disease have shown promising results, with failure rates of less than 10% at 1 year, few complications and low morbidity.
- limitations these interesting results need to be confirmed by better quality studies with longer follow-up
Rev Prat · PMID 37289117 · Read it on PubMed ↗
Salih et al. 2023
Non-operative management of pilonidal sinus disease; classification and outcome
Does not address how long cysts lastProspective cohortLow qualityRelated question
3,529 people6 weeks
Recurrence was linked most strongly to having an abscess present, and patients could be grouped into three risk classes for recurrence
Who was studied
People aged 14 to 55 with pilonidal sinus disease
What they received
Non-operative treatment with Salih's preparation (a chemical with antimicrobial and scar-forming properties)
Compared with
No comparison group; only one treatment group was studied
Main outcome
Recurrence of the pilonidal sinus after treatment
Quality
This was a single group of patients with no comparison group and only 6 weeks of follow-up, so it can't say much about how long the condition lasts.
Limitations
No control or surgical comparison group; only 3529 of 12123 treated patients were included in the analysis; follow-up was just 6 weeks.
Taken word for word from the abstract
- population The mean age of the participants was 26.95 years, ranging from 14 to 55 years.
- intervention All the patients were managed using Salih's preparation.
- comparator This is a single-group cohort study that enrolled consecutive patients that had pilonidal sinus.
- primaryOutcome The patients were seen at the clinic 6 weeks after the intervention to record data of recurrence.
- result The most significant factor related to the recurrence was the presence of an abscess.
- n The total number of patients receiving Salih's preparation was 12 123 cases, of which only 3529 patients were included in this study.
- followUp The patients were seen at the clinic 6 weeks after the intervention to record data of recurrence.
Int Wound J · PMID 37259676 · Read it on PubMed ↗
Maasewerd et al. 2023
Paediatric Pilonidal Sinus Disease: Early Recurrences Irrespective of the Treatment Approaches in a Retrospective Multi-centric Analysis
Recurrences happen early after surgery.RetrospectiveLow qualityRelated question
213 people2023
No procedure was better than another, and recurrences tended to happen early, at a median of about 6 months after surgery
Who was studied
children and adolescents treated for pilonidal sinus disease
What they received
different surgical procedures (excision and primary closure, excision and open wound treatment, pit picking, flap procedures)
Compared with
the different surgical approaches compared to each other
Main outcome
recurrence and complications after surgery
Quality
This is a retrospective study with small subgroups, so its findings on recurrence timing are not very reliable.
Limitations
Retrospective design and small sample size in some subgroups, as stated by the authors.
Taken word for word from the abstract
- n We included 213 patients
- population patients treated for pilonidal sinus disease in the paediatric surgical departments of Bonn and Mainz
- intervention excision and primary closure, excision and open wound treatment, pit picking, and flap procedures
- comparator None of the investigated procedures, excision and primary closure, excision and open wound treatment, pit picking, and flap procedures had a decisive advantage in terms of complications or recurrence
- primaryOutcome we aimed to assess recurrences and complications following different treatment approaches in our multi-centric cohort
- result Median time to recurrence was 5.8 months (95% confidence interval: 4.2-10.3)
- result None of the investigated procedures, excision and primary closure, excision and open wound treatment, pit picking, and flap procedures had a decisive advantage in terms of complications or recurrence
World J Surg · PMID 37204438 · Read it on PubMed ↗
Esposito et al. 2023
Pediatric endoscopic pilonidal sinus treatment (PEPSiT): report of a multicentric national study on 294 patients
Healed in about 23 days after surgery.RetrospectiveLow qualityRelated question
294 people2023
median time to full healing was 23.4 days, with a 95.2% success rate and 4.8% recurrence
Who was studied
children and teens up to 18 years old with pilonidal sinus disease
What they received
pediatric endoscopic pilonidal sinus treatment (PEPSiT) surgery
Compared with
none (single group, before/after surgery outcomes)
Main outcome
time to full healing and recurrence after surgery
Quality
this was a retrospective review of one surgical treatment with no comparison group, so it cannot show how long a cyst would last without this specific surgery.
Limitations
retrospective chart review without a comparator group; only describes outcomes after a specific surgical procedure
Taken word for word from the abstract
- population pediatric patients, aged up to 18 years, who underwent PEPSiT
- intervention pediatric endoscopic pilonidal sinus treatment (PEPSiT)
- comparator The medical records of all pediatric patients, aged up to 18 years, who underwent PEPSiT in the period 2019-2021, were retrospectively reviewed.
- primaryOutcome the median time to full healing was 23.4 days (range 19-50)
- result The overall success rate was 95.2% (280/294) and the median time to full healing was 23.4 days (range 19-50).
- n A total of 294 patients (182 boys)
Updates Surg · PMID 37145226 · Read it on PubMed ↗
Koskinen et al. 2023
Long-term results for pit-picking and flap procedures in primary pilonidal sinus disease
Pit-picking surgery recurs far more than flap surgeryRetrospectiveLow qualityRelated question
113 peoplemedian 9.3 years (range 5.4-10.6)
both surgeries healed similarly at first follow-up, but long-term recurrence was much higher after pit-picking surgery than after flap surgery
Who was studied
adults who had surgery for pilonidal sinus disease for the first time
What they received
mini-invasive pit-picking surgery
Compared with
asymmetrical excision with local flap surgery
Main outcome
wound healing and disease recurrence after surgery
Quality
This was a retrospective chart review without randomization, so differences between groups could be due to patient selection rather than the surgery itself.
Limitations
Retrospective design, not randomized, and patients were not similarly selected for each surgery type.
Taken word for word from the abstract
- n 113 underwent either the mini-invasive pit-picking surgery (PSS) (n = 55) or asymmetrical excision with local flap (AELF) (n = 58)
- population 146 patients who underwent primary PSD surgery between November 2010 and October 2015
- intervention mini-invasive pit-picking surgery (PSS)
- comparator asymmetrical excision with local flap (AELF)
- primaryOutcome both surgery methods healed similarly (75.0% vs 76.8%, p = 0.83)
- result recurrence after PPS was markedly higher than after AELF (50.9% vs 10.3%, HR 6.65, p < 0.001)
- followUp long-term follow-up, at a median of 9.3 years (range 5.4-10.6)
BMC Surg · PMID 37118772 · Read it on PubMed ↗
Chen et al. 2023
[Effectiveness of fascial tissue flaps and skin flaps with layered sutures for repair of wounds after excision of sacrococcygeal pilonidal sinus]
Surgical wounds healed well, no recurrenceCase seriesVery low qualityRelated question
9 people3-36 months
all incisions healed completely with no complications and no recurrence of the sinus tract during follow-up
Who was studied
patients with sacrococcygeal pilonidal sinus undergoing excision surgery
What they received
fascial tissue flap and skin flap with layered three-layer sutures to repair the wound after excision
Compared with
no comparison group
Main outcome
wound healing, complications, and recurrence of the sinus tract after surgery
Quality
This is a very small, uncontrolled case series of only 9 patients, so it cannot reliably show how well the technique works compared to other options.
Limitations
No comparison group, very small sample size, and this abstract addresses a surgical repair technique rather than the natural course or duration of pilonidal disease.
Taken word for word from the abstract
- n 9 patients with sacrococcygeal pilonidal sinus were admitted
- population 9 patients with sacrococcygeal pilonidal sinus were admitted, including 7 males and 2 females
- intervention the fascial tissue flap and skin flap were advanced and sutured in three layers, namely, 8-string sutures in the fascial layer, barbed wire reduction sutures in the dermis, and interrupted skin sutures
- comparator Enlarged resection was performed during operation
- primaryOutcome All incisions healed by first intention, and no complication such as incisional dehiscence or infection in the operative area occurred.
- result There was no recurrence of sinus tracts, the shape of gluteal sulcus was satisfactory, both sides of buttocks were symmetrical, local incision scar was concealed, and the shape disruption was minimal.
- followUp All 9 patients were followed up 3-36 months, with an average of 12 months.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi · PMID 37070318 · Read it on PubMed ↗
Esposito et al. 2023
Endoscopic Treatment of Pilonidal Sinus Disease in Children: A Systematic Review
Compares surgery types, not cyst duration.Systematic reviewLow qualityRelated question
size not given2023
endoscopic techniques were better tolerated and had fewer recurrences and complications than excision and primary closure
Who was studied
children with pilonidal sinus disease
What they received
endoscopic (minimally invasive) treatment of pilonidal sinus disease
Compared with
excision and primary closure (EPC)
Main outcome
tolerance, postoperative conditions, recurrence and complications
Quality
This is a review of a small number of pediatric studies, not a controlled trial, so its conclusions are tentative and don't address how long a cyst naturally lasts.
Limitations
Abstract does not report number of patients, study designs pooled, or statistical details; focuses on surgical technique comparison rather than natural course or duration of disease.
Taken word for word from the abstract
- population PSD management in pediatric patients
- intervention endoscopic techniques for PSD
- comparator excision and primary closure (EPC)
- primaryOutcome tolerance and postoperative conditions
- result minimally invasive techniques were statistically superior to EPC in terms of recurrence and complications
J Laparoendosc Adv Surg Tech A · PMID 37023403 · Read it on PubMed ↗
Karki et al. 2022
Surgical Outcome of Limberg's Flap Reconstruction in the Treatment of Pilonidal Sinus Disease in a Community Hospital
Surgery had few complications, no recurrence.Prospective cohortLow qualityRelated question
42 people2022
low complication rate (9.52%) with no flap necrosis or recurrence, mean return to work 14.5 days
Who was studied
patients aged 16-31 with pilonidal sinus disease treated at a community hospital
What they received
Limberg's flap reconstruction surgery
Main outcome
surgical complications, recurrence, hospital stay and return to work after flap surgery
Quality
This is a small, single-center study with no comparison group, so it can't reliably show how well this treatment works compared to other options.
Limitations
No control group for comparison; small sample size of 42 patients; single center study
Taken word for word from the abstract
- n Total of 42 patients were operated ranging from 16-31 years
- population Total of 42 patients were operated ranging from 16-31 years with mean of 22.86 years
- intervention To evaluate the efficacy and outcome of Limberg's flap reconstruction in a community hospital.
- primaryOutcome To evaluate the efficacy and outcome of Limberg's flap reconstruction in a community hospital.
- result We had a complication rate of 9.52% out of which 4.76% had seroma, 2.38% hematoma, 2.38% wound infection, and there was no flap necrosis or recurrence.
Kathmandu Univ Med J (KUMJ) · PMID 37017164 · Read it on PubMed ↗
Salimi-Jazi et al. 2023
Increasing Amount of Hair Reduction using Laser Correlates with Lower Probability of Recurrence in Patients with Pilonidal Disease
More hair removal, less recurrence.RetrospectiveLow qualityRelated question
198 people217 days
Greater hair reduction from laser was linked to much lower chance of the disease coming back
Who was studied
patients with pilonidal disease, average age about 18 years, undergoing laser hair removal
What they received
laser hair removal sessions to reduce gluteal cleft hair
Compared with
patients who achieved less hair reduction (fewer laser sessions)
Main outcome
recurrence of pilonidal disease
Quality
This was a retrospective, uncontrolled study (Level IV evidence) without randomization, so it can't prove cause and effect.
Limitations
No control group, retrospective design, relies on photo comparisons for hair reduction estimates, and short follow-up.
Taken word for word from the abstract
- n 198 PD patients had mean age 18.1 ± 3.6 years.
- population PD patients who underwent laser epilation (LE) were categorized by Fitzpatrick skin type, hair color, and hair thickness.
- intervention more hair reduction achieved using laser
- comparator Probability of recurrence after 20%, 50%, 75% hair reduction was decreased by 50%, 78%, 100%, respectively.
- primaryOutcome PD recurrence rate was 6%.
- result more hair reduction correlated with lower chance of recurrence
- followUp Median follow-up was 217 days.
J Pediatr Surg · PMID 36934004 · Read it on PubMed ↗
Horesh et al. 2023
Outcomes of Laser-Assisted Closure (SiLaC) Surgery for Chronic Pilonidal Sinus Disease
Most healed after laser surgery.RetrospectiveLow qualityRelated question
91 people2023
81.3% of patients achieved complete healing after SiLaC surgery
Who was studied
patients with chronic pilonidal sinus disease
What they received
minimally invasive laser-assisted closure (SiLaC) surgery
Compared with
none (single-group study; subgroup comparison of local vs general anesthesia for recurrence risk)
Main outcome
complete healing of the pilonidal sinus
Quality
This is a retrospective, single-arm case series without a comparison group, so it can't reliably show how the treatment compares to no treatment or other options.
Limitations
Retrospective design, one patient lost to follow-up, no control group, and no information on natural disease duration without treatment.
Taken word for word from the abstract
- n leaving 91 patients for final analysis
- population all patients who underwent minimally invasive surgery combined with laser therapy for PNS
- intervention sinus laser-assisted closure (SiLaC) of pilonidal disease
- comparator Analysis of risk factors for PNS recurrence demonstrated that general anesthesia (P = .02) was associated with increased risk for recurrence
- primaryOutcome The primary outcome was complete healing rate
- result standing at 81.3% (74/91 patients)
J Laparoendosc Adv Surg Tech A · PMID 36888964 · Read it on PubMed ↗
Anjum et al. 2023
A case report of sacrococcygeal foreign body presenting as pilonidal sinus
Healed within three weeks after treatment.Case seriesVery low qualityRelated question
1 peoplethree weeks
patient was completely fine by the end of the third week after treatment
Who was studied
13-year-old female student with a pilonidal sinus in the tailbone area
What they received
crystalloid phenol treatment after removal of a foreign body (grass straw) from the sinus
Compared with
no comparator; prior unresponsive treatments
Main outcome
complete healing of the pilonidal sinus
Quality
this is a single case report, which cannot show how long pilonidal cysts last in general or prove what caused improvement.
Limitations
only one patient, unusual cause (foreign body rather than typical hair-related case), no control group.
Taken word for word from the abstract
- n the case of a 13-year-old female student
- population 13-year-old female student who had pilonidal sinus in sacrococcygeal region for six months
- intervention The patient was treated with crystalloid phenol
- comparator unresponsive to multiple treatments
- primaryOutcome on regular follow-up she was completely fine by the end of the third week
- result on regular follow-up she was completely fine by the end of the third week
J Pak Med Assoc · PMID 36800737 · Read it on PubMed ↗
Elvira Lopez et al. 2023
Randomised clinical trial to test the phenolization in sacrococcygeal pilonidal disease
Shorter sick leave, same recurrence.Randomised trialLow qualityRelated question
124 people493.8 days
no recurrence in either group, but sick leave was shorter with phenolization
Who was studied
adults with uncomplicated sacrococcygeal pilonidal disease with a single midline opening
What they received
phenolization treatment
Compared with
conventional surgery
Main outcome
recurrence of pilonidal disease
Quality
single-center trial with no recurrences in either arm, making it hard to judge differences in the main outcome.
Limitations
Single-center design, primary outcome (recurrence) had zero events in both groups limiting statistical power, and the abstract does not describe blinding.
Taken word for word from the abstract
- n 124 patients were included in the study.
- population All patients with uncomplicated sacrococcygeal disease, localised in the midline and with only 1 fistulous orifice.
- intervention the phenolization group (PhG)
- comparator conventional-surgery group (CsG)
- primaryOutcome The main endpoint was the recurrence of sacrococcygeal disease.
- result No disease recurrence was observed in either group.
- result The LSL was shorter in the PhG (mean 19.63 days, SD 28.15) than in the CSG (43.95 days, SD 38.60).
- followUp Clinical follow-up was carried out with a mean of 493.8 days (SD 6.59).
Int Wound J · PMID 36700412 · Read it on PubMed ↗
Ulusoy et al. 2022
Factors affecting the success of crystallized phenol treatment in sacrococcygeal pilonidal sinus disease
About 1 in 5 recurred after treatment.RetrospectiveLow qualityRelated question
92 people2022
recurrence rate after the procedure was 20.7%, with hirsutism grade and pit number linked to recurrence
Who was studied
patients with primary and recurrent sacrococcygeal pilonidal sinus disease
What they received
crystallized phenol treatment applied in outpatient clinic under local anesthesia
Compared with
none; single-arm study comparing patient and disease factors
Main outcome
recurrence of pilonidal sinus disease after treatment
Quality
This is a retrospective study without a comparison group, so it can show treatment recurrence rates but not prove how long a cyst naturally lasts.
Limitations
Retrospective design, no control group, and it studies recurrence after a specific treatment rather than the natural course of untreated pilonidal cysts.
Taken word for word from the abstract
- n A total of 92 patients were included and followed up.
- population patients with primary and recurrent SPD
- intervention Crystallized phenol was administered in an outpatient setting under local anesthesia.
- comparator There are 2 mainstays of sacrococcygeal pilonidal disease (SPD) treatment: non-operative and surgical. None of them was superior
- primaryOutcome factors that influence disease recurrence
- result Recurrence rate after the procedure was 20.7%.
Medicine (Baltimore) · PMID 36550830 · Read it on PubMed ↗
Mahjoubi et al. 2022
RADICAL VERSUS CONSERVATIVE METHODS IN ONE-STAGE PILONIDAL ABSCESS SURGERY: THE EXPERIENCE OF A TUNISIAN CENTER
Excision lowers recurrence, slows recovery.RetrospectiveLow qualityRelated question
57 people2022
Excision had lower recurrence (19%) but longer recovery time; incision had faster wound healing but higher recurrence (54%)
Who was studied
patients operated on for pilonidal abscess
What they received
radical surgery (excision)
Compared with
conservative surgery (incision with curettage or drainage)
Main outcome
recurrence of pilonidal disease after surgery
Quality
Small retrospective comparative study with no randomization, so differences between groups could be due to other factors.
Limitations
Retrospective design, small sample size, no randomization, reliance on medical records and patient interviews for recurrence data.
Taken word for word from the abstract
- n We analyzed 57 patients
- population patients operated on for pilonidal abscess
- intervention Excision of pilonidal abscess
- comparator Conservative surgery
- primaryOutcome We looked for the occurrence of postoperative recurrence
- result The recurrence rate was 19% in radical surgery and 54% in conservative surgery.
- result Conservative surgery was significantly associated with faster healing of the surgical wound (p<0.001).
- result Excision of pilonidal abscess was significantly associated with a longer time to return to activity (p=0.04).
Arq Bras Cir Dig · PMID 36542008 · Read it on PubMed ↗
Svarre et al. 2023
Long-term outcome after Bascom's cleft-lift procedure under tumescent local analgesia for pilonidal sinus disease: a cohort study
Most healed within a month after surgery.Prospective cohortLow qualityRelated question
200 peoplemedian follow-up time of 8.5 (1.0-10.7) years
195 of 200 patients healed completely within 180 days (median 29 days); 10-year recurrence risk was 11.3%, giving an 86.1% treatment success rate
Who was studied
patients with complex pilonidal sinus disease needing surgery
What they received
Bascom's cleft-lift surgery done under local numbing medicine (tumescent local analgesia)
Compared with
none - all patients received the same surgery, no comparison group
Main outcome
complete wound healing within 180 days of surgery or no recurrence over 10 years
Quality
this is a single-group study without a comparison treatment, so it shows how this surgery performed but can't say how it compares to other options or to leaving a cyst untreated.
Limitations
single-centre study with no comparator group, so findings reflect this specific surgery's outcomes rather than the natural course of untreated pilonidal cysts.
Taken word for word from the abstract
- n Two hundred patients with complex pilonidal sinus disease were included.
- population Two hundred patients with complex pilonidal sinus disease were included.
- intervention The cleft-lift procedure was performed under tumescent local analgesia in a day-surgical setting
- comparator This was a single-centre cohort study based on prospectively registered perioperative data
- primaryOutcome The primary outcome was the 10-year risk treatment success defined as complete wound healing within 180 days of surgery or no recurrence assessed with competing risk analyses.
- result One hundred and ninety-five patients had complete wound healing within 180 days with a median time of 29 days (interquartile range 16-47). The cumulative risk of 10-year recurrence was 11.3% (95% CI 6.2%-16.4%) with a median follow-up time of 8.5 (1.0-10.7) years. Treatment success was 86.1% (95% CI 80.6%-91.5%).
- followUp median follow-up time of 8.5 (1.0-10.7) years
Colorectal Dis · PMID 36401803 · Read it on PubMed ↗
Chen et al. 2022
Comparative analysis on the effect of the endoscopic versus conventional treatment for pilonidal sinus: A meta-analysis of controlled clinical trials
Endoscopic surgery: less pain, fewer complicationsMeta-analysisLow qualityRelated question
size not given2022
endoscopic treatment had lower complication rates and lower pain scores, but no significant difference in recurrence, and similar operation time, healing time, and satisfaction compared with primary closure
Who was studied
people with pilonidal sinus disease needing surgery
What they received
endoscopic surgical treatment
Compared with
conventional surgery (including excision with primary closure)
Main outcome
operation time, recurrence, complications, pain, and healing time
Quality
only six studies were pooled, with very high variability between studies and the authors say more rigorous large trials are needed.
Limitations
small number of included studies, very high heterogeneity (I2=99%) for the pain outcome, and the authors call for larger randomized trials
Taken word for word from the abstract
- n Six studies were included in the review.
- population Pilonidal sinus is a common disease in the sacrococcygeal region.
- intervention endoscopic treatment versus conventional treatment for pilonidal sinus disease
- comparator Compared to the excision followed by the primary closure technique, the operation time, time to complete wound healing, and satisfaction were similar.
- primaryOutcome The primary outcome parameters were operative time, recurrence, postoperative complications and pain, and total healing time.
- result Endoscopic pilonidal sinus treatment had a lower overall complication rate than the conventional surgery group (risk ratio = 0.33 [0.19-0.58], P = .0001) and lower pain score with a weighted mean difference of -2.44 (95% confidence interval: (-3.96) to (-0.92), I2 = 99%, P = .002). There was no significant difference in recurrence (risk ratio = 0.75, 95% confidence interval [0.30-1.90],P = .55).
Medicine (Baltimore) · PMID 36397424 · Read it on PubMed ↗
Esposito et al. 2023
Quality of life of pediatric patients operated for pilonidal sinus disease
Faster healing with endoscopic surgery.RetrospectiveLow qualityRelated question
177 people2023
PEPSIT group had shorter hospital stay, faster healing, quicker return to sport/school/social life, and lower recurrence than open surgery group
Who was studied
children who had surgery for pilonidal sinus disease
What they received
endoscopic pilonidal sinus treatment (PEPSIT)
Compared with
open surgery
Main outcome
quality of life measures including healing time, hospital stay, return to activities, and recurrence
Quality
This is a retrospective, non-randomized comparison of two surgical groups of very different sizes, so differences could be due to other factors besides the treatment itself.
Limitations
Retrospective design, unequal group sizes (20 vs 157), not randomized, and authors call for further prospective studies.
Taken word for word from the abstract
- n The records of 177 patients undergoing surgery for PSD from 2008 to 2021 were retrospectively reviewed.
- population In children operated for pilonidal sinus disease (PSD), open procedures imply prolonged wound care, significant morbidity, and high recurrence rates.
- intervention Endoscopic treatment (PEPSIT) overcomes these limitations.
- comparator Twenty patients were operated with open surgery (G1) and 157 with PEPSIT (G2).
- primaryOutcome We analyzed QOL through the following criteria: hospital stay (HS), healing time (HT), return to sport (RTSp), return to school (RTSc), resumption of social life (RSL), and recurrence rate and reoperation (RRR).
- result HT from 40 to 75 days in G1 while from 20 to 41 days in G2; RTSp from 50 to 80 days in G1 while from 7 to 21 days in G2
- result RRR was 25% in G1 and 4.4% in G2.
Eur J Pediatr · PMID 36348071 · Read it on PubMed ↗
Serup et al. 2023
Long-term outcome after Bascom's pit-pick procedure for pilonidal sinus disease: A cohort study
About 1 in 4 recur after surgery by 10 years.RetrospectiveLow qualityRelated question
158 people7.98 (0.66, 10.96) years
10-year recurrence rate was 27%, treatment success was 68%, and most patients had no complications or chronic pain
Who was studied
patients with simple pilonidal sinus disease who had the pit-pick surgery
What they received
Bascom's pit-pick procedure (minimally invasive surgery for pilonidal sinus)
Main outcome
long-term risk of treatment failure, incomplete healing, recurrence, complications, pain and cosmetic satisfaction
Quality
This is a single-group cohort with no comparison group, relying partly on surveys years later, so it cannot show whether outcomes differ from no treatment or another treatment.
Limitations
No comparator group, follow-up relied on survey and telephone interviews with possible recall or response bias, single-centre design
Taken word for word from the abstract
- n A total of 158 patients underwent Bascom's pit-pick procedure during the period August 2007 to March 2014.
- population for simple pilonidal sinus disease
- intervention Bascom's pit-pick procedure
- primaryOutcome we aimed to estimate the long-term risk of treatment failure, incomplete wound healing or recurrence, postoperative complications and patient reported outcome measures such as chronic pain and satisfaction with cosmetic appearance
- result the 10-year cumulative recurrence rate was 27% (95% CI: 19%-35%) of patients with complete wound healing. Treatment success was 68%.
- followUp Median follow-up was 7.98 (0.66, 10.96) years.
Colorectal Dis · PMID 36268754 · Read it on PubMed ↗
Milone et al. 2023
Endoscopic sinusectomy: 'a rose by any other name'. A systematic review of different endoscopic procedures to treat pilonidal disease
Recurrence varied widely across techniques.Systematic reviewVery low qualityRelated question
size not given1 to 60 months
Postoperative complications occurred in 0%-6% of cases, and recurrence rate varied from 0% to 22%; reporting of technical details was generally poor
Who was studied
people with pilonidal sinus/pilonidal disease treated with endoscopic surgery
What they received
endoscopic sinusectomy (video-assisted surgical techniques) for pilonidal disease
Compared with
different endoscopic technique variants compared with each other, not with non-surgical care
Main outcome
stage of surgical innovation reached by each technique (IDEAL framework), plus reporting quality and complication/recurrence rates
Quality
The review found that most of the included studies were poorly reported early-stage surgical series with moderate to critical risk of bias, so the findings carry little weight.
Limitations
Reporting of domains in the IDEAL reporting guidelines and Blencowe framework was poor, with most studies not reporting the component steps of procedures or efforts to standardize them; quality of evidence had risk of bias from moderate to critical level in all nine comparative non-randomized series.
Taken word for word from the abstract
- population Pilonidal sinus or Pilonidal Disease (PD) is a relatively common, benign but challenging condition.
- intervention video-assisted surgery
- comparator reporting a very similar technique under eight different acronyms
- primaryOutcome The primary outcome measure was the IDEAL framework stage of innovation.
- result Postoperative complications occurred in 0%-6% of cases, including surgical site infection, poor or failed wound healing bleeding, granuloma, haematoma, and pain requiring intervention. The recurrence rate varied from 0% to 22%.
- followUp Mean follow-up ranged from 1 to 60 months.
- qualityWhy The quality of the evidence was categorized as having a risk of bias from moderate to critical level in all nine comparative non-randomized series.
Colorectal Dis · PMID 36217688 · Read it on PubMed ↗
Sophie et al. 2022
Injection of freshly collected autologous adipose tissue in complicated pilonidal disease: a prospective pilot study
Most healed within about 5 months.Prospective cohortLow qualityRelated question
30 people2022
25 of 30 patients (83.3%) healed completely, with a median time to healing of 159 days
Who was studied
patients with pilonidal sinus disease that failed to heal after surgery, or with pilonidal disease near the anus
What they received
injection of the patient's own fat tissue after surgical revision
Compared with
none (single-group study)
Main outcome
time until the wound healed completely
Quality
This was a small pilot study with only 30 patients and no comparison group, so it cannot show whether healing was better than without this treatment.
Limitations
Small pilot study, no control group, so results may not generalise and cannot isolate the effect of the fat injection itself.
Taken word for word from the abstract
- n We included 30 patients
- population consecutive PSD patients with lack of healing 3 months after surgery (Bascom's cleft lift) or with primary or recurrent anal-near pilonidal sinus disease
- intervention Autologous adipose tissue was harvested from the patients and injected into the lesions after surgical revision.
- comparator a prospective pilot study was conducted on consecutive PSD patients
- primaryOutcome The primary endpoint was time to healing.
- result Complete healing was achieved in 25 patients [83.3%; 95% CI (69.9-96.7)]. Two patients had recurrence (6.7%). The median time to complete healing was 159 (189) days.
Tech Coloproctol · PMID 35963978 · Read it on PubMed ↗
Isik et al. 2022
Factors Associated with the Occurrence and Healing of Umbilical Pilonidal Sinus: A Rare Clinical Entity
No duration data reported.RetrospectiveLow qualityRelated question
82 people2022
no significant difference in recurrence rate between the three treatment methods, though smoking was linked to recurrence
Who was studied
patients with pilonidal sinus located at the belly button (umbilicus), not the more common tailbone area
What they received
three treatment approaches: conservative treatment, surgical treatment, and silver nitrate application
Compared with
the three treatment methods compared against each other
Main outcome
rate of the sinus coming back (recurrence) after treatment
Quality
this is a small retrospective study of a rare condition in a different body location, and it does not report how long a pilonidal cyst actually lasts.
Limitations
retrospective design, rare condition with small numbers, focuses on umbilical location rather than the typical sacrococcygeal pilonidal cyst, and does not report duration or natural history of the condition
Taken word for word from the abstract
- n the authors evaluated 82 patients (19 women, 63 men) with a history of umbilical PSD
- population umbilical PSD
- intervention The three different treatment methods studied (conservative treatment, surgical treatment, silver nitrate)
- comparator did not differ in recurrence rate (P = .57)
- primaryOutcome did not differ in recurrence rate (P = .57)
- result Smoking was the only modifying factor for recurrence.
Adv Skin Wound Care · PMID 35856614 · Read it on PubMed ↗
Salimi-Jazi et al. 2022
Burden of pilonidal disease and improvement in quality of life after treatment in adolescents
Less daily-life disruption after treatmentRetrospectiveLow qualityRelated question
101 people2022
After treatment, far fewer patients reported their daily activities, sports, school/work, and socializing being affected, with the difference being statistically significant
Who was studied
Adolescents with pilonidal disease who underwent minimally invasive treatment
What they received
Minimally invasive treatment (laser hair removal with or without trephination)
Compared with
Patients' own quality-of-life scores before treatment compared with after treatment
Main outcome
Impact of pilonidal disease on quality of life (daily activities, sports, school/work attendance, socializing)
Quality
This was a retrospective study of one treatment group with no comparison group, relying on patient-reported questionnaires and missing data for some patients.
Limitations
30 patients with incomplete data were excluded, no untreated control group, retrospective design, single-center study
Taken word for word from the abstract
- n 101 (51 male, 50 female) patients were included.
- population Pilonidal Disease (PD) affects adolescents in different aspects.
- intervention 131 PD patients underwent MIT (laser epilation ± trephination) from 2019 to 2021.
- comparator Before and after MIT, patients received QOL questionnaire consisting of four categories: daily activities, sports participation, school/work attendance, and socializing.
- primaryOutcome QOL questionnaire consisting of four categories: daily activities, sports participation, school/work attendance, and socializing.
- result after MIT, only 7%, 8%, 2%, and 4% were affected (p < 0.01).
Pediatr Surg Int · PMID 35842877 · Read it on PubMed ↗
Erculiani et al. 2022
Long-term results of EPSiT in children and adolescents: still the right way to go
Cyst often returns years laterRetrospectiveLow qualityRelated question
99 peoplemedian follow-up of 49 months (36-61 months)
15% of patients followed for over 3 years had the cyst return, happening on average 19 months after surgery
Who was studied
children and teenagers who had pilonidal cyst surgery
What they received
endoscopic pilonidal sinus treatment (EPSiT)
Compared with
comparing short-term (12 months) versus long-term (over 36 months) follow-up after the same surgery
Main outcome
rate of cyst coming back (recurrence) after surgery
Quality
This is a single-center look-back study with no comparison group, so it can show how often the cyst returns after this surgery but can't prove cause and effect.
Limitations
Retrospective design, no control group, and not all patients had long-term follow-up (59 of 99).
Taken word for word from the abstract
- n A total of 99 patients underwent 115 EPSiT procedures in a 5-year period.
- population Patients under 18 years of age at first surgery were included.
- intervention Endoscopic pilonidal sinus treatment (EPSiT)
- comparator Patients were also divided into short-term (follow-up of 12 months) and long-term (follow-up longer than 36 months) to compare results
- primaryOutcome Details regarding demographic data, surgical procedure, and recurrences were recorded.
- result Fifty-nine patients have been followed up for at least 36 months (long-term results) with a median follow-up of 49 months (36-61 months) and reported a 15% incidence of recurrences occurring after a mean of 19 months postoperatively.
- followUp median follow-up of 49 months (36-61 months)
Pediatr Surg Int · PMID 35779104 · Read it on PubMed ↗
Fernandes et al. 2022
Minimally invasive treatment of pilonidal sinus disease in a paediatric population: comparison of two techniques
Faster healing with sinusectomy than laserRetrospectiveLow qualityRelated question
106 people2022
Median healing time was 20 days with sinusectomy versus 30 days with pit-picking plus laser ablation, with similar recurrence rates (16% vs 17%) but more complications with PPL
Who was studied
children and teenagers with pilonidal disease (median age 16)
What they received
sinusectomy (SE) minimally invasive surgery
Compared with
pit-picking plus laser ablation (PPL)
Main outcome
time to healing, complication and recurrence rates after treatment
Quality
This is a retrospective comparison without randomization, so differences between groups could be influenced by other factors besides the treatment itself.
Limitations
Retrospective design, no randomization, single center
Taken word for word from the abstract
- population All cases of paediatric PD treated by PPL and SE at our center between August 2018 and August 2020 were retrospectively reviewed.
- population median age of 16 years (IQR 15-16)
- intervention sinusectomy (SE)
- comparator pit-picking plus laser ablation (PPL)
- n One-hundred and six patients were included
- primaryOutcome Median healing time was significantly lower in SE group (20 days), comparing to PPL (30 days) (p = 0.002).
- result Median healing time was significantly lower in SE group (20 days), comparing to PPL (30 days) (p = 0.002). Early healing failure occurred more frequently in the PPL group (p = 0.003). Recurrence rate was similar between groups - PPL 17% versus SE 16% (p = 0.89). Overall complication rate was 9% and was significantly higher in PPL (p = 0.03).
ANZ J Surg · PMID 35678224 · Read it on PubMed ↗
Herrod et al. 2022
Dressings and topical agents for the management of open wounds after surgical treatment for sacrococcygeal pilonidal sinus
No clear best dressing for healing.Systematic reviewVery low qualityRelated question
932 people2022
Evidence for any dressing or topical agent improving healing time was low to very low certainty, with inconsistent or weak results across comparisons
Who was studied
adults who had surgery for a pilonidal sinus and were left with an open wound to heal
What they received
various wound dressings and topical treatments (e.g. negative pressure therapy, platelet-rich plasma, creams, hydrogel, zinc oxide mesh)
Compared with
conventional wound care, placebo dressings, or other dressing types
Main outcome
how long the wound took to heal
Quality
Most comparisons came from single small trials with high risk of bias, so the findings are very uncertain.
Limitations
All studies had high risk of bias in at least one area; most comparisons relied on only one small trial; no data on quality of life, cost, or long-term healing at 6-12 months.
Taken word for word from the abstract
- n We included 11 RCTs comprising 932 participants.
- population participants who had undergone any type of sacrococcygeal pilonidal sinus disease surgery and were left with an open wound
- intervention dressings and topical agents for the management of open wounds following surgical treatment for sacrococcygeal pilonidal sinus
- comparator the other seven studies compared various dressings and topical agents
- primaryOutcome It is unclear whether TNPWT reduces time to wound healing compared with conventional open wound healing
- result the evidence that any of the dressings or topical agents contained in this review have a benefit on time to wound healing, the proportion of wounds that heal at a specific time point or on any of the secondary outcomes of our review ranges from low certainty to very low certainty
Cochrane Database Syst Rev · PMID 35593897 · Read it on PubMed ↗
Gozukucuk et al. 2022
Comparing Crystallized Phenol and Surgical Excision Treatments in Pilonidal Sinus Disease
Faster recovery with phenol than surgery.RetrospectiveLow qualityRelated question
319 people2022
Phenol group returned to school much faster than surgery group, with similar success and recurrence rates
Who was studied
Children and teens (average age 15.5) with pilonidal sinus disease
What they received
Crystallized phenol application
Compared with
Surgical excision (Karydakis flap method)
Main outcome
Treatment success, complications, hospital stay and recurrence
Quality
This was a non-randomized comparison of two treatments with uneven group sizes, not a study of how long cysts last on their own.
Limitations
Abstract does not report randomization, blinding, or how patients were allocated to each treatment
Taken word for word from the abstract
- n 111 (34.7%) were treated with surgical repair, and 208 (65.3%) with the crystallized phenol method
- population The mean age was calculated as 15.5 (± 1.4)
- intervention crystallized phenol method
- comparator surgical repair (karydakis flap method)
- primaryOutcome The efficacy and complications of both treatments were compared.
- result The mean time to return to school was 2.8 ± 1.02 days in the phenol group and 12.3 ± 2.2 days in the Surgery group.
J Coll Physicians Surg Pak · PMID 35546704 · Read it on PubMed ↗
Johnson et al. 2023
Pilonidal sinus laser-assisted closure (PiLAC) - a low-morbidity alternative to excision with excellent long-term outcomes
High healing rate after laser treatmentCase seriesLow qualityRelated question
35 peoplemean 407 days (range 67-887 days)
89.3% of patients with long-term follow-up had healed with no recurrence
Who was studied
adults with primary or recurrent pilonidal sinus disease treated as day-case surgery
What they received
laser-assisted closure of the pilonidal sinus (PiLAC)
Compared with
none (single group, no comparison treatment)
Main outcome
complete healing or recurrence of the pilonidal sinus after treatment
Quality
This is a small, single-arm case series without a comparison group, so it mainly shows treatment healing rates rather than answering how long an untreated cyst lasts.
Limitations
Small sample size, no comparator group, follow-up data only available for 28 of 35 patients, and outcomes based partly on telephone follow-up.
Taken word for word from the abstract
- n A total of 35 patients underwent PiLAC
- population All patients undergoing PiLAC as a day-case between April 2016 and July 2019 were included.
- intervention Pilonidal sinus Laser-Assisted Closure (PiLAC)
- comparator We recommend it as an alternative to surgical excision.
- primaryOutcome Patients were followed up in a nurse-led clinic until complete healing or recurrence.
- result 25/28 patients (89.3%) had healed with no recurrence on long-term follow-up.
- followUp mean 407 days (range 67-887 days)
Ann R Coll Surg Engl · PMID 35446708 · Read it on PubMed ↗
Hinksman et al. 2022
Long-term efficacy of endoscopic pilonidal sinus treatment: a single-centre Australian experience
Healed in about 6 weeks with treatment.RetrospectiveLow qualityRelated question
137 people56.2 months
72.2% of patients healed completely without further treatment, at a median of 6 weeks; some had recurrence or failed to heal
Who was studied
patients with pilonidal sinus disease, some who had prior surgery
What they received
endoscopic pilonidal sinus treatment (EPSiT), a minimally invasive procedure using a video fistuloscope
Main outcome
whether the sinus healed and how long healing took
Quality
This is a retrospective, single-centre study with no comparison group, so it mainly shows how this treatment performed rather than how long cysts last on their own.
Limitations
Retrospective design, no control group, 11 patients lost to follow-up, and it studies a specific endoscopic treatment rather than the natural course of untreated disease.
Taken word for word from the abstract
- n 137 patients with PSD underwent EPSiT
- population 137 patients with PSD underwent EPSiT. Seventy-two had undergone previous surgery for PSD.
- intervention Endoscopic pilonidal sinus treatment (EPSiT) is a novel minimally invasive technique for treating pilonidal sinus disease (PSD) involving endoscopic assessment and treatment.
- primaryOutcome 72.2% (n = 91) of patients undergoing EPSiT achieved primary healing (needing nil further intervention) at a median of 6 weeks
- result 72.2% (n = 91) of patients undergoing EPSiT achieved primary healing (needing nil further intervention) at a median of 6 weeks; 13.5% (n = 17) experienced healing followed by recurrence while 14.3% (n = 18) experienced non-healing.
- followUp Patients were then followed up for a mean 56.2 months.
ANZ J Surg · PMID 35347830 · Read it on PubMed ↗
Basso et al. 2022
The impact of experience on recurrence rates after biopsy punch excision for pilonidal disease
Recurrence risk grew over time after surgery.Case seriesLow qualityRelated question
848 people12, 24 and 60 months
Recurrence rates increased the longer patients were followed (8.1% at 1 year, 13.0% at 2 years, 16.4% at 5 years), but recurrence rates were lower in later treatment periods as the surgical team gained more experience
Who was studied
patients with pilonidal disease, mostly men, median age about 26 years
What they received
a surgical technique called biopsy punch excision (a mix of two established minimally invasive methods)
Compared with
the same procedure performed by surgeons with increasing experience over three separate time periods (2011-12, 2013-14, 2015-16)
Main outcome
rate of cyst recurrence after surgery at 1, 2 and 5 years
Quality
This was a single-group study with no comparison treatment, and nearly 30% of patients were missing from the 5-year follow-up, which weakens confidence in the numbers.
Limitations
No control/comparison group was studied, follow-up data were incomplete (down to 70.2% of patients retained by 5 years), and the study looks at recurrence after a specific surgery rather than the natural course of an untreated cyst.
Taken word for word from the abstract
- n 848 consecutive patients with PD were treated
- population sex 622 [73.4%] men and 226 [26.6%] women; median age 26.2 years
- intervention treated by biopsy punch excision (BPE)
- comparator the three biennia 2011-2012 (group A), 2013-2014 (group B) and 2015-2016 (group C)
- primaryOutcome The recurrence rates were recorded 12, 24 and 60 months after surgery
- result 59 recurrences/725 patients (or 8.1%) after 1 year, 89 recurrences/682 patients (or 13.0%) after 2 years and 98 recurrences/595 (or 16.4%) after 5 years
- result the recurrence rates showed a steady and progressive decrease in the three biennia
Colorectal Dis · PMID 35344244 · Read it on PubMed ↗
Zoarets et al. 2022
Trephine Minimally Invasive Procedure for Pilonidal Sinus
Nearly half recurred after surgeryRetrospectiveLow qualityRelated question
113 people29 months
45.1% of patients had the condition come back after a median follow-up of 29 months, and about a third needed another operation
Who was studied
patients with pilonidal sinus who had the trephine surgical procedure, median age 20
What they received
trephine minimally invasive surgical procedure for pilonidal sinus
Compared with
none - single group, no comparison treatment
Main outcome
long-term recurrence of pilonidal sinus after surgery
Quality
This was a retrospective single-center study without a comparison group, relying partly on phone interviews, so the findings are not very reliable.
Limitations
Retrospective design, no control group, follow-up data obtained partly by telephone interview, and only 113 of 169 original patients were followed up.
Taken word for word from the abstract
- n Follow-up included 113 patients, median age 20 years.
- population Patients who underwent trephine procedure between 2011 and 2015 were included.
- intervention To assess the short- and long-term outcomes and success rate of the trephine procedure for the treatment of pilonidal sinus.
- comparator A total of 169 patients underwent the trephine technique for the repair of pilonidal sinus.
- primaryOutcome recurrence rate was 45.1% (51/113), and 38 (33.9%) of the patients underwent another surgical procedure
- result At a median follow-up of 29 months (IQR 19-40), recurrence rate was 45.1% (51/113), and 38 (33.9%) of the patients underwent another surgical procedure
- followUp median follow-up of 29 months (IQR 19-40)
Isr Med Assoc J · PMID 35187898 · Read it on PubMed ↗
Gips et al. 2022
Minimal Pilonidal Surgery vs. Common Wide Excision Operations: Better Well-Being and Comparable Recurrence Rates
Similar recurrence, less pain with minimal surgery.RetrospectiveLow qualityRelated question
1,260 people7.2 years
no significant difference in recurrence rates between minimal and wide excision surgeries, though minimal surgery caused less pain
Who was studied
patients with primary pilonidal disease who had surgery
What they received
minimal trephine (minimally invasive) surgery
Compared with
wide excision surgery (primary closure or lay-open)
Main outcome
rate of pilonidal disease recurrence
Quality
It is a retrospective study where each surgeon only performed one type of surgery, so patient selection wasn't random and could bias results.
Limitations
Retrospective design; each of 53 surgeons performed only one surgery type regardless of patient characteristics or disease severity, which could confound comparisons.
Taken word for word from the abstract
- n Pilonidal recurrence rates were evaluated in a subset of 1260 patients operated by 53 surgeons
- population patients with primary pilonidal disease
- intervention minimal trephine surgery
- comparator wide excision operations
- primaryOutcome Pilonidal recurrence rates were evaluated
- result 81.5%, 85%, and 88% of patients were disease-free after minimally invasive surgery, wide excision with primary closure, and lay-open surgery, respectively, with no statistically significant difference in recurrence rates
- followUp With a mean follow-up of 7.2 years
Isr Med Assoc J · PMID 35187897 · Read it on PubMed ↗
Mamaloudis et al. 2022
The role of alginate dressings in wound healing and quality of life after pilonidal sinus resection: A randomised controlled trial
No faster healing with alginate dressing.Randomised trialLow qualityRelated question
65 people2022
no difference in healing time between dressing types
Who was studied
patients who had surgery to remove a pilonidal cyst
What they received
alginate dressings with silver and high-G cellulose after cyst removal surgery
Compared with
simple gauze dressings after cyst removal surgery
Main outcome
time for the wound to heal
Quality
small trial with an admitted suboptimal sample size and other limitations, so results are not very reliable.
Limitations
Suboptimal sample size and several study limitations, as stated by the authors.
Taken word for word from the abstract
- n Overall, 65 patients were included during the study period.
- population after elective pilonidal cyst excision
- intervention alginate dressings with silver and high-G cellulose were introduced after elective pilonidal cyst excision
- comparator in the control group, simple gauges were used
- primaryOutcome The primary end point was the difference in terms of the wound healing period.
- result Wound healing duration was comparable between the two groups (P = .381).
Int Wound J · PMID 35043571 · Read it on PubMed ↗
Sahin et al. 2022
Unroofing Curettage Versus Modified Limberg Flap in Pilonidal Disease: A Retrospective Cohort Study
Healing took about 35 days.RetrospectiveLow qualityRelated question
278 people60-month median follow-up period
recurrence was lower with unroofing curettage but not statistically significant; healing took longer with unroofing curettage (35.3 vs 23.2 days)
Who was studied
patients having surgery for pilonidal disease
What they received
unroofing curettage surgery
Compared with
modified Limberg flap surgery
Main outcome
recurrence rate
Quality
This was a retrospective, non-randomized comparison of two surgeries, which cannot reliably show cause and effect.
Limitations
The retrospective study design was a limitation of this study.
Taken word for word from the abstract
- n unroofing curettage, n = 135; modified Limberg flap, n = 143
- population The data of 278 patients who underwent surgery for the treatment of pilonidal disease were analyzed.
- intervention Unroofing curettage was performed under local or spinal anesthesia
- comparator spinal anesthesia was used for the modified Limberg flap procedure
- primaryOutcome The primary outcome was recurrence rate.
- result recurrence was lower in the unroofing curettage group after a 60-month median follow-up period, but the difference was not statistically significant (1.5% vs 4.2%, p = 0.45)
- result The complete healing time was longer in the unroofing curettage group (35.3 ± 9.2 days vs 23.2 ± 5.4 days, p < 0.001).
- followUp 60-month median follow-up period
- limitations The retrospective study design was a limitation of this study.
Dis Colon Rectum · PMID 34840296 · Read it on PubMed ↗
Fadgyas et al. 2021
[Fistuloscopy in the management of pediatric pilonidal sinus disease]
Healed in about 6 weeks.Case seriesLow qualityRelated question
28 people2021
average healing time was 5.9 weeks, with 6 recurrences out of 31 operations and return to activity in 1.37 days
Who was studied
children and teenagers with pilonidal sinus disease
What they received
PEPSiT (pediatric endoscopic pilonidal sinus treatment)
Compared with
none; single group before-after study
Main outcome
wound healing time, recurrence, return to daily activity
Quality
small single-group study without a comparison group, so it can't show if this is better than other treatments.
Limitations
No control group, small number of patients, only pediatric patients who had this specific surgical technique.
Taken word for word from the abstract
- population patients subjected to PEPSiT from 2019 to 2020 between ages 0-18 years
- intervention PEPSiT (pediatric endoscopic pilonidal sinus treatment)
- comparator Recurrence rate is similar to that of other treatment techniques.
- primaryOutcome Adverse events, recurrences, length of hospital stay, wound healing time and return to everyday activity were assessed.
- result mean wound healing time was 5.9 weeks
- result 6 recurrences and 1 wound suppuration were documented
- result Return to everyday activity was an average 1.37 days
- n 31 PEPSiT operations were recorded on 28 patients
Orv Hetil · PMID 34689133 · Read it on PubMed ↗
Boztug et al. 2021
Platelet-rich plasma treatment improves postoperative recovery in patients with pilonidal sinus disease: a randomized controlled clinical trial
PRP sped healing and recovery after surgery.Randomised trialLow qualityRelated question
size not given2021
PRP groups had lower pain scores, faster return to daily activities, and improved quality of life compared with the non-PRP group
Who was studied
adults over 18 with chronic pilonidal sinus disease
What they received
platelet-rich plasma (PRP) applied after surgery
Compared with
open surgery with moist dressings (no PRP)
Main outcome
pain reduction, return to daily activities, quality of life, and wound healing time after surgery
Quality
it is a randomized trial but does not report participant numbers or other key details needed to judge its reliability.
Limitations
The abstract does not report sample size, blinding, or long-term recurrence outcomes.
Taken word for word from the abstract
- population Patients who were over 18 years old and had chronic PS disease between March 2018 and January 2019 were enrolled
- intervention Open surgery followed by PRP application was performed on patients in group B.
- comparator Open surgery and moist dressings were applied to patients in group A.
- primaryOutcome compare the impact of autologous platelet-rich plasma (PRP) with that of minimally invasive techniques in terms of pain reduction, return to daily activities, quality of life, and duration of wound healing after open excision and secondary closure
- result PRP application improves postoperative recovery in that it speeds patients' return to daily activities, reduces their pain scores and increases their quality of life.
- result Overall postoperative pain scores were significantly lower for both PRP groups (open surgery, group B; minimally invasive surgery, group C) than for group A (p < 0.001)
BMC Surg · PMID 34670534 · Read it on PubMed ↗
Sevinç et al. 2022
Comparison of Curettage Plus Platelet-Rich Plasma Gel and Curettage Plus Phenol Application in Treatment of Pilonidal Sinus Disease: A Randomized Trial
Faster healing with platelet-rich plasma treatmentRandomised trialLow qualityRelated question
size not given43.1 months
median healing time was 6 days with platelet-rich plasma versus 10 days with phenol, and recurrence was 4% versus 12%
Who was studied
people with pilonidal sinus disease
What they received
curettage plus platelet-rich plasma gel
Compared with
curettage plus phenol application
Main outcome
time to achieve healing
Quality
it was a randomized trial but neither patients nor investigators were blinded and the total number of patients is not stated.
Limitations
neither the patients nor the investigators were blinded
Taken word for word from the abstract
- population Patients with pilonidal disease were evaluated for the study
- intervention Patients in the platelet-rich plasma group were treated using curettage + platelet-rich plasma gel.
- comparator Patients in the phenol group were treated by using curettage + crystallized phenol.
- primaryOutcome The primary study end point was the time to achieve healing
- result The median healing time was shorter in the platelet-rich plasma group: 6 (4-14) vs 10 (5-42) days (p < 0.001).
- result there was a 4% recurrence rate in the platelet-rich plasma group in comparison with a 12% recurrence rate in the phenol group
- followUp After a mean follow-up of 43.1 months
- limitations neither the patients nor the investigators were blinded
Dis Colon Rectum · PMID 34629430 · Read it on PubMed ↗
Kubat et al. 2021
Effect of propolis on wound healing in sacrococcygeal pilonidal disease: A randomized controlled clinical trial
Propolis sped up surgical wound healing.Randomised trialLow qualityRelated question
33 people2021
wound healing was faster and the complete recovery score was significantly lower in the propolis group
Who was studied
patients with sacrococcygeal pilonidal disease treated with marsupialization surgery
What they received
propolis applied to the surgical wound
Compared with
control group without propolis
Main outcome
time to complete wound healing after marsupialization
Quality
Small trial of only 33 patients looking at post-surgical wound healing, not the natural course of an untreated cyst.
Limitations
Abstract does not report blinding, exact recovery times in days, or detail on randomization method.
Taken word for word from the abstract
- n a total of 33 patients divided into study and control groups
- population Patients who were admitted to our clinic with sacrococcygeal pilonidal disease
- intervention the effect of propolis on wound healing in sacrococcygeal pilonidal diseases treated with marsupialization
- comparator a total of 33 patients divided into study and control groups
- primaryOutcome the wound areas were analyzed post-operatively, on the 0, 7th, 14th, 28th days and on the day of complete recovery
- result An acceleration of wound healing was observed from the first week that was found to be even faster between days 14 and 28. The complete recovery score in the study group was significantly lower.
Pak J Pharm Sci · PMID 34602433 · Read it on PubMed ↗
Hannan et al. 2021
Negative pressure wound therapy following excision of pilonidal sinus disease: A retrospective review
Wounds healed in about a month.RetrospectiveLow qualityRelated question
61 people2021
all wounds healed, with a median healing time of 28 days and only 1.6% recurrence
Who was studied
patients with pilonidal sinus disease
What they received
complete surgical excision followed by negative pressure wound therapy
Compared with
none (single-group study, no comparison treatment)
Main outcome
cyst recurrence and whether the wound failed to heal
Quality
this was a retrospective, single-group study without a comparison treatment, so it mainly shows how quickly wounds healed after this specific surgery rather than proving it is better than other options.
Limitations
Retrospective design, no comparator group, and the study measures healing after a specific surgical technique rather than the natural duration of an untreated or variously treated cyst.
Taken word for word from the abstract
- n Sixty-one patients underwent treatment during the study period.
- population patients with PSD managed by complete surgical excision followed by application of NPWT
- intervention complete surgical excision followed by the application of NPWT
- comparator A retrospective observational cohort study of all patients with PSD managed by complete surgical excision followed by application of NPWT was performed
- primaryOutcome The primary endpoints were PSD recurrence and failed wound healing.
- result All patients' wounds healed successfully, with the median time to healing being 28 days. One patient (1.6%) developed recurrent PSD and required further surgery.
Colorectal Dis · PMID 34455675 · Read it on PubMed ↗

How we searchedThe exact query, the date it ran, and what came back — so you can run it yourself.

Searched: PubMed · ClinicalTrials.gov · Crossref on 2026-10-13
The exact search — paste this into PubMed to repeat it: "Pilonidal Sinus"[Mesh] AND ("natural history"[tiab] OR "disease course"[tiab] OR "time factors"[Mesh] OR duration[tiab] OR recurrence[tiab] OR "spontaneous resolution"[tiab] OR "conservative management"[tiab]); PubMed expanded that to: "Pilonidal Sinus"[MeSH Terms] AND ("natural history"[Title/Abstract] OR "disease course"[Title/Abstract] OR "time factors"[MeSH Terms] OR "duration"[Title/Abstract] OR "recurrence"[Title/Abstract] OR "spontaneous resolution"[Title/Abstract] OR "conservative management"[Title/Abstract])
What came back: 832 records found · 200 read · 134 answered the question
Included: Human, animal or laboratory studies reporting an outcome relevant to the question
Excluded: Records about a different condition or intervention
Records reporting no outcome
Retracted publications, which are listed but excluded from every count
Limits: Details were read from abstracts, not full papers, so anything reported only in a paper's methods section is not captured here.
Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured.
Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.

832records came back from the search
200were read
134actually answered the question

Why people try thisThe reasoning behind the question — not a claim that it works.

A flare-up can be painful, swollen, and draining, so people want to know whether it's an emergency or something that will settle down on its own.
Surgery is the usual option offered, so people search to see if waiting it out is a reasonable alternative.
The area is hard to see and awkward to discuss, so people often try to manage it themselves and look online before seeing a clinician.
Fear of surgical recovery time and scarring makes people hope the cyst will simply go away if they wait.

Common questionsShort answers, drawn from the same studies.

How long does a pilonidal cyst last?: No study has actually timed how long a pilonidal cyst lasts if it's left untreated — the research instead measures how fast different treatments heal it. What is clear is that disease present for more than three years was linked to a small, rare increase in cancerous change in one tissue-lab study, which is a reason to get it checked rather than just waiting.
How long does a pilonidal cyst flare-up last?: This hasn't been directly studied. The closest figures available describe how long it took specific treatments to heal a flare-up — for example, one phenol treatment took around 18 days on average, and laser treatments healed in roughly 10 to 15 days in some studies — but none of this tells you how long an untreated flare-up would last on its own.
How long does pilonidal cyst pain last?: No study tracked pain duration without treatment. One case series of laser treatment found pain could persist for up to a year in some patients afterward, but this describes pain after a procedure, not the natural course of untreated pain.
Should I just wait it out instead of seeing a doctor?: The evidence doesn't support waiting indefinitely. Disease that lingered for more than three years was linked to a small increased risk of a rare skin cancer in one study. Some mild cases did improve with simple measures like better hygiene and hair removal, so see a clinician who can guide safe conservative care rather than ignoring it for years.
Does a pilonidal cyst go away without surgery?: It can for some people. In one study, almost all teenagers with mild disease improved using hygiene, hair removal, and minor pit removal, without needing the cyst cut out. In another small study, laser hair removal alone resolved the problem in about 4 of 10 patients. But no study tested doing absolutely nothing.

This is information, not advice

This page summarises published research. It cannot tell you what is happening in your own body, and evidence changes. If something is bleeding, painful, or new, it is worth being looked at — that is a different question from the one on this page, and a better one to bring to a consultation.

Contact the office

Automated evidence review — PubMed, ClinicalTrials.gov, Crossref. Search strategy, grading rules and the checks that must pass before anything publishes were written by Allen Kamrava, MD, MBA, FACS, FASCRS, colon & rectal surgery, Beverly Hills. The pages themselves are compiled by software running that method and are not read one by one before publication — saying otherwise would be the one claim here that could not be checked.

Allen Kamrava, MD, MBA, FACS, FASCRS · 435 N. Bedford Dr., Suite 308, Beverly Hills, CA 90210 · 424.279.8222

Educational information — not medical advice.