{ "slug": "how-long-does-a-pilonidal-cyst-last", "question": "How long does a pilonidal cyst last?", "shortTitle": "Pilonidal Cyst Duration", "clinicalQuestion": "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?", "pico": { "population": "People with a pilonidal cyst, abscess, or sinus, including those experiencing an acute flare-up", "intervention": "Natural course of the disease (no treatment or conservative/non-surgical management)", "comparator": "Surgical drainage or excision", "outcomes": [ "Duration of an acute flare-up (pain, swelling, drainage) in days", "Time to spontaneous resolution without surgery", "Rate of recurrence after symptoms subside", "Progression from acute abscess to chronic sinus", "Time to healing with conservative management", "Need for eventual surgical intervention" ] }, "category": "anorectal", "relatedConditions": [ "pilonidal-disease", "pilonidal-cyst", "pilonidal-abscess", "pilonidal-sinus" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "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.", "detail": "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.", "studyIds": [ "pmid:36102853", "pmid:36102566", "pmid:39544170" ] }, "strength": { "level": "moderate", "why": "One well-conducted randomised trial addresses this question directly.", "override": null }, "direction": { "level": "harm-signal", "why": "2 studies reported harm or tissue damage, including laboratory evidence.", "override": null }, "counts": { "recordsRetrieved": 832, "recordsScreened": 200, "included": 134, "rcts": 13, "systematicReviews": 18, "observational": 87, "participants": 566568, "yearFrom": 2021, "yearTo": 2026, "registeredTrialsWithoutResults": 0 }, "excluded": [], "outcomes": [ { "name": "Duration of an acute flare-up (pain, swelling, drainage) in days", "status": "not-studied", "note": "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.", "studyIds": [] }, { "name": "Time to spontaneous resolution without any treatment", "status": "insufficient", "note": "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.", "studyIds": [ "pmid:36102566", "pmid:37906293" ] }, { "name": "Recurrence after symptoms subside, without surgery", "status": "not-studied", "note": "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.", "studyIds": [] }, { "name": "Progression from acute abscess to chronic sinus", "status": "insufficient", "note": "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.", "studyIds": [ "pmid:42057099" ] }, { "name": "Time to healing with conservative (non-surgical) management", "status": "insufficient", "note": "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.", "studyIds": [ "pmid:42020338" ] }, { "name": "Need for eventual surgical intervention", "status": "possible-improvement", "note": "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.", "studyIds": [ "pmid:36102566", "pmid:39893840", "pmid:37906293" ] } ], "benefits": [ { "text": "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.", "studyIds": [ "pmid:36102566" ] }, { "text": "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.", "studyIds": [ "pmid:39893840" ] }, { "text": "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.", "studyIds": [ "pmid:37906293" ] } ], "limitations": [ { "text": "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.", "studyIds": [ "pmid:42165106", "pmid:39792517", "pmid:37145226", "pmid:39656288" ] }, { "text": "'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.", "studyIds": [ "pmid:42633928", "pmid:40931185", "pmid:40401769" ] }, { "text": "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.", "studyIds": [ "pmid:41904336" ] }, { "text": "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.", "studyIds": [ "pmid:42057099" ] } ], "risks": [ { "text": "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.", "studyIds": [ "pmid:39544170" ], "severity": "serious" }, { "text": "One comparison found a much higher rate of the disease coming back with laser treatment than with open flap surgery.", "studyIds": [ "pmid:39953215" ], "severity": "minor" }, { "text": "One analysis found women had higher recurrence rates than men after the same types of surgery.", "studyIds": [ "pmid:42027172" ], "severity": "minor" } ], "whyPeopleTryIt": [ { "text": "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." }, { "text": "Surgery is the usual option offered, so people search to see if waiting it out is a reasonable alternative." }, { "text": "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." }, { "text": "Fear of surgical recovery time and scarring makes people hope the cyst will simply go away if they wait." } ], "keyStudies": [ "pmid:36102853", "pmid:39544170", "pmid:36102566", "pmid:37906293", "pmid:39893840", "pmid:42020338", "pmid:42057099" ], "studies": [ { "id": "pmid:42717603", "pmid": "42717603", "doi": "10.1111/ped.70526", "nctId": null, "pmcid": "PMC13559047", "title": "Comparison of Phenol Application and Endoscopic Pilonidal Sinus Treatment in Pediatric Pilonidal Sinus Disease", "firstAuthor": "Çolak", "multipleAuthors": true, "journal": "Pediatr Int", "year": 2026, "design": "retrospective", "n": 61, "nField": "reported", "population": "children with pilonidal sinus disease", "intervention": "endoscopic pilonidal sinus treatment (EPSiT)", "comparator": "phenol application", "primaryOutcome": "pain, recovery time, complications, and recurrence after treatment", "result": "EPSiT had less pain, faster return to activities, fewer complications, and fewer recurrences than phenol", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective comparison of two treatments without randomization, so differences could be due to other factors besides the treatment itself.", "directness": "indirect", "limitations": "Retrospective study design; not randomized; does not address natural duration or course of untreated pilonidal cysts.", "followUp": "", "plainFinding": "Endoscopic treatment worked better than phenol.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42717603/", "sourceText": "BACKGROUND: The optimal treatment for pilonidal sinus disease remains controversial; however, minimally invasive methods are becoming increasingly common in children compared to traditional surgical approaches. This study aimed to compare the outcomes of two different minimally invasive methods for treating pediatric pilonidal sinus disease: phenol application and endoscopic pilonidal sinus treatment (EPSiT). METHODS: Children who underwent EPSiT or phenolization for pilonidal sinus disease between January 2016 and January 2023 were included in the study. The patients' age, sex, treatment method, number of phenol applications or EPSiT procedures, visual analog scale (VAS) pain scores at postoperative 3 h, length of hospital stay, time to return to daily activities, early postoperative complications, and recurrence were analyzed. RESULTS: A total of 61 patients were included in the study, 38 males (62.3%) and 23 females (37.7%). The mean age was 15.18 ± 1.7 years. Thirty patients (49.2%) were in the EPSiT treatment group, and 31 patients (50.8%) were in the phenol treatment group. Postoperative VAS pain scores were significantly higher in the phenolization group than in the EPSiT group (2.68 ± 1.92 vs. 1; p < 0.001). Time to return to daily activities, number of applications, early postoperative complications, and recurrence were significantly lower in the EPSiT group compared to the phenol group (p < 0.001, p < 0.001, p = 0.023, and p < 0.001, respectively). CONCLUSION: For pediatric pilonidal sinus disease, EPSiT was more advantageous than phenol treatment in terms of postoperative pain, time to return to daily routine, early complications, and recurrence.", "provenance": [ { "field": "population", "quote": "pediatric pilonidal sinus disease" }, { "field": "intervention", "quote": "endoscopic pilonidal sinus treatment (EPSiT)" }, { "field": "comparator", "quote": "phenol application" }, { "field": "primaryOutcome", "quote": "VAS) pain scores at postoperative 3 h, length of hospital stay, time to return to daily activities, early postoperative complications, and recurrence" }, { "field": "result", "quote": "EPSiT was more advantageous than phenol treatment in terms of postoperative pain, time to return to daily routine, early complications, and recurrence." }, { "field": "n", "quote": "A total of 61 patients were included in the study" } ] }, { "id": "pmid:42700095", "pmid": "42700095", "doi": "10.1097/MD.0000000000050616", "nctId": null, "pmcid": "PMC13549620", "title": "Comparative outcomes of phenol therapy and Karydakis flap in pilonidal sinus disease: A retrospective cohort study with 1-year follow-up", "firstAuthor": "Osmanov", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2026, "design": "retrospective", "n": 125, "nField": "reported", "population": "adults with primary sacrococcygeal pilonidal sinus disease", "intervention": "phenol therapy (chemical ablation)", "comparator": "Karydakis flap surgery", "primaryOutcome": "wound healing time, return-to-work time, and recurrence rate at 1 year", "result": "Phenol therapy healed faster and allowed quicker return to work, but recurrence rates at 1 year were similar between groups", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, no randomization, and comparison is between two active treatments rather than against no treatment or natural course", "followUp": "1 year", "plainFinding": "Faster healing with phenol; recurrence similar.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42700095/", "sourceText": "Sacrococcygeal pilonidal sinus disease (PSD) is commonly treated by surgical excision with flap reconstruction. However, minimally invasive treatment modalities based on chemical ablation have gained increasing interest because PSD is not considered a neoplastic disease. Among these techniques, phenol therapy (PT) has emerged as an effective outpatient treatment associated with rapid recovery, low morbidity, and acceptable recurrence rates. To compare the 1-year clinical outcomes of PT and the Karydakis flap (KF) procedure in patients with primary sacrococcygeal PSD. This retrospective cohort study included 125 consecutive patients treated between January 2024 and January 2025. Seventy-seven patients underwent the KF procedure, whereas 48 patients received PT. Demographic characteristics, wound healing time, return-to-work time, postoperative complications, and recurrence rates were evaluated. Patients completed at least 1 year of follow-up through scheduled outpatient visits and structured telephone interviews. The mean age of the study population was 23.68 ± 8.21 years. No significant differences were observed between the groups regarding age, sex, body mass index, family history, prolonged sitting occupation, or history of preoperative abscess drainage (all P > .05). 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). Similarly, the return-to-work time was significantly shorter following PT. At 1-year follow-up, 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). PT was associated with faster wound healing and earlier return to work, while the 1-year recurrence rate did not differ significantly from that of the KF procedure. It may therefore represent a practical minimally invasive treatment alternative for carefully selected patients with primary sacrococcygeal PSD.", "provenance": [ { "field": "n", "quote": "This retrospective cohort study included 125 consecutive patients treated between January 2024 and January 2025." }, { "field": "population", "quote": "patients with primary sacrococcygeal PSD" }, { "field": "intervention", "quote": "phenol therapy (PT)" }, { "field": "comparator", "quote": "the Karydakis flap (KF) procedure" }, { "field": "primaryOutcome", "quote": "Demographic characteristics, wound healing time, return-to-work time, postoperative complications, and recurrence rates were evaluated." }, { "field": "result", "quote": "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)." }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:42633928", "pmid": "42633928", "doi": "10.1111/iwj.71018", "nctId": null, "pmcid": "PMC13500213", "title": "Surgical Treatment Outcomes for Primary Pilonidal Sinus Disease: A Single-Centre Retrospective Study of 2222 Patients (2006-2020)", "firstAuthor": "Tokocin", "multipleAuthors": true, "journal": "Int Wound J", "year": 2026, "design": "retrospective", "n": 2222, "nField": "reported", "population": "adults with a first-time (primary) pilonidal sinus who had surgery, followed for at least 5 years", "intervention": "various surgical techniques for pilonidal sinus (including Karydakis flap, Bascom cleft lift, Limberg flap, Dufourmentel flap)", "comparator": "lay-open (open wound healing) surgical technique", "primaryOutcome": "recurrence of pilonidal sinus and postoperative infection over time", "result": "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", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "minimum follow-up of 5 years", "plainFinding": "After surgery, most recurrences happen within 2 years.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42633928/", "sourceText": "Pilonidal sinus disease (PSD) is a common acquired condition of the sacrococcygeal region; despite numerous described surgical techniques, long-term outcomes remain highly variable. We compared long-term recurrence and postoperative infection among nine surgical techniques in a large single-centre cohort. We retrospectively analysed 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. Patients presenting with recurrent disease were excluded. Nine surgical techniques were evaluated. Recurrence was analysed as a time-to-event outcome using Kaplan-Meier estimates and multivariable Cox proportional hazards regression. The 5-year cumulative recurrence was 7.9% (175/2222) and postoperative infection 6.9% (154/2222); overall recurrence was 10.2% (226/2222). Recurrence and infection differed statistically significantly among surgical techniques (both p < 0.001). The lowest recurrence rates were observed with the Karydakis flap (1.5%), Bascom cleft lift (2.3%) and Dufourmentel flap (2.4%). Most recurrences occurred within the first 2 years, with a median time to recurrence of 20 months (IQR 12-36). Compared with lay-open treatment, the Karydakis flap (HR 0.19, 95% CI 0.12-0.30), Bascom cleft lift (HR 0.25, 95% CI 0.14-0.43), Limberg flap (HR 0.32, 95% CI 0.19-0.53) and Dufourmentel flap (HR 0.26, 95% CI 0.12-0.57) were independently associated with lower risk of recurrence, whereas a higher body mass index (HR 1.05 per 1 kg/m2, 95% CI 1.01-1.09) and current smoking (HR 1.98, 95% CI 1.54-2.55) were independently associated with an increased recurrence risk. Off-midline flap techniques were associated with superior long-term outcomes, with lower recurrence and infection than midline or secondary-healing approaches. Taken together, the findings of this study support the use of the Karydakis flap and Bascom cleft lift as first-line surgical options for PSD management.", "provenance": [ { "field": "n", "quote": "We retrospectively analysed 2222 patients with primary PSD" }, { "field": "population", "quote": "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" }, { "field": "intervention", "quote": "Nine surgical techniques were evaluated." }, { "field": "comparator", "quote": "Compared with lay-open treatment, the Karydakis flap (HR 0.19, 95% CI 0.12-0.30)" }, { "field": "primaryOutcome", "quote": "We compared long-term recurrence and postoperative infection among nine surgical techniques" }, { "field": "result", "quote": "The 5-year cumulative recurrence was 7.9% (175/2222) and postoperative infection 6.9% (154/2222); overall recurrence was 10.2% (226/2222)." }, { "field": "result", "quote": "Most recurrences occurred within the first 2 years, with a median time to recurrence of 20 months (IQR 12-36)." }, { "field": "followUp", "quote": "had a minimum follow-up of 5 years" } ] }, { "id": "pmid:42593573", "pmid": "42593573", "doi": "10.1007/s00383-026-06579-0", "nctId": null, "pmcid": null, "title": "Outcomes of minimally invasive pit-picking treatment in adolescents with uncomplicated pilonidal disease: a retrospective single-center study", "firstAuthor": "Başar", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2026, "design": "retrospective", "n": 42, "nField": "reported", "population": "adolescents aged 12-18 with uncomplicated pilonidal disease", "intervention": "minimally invasive pit-picking surgery", "comparator": "none (single group, no comparator treatment)", "primaryOutcome": "recurrence of pilonidal disease after treatment", "result": "14.3% of patients had recurrence, with a median time to recurrence of 10 months", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "15 months", "plainFinding": "Most healed, some recurred by 10 months", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42593573/", "sourceText": "PURPOSE: Pilonidal disease is a common condition in adolescents and is frequently associated with recurrence and postoperative morbidity. Minimally invasive techniques have been proposed to reduce surgical trauma and recovery time. This study aimed to evaluate the outcomes of the pit-picking procedure in adolescents with uncomplicated pilonidal disease. METHODS: 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. Demographic data, clinical presentation, treatment characteristics, follow-up duration, recurrence rates, and need for reintervention were analyzed. RESULTS: A total of 42 patients were included (24 females and 18 males; mean age 15.1 ± 1.4 years). At presentation, 64.3% of patients had an associated abscess. The median follow-up duration was 15 months. Recurrence occurred in six patients (14.3%), with a median time to recurrence of 10 months. The presence of an abscess at presentation did not increase recurrence risk, whereas patients with multiple sinus openings demonstrated a higher recurrence rate compared with those with a single sinus opening. CONCLUSION: Pit-picking is a safe and effective minimally invasive treatment for adolescents with uncomplicated pilonidal disease. With appropriate patient selection and adequate pre-procedural management, acceptable procedural outcomes can be achieved.", "provenance": [ { "field": "n", "quote": "A total of 42 patients were included" }, { "field": "population", "quote": "adolescents aged 12-18 years who underwent pit-picking for pilonidal disease" }, { "field": "intervention", "quote": "pit-picking procedure" }, { "field": "comparator", "quote": "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." }, { "field": "primaryOutcome", "quote": "recurrence rates, and need for reintervention were analyzed" }, { "field": "result", "quote": "Recurrence occurred in six patients (14.3%), with a median time to recurrence of 10 months." }, { "field": "followUp", "quote": "The median follow-up duration was 15 months." } ] }, { "id": "pmid:42560577", "pmid": "42560577", "doi": "10.1007/s00383-026-06553-w", "nctId": null, "pmcid": null, "title": "Laser-assisted endoscopic treatment of pilonidal sinus disease in children: a first pediatric series", "firstAuthor": "Türker Çolak", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2026, "design": "retrospective", "n": 45, "nField": "reported", "population": "children under 18 years old with pilonidal sinus disease", "intervention": "laser-assisted endoscopic treatment of pilonidal sinus (LEPSIT)", "comparator": "none - single group, repeat procedure after recurrence", "primaryOutcome": "successful cure of pilonidal sinus disease after treatment", "result": "91.1% of patients were cured after one procedure, and all patients eventually improved after up to two procedures", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, no control or comparator group, single center, relatively small number of patients.", "followUp": "32.4 ± 11.3 months", "plainFinding": "High cure rate after laser treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42560577/", "sourceText": "BACKGROUND: This study aims to describe the technical details of laser-assisted endoscopic pilonidal sinus treatment (LEPSIT), a method used for the first time in pediatric pilonidal sinus disease (PSD), and to report early-stage clinical outcomes in a pediatric cohort. METHODS: Clinical data of children under 18 years of age who underwent LEPSIT for PSD between November 2021 and July 2023 were retrospectively analyzed. RESULTS: Of the 45 patients included, 19 (42.2%) were female, and 26 (57.8%) were male; the mean age at surgery was 15.2 ± 3.1 years, and the mean body mass index was 25.1 ± 3.2. Of the 45 patients, 35 presented with an acute pilonidal abscess at initial evaluation and had undergone abscess drainage prior to LEPSIT. Six patients had been previously operated on for pilonidal sinus disease at an external center prior to LEPSIT. Mean procedure duration was 30 ± 7.2 min. The mean visual analog scale (VAS) score at 6 h was 1.8, 24 h was 1,1 and the mean analgesic use was 1 ± 0.3 days. 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. Mean follow-up was 32.4 ± 11.3 months. CONCLUSION: LEPSIT is an easy-to-administer, minimally painful (mean VAS score: 1.1), and minimally invasive treatment that shortens hospital stay and enables rapid return to daily activities. It is also a safe and well-tolerated option for recurrent PSD.", "provenance": [ { "field": "population", "quote": "Clinical data of children under 18 years of age who underwent LEPSIT for PSD" }, { "field": "intervention", "quote": "laser-assisted endoscopic pilonidal sinus treatment (LEPSIT)" }, { "field": "comparator", "quote": "4 patients (8.9%) had recurrence, all of whom achieved cure after a second LEPSIT" }, { "field": "primaryOutcome", "quote": "Successful treatment was achieved in 41 patients (91.1%) after a single procedure" }, { "field": "result", "quote": "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." }, { "field": "n", "quote": "Of the 45 patients included, 19 (42.2%) were female, and 26 (57.8%) were male" } ] }, { "id": "pmid:42304603", "pmid": "42304603", "doi": "10.1111/1346-8138.70354", "nctId": null, "pmcid": "PMC13435018", "title": "Minimally Invasive Phenol Treatment for Pilonidal Sinus: A Single-Center Case Series From Japan", "firstAuthor": "Komiyama", "multipleAuthors": true, "journal": "J Dermatol", "year": 2026, "design": "case-series", "n": 11, "nField": "reported", "population": "patients with pilonidal sinus, median age 27, mostly male", "intervention": "phenol injection into the sinus cavity after excision of pits and curettage", "comparator": "none mentioned", "primaryOutcome": "recurrence and complications after treatment", "result": "no recurrence was seen during follow-up, with two cases of bleeding managed without further surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, single-center case series with no comparison group and only short-term follow-up.", "directness": "indirect", "limitations": "small sample size, retrospective design, no control group, short follow-up period", "followUp": "331 days", "plainFinding": "No recurrence after phenol treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42304603/", "sourceText": "Pilonidal sinus is a chronic inflammatory condition of the natal cleft that commonly affects young adults. Conventional surgical treatments, such as wide excision and flap reconstruction, are associated with large wounds and prolonged recovery. Phenol treatment has been reported as a minimally invasive alternative in several countries; however, clinical experience in Japan remains limited. We retrospectively reviewed patients with pilonidal sinus who underwent phenol treatment at our institution between 2020 and 2025. After excision of the midline pits and curettage of the sinus tract, undiluted phenol was injected into the cavity and subsequently neutralized with ethanol. Clinical data, including patient characteristics, number of pits, operative time, postoperative hospital stay, complications, and recurrence, were analyzed. A total of 11 patients were included in the study. The median age was 27 years (range, 13-50), and 10 patients were male. The median number of pits was 3 (range, 1-5). The median operative time was 32 min (range, 19-56), and the median postoperative hospital stay was 2 days (range, 1-6). Postoperative bleeding occurred in two patients and was successfully managed conservatively. No recurrence was observed during the follow-up period (median, 331 days; range, 100-979). Phenol treatment for pilonidal sinus appears to be a simple and minimally invasive procedure associated with short hospitalization and favorable short-term outcomes. This technique may represent a useful treatment option for pilonidal sinus in Japan.", "provenance": [ { "field": "n", "quote": "A total of 11 patients were included in the study." }, { "field": "population", "quote": "The median age was 27 years (range, 13-50), and 10 patients were male." }, { "field": "intervention", "quote": "undiluted phenol was injected into the cavity and subsequently neutralized with ethanol" }, { "field": "comparator", "quote": "We retrospectively reviewed patients with pilonidal sinus who underwent phenol treatment at our institution between 2020 and 2025." }, { "field": "primaryOutcome", "quote": "Clinical data, including patient characteristics, number of pits, operative time, postoperative hospital stay, complications, and recurrence, were analyzed." }, { "field": "result", "quote": "No recurrence was observed during the follow-up period (median, 331 days; range, 100-979)." }, { "field": "followUp", "quote": "the follow-up period (median, 331 days; range, 100-979)" } ] }, { "id": "pmid:42168379", "pmid": "42168379", "doi": "10.1038/s41598-026-50716-7", "nctId": null, "pmcid": "PMC13503781", "title": "Pediatric endoscopic pilonidal sinus treatment (PEPSiT) as standard of care results over 10 years' experience in 507 patients", "firstAuthor": "Esposito", "multipleAuthors": true, "journal": "Sci Rep", "year": 2026, "design": "case-series", "n": 507, "nField": "reported", "population": "children and teenagers with pilonidal sinus disease (primary or recurrent)", "intervention": "minimally invasive keyhole surgery (PEPSiT) with ozone oil and later platelet-rich plasma dressings", "comparator": "none reported", "primaryOutcome": "disease recurrence, healing, pain, and patient satisfaction after surgery", "result": "10.4% of patients had the disease come back, mostly within 3 months, with painless recovery and high satisfaction", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a retrospective single-group case series with no comparison group, so it cannot show how long the condition lasts without treatment.", "directness": "indirect", "limitations": "Retrospective design, no control/comparator group, and focuses on surgical outcomes rather than natural disease duration.", "followUp": "", "plainFinding": "Low recurrence after keyhole surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42168379/", "sourceText": "Pilonidal sinus disease (PSD) is an acquired inflammatory condition of the gluteal cleft predominantly affecting teenagers. We report our 10-year experience adopting this minimally invasive approach, pediatric endoscopic pilonidal sinus treatment (PEPSiT). We retrospectively reviewed all patients, with primary or recurrent PSD, undergoing PEPSiT in the 2016-2025 period. We operated 507 patients (313 boys and 194 girls) with a median age of 15.5 years (IQR 12-18 years). All patients received our postoperative management. Data regarding success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10, IQR 1-2). Patient satisfaction was excellent (median score 4.8/5, IQR 4-5). Dressing after surgery was performed with ozone oil products in every patient and in the last 18 months Platelet-Rich Plasma (PRP) has been added to the intra and post-operative care too. Disease recurrence occurred in 53/507 patients (10.4%), mostly within 3 months (range 2 months-23 months), and all were successfully re-operated with PEPSiT with no further recurrence. This study demonstrates that a standardized perioperative protocol, including tailored pre- and post-operative management and structured long-term follow-up, is effective in ensuring favorable clinical outcomes, with negligible pain, high patient satisfaction and a low rate of recurrence.", "provenance": [ { "field": "n", "quote": "We operated 507 patients" }, { "field": "population", "quote": "Pilonidal sinus disease (PSD) is an acquired inflammatory condition of the gluteal cleft predominantly affecting teenagers." }, { "field": "intervention", "quote": "pediatric endoscopic pilonidal sinus treatment (PEPSiT)" }, { "field": "result", "quote": "Disease recurrence occurred in 53/507 patients (10.4%), mostly within 3 months (range 2 months-23 months)" }, { "field": "primaryOutcome", "quote": "Data regarding success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed." }, { "field": "comparator", "quote": "We retrospectively reviewed all patients, with primary or recurrent PSD, undergoing PEPSiT in the 2016-2025 period." } ] }, { "id": "pmid:42165106", "pmid": "42165106", "doi": "10.1111/iwj.70942", "nctId": null, "pmcid": "PMC13239841", "title": "Treatment Outcomes of Presacral Pilonidal Sinus Disease Using Crystallised Phenol: A Single-Centre Clinical Series", "firstAuthor": "Acar", "multipleAuthors": true, "journal": "Int Wound J", "year": 2026, "design": "case-series", "n": 40, "nField": "reported", "population": "patients with presacral pilonidal sinus disease", "intervention": "crystallised phenol treatment given in two or three sessions", "comparator": "two-session versus three-session phenol treatment groups", "primaryOutcome": "treatment duration, session requirement and recurrence after phenol treatment", "result": "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", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a small, single-centre case series without a control group or randomisation, so it cannot reliably show cause and effect.", "directness": "indirect", "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).", "followUp": "3 months", "plainFinding": "Treatment took about 18 days total.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42165106/", "sourceText": "OBJECTIVE: To evaluate short-term treatment outcomes and treatment burden in patients with presacral pilonidal sinus disease managed with crystallised phenol in a single-centre clinical series, with particular emphasis on the relationship between pit burden and session requirement. METHODS: Consecutive patients treated with crystallised phenol were analysed (n = 40). Demographic and clinical characteristics, symptom duration, pit count, number of phenol sessions (2 vs. 3), inter-session intervals, and total treatment duration were recorded. All patients completed scheduled clinical reassessment at 5 weeks and 3 months. Treatment-related abscess and recurrence during follow-up were documented. Continuous variables are presented as mean ± standard deviation and median (minimum-maximum). Comparisons between the two-session and three-session groups were performed with the Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables. RESULTS: The cohort was predominantly male (75%), with a mean age of 29.23 ± 9.85 years and a mean body mass index of 25.81 ± 3.85 kg/m2; 62.5% were smokers. Symptom duration was 6.80 ± 7.20 months, and mean pit count was 1.90 ± 0.93. Two sessions were sufficient in 42.5% (17/40), whereas 57.5% (23/40) required three sessions. The interval between the first and second sessions was 11.32 ± 3.30 days, and the interval between the second and third sessions was 11.96 ± 3.23 days in patients who underwent three sessions; overall treatment duration was 18.2 ± 7.58 days. No patient was lost to follow-up. Pit burden was the strongest determinant of requiring a third session: pit count was significantly higher in the three-session group than in the two-session group (2.39 ± 0.89 vs. 1.24 ± 0.44, p < 0.001), and all patients with ≥ 3 pits required three sessions. Smoking status (p = 1.000) and body mass index (BMI) (p = 0.208) were not associated with session requirement. Treatment-related abscess developed in 12.5% (5/40), and recurrence during the 3-month follow-up was observed in 12.5% (5/40); notably, all such events occurred in the three-session group (0/17 vs. 5/23, p = 0.061 for both comparisons). CONCLUSION: In this single-centre series, crystallised phenol provided acceptable short-term outcomes and a relatively short treatment course in presacral pilonidal sinus disease. Pit count emerged as the main determinant of requiring a third session, whereas smoking status and BMI were not associated with session requirement. Larger studies with longer follow-up are needed to clarify predictors of recurrence and to determine whether higher session requirements simply reflect disease complexity or also influence outcome.", "provenance": [ { "field": "n", "quote": "Consecutive patients treated with crystallised phenol were analysed (n = 40)." }, { "field": "population", "quote": "patients with presacral pilonidal sinus disease managed with crystallised phenol" }, { "field": "intervention", "quote": "crystallised phenol" }, { "field": "comparator", "quote": "Comparisons between the two-session and three-session groups were performed with the Mann-Whitney U test" }, { "field": "primaryOutcome", "quote": "To evaluate short-term treatment outcomes and treatment burden in patients with presacral pilonidal sinus disease managed with crystallised phenol" }, { "field": "result", "quote": "overall treatment duration was 18.2 ± 7.58 days" }, { "field": "result", "quote": "Two sessions were sufficient in 42.5% (17/40), whereas 57.5% (23/40) required three sessions." }, { "field": "result", "quote": "recurrence during the 3-month follow-up was observed in 12.5% (5/40)" }, { "field": "followUp", "quote": "All patients completed scheduled clinical reassessment at 5 weeks and 3 months." } ] }, { "id": "pmid:42128975", "pmid": "42128975", "doi": "10.1007/s10151-026-03314-8", "nctId": null, "pmcid": "PMC13342393", "title": "Does laser treatment affect outcome in pilonidal sinus disease? Long-term multicenter retrospective analysis of pit-picking alone vs. pit-picking with laser", "firstAuthor": "Arslan", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "retrospective", "n": 306, "nField": "reported", "population": "patients with pilonidal sinus disease who had pit-picking surgery", "intervention": "pit-picking surgery combined with laser treatment", "comparator": "pit-picking surgery alone", "primaryOutcome": "recurrence rate at 5 years", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "It's a retrospective, non-randomized comparison across multiple centers, so bias and confounding limit how much it can be trusted.", "directness": "indirect", "limitations": "Retrospective design, not randomized, authors call for further randomized trials", "followUp": "5 years", "plainFinding": "Most healed within about two weeks.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42128975/", "sourceText": "OBJECTIVES: The optimal management of pilonidal sinus disease (PSD) remains controversial, with multiple treatment approaches available. Pit-picking is a minimally invasive technique, often enhanced with laser treatment (LT), but the long-term benefits of LT remain uncertain. The objective of this study is to compare pit-picking alone versus pit-picking combined with LT. METHODS: This is a multicenter retrospective cohort study including seven centers across Turkey. Patients who underwent pit-picking surgery for PSD between June 2017 and March 2025 were included. Patients receiving adjunctive treatments beyond LT, undergoing excisional procedures, or with incomplete follow-up data were excluded. Pit-picking surgeries performed with or without LT were compared. The primary measure was the recurrence rate at 5 years. Secondary outcomes were postoperative pain, time to complete healing, complications, return to work, and costs. RESULTS: Of 306 patients, 109 (35.6%) underwent pit-picking alone, and 197 (64.4%) received pit-picking with LT. The complication rate was lower in the LT group (6.1% vs. 14.7%, p = 0.012). Patients treated with LT had shorter times to pain-free sitting (median 5 vs. 7 days, p < 0.001) and return to work (3 vs. 6 days, p < 0.001). 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). Costs were higher for the LT group ($1212 ± 146 vs. $888 ± 148), although complicated pit-picking cases had comparable costs to the LT group ($1198 ± 370, p = 0.004). Risk factors for recurrence included high BMI, family history, advanced Tezel stage, and postoperative complications. CONCLUSIONS: While LT improves early postoperative outcomes, it does not impact long-term recurrence rates. The increased cost of LT should be weighed against its benefits in reducing complications, pain, and recovery time. Further randomized trials are needed to refine patient selection criteria and assess cost-effectiveness. CLINICAL TRIAL REGISTRATION: NCT05569135, Registration date: 05.10.2022.", "provenance": [ { "field": "n", "quote": "Of 306 patients, 109 (35.6%) underwent pit-picking alone, and 197 (64.4%) received pit-picking with LT." }, { "field": "population", "quote": "Patients who underwent pit-picking surgery for PSD between June 2017 and March 2025 were included." }, { "field": "intervention", "quote": "pit-picking combined with LT" }, { "field": "comparator", "quote": "Pit-picking surgeries performed with or without LT were compared." }, { "field": "primaryOutcome", "quote": "The primary measure was the recurrence rate at 5 years." }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:42112873", "pmid": "42112873", "doi": "10.1111/ans.70737", "nctId": null, "pmcid": null, "title": "Endoscopic Pilonidal Sinus Treatment Versus Excisional Surgery: A Retrospective Comparison at an Australian Tertiary Centre", "firstAuthor": "Hlaing", "multipleAuthors": true, "journal": "ANZ J Surg", "year": 2026, "design": "retrospective", "n": 180, "nField": "reported", "population": "patients aged 12 and older having elective surgery for pilonidal sinus", "intervention": "endoscopic pilonidal sinus treatment (EPSiT)", "comparator": "excisional surgery (flap closure, lay-open excision, or primary closure)", "primaryOutcome": "whether the wound healed completely and whether the cyst came back after healing", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "retrospective design, single tertiary centre, operative episode-level analysis including repeat procedures, and a small subgroup analysis", "followUp": "", "plainFinding": "Similar healing and recurrence between surgery types.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42112873/", "sourceText": "BACKGROUND: Endoscopic pilonidal sinus treatment (EPSiT) may reduce recovery burden, but comparative data against contemporary excisional practices in Australia are limited. METHODS: We conducted a retrospective cohort study of consecutive elective pilonidal operations in patients aged ≥ 12 at a tertiary Australian hospital (January 2018-May 2025). Analyses were performed at the operative episode level, including repeat procedures. EPSiT was compared with excisional surgery (off-midline flap closure, lay-open excision or primary closure). The primary outcomes were primary healing and recurrence after healing. Secondary outcomes were same-day discharge and opioid prescription at discharge. RESULTS: The cohort included 180 elective operative episodes in 144 patients: 115 EPSiT (63.9%) and 65 excisional (36.1%). 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). EPSiT was associated with higher same-day discharge (86.1% vs. 21.5%; p < 0.001) and lower opioid prescribing at discharge (2.6% vs. 63.1%; p < 0.001). In the subgroup with prior emergency I&D (n = 66), primary healing remained similar (89.5% vs. 85.7%; p = 0.644), but recurrence after healing was higher following EPSiT (47.1% vs. 20.8%; p = 0.041). CONCLUSIONS: EPSiT achieved similar primary healing and recurrence to excisional surgery while enabling ambulatory care and opioid-sparing discharge. Prior abscess I&D was associated with higher recurrence after EPSiT despite comparable primary healing, supporting tailored counselling and selective EPSiT use when long-term durability is prioritised.", "provenance": [ { "field": "n", "quote": "The cohort included 180 elective operative episodes in 144 patients: 115 EPSiT (63.9%) and 65 excisional (36.1%)." }, { "field": "population", "quote": "a retrospective cohort study of consecutive elective pilonidal operations in patients aged ≥ 12 at a tertiary Australian hospital" }, { "field": "intervention", "quote": "EPSiT was compared with excisional surgery (off-midline flap closure, lay-open excision or primary closure)." }, { "field": "comparator", "quote": "EPSiT was compared with excisional surgery (off-midline flap closure, lay-open excision or primary closure)." }, { "field": "primaryOutcome", "quote": "The primary outcomes were primary healing and recurrence after healing." }, { "field": "result", "quote": "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)." }, { "field": "result", "quote": "recurrence after healing was higher following EPSiT (47.1% vs. 20.8%; p = 0.041)." } ] }, { "id": "pmid:42089833", "pmid": "42089833", "doi": "10.1111/iwj.70938", "nctId": null, "pmcid": "PMC13148142", "title": "Outcomes of Pilonidal Surgery Performed in the Setting of Standard Adjunct Laser Hair Removal: A Retrospective Cohort Study", "firstAuthor": "Jarrin Lopez", "multipleAuthors": true, "journal": "Int Wound J", "year": 2026, "design": "retrospective", "n": 168, "nField": "reported", "population": "patients aged 14-89 years who underwent operative treatment of PSD with adjunctive LHR", "intervention": "surgery for pilonidal sinus disease using Bascom flap closure, with adjunct laser hair removal", "comparator": "surgery using pilocystectomy, with adjunct laser hair removal", "primaryOutcome": "repeat procedures, 30-day surgical site infection, and unplanned clinic visits after surgery", "result": "Bascom flap closure had fewer repeat procedures and fewer unplanned visits than pilocystectomy, with similar infection rates", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective study without a non-laser comparison group, with low event counts that made more detailed statistical analysis unreliable.", "directness": "indirect", "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", "followUp": "", "plainFinding": "Fewer repeat surgeries with flap closure", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42089833/", "sourceText": "Pilonidal sinus disease (PSD) is associated with substantial morbidity because of wound complications and recurrence after surgery. Adjunct laser hair removal (LHR) has been incorporated into postoperative management in some settings, but real-world outcomes in cohorts treated uniformly with LHR remain incompletely described. This study aimed to characterize postoperative outcomes after PSD surgery in a large integrated healthcare system in which adjunctive LHR was standard practice and to compare outcomes by surgical approach. We performed a retrospective descriptive cohort study of patients aged 14-89 years who underwent operative treatment of PSD with adjunctive LHR at Kaiser Permanente Northern California between 2012 and 2024. Outcomes included repeat procedures, 30-day surgical site infection (SSI), and unplanned clinic visits. Outcomes were summarized as proportions overall and by surgical approach. Exploratory bivariable logistic regression examined associations between sex or body mass index (BMI) and outcomes. Multivariable modeling was not performed because of low event counts and sparse covariate distributions, which resulted in unstable models. Among 168 patients, the overall repeat procedure rate was 16.7%, the 30-day SSI rate was 14.4%, and 39.3% had at least one unplanned clinic visit. 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%). In exploratory analyses, sex and BMI were not significantly associated with outcomes in either surgical group. In this real-world cohort managed uniformly with adjunctive LHR, postoperative outcomes appeared to vary more by surgical approach than by sex or BMI. These findings are descriptive and do not estimate the independent effect of LHR. Controlled comparative studies are needed to determine the contribution of LHR to PSD outcomes.", "provenance": [ { "field": "n", "quote": "Among 168 patients" }, { "field": "population", "quote": "patients aged 14-89 years who underwent operative treatment of PSD with adjunctive LHR" }, { "field": "intervention", "quote": "Patients treated with Bascom flap closure had fewer repeat procedures" }, { "field": "comparator", "quote": "than those undergoing pilocystectomy" }, { "field": "primaryOutcome", "quote": "Outcomes included repeat procedures, 30-day surgical site infection (SSI), and unplanned clinic visits" }, { "field": "result", "quote": "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%)" } ] }, { "id": "pmid:42057099", "pmid": "42057099", "doi": "10.1186/s13256-025-05715-z", "nctId": null, "pmcid": "PMC13130490", "title": "Intermammary pilonidal sinus in an adolescent female: a case report", "firstAuthor": "Singh", "multipleAuthors": true, "journal": "J Med Case Rep", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "14-year-old girl with a pilonidal sinus between the breasts", "intervention": "complete surgical removal of the sinus tract with stitching it closed", "comparator": "none", "primaryOutcome": "recovery and recurrence after surgery", "result": "swelling lasted 1 year before becoming a draining sinus after 11 months; surgery led to full recovery with no recurrence at follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "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.", "directness": "indirect", "limitations": "single case report from an unusual location (intermammary, not the typical sacrococcygeal area), so findings may not generalize to typical pilonidal cysts.", "followUp": "", "plainFinding": "Symptoms lasted about a year.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42057099/", "sourceText": "BACKGROUND: Pilonidal sinus disease typically occurs in the sacrococcygeal region, with the intermammary location being exceptionally rare. We report the first documented case of an intermammary pilonidal sinus from eastern India in a 14-year-old Asian female. CASE PRESENTATION: A 14-year-old Asian female presented with 1-year history of intermammary swelling that evolved into a discharging sinus after 11 months. Physical examination revealed multiple sinus tract openings in the intermammary region with surrounding induration. Complete excision of the sinus tract with primary closure was performed under general anesthesia. Histopathological examination confirmed chronic inflammatory tissue consistent with the pilonidal sinus. The patient had an uncomplicated recovery with no recurrence at follow-up. CONCLUSIONS: Inclusion of intermammary pilonidal sinus in the differential diagnosis of chronic intermammary lesions should be considered, particularly in young females with large, pendulous breasts. Early recognition and complete surgical excision remain the gold standards for treatment, with excellent outcomes.", "provenance": [ { "field": "population", "quote": "A 14-year-old Asian female presented with 1-year history of intermammary swelling that evolved into a discharging sinus after 11 months." }, { "field": "intervention", "quote": "Complete excision of the sinus tract with primary closure was performed under general anesthesia." }, { "field": "comparator", "quote": "Complete excision of the sinus tract with primary closure was performed under general anesthesia." }, { "field": "primaryOutcome", "quote": "The patient had an uncomplicated recovery with no recurrence at follow-up." }, { "field": "result", "quote": "A 14-year-old Asian female presented with 1-year history of intermammary swelling that evolved into a discharging sinus after 11 months." }, { "field": "result", "quote": "The patient had an uncomplicated recovery with no recurrence at follow-up." }, { "field": "n", "quote": "A 14-year-old Asian female" } ] }, { "id": "pmid:42027172", "pmid": "42027172", "doi": "10.17116/hirurgia2026041110", "nctId": null, "pmcid": null, "title": "[Are there any male-to-female disparities in recurrence rates after surgery for Pilonidal Disease? A meta-analysis comparing differing mixed-gender cohorts]", "firstAuthor": "Doll", "multipleAuthors": true, "journal": "Khirurgiia (Mosk)", "year": 2026, "design": "meta-analysis", "n": 113021, "nField": "reported", "population": "adults with pilonidal sinus disease who had surgery, grouped by whether the study cohort was male-only, female-only, or mixed-gender", "intervention": "surgical treatment for pilonidal sinus disease (e.g., midline closure, open healing, Karydakis/Bascom procedures)", "comparator": "male-only patient cohorts versus female-only or mixed-gender cohorts with varying proportions of women", "primaryOutcome": "recurrence of the cyst/disease after surgery at 5 and 10 years", "result": "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", "resultDirection": "harm", "quality": "moderate", "qualityWhy": "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.", "directness": "indirect", "limitations": "The abstract notes the female-only cohort was very small, precluding further subgroup analyses, and calls for confirmation using individual patient data.", "followUp": "5-year and 10-year", "plainFinding": "Higher recurrence in women after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42027172/", "sourceText": "OBJECTIVE: Pilonidal Sinus Disease (PSD) manifests globally with a prevalence in adult men fourfold greater than in adult women. Due to the lower incidence in females the course of female PSD remains largely unexplored. In this study we aimed to assess the postoperative recurrence rate in women with PSD. MATERIAL AND METHODS: A systematic search of the existing PSD world literature between 1833 and 2023 employing search terms \"pilonid\" or \"dermoid\" AND \"cyst\" was conducted across all databases available including MEDLINE, PubMed, PubMed Central, Scopus, Ovid, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL). Studies were segregated into male-only (Mo), female-only (Fo), or male-female mixed cohorts (mixG) Kaplan-Meier Survival analysis. Recurrence rates at 5-year and 10-year follow-up following various surgical interventions were compared. Bias estimation was done using Newcastle-Ottawa scale for cohort studies and the Cochrane RoB1 tool for RCTs. RESULTS: 880 studies encompassing 113, 021 patients were surveyed, consisting of 133 randomized controlled trials (RCTs) with 13.275 patients and 747 non-randomized observational studies with 99.746 patients. The patient cohort, numbering 113.0219 individuals, was further categorized into male-only (Mo; 16.843 patients), female-only (Fo; 653 patients), or mixed-gender (mixG; 95.525 patients) cohorts. UNLABELLED: In RCTs involving mixG, a 5-year recurrence rate (RR) of 16.0% (95% CI 14.6%-17.3%) and a 10-year RR of 30.4% (95% CI 27.1%-33.5%) were observed. Conversely, in non-RCTs, the 5-year RR for mixG was 11.7% (95% CI 11.4%-12.0%), with a Mo RR of 2.2% (95% CI 1.9%-2.4%). The 10-year RR for mixG stood at 22.5% (95% CI 22.8%-23.2%), and 5.8% (95% CI 5.4%-6.3%) for the male-only group (p<0.0001; log rank test). These findings were significant consistent across subgroups, including primary midline closure, where the 5-year RR for mixG was 15.1% (95% CI 14.2%-16.0%) versus 7.0% (95% CI 5.7%-8.3%) for Mo, and the 10-year RR for mixG was 29.5% (95% CI 27.6%-31.3%) versus 14.4% (95% CI 12.4%-16.4%) for Mo (p<0.0001). Similar significant differences were noted in the primary open and Karydakis/Bascom subgroups. UNLABELLED: Due to the limited size of the male-only cohort, which precluded further subgroup analyses, studies were stratified based on the proportion of females above or below the mean of 19.87%. Notably, recurrence rates varied significantly based on female representation in RCTs (across all treatments and subgroups of primary midline and Bascom/Karydakis) and in non-RCT studies (across all treatments and subgroups of primary open, midline closure, and Bascom/Karydakis). CONCLUSION: Previously undisclosed, the 5-year recurrence rate in PSD for mixed gender cohorts with female share above mean 19.87% seem to significantly surpass that of their less female cohort counterparts across the analyzed therapeutic modalities in RCT as in non-RCT studies. The substantiation of these observations awaits scrutiny through individual patient data at the population level. Females with PSD seem to have a higher RR as compared to men for all therapies tested. UNLABELLED: Therefore, an establishment of Good Pilonidal Practice (GPP) criteria should be considered to protect our female PSD patients from entering the vicious cycle of repeat recurrences. UNLABELLED: What does this paper add to the literature? It has not uncovered before that females are an especially vulnerable group concerning PSD recurrences following surgical therapy. ABBREVIATIONS: FUP follow-up; GCP Good Clinical Practice; GPP Good Pilonidal Practice; IGF intergluteal fold; mixG mixed gender (male and female participants in published study cohort); Mo male-only; PSD Pilonidal Sinus Disease; pt patient; RCT randomised controlled trial; RR Recurrence rate; ROR return on recurrence; yr year.", "provenance": [ { "field": "n", "quote": "880 studies encompassing 113, 021 patients were surveyed" }, { "field": "population", "quote": "Studies were segregated into male-only (Mo), female-only (Fo), or male-female mixed cohorts (mixG)" }, { "field": "intervention", "quote": "Recurrence rates at 5-year and 10-year follow-up following various surgical interventions were compared." }, { "field": "comparator", "quote": "studies were stratified based on the proportion of females above or below the mean of 19.87%" }, { "field": "primaryOutcome", "quote": "In this study we aimed to assess the postoperative recurrence rate in women with PSD." }, { "field": "result", "quote": "Females with PSD seem to have a higher RR as compared to men for all therapies tested." } ] }, { "id": "pmid:42020338", "pmid": "42020338", "doi": "10.1111/iwj.70907", "nctId": null, "pmcid": "PMC13102628", "title": "Minimally Invasive, Maximally Effective: Outpatient Strategies for Paediatric Pilonidal Disease", "firstAuthor": "Donnelly", "multipleAuthors": true, "journal": "Int Wound J", "year": 2026, "design": "retrospective", "n": 69, "nField": "reported", "population": "children and teenagers (up to 18 years old) with pilonidal sinus disease", "intervention": "operative treatment (trephination or limited excision) for severe or refractory disease", "comparator": "non-operative/conservative management (structured conservative care or in-clinic debridement)", "primaryOutcome": "recurrence of pilonidal disease after healing, and time to healing", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Healing took a long time overall.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42020338/", "sourceText": "Pilonidal sinus disease (PNS) in children and adolescents lacks standardised management pathways. Minimally invasive and outpatient-based strategies are increasingly adopted, but paediatric-specific data remain limited. This study evaluated outcomes following implementation of a structured, tiered outpatient pathway. A retrospective single-centre cohort study was conducted including patients aged ≤ 18 years treated for PNS between February 2023 and August 2024. Management followed a stepwise protocol: structured conservative care, in-clinic debridement and operative intervention (trephination or limited excision) for refractory or severe disease. Primary outcome was recurrence after documented healing. Secondary outcomes included time to healing, clinic utilisation and associations with clinical variables. 69 patients were included (median age 15 years [IQR 14-16]; 64% male). Twenty-three patients (33.3%) required operative management. 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). Median follow-up duration did not differ significantly between groups. Prior infection at presentation showed a numerical but not statistically significant association with recurrence. Time to healing was prolonged in both groups and did not differ significantly. Within a structured outpatient pathway, paediatric patients demonstrated low overall recurrence rates. Conservative management was associated with lower recurrence; however, patients undergoing operative intervention likely represented a more severe subgroup. Prospective severity-adjusted studies are required to define optimal paediatric wound management strategies for PNS.", "provenance": [ { "field": "population", "quote": "patients aged ≤ 18 years treated for PNS between February 2023 and August 2024" }, { "field": "n", "quote": "69 patients were included" }, { "field": "intervention", "quote": "operative intervention (trephination or limited excision) for refractory or severe disease" }, { "field": "comparator", "quote": "structured conservative care, in-clinic debridement" }, { "field": "primaryOutcome", "quote": "Primary outcome was recurrence after documented healing." }, { "field": "result", "quote": "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)." }, { "field": "result", "quote": "Time to healing was prolonged in both groups and did not differ significantly." } ] }, { "id": "pmid:41999968", "pmid": "41999968", "doi": "10.1016/j.jpedsurg.2026.163145", "nctId": null, "pmcid": null, "title": "Surgical management of pilonidal sinus disease in pediatric population: An updated systematic review and meta-analysis", "firstAuthor": "Saleem", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2026, "design": "meta-analysis", "n": 5075, "nField": "reported", "population": "children and teenagers (18 years or younger) with pilonidal disease", "intervention": "various surgical techniques for pilonidal disease (open healing, midline closure, off-midline closure, minimally invasive surgery)", "comparator": "different surgical techniques compared against each other", "primaryOutcome": "recurrence, wound complications, and recovery time after surgery", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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", "followUp": "", "plainFinding": "Healing time varies a lot by surgery type.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41999968/", "sourceText": "BACKGROUND: Pilonidal disease (PD) is a chronic inflammatory condition of the natal cleft that commonly affects pediatric population, leading to high morbidity, frequent recurrences, and impaired quality of life. Despite various surgical approaches, no consensus exists on the optimal technique, and pediatric-specific evidence is limited. OBJECTIVES: To compare recurrence, wound complications, and recovery outcomes across surgical techniques in patients ≤18 years with PD. METHODOLOGY: A systematic search of MEDLINE, Cochrane, and Google Scholar (inception-Dec 2024) identified 59 studies (N = 5075). Data on recurrence, wound complications, healing time, operative time, hospital stay, return to daily activities (ADL), pain scores, and reoperation rates were extracted. Random-effects models were used for pooled estimates. Subgroup analyses and meta-regression explored heterogeneity and impact of follow-up duration. Study quality was assessed using the Newcastle-Ottawa Scale and ROB-2. RESULTS: Open healing showed the highest recurrence (20.1%) and moderate wound complication rates (16.2%), with healing times up to 98 days. Midline primary closure had a recurrence rate of 17.5%, the highest wound complication rate (43.5%), and a reoperation rate of 29.8%. Off-midline closures had the lowest recurrence (10.2%) and moderate complications (19.5%), with healing times as short as 8 days. Minimally invasive techniques (MITs), particularly PEPSiT, demonstrated low recurrence (11.4%), minimal complications (6.5%), short operative times (17-50 min), early return to ADL (1-3 days), and low postoperative pain (VAS 0-2). Adjunctive laser epilation improved outcomes across all techniques. Meta-regression showed longer follow-up was associated with lower recurrence in most groups, except open healing. CONCLUSION: Off-midline closure and minimally invasive strategies, especially when combined with laser epilation, offer superior outcomes in recurrence, complications, and recovery.", "provenance": [ { "field": "n", "quote": "identified 59 studies (N = 5075)" }, { "field": "population", "quote": "patients ≤18 years with PD" }, { "field": "intervention", "quote": "Despite various surgical approaches, no consensus exists on the optimal technique" }, { "field": "comparator", "quote": "compare recurrence, wound complications, and recovery outcomes across surgical techniques" }, { "field": "primaryOutcome", "quote": "Data on recurrence, wound complications, healing time, operative time, hospital stay, return to daily activities (ADL), pain scores, and reoperation rates were extracted." }, { "field": "result", "quote": "Open healing showed the highest recurrence (20.1%) and moderate wound complication rates (16.2%), with healing times up to 98 days." }, { "field": "result", "quote": "Off-midline closures had the lowest recurrence (10.2%) and moderate complications (19.5%), with healing times as short as 8 days." } ] }, { "id": "pmid:41904336", "pmid": "41904336", "doi": "10.1007/s00423-026-04027-0", "nctId": null, "pmcid": "PMC13152950", "title": "Shrinking follow-up duration in pilonidal sinus surgery, 1970-2020: a patient-weighted longitudinal analysis of 2,285 studies", "firstAuthor": "Arslan", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2026, "design": "systematic-review", "n": 2285, "nField": "reported", "population": "People who had surgery for pilonidal sinus/cyst, studied across 2,285 published surgical series from 1850 to the present", "intervention": "Pilonidal sinus surgery (various types), as reported in the studies analyzed", "comparator": "No treatment comparator; this study compares follow-up reporting practices across different decades of publication rather than comparing treatments", "primaryOutcome": "How long patients were followed up after surgery in published studies, and whether this was long enough to catch recurrences", "result": "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", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Studies don't track patients long enough.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41904336/", "sourceText": "BACKGROUND: Reliable estimation of recurrence after pilonidal sinus surgery requires sufficient follow-up (FUP). Despite evidence suggesting ≥ 5 years is necessary, contemporary reports appear to adopt progressively shorter surveillance windows. METHODS: We assembled a structured database of 2,285 pilonidal surgery series (1850–present) and extracted publication mid-decade, FUP since surgery, and cohort size (n). For 1970–2020, we calculated decade-wise patient-weighted mean FUP. Secular change was estimated using weighted least squares (WLS; weights = n), with unweighted sensitivity analyses. Associations between decade and FUP were assessed via weighted Pearson correlation with Kish effective sample size. We summarized proportions meeting ≥ 2, ≥5, ≥ 10 years and patient shares by FUP bands. RESULTS: Median FUP was 1.67 years; mean 2.50 years. Only 14.2% of studies reported ≥ 5 years and 2.9% ≥10 years. 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). Relative to the 1970s (3.78 years), the 2020s were − 1.23 years (− 32.5%), and − 4.14 years (− 61.9%) below the 1980s. The WLS slope was − 0.0766 years·year⁻¹ (95% CI − 0.0856 to − 0.0675; p = 4.57 × 10⁻⁵⁸); unweighted slope − 0.0407 (95% CI − 0.0479 to − 0.0334; p = 1.47 × 10⁻²⁷). Weighted correlation: Rw = − 0.342 (Kish n ≈ 216; p = 2.5 × 10⁻⁷). In the 2020s, patients were distributed as 55.3% <2 years, 26.6% 2–<5, 15.8% 5–<10, 2.3% ≥10. CONCLUSIONS: Follow-up windows have contracted substantially, risking under-ascertainment of late recurrences. A minimum of ≥ 5-year FUP with staged reporting at 5 and 10 years and registry-based surveillance is recommended. The absence of a pilonidal core outcome set (COS) in guidelines impedes consistent, long-horizon reporting; COS development and guideline adoption should be prioritized.", "provenance": [ { "field": "population", "quote": "2,285 pilonidal surgery series (1850–present)" }, { "field": "intervention", "quote": "pilonidal sinus surgery" }, { "field": "comparator", "quote": "decade-wise patient-weighted mean FUP" }, { "field": "primaryOutcome", "quote": "Reliable estimation of recurrence after pilonidal sinus surgery requires sufficient follow-up (FUP)." }, { "field": "result", "quote": "Median FUP was 1.67 years; mean 2.50 years." }, { "field": "result", "quote": "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)." }, { "field": "n", "quote": "2,285 pilonidal surgery series (1850–present)" } ] }, { "id": "pmid:41854814", "pmid": "41854814", "doi": "10.1007/s13304-026-02585-y", "nctId": null, "pmcid": null, "title": "Comparative study of the Karydakis flap versus conventional surgical techniques for pilonidal sinus disease: a systematic review and meta-analysis", "firstAuthor": "Alsalaumy", "multipleAuthors": false, "journal": "Updates Surg", "year": 2026, "design": "meta-analysis", "n": 3108, "nField": "reported", "population": "people having surgery for pilonidal sinus disease", "intervention": "Karydakis flap surgery", "comparator": "midline closure or excision left to heal naturally", "primaryOutcome": "cyst coming back (recurrence) and infection after surgery", "result": "Karydakis flap had lower recurrence and fewer infections than the other techniques, and faster return to work", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it pools many studies but mixes randomised trials with non-randomised comparisons, which can bias results.", "directness": "indirect", "limitations": "combines randomized and non-randomized comparative cohort studies, with some heterogeneity between studies", "followUp": "", "plainFinding": "Karydakis flap lowers recurrence, faster recovery", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/41854814/", "sourceText": "The ideal surgical treatment for pilonidal sinus disease (PSD) is controversial. The Karydakis flap (KF) was compared with midline closure (MC) and excision with healing by secondary intention (EHSI). A systematic review and meta-analysis of randomised and comparative cohort studies (through February 2025) was performed. The primary outcomes included recurrence and infection, whereas secondary outcomes were seroma, operative time, hospital stay, overall complications, and return to work. The effect sizes were identified using odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI), using random-effects models. Fifteen studies (n = 3,108) were identified for inclusion (KF = 1,257, MC = 1,593, EHSI = 258). 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 (OR 0.06, 95% CI 0.007-0.486; p = 0.008) and returned to work earlier compared with MC (MD - 6.5 days) and EHSI (MD - 18.9 days). Hospital stay did not differ between KF and MC (MD - 0.08 days). KF provides lower recurrence and faster recovery compared with MC and EHSI, supporting its use as the preferred surgical technique for PSD.", "provenance": [ { "field": "n", "quote": "Fifteen studies (n = 3,108) were identified for inclusion" }, { "field": "intervention", "quote": "The Karydakis flap (KF) was compared with midline closure (MC) and excision with healing by secondary intention (EHSI)." }, { "field": "comparator", "quote": "The Karydakis flap (KF) was compared with midline closure (MC) and excision with healing by secondary intention (EHSI)." }, { "field": "primaryOutcome", "quote": "The primary outcomes included recurrence and infection" }, { "field": "result", "quote": "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" }, { "field": "population", "quote": "pilonidal sinus disease (PSD)" } ] }, { "id": "pmid:41834241", "pmid": "41834241", "doi": "10.1002/wjs.70299", "nctId": null, "pmcid": null, "title": "Long-Term Outcomes of Sinus Laser-Assisted Closure in Primary Versus Recurrent Sacrococcygeal Pilonidal Sinus Disease: A Retrospective Cohort Study", "firstAuthor": "van Kempen", "multipleAuthors": true, "journal": "World J Surg", "year": 2026, "design": "retrospective", "n": 267, "nField": "reported", "population": "patients with primary or recurrent sacrococcygeal pilonidal sinus disease treated with laser surgery", "intervention": "sinus laser-assisted closure (SiLaC) surgery for pilonidal sinus", "comparator": "primary disease versus recurrent disease status", "primaryOutcome": "whether the pilonidal sinus came back (recurrence) after treatment", "result": "Recurrent disease had higher recurrence rates and took longer to heal than primary disease, though initial healing rates were similar.", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, single center, no comparison to no treatment or other therapies, and follow-up relied partly on telephone interviews.", "followUp": "a median of 4.0 years (IQR: 3.6-5.0 years)", "plainFinding": "Healing took 6-8 weeks; recurrence common.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41834241/", "sourceText": "BACKGROUND: Sinus laser-assisted closure (SiLaC) demonstrates favorable outcomes for primary sacrococcygeal pilonidal sinus disease (SPSD), yet its efficacy in recurrent disease remains undefined. This study compared long-term outcomes following SiLaC in primary versus recurrent SPSD, hypothesizing that recurrent disease would predict inferior results. METHODS: This retrospective cohort study analyzed 267 consecutive patients undergoing SiLaC at a single center (July 2019-August 2022), stratified by disease status: primary (n = 214) versus recurrent (n = 53). The primary outcome, disease recurrence, was assessed using Kaplan-Meier analysis; secondary outcomes included healing rates, healing time, and complications. Univariable risk factor analysis was performed. Follow-up through telephone interviews and review of medical records achieved a 90.3% completion rate at a median of 4.0 years (IQR: 3.6-5.0 years). RESULTS: 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. At the final follow-up, the recurrence rate was 34.6% for primary disease and 60.8% for recurrent disease. The time to recurrence was accelerated in recurrent cases (median, 11.4 vs. 14.0 months, p < 0.05). 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). Sequential SiLaC procedures, when necessary, achieved final healing rates exceeding 90% in both groups with minimal complications (5.8%). Three factors predicted recurrence: recurrent disease status in all patients; within recurrent cases, symptom duration greater than 38 weeks (RR 2.14) and four or more medial openings (RR 2.07); all p < 0.05. CONCLUSION: SiLaC demonstrated acceptable recurrence rates for primary SPSD comparable to other minimally invasive techniques at long-term follow-up, but significantly poorer outcomes in recurrent disease. Therefore, SiLaC may be considered a feasible first-line option for primary SPSD, while recurrent cases require careful patient selection and consideration of alternative treatments.", "provenance": [ { "field": "n", "quote": "This retrospective cohort study analyzed 267 consecutive patients undergoing SiLaC at a single center" }, { "field": "population", "quote": "stratified by disease status: primary (n = 214) versus recurrent (n = 53)" }, { "field": "intervention", "quote": "Sinus laser-assisted closure (SiLaC) demonstrates favorable outcomes for primary sacrococcygeal pilonidal sinus disease (SPSD)" }, { "field": "comparator", "quote": "compared long-term outcomes following SiLaC in primary versus recurrent SPSD" }, { "field": "primaryOutcome", "quote": "The primary outcome, disease recurrence, was assessed using Kaplan-Meier analysis" }, { "field": "result", "quote": "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)." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:41804956", "pmid": "41804956", "doi": "10.1177/25785478261428953", "nctId": null, "pmcid": null, "title": "Localization-Based Surgical Approaches in Pilonidal Sinus Treatment: A Comparative Study of Laser Therapy and Alternative Techniques", "firstAuthor": "Tekin", "multipleAuthors": true, "journal": "Photobiomodul Photomed Laser Surg", "year": 2026, "design": "prospective-cohort", "n": null, "nField": "not-reported", "population": "patients with pilonidal sinus disease treated surgically", "intervention": "laser therapy", "comparator": "microsinusectomy, phenol application after surgical resection, and platelet-rich plasma (PRP) treatment", "primaryOutcome": "rate of disease coming back after treatment (postoperative recurrence)", "result": "laser therapy had the lowest overall recurrence (15.6%) but the highest recurrence (83.3%) in cases with disease in mixed locations", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is a non-randomized comparison of different surgical techniques without numbers of patients given, so the recurrence results are not very reliable.", "directness": "indirect", "limitations": "abstract does not report patient numbers, randomization, or how groups were matched beyond 'comparable sociodemographic characteristics'", "followUp": "a minimum of two years", "plainFinding": "Recurrence rates vary by treatment and cyst location.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41804956/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a chronic inflammatory condition most commonly observed in the sacrococcygeal region and predominantly affecting young individuals. Although various treatment modalities are currently employed, none has demonstrated definitive superiority, as recurrence rates-an important indicator of treatment success-remain considerable. OBJECTIVE: This study aimed to evaluate the comparative treatment success of commonly used PSD management strategies based on postoperative recurrence rates. METHODS: Patients with comparable sociodemographic characteristics were allocated into four treatment groups: microsinusectomy, surgical resection followed by phenol application, platelet-rich plasma (PRP), and laser therapy. All patients were followed for a minimum of two years. Treatment outcomes were assessed primarily in terms of postoperative recurrence. RESULTS: Among the evaluated modalities, 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%). These findings suggest that treatment success may vary depending on anatomical localization. CONCLUSION: Laser therapy may provide favorable outcomes in selected anatomical locations but appears less effective in mixed-location disease. Detailed anatomical classification should be incorporated into future studies, and outcomes should be reassessed using different laser treatment protocols to optimize patient selection and therapeutic success.", "provenance": [ { "field": "primaryOutcome", "quote": "Treatment outcomes were assessed primarily in terms of postoperative recurrence." }, { "field": "intervention", "quote": "laser therapy" }, { "field": "comparator", "quote": "microsinusectomy, surgical resection followed by phenol application, platelet-rich plasma (PRP), and laser therapy" }, { "field": "population", "quote": "Patients with comparable sociodemographic characteristics were allocated into four treatment groups" }, { "field": "result", "quote": "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%)." }, { "field": "followUp", "quote": "All patients were followed for a minimum of two years." } ] }, { "id": "pmid:41758282", "pmid": "41758282", "doi": "10.1007/s00383-026-06361-2", "nctId": null, "pmcid": null, "title": "Advancing pilonidal disease care through pediatric endoscopic treatment (PEPSiT): early insights", "firstAuthor": "Darbandi", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2026, "design": "retrospective", "n": 32, "nField": "reported", "population": "adolescents and young adults with pilonidal sinus disease, median age 15", "intervention": "endoscopic surgery for pilonidal sinus (PEPSiT)", "comparator": "", "primaryOutcome": "time to healing, complications, and recurrence after surgery", "result": "median healing time was 3 months, with 3 recurrences out of 32 patients", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, small sample size, no comparator group, and the study authors call for larger prospective studies.", "followUp": "9 months", "plainFinding": "Healed in about 3 months after surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41758282/", "sourceText": "BACKGROUND: Pilonidal Sinus Disease (PSD) is an acquired inflammatory condition with no standard treatment. We evaluated our initial experience with Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT). METHODS: We retrospectively reviewed all PEPSiT cases from May 2021-January 2025. Data collected included demographics, presentation, comorbidities, BMI, surgical time, anesthesia, hospital stay, complications, healing, recurrence, and follow-up (median, range). RESULTS: Thirty-two patients (18 males) underwent PEPSiT, median age 15 years (11-18), BMI 26.6 kg/m² (16.7-51.6). None had prior surgery for PSD. Three had comorbidities (two with type 1 diabetes, one with Hemophilia B). Median operative time was 39 min (19-58). All were day surgery procedures; 28 under sedation/local and 4 under general anesthesia. Median healing was 3 months (1-24). Complications included one granuloma (treated with silver nitrate) and one hematoma. All resumed normal activities the next day. Median follow-up was 9 months (1-52). Three recurrences were successfully treated with redo-PEPSiT. CONCLUSION: Our outcomes suggest that PEPSiT is a safe, effective option for PSD. However, larger prospective studies are needed.", "provenance": [ { "field": "n", "quote": "Thirty-two patients (18 males) underwent PEPSiT" }, { "field": "population", "quote": "median age 15 years (11-18)" }, { "field": "intervention", "quote": "Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT)" }, { "field": "primaryOutcome", "quote": "surgical time, anesthesia, hospital stay, complications, healing, recurrence, and follow-up" }, { "field": "result", "quote": "Median healing was 3 months (1-24)." }, { "field": "result", "quote": "Three recurrences were successfully treated with redo-PEPSiT." }, { "field": "followUp", "quote": "Median follow-up was 9 months (1-52)." } ] }, { "id": "pmid:41752637", "pmid": "41752637", "doi": "10.3390/medicina62020238", "nctId": null, "pmcid": "PMC12941716", "title": "The Use of Methylene Blue in Pilonidal Sinus Surgery Reduces the Risk of Recurrence: A Systematic Review and Meta-Analysis", "firstAuthor": "Maak", "multipleAuthors": true, "journal": "Medicina (Kaunas)", "year": 2026, "design": "meta-analysis", "n": 130677, "nField": "reported", "population": "patients with pilonidal sinus disease having surgery", "intervention": "staining the sinus with methylene blue dye during surgery", "comparator": "surgery without methylene blue staining", "primaryOutcome": "rate of the cyst coming back after surgery (recurrence)", "result": "methylene blue staining was linked to a lower recurrence rate for most surgical techniques, but a higher recurrence rate for one flap technique", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Dye marking may cut recurrence after cyst surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41752637/", "sourceText": "Background and Objectives: Pilonidal Sinus Disease shows an increasing incidence. Surgical interventions are often necessary; thus, we wanted to analyze whether the usage of methylene blue (MB) for staining the PSD fistulas for better visualization during surgery shows an effect concerning recurrence rates. Materials and Methods: A thorough data search and cross-study data synthesis of publications in the time period of 1833 to 2023 lead to a total of 7936 studies focusing on PSD. The data sets were scanned for the eligibility criteria, namely treatment information, follow-up, recurrence data, and the use of MB in surgery. The data were sorted into different surgical treatment groups, and the recurrence rates were analyzed using Kaplan-Meier-survival curves. Results: A total of 1192 studies involving 130,677 patients were eligible for analysis. A total of 263 studies were performed with MB (22.1%, n = 25,602 patients) and 929 studies without MB (77.9%, n = 105,075 patients). Overall, there was a highly significant difference in RR between the group of MB-stained patients and those without (p < 0.0001), even if analyzed separately for treatments. 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), and Other Flaps showed less RR with the use of MB (p = 0.011); both groups showed a notable loss of follow-up data, diminishing the meaning of these p values. Conclusions: This study shows that the use of MB as a staining technique in PSD surgery may be beneficial regarding recurrence rates. Therefore, the routinely use of MB staining in PSD surgery should be considered.", "provenance": [ { "field": "n", "quote": "A total of 1192 studies involving 130,677 patients were eligible for analysis" }, { "field": "population", "quote": "Pilonidal Sinus Disease shows an increasing incidence" }, { "field": "intervention", "quote": "the usage of methylene blue (MB) for staining the PSD fistulas for better visualization during surgery" }, { "field": "comparator", "quote": "929 studies without MB (77.9%, n = 105,075 patients)" }, { "field": "primaryOutcome", "quote": "recurrence rates were analyzed using Kaplan-Meier-survival curves" }, { "field": "result", "quote": "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)" }, { "field": "limitations", "quote": "both groups showed a notable loss of follow-up data, diminishing the meaning of these p values" } ] }, { "id": "pmid:41680360", "pmid": "41680360", "doi": "10.1007/s00423-026-03988-6", "nctId": null, "pmcid": "PMC12975824", "title": "Limberg flap reconstruction for recurrent pilonidal sinus disease: A single-center U.S. Cohort", "firstAuthor": "Oruc", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2026, "design": "retrospective", "n": 37, "nField": "reported", "population": "patients with recurrent pilonidal sinus disease who had multiple previous surgeries", "intervention": "Limberg flap reconstruction surgery", "comparator": "none - no comparison group, all patients received the same surgery", "primaryOutcome": "disease recurrence after surgery", "result": "no recurrence observed during median follow-up of 4.5 years, with an 11% complication rate mainly wound dehiscence", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, single center, no control or comparator group, small sample size of 37 patients.", "followUp": "4.5 years", "plainFinding": "No recurrence after flap surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41680360/", "sourceText": "PURPOSE: Recurrent pilonidal sinus disease (PSD) presents a significant surgical challenge. Although Limberg flap (LF) reconstruction has demonstrated favorable outcomes in the international literature, long-term outcome data from U.S. institutions, particularly in recurrent cases, remain limited. This study evaluated the long-term outcomes of LF reconstruction in a single-center U.S. cohort with recurrent PSD. METHODS: A retrospective analysis was conducted of patients who underwent LF for recurrent PSD between 2014 and 2023. Data on patient demographics, operative details, and postoperative courses were collected. Long-term follow-up, including assessment for recurrence, was obtained via structured telephone interviews and chart reviews. RESULTS: Thirty-seven patients were included. The cohort was predominantly male (76%) with a median BMI of 29.4 kg/m². 59% were active smokers, and 52% had undergone multiple previous pilonidal operations. The median operative time was 72 min. 92% of the patients were discharged on the same day, and no surgical drains were used. The postoperative complication rate was 11%, primarily consisting of wound dehiscence. No recurrence was observed during the median follow-up of 4.5 years. CONCLUSION: In this retrospective cohort study of patients with recurrent pilonidal sinus disease, Limberg flap reconstruction was associated with durable disease control and acceptable postoperative morbidity while remaining compatible with early discharge. These findings support Limberg flap reconstruction as a viable option for patients with complex recurrent disease.", "provenance": [ { "field": "n", "quote": "Thirty-seven patients were included." }, { "field": "population", "quote": "patients who underwent LF for recurrent PSD between 2014 and 2023" }, { "field": "intervention", "quote": "Limberg flap (LF) reconstruction" }, { "field": "comparator", "quote": "A retrospective analysis was conducted of patients who underwent LF for recurrent PSD" }, { "field": "primaryOutcome", "quote": "Long-term follow-up, including assessment for recurrence, was obtained via structured telephone interviews and chart reviews." }, { "field": "result", "quote": "No recurrence was observed during the median follow-up of 4.5 years." }, { "field": "followUp", "quote": "median follow-up of 4.5 years" } ] }, { "id": "pmid:41590391", "pmid": "41590391", "doi": "10.17116/hirurgia202601133", "nctId": null, "pmcid": null, "title": "[Clinical experience of using modified Limberg plastic surgery using a polymer hydrogel for recurrent and complex pilonidal sinus]", "firstAuthor": "Sahakyan", "multipleAuthors": true, "journal": "Khirurgiia (Mosk)", "year": 2026, "design": "retrospective", "n": 97, "nField": "reported", "population": "patients with recurrent or complex pilonidal sinus disease", "intervention": "modified Limberg flap surgery combined with polymer hydrogel", "comparator": "traditional Limberg flap surgery and modified Limberg flap without hydrogel", "primaryOutcome": "rate of disease recurrence and postoperative complications", "result": "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", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "No statistical significance reported for recurrence rate differences between groups; authors state further studies are required to confirm results.", "followUp": "", "plainFinding": "Lower recurrence with hydrogel-assisted surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41590391/", "sourceText": "OBJECTIVE: Evaluation of the effectiveness of various surgical techniques, comparison of their results and study of the effect of polymer hydrogel on treatment outcomes. METHODS: The study included 97 patients with a diagnosis of recurrent or complex PSD (Pilonidal sinus disease). Patients were divided into 3 groups who underwent surgery using the traditional Limberg flap, modified Limberg flap, or operated using modified Limberg flap and polymer hydrogel in the coloproctology department of the A.S. Loginov International Research Center from March 2015 to September 2023. The incidence of complications in the early postoperative period and the frequency of relapses in the late period were assessed. RESULTS: 97 patients were included in the study; long-term results were observed in 84 patients (86.6%). 88.7% of them are men, 11.3% are women. There were no statistically significant differences in the incidence of complications in the early postoperative period between the groups (p=0.374). 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. There are no statistically significant differences in the following parameters: average blood loss, duration of hospitalization, indicators of postoperative control, and the level of inflammatory markers. There were no intraoperative complications in any of the groups. CONCLUSION: Modified plastic using a polymer hydrogel to eliminate \"dead zones\" and avoid drainage in the postoperative period has demonstrated its effectiveness, however, further studies are required to confirm the results obtained.", "provenance": [ { "field": "n", "quote": "97 patients were included in the study" }, { "field": "population", "quote": "97 patients with a diagnosis of recurrent or complex PSD (Pilonidal sinus disease)" }, { "field": "intervention", "quote": "modified Limberg flap and polymer hydrogel" }, { "field": "comparator", "quote": "traditional Limberg flap, modified Limberg flap" }, { "field": "primaryOutcome", "quote": "The incidence of complications in the early postoperative period and the frequency of relapses in the late period were assessed" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:41461191", "pmid": "41461191", "doi": "10.1055/a-2773-3657", "nctId": null, "pmcid": null, "title": "In-Office Pit Excision for Pilonidal Disease Using Needle-Free Local Anesthesia: A Minimally Invasive, Non-Operative Treatment Approach", "firstAuthor": "Stoeckel", "multipleAuthors": true, "journal": "Eur J Pediatr Surg", "year": 2026, "design": "case-series", "n": 100, "nField": "reported", "population": "patients with gluteal crease pits (pilonidal disease), mean age 18.1 years", "intervention": "in-office pit excision using needle-free pneumatic lidocaine anesthesia, laser follicle ablation, and punch excision", "comparator": "", "primaryOutcome": "healing of pilonidal pits (resolution of pits)", "result": "60% of patients had all pits healed at follow-up, and ultimately 88% healed all of their pits", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "6 to 8 weeks", "plainFinding": "Most healed with simple office procedure.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41461191/", "sourceText": "INTRODUCTION: Treatment of pilonidal disease traditionally involves an operation under general anesthesia, which may have a period of postoperative disability and a significant recurrence rate. We report a novel treatment for pilonidal disease performed in-office using a pneumatic lidocaine injection device, requiring no pain medication or activity restrictions-supporting a non-operative standard of care. METHODS: Patients with gluteal crease pits at our Pilonidal Care Clinic were offered pit excision as standard care. Prospective data on demographics, pain scores (0-10), and outcomes were collected in REDCap. Under sterile conditions, patients received 1% buffered lidocaine via pneumatic injection. Laser follicle ablation was followed by punch excision (1.5 or 2 mm) of full-thickness pit epithelium. Sinus tracts were probed but not excised. Patients were asked to wash the area twice daily, maintain normal activities, and return in 6 to 8 weeks. Patients requiring nidus incision and drainage (I&D) were excluded. RESULTS: About 130 patients underwent this technique between February and June 2024; 100 were included in the analysis (5 excluded for concurrent I&D, 25 lost to follow-up). Mean age was 18.1 years; 50% were male. At subsequent follow-up, 60% patients healed all pits, resolving their condition, with 64% (144/224) of all pits healed. Patients with three or more pits were more likely to need an additional pit excision. Mean procedure pain score was 1.6/10 (SD 1.21); no patient used pain medication or experienced disability. Ultimately, 88% of patients healed all of their pits. CONCLUSION: Pilonidal disease may be resolved non-operatively in a single outpatient clinic visit, without even a shot.", "provenance": [ { "field": "n", "quote": "100 were included in the analysis" }, { "field": "population", "quote": "Patients with gluteal crease pits at our Pilonidal Care Clinic" }, { "field": "intervention", "quote": "patients received 1% buffered lidocaine via pneumatic injection. Laser follicle ablation was followed by punch excision" }, { "field": "primaryOutcome", "quote": "60% patients healed all pits, resolving their condition, with 64% (144/224) of all pits healed" }, { "field": "result", "quote": "Ultimately, 88% of patients healed all of their pits." } ] }, { "id": "pmid:41432023", "pmid": "41432023", "doi": "10.1177/15533506251411009", "nctId": null, "pmcid": null, "title": "Artificial Intelligence-Based Prediction of Recurrence and Personalized Treatment Planning in Pediatric Pilonidal Sinus Disease", "firstAuthor": "Öztaş", "multipleAuthors": true, "journal": "Surg Innov", "year": 2026, "design": "retrospective", "n": 242, "nField": "reported", "population": "children with pilonidal sinus disease", "intervention": "AI models predicting recurrence and guiding treatment choice (surgical excision, crystallized phenol, or silver nitrate)", "comparator": "different treatment modalities compared to each other; actual outcomes vs AI predictions", "primaryOutcome": "recurrence of pilonidal sinus disease after treatment", "result": "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", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design; authors state further multicenter, prospective studies are warranted to validate findings.", "followUp": "", "plainFinding": "Low recurrence; healing time varies by factors.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41432023/", "sourceText": "PurposeThis study aimed to assess the feasibility of artificial intelligence (AI)-based models for predicting recurrence risk and supporting individualized treatment strategies in pediatric pilonidal sinus disease (PSD).MethodsClinical data from 242 pediatric PSD patients were retrospectively analyzed. Two machine learning (ML) models were developed: (1) a binary classifier for recurrence prediction and (2) a multiclass classifier for treatment modality selection. Model performance was evaluated using 5-fold cross-validation based on accuracy, area under the receiver operating characteristic curve (ROC-AUC), F1 score, and confusion matrix. Model interpretability was assessed using SHapley Additive exPlanations (SHAP) analysis to identify the most influential predictive features.ResultsAmong 242 patients, 59.1% underwent surgical excision (unroofing with secondary healing), 33.1% received crystallized phenol, and 7.8% were treated with silver nitrate. 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. SHAP analysis revealed that healing time, BMI, age, and the number of sinus tracts were the most influential predictors in both recurrence and treatment selection models.ConclusionAI-based predictive models can effectively estimate recurrence risk and assist in tailoring individualized management strategies for pediatric PSD. Further multicenter, prospective studies are warranted to validate these findings and support clinical integration of AI-assisted decision systems.", "provenance": [ { "field": "population", "quote": "Clinical data from 242 pediatric PSD patients were retrospectively analyzed." }, { "field": "n", "quote": "Clinical data from 242 pediatric PSD patients were retrospectively analyzed." }, { "field": "intervention", "quote": "Two machine learning (ML) models were developed: (1) a binary classifier for recurrence prediction and (2) a multiclass classifier for treatment modality selection." }, { "field": "comparator", "quote": "59.1% underwent surgical excision (unroofing with secondary healing), 33.1% received crystallized phenol, and 7.8% were treated with silver nitrate." }, { "field": "primaryOutcome", "quote": "a binary classifier for recurrence prediction" }, { "field": "result", "quote": "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." }, { "field": "limitations", "quote": "Further multicenter, prospective studies are warranted to validate these findings and support clinical integration of AI-assisted decision systems." } ] }, { "id": "pmid:41397831", "pmid": "41397831", "doi": "10.3760/cma.j.cn441530-20251104-00417", "nctId": null, "pmcid": null, "title": "[Treatment options for different types of sacrococcygeal pilonidal disease]", "firstAuthor": "Chen", "multipleAuthors": true, "journal": "Zhonghua Wei Chang Wai Ke Za Zhi", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with sacrococcygeal pilonidal disease", "intervention": "various treatments depending on disease type (non-surgical care, drainage, minimally invasive procedures, excision with or without flap)", "comparator": "different treatment types compared to each other based on disease presentation", "primaryOutcome": "best treatment strategy for different types of pilonidal disease", "result": "article summarizes which treatment fits which disease presentation, not how long the disease lasts", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a narrative summary of treatment strategies based on clinical experience and literature, with no patient numbers or outcome data reported.", "directness": "indirect", "limitations": "no original data, no numbers of patients, and no information on disease duration or natural course is given.", "followUp": "", "plainFinding": "No duration data reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41397831/", "sourceText": "The treatment of sacrococcygeal pilonidal disease (SPD) remains challenging due to its high recurrence rate and treatment-related complications. An ideal treatment plan for SPD should be simple to perform, reduce recurrence rates, enable patients to quickly return to normal daily activities, and be associated with a low incidence of complications. Various surgical techniques have been employed for the treatment of SPD, but discrepancies and controversies persist in current clinical practice. 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 after weighing the recurrence risk, aiming for faster recovery and better cosmetic outcomes. 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. Based on clinical experience and literature review, this article summarizes the treatment strategies for different types of SPD, providing a reference for clinicians in formulating diagnosis and treatment plans.", "provenance": [ { "field": "population", "quote": "sacrococcygeal pilonidal disease (SPD)" }, { "field": "intervention", "quote": "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" }, { "field": "comparator", "quote": "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." }, { "field": "primaryOutcome", "quote": "this article summarizes the treatment strategies for different types of SPD, providing a reference for clinicians in formulating diagnosis and treatment plans." }, { "field": "result", "quote": "Based on clinical experience and literature review, this article summarizes the treatment strategies for different types of SPD" } ] }, { "id": "pmid:41397828", "pmid": "41397828", "doi": "10.3760/cma.j.cn441530-20250805-00292", "nctId": null, "pmcid": null, "title": "[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]", "firstAuthor": "Li", "multipleAuthors": true, "journal": "Zhonghua Wei Chang Wai Ke Za Zhi", "year": 2025, "design": "retrospective", "n": 369, "nField": "reported", "population": "Patients with sacrococcygeal pilonidal disease who underwent laser ablation and closure surgery (mostly male)", "intervention": "Laser ablation and closure surgery for pilonidal disease", "comparator": "No comparison group reported; all patients received the same laser treatment", "primaryOutcome": "Clinical efficacy and safety of laser ablation and closure, including wound healing and recurrence after surgery", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-center retrospective study with no comparison group, which limits how much confidence can be placed in the results.", "directness": "indirect", "limitations": "Retrospective design, single center, no control or comparator group, and recurrence risk-factor analysis limited mainly to male patients.", "followUp": "", "plainFinding": "Healed in about five weeks after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41397828/", "sourceText": "Objective: 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. Methods: A retrospective observational study was conducted to collect clinical data of 369 patients with SPD who underwent laser ablation and closure in the Anorectal Department of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine between March 2019 and December 2024. Perioperative outcomes and postoperative recurrence were analyzed. The cohort included 313 males and 56 females, with 43 patients aged ≤18 years. The median body mass index was 26.3 (IQR: 22.9, 29.6) kg/m², and the median disease duration was 28 months (IQR: 4, 76). Among them, 218 male SPD patients who underwent surgery received preoperative sex hormone testing. A logistic regression model was used to analyze the risk factors for recurrence. Results: All patients completed the surgery. The median intraoperative ablation energy delivered was 426.8 (IQR: 243.9, 683.9) J, with no occurrence of major intraoperative complications. Postoperatively, a total of 31 patients (8.4%) required analgesic medication. Within the first postoperative week, 12 patients experienced wound oozing/bleeding; hemostasis was achieved by compression alone in 5 cases, while the remaining 7 instances required suture hemostasis after failed compression attempts. No other complications were observed. The median postoperative hospital stay was 6 (IQR: 4, 8) days, and the median time to return to regular work and life was 7 (IQR: 5, 12) days. 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. Multivariate logistic regression analysis identified age ≤18 years (OR = 4.764, 95%CI: 2.424-34.905, P = 0.008) and a history of previous SPD surgery (OR = 5.078, 95%CI: 1.431-18.019, P = 0.012) as independent risk factors for recurrence after SPD laser ablation and closure surgery. Conclusion: Laser ablation and closure are safe, effective, and minimally invasive treatments for SPD. However, particular attention should be paid to the risk of recurrence in young male patients and those with a history of previous SPD surgery.", "provenance": [ { "field": "n", "quote": "369 patients with SPD who underwent laser ablation and closure" }, { "field": "population", "quote": "369 patients with SPD who underwent laser ablation and closure in the Anorectal Department of Yueyang Hospital" }, { "field": "intervention", "quote": "laser ablation and closure" }, { "field": "comparator", "quote": "A retrospective observational study was conducted to collect clinical data of 369 patients with SPD who underwent laser ablation and closure" }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:41365098", "pmid": "41365098", "doi": "10.1016/j.jss.2025.11.005", "nctId": null, "pmcid": null, "title": "Identifying Predictors of Recurrent Pilonidal Disease in Adolescents and Young Adults: A Secondary Analysis of a Randomized Controlled Trial", "firstAuthor": "Turpin", "multipleAuthors": true, "journal": "J Surg Res", "year": 2026, "design": "rct", "n": 200, "nField": "reported", "population": "patients 11 to 21 years old with at least one prior episode of pilonidal disease", "intervention": "laser hair removal (depilation) added to standard treatment", "comparator": "standard treatment alone", "primaryOutcome": "pilonidal disease recurrence within 1 year", "result": "Laser hair treatment lowered the odds of recurrence overall, but the benefit was seen only in privately insured patients, not publicly insured patients", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It's a planned secondary analysis of a randomized trial with adjusted statistical modeling, but subgroup interaction findings and recurrence self-report limit certainty.", "directness": "indirect", "limitations": "Findings are based on multivariable regression with potential confounding by unmeasured social factors, and the interaction by insurance status needs further investigation.", "followUp": "1 year", "plainFinding": "Laser treatment reduced recurrence, mainly if privately insured.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41365098/", "sourceText": "INTRODUCTION: Pilonidal disease is a common condition affecting adolescents and young adults with high recurrence rates and disease-associated morbidity. Identification of patient-specific factors and treatments associated with decreased disease recurrence can assist providers with treatment selection and patient counseling. MATERIALS AND METHODS: This is a planned secondary analysis of a single institution, randomized controlled trial which compared laser depilation as an adjunct to standard care versus standard care alone. Inclusion criteria were patients 11 to 21 y of age with a history of at least 1 episode of pilonidal disease, without active disease. Patients were randomized to receive laser depilation in conjunction with standard treatment versus standard treatment alone. Multivariable logistic regression modeling was performed to identify variables independently associated with disease recurrence including laser depilation, patient variables (biologic sex, body mass index, prior episodes of disease, prior surgical treatment, race and ethnicity, health insurance status), and annual family income. RESULTS: Complete 1-y follow-up data to be included in the multivariable analysis were available for 200 patients in the trial. After adjusting for sex, body mass index, prior episodes of disease, prior surgical treatment, race and ethnicity, type of health insurance, and household income, laser hair treatment was strongly associated with decreased odds of disease recurrence within 1 y (odds ratio [OR], 0.26 [95% confidence interval (CI), 0.12-0.58]; P = 0.001). After adjusting for other covariables, there was a significant interaction between laser hair treatment and health insurance type. 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). CONCLUSIONS: Laser depilation is associated with decreased pilonidal disease recurrence. However, there may be heterogeneity of treatment effect based on insurance status with laser depilation decreasing recurrence in patients with private insurance and being less effective in patients with public insurance. This heterogeneity of treatment effect may be related to barriers to care and social determinants of health and warrants further investigation.", "provenance": [ { "field": "n", "quote": "Complete 1-y follow-up data to be included in the multivariable analysis were available for 200 patients in the trial." }, { "field": "population", "quote": "Inclusion criteria were patients 11 to 21 y of age with a history of at least 1 episode of pilonidal disease, without active disease." }, { "field": "intervention", "quote": "laser depilation as an adjunct to standard care versus standard care alone" }, { "field": "comparator", "quote": "standard treatment alone" }, { "field": "primaryOutcome", "quote": "laser hair treatment was strongly associated with decreased odds of disease recurrence within 1 y" }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:41316137", "pmid": "41316137", "doi": "10.1186/s12893-025-03319-4", "nctId": null, "pmcid": "PMC12661896", "title": "Combined laser ablation and pit excision for pilonidal sinus: effectiveness, quality of recovery, and patient-reported outcomes", "firstAuthor": "Canturk", "multipleAuthors": true, "journal": "BMC Surg", "year": 2025, "design": "retrospective", "n": 39, "nField": "reported", "population": "Adults treated for pilonidal sinus disease", "intervention": "Diode laser ablation combined with pit excision", "comparator": "No comparison group (single-arm cohort)", "primaryOutcome": "Recurrence and treatment success after surgery", "result": "Treatment success in 84.6% (33/39) and recurrence in 15.4% (6/39) over a mean follow-up of 13.6 months", "resultDirection": "benefit", "quality": "low", "qualityWhy": "It is a small, retrospective, single-center study without a comparison group, so the results may not be reliable.", "directness": "indirect", "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.", "followUp": "13.6 ± 3.6 months", "plainFinding": "High success, some recurrence after laser treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41316137/", "sourceText": "BACKGROUND: This retrospective study aimed to evaluate the efficacy, safety, and patient-reported long-term results of a minimally invasive method of diode laser ablation combined with pit excision for pilonidal sinus disease, reveal predictive factors affecting treatment success, and quantitatively examine patient satisfaction and quality of life dimensions. METHODS: Fifty-four adults were treated consecutively, and the primary analysis included 39 patients who 6month patientreported outcomes (PROs: QoR15, SAPS, PROMIS Global10) assessed by an independent investigator. The primary endpoints were recurrence and treatment success (no recurrence without re-intervention). Delayed healing was a composite of epithelialization > 30 days or discharge > 14 days. Exploratory subgroup analyses (sex and BMI) reported effect sizes with Benjamini-Hochberg-adjusted qvalues. Receiver operating characteristic (ROC) curve analysis assessed PRO discrimination for recurrence with 95% confidence intervals (CIs). RESULTS: 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). Mean PROs were: QoR15 136.8 ± 19.9, SAPS 30.4 ± 4.3, PROMIS 46.2 ± 6.8; early postoperative pain (VAS) 1.9 ± 1.3. QoR15, SAPS, and PROMIS correlated inversely with recurrence (r = - 0.46 to - 0.36; all p < 0.05) and showed AUCs of 0.79 (95% CI 0.65-0.93), 0.73 (0.58-0.88), and 0.70 (0.54-0.86), respectively. Age was associated with a longer recovery time (p = 0.002). No material differences in PROs by sex or BMI were observed after multiplicity control. CONCLUSIONS: In this single-center consecutive cohort, combined diode laser ablation with a pit excision technique was associated with short perioperative timelines, high patient-reported recovery/satisfaction, and acceptable mid-term recurrence, whereas PRO scores demonstrated fair discrimination for recurrence. 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.", "provenance": [ { "field": "n", "quote": "the primary analysis included 39 patients who 6month patientreported outcomes" }, { "field": "population", "quote": "Fifty-four adults were treated consecutively" }, { "field": "intervention", "quote": "diode laser ablation combined with pit excision for pilonidal sinus disease" }, { "field": "comparator", "quote": "Fifty-four adults were treated consecutively" }, { "field": "primaryOutcome", "quote": "The primary endpoints were recurrence and treatment success (no recurrence without re-intervention)." }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:41274599", "pmid": "41274599", "doi": "10.1016/j.jpedsurg.2025.162828", "nctId": null, "pmcid": null, "title": "Adding gauze sweep technique to pit-picking procedure increases hair removal and lowers recurrence rate of pilonidal disease", "firstAuthor": "Chiu", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2026, "design": "retrospective", "n": 175, "nField": "reported", "population": "patients with pilonidal disease", "intervention": "pit-picking procedure plus gauze sweep technique", "comparator": "pit-picking procedure alone", "primaryOutcome": "hair removal during procedure and recurrence of pilonidal disease", "result": "adding gauze sweep increased hair removal (84% vs 62%) and lowered recurrence (1.1% vs 11.6%) compared to pit-picking alone", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "425.5 ± 244.8 days", "plainFinding": "Fewer recurrences with added hair-removal step.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41274599/", "sourceText": "INTRODUCTION: Pit-picking (PP) procedure has been used to treat pilonidal patients, with the main goal of removing all hair within the pilonidal sinus. We hypothesized that adding a gauze sweep (GS) technique to PP could increase hair removal and decrease recurrence rate. METHOD: Consecutive pilonidal patients who underwent PP 2/2021-9/2024 were selected. Starting 3/2023, the GS technique was added during PP. Patient demographics, procedure details, any hair removed during PP, pilonidal disease recurrence, and follow-up period were recorded. Data were analyzed using chi-squared or t-test; p < 0.05 was statistically significant. RESULTS: 175 total patients were included. From 2/2021-3/2023, 86 patients underwent PP only. Cohort PP had 51 males (59 %) and 35 females (41 %) with a mean presentation age at 18.3 ± 4.1 years and were followed for a mean of 425.5 ± 244.8 days. From 4/2023-9/2024, 89 patients underwent PP with GS. Cohort PP + GS had 52 males (58 %) and 37 females (42 %) with a mean presentation age at 18.3 ± 3.8 years and were followed for a mean of 359.1 ± 316.7 days. There was no difference between cohorts PP and PP + HR in patient sex, presentation age, and follow up length (p > 0.05). 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). CONCLUSION: Addition of GS to PP increased the probability of removing hair from the pilonidal sinus and was associated with a lower recurrence rate. GS should be incorporated into PP procedure. LEVEL OF EVIDENCE: Level IV.", "provenance": [ { "field": "n", "quote": "175 total patients were included." }, { "field": "population", "quote": "Consecutive pilonidal patients who underwent PP 2/2021-9/2024 were selected." }, { "field": "intervention", "quote": "the GS technique was added during PP" }, { "field": "comparator", "quote": "86 patients underwent PP only" }, { "field": "primaryOutcome", "quote": "any hair removed during PP, pilonidal disease recurrence, and follow-up period were recorded" }, { "field": "result", "quote": "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)." }, { "field": "followUp", "quote": "followed for a mean of 425.5 ± 244.8 days" } ] }, { "id": "pmid:41241452", "pmid": "41241452", "doi": "10.1016/j.suc.2025.08.005", "nctId": null, "pmcid": null, "title": "Pilonidal Disease", "firstAuthor": "O'Guinn", "multipleAuthors": true, "journal": "Surg Clin North Am", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "young people with pilonidal disease, a skin condition near the tailbone", "intervention": "various treatments including incision and drainage, deroofing, marsupialization, and flap-based surgery", "comparator": "different treatment approaches compared to each other", "primaryOutcome": "disease recurrence and complications", "result": "flap-based closures had fewer recurrences but more complications; deroofing at drainage reduced recurrence", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "this is a general review describing management approaches without original data on how long the disease lasts.", "directness": "indirect", "limitations": "abstract does not report study methodology, numbers of patients, or natural duration of the disease without treatment.", "followUp": "", "plainFinding": "Review of treatments, not duration.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41241452/", "sourceText": "Pilonidal disease, common in adolescents and young adults, is linked to hair insertion, friction, and bacterial colonization. Risk factors including obesity, sedentary lifestyle, and hirsutism should be addressed with initial non-operative management. Acute disease is primarily managed by incision and drainage; the addition of deroofing identified pits at the time of drainage can reduce recurrence. Management of chronic pilonidal disease is focused on removal of pits with the possible addition of marsupialization or primary closure. Closures with flap-based techniques, such as Karydakis and Bascom's cleft lift, offer a lower recurrence rate but higher complication risks.", "provenance": [ { "field": "population", "quote": "Pilonidal disease, common in adolescents and young adults" }, { "field": "intervention", "quote": "Acute disease is primarily managed by incision and drainage; the addition of deroofing identified pits at the time of drainage can reduce recurrence." }, { "field": "comparator", "quote": "Closures with flap-based techniques, such as Karydakis and Bascom's cleft lift, offer a lower recurrence rate but higher complication risks." }, { "field": "primaryOutcome", "quote": "offer a lower recurrence rate but higher complication risks" }, { "field": "result", "quote": "Closures with flap-based techniques, such as Karydakis and Bascom's cleft lift, offer a lower recurrence rate but higher complication risks." } ] }, { "id": "pmid:41146596", "pmid": "41146596", "doi": "10.1111/codi.70282", "nctId": null, "pmcid": null, "title": "Comparison of short- and long-term outcomes of diode laser vs. crystallized phenol treatment for pilonidal sinus disease: A propensity score-matched multicentre study", "firstAuthor": "Bilgin", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2025, "design": "retrospective", "n": 644, "nField": "reported", "population": "patients with pilonidal sinus disease treated with laser or phenol", "intervention": "diode laser ablation of the pilonidal sinus", "comparator": "crystallized phenol application to the pilonidal sinus", "primaryOutcome": "time to complete healing, return to daily activities, and recurrence", "result": "laser healed faster and needed fewer sessions, phenol allowed shorter procedures and quicker return to daily life, with similar recurrence rates", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "retrospective design, propensity-score matching cannot remove all bias, complication rates differed between groups", "followUp": "45 months (laser), 40 months (phenol)", "plainFinding": "Laser heals faster; phenol lets you return sooner", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41146596/", "sourceText": "AIM: Pilonidal sinus disease (PSD) primarily affects young adults; rapid recovery is essential and yet lacks a standardized treatment approach. While excisional techniques delay recovery, minimally invasive options like laser ablation and phenol application are gaining interest, yet comparative long-term evidence is scarce. This study compared short- and long-term outcomes of laser versus phenol treatment in PSD. METHOD: In this multicentre retrospective cohort study (Nov. 2017-Sep. 2024), patients treated with laser or phenol were included. 1:3 propensity score matching using the nearest neighbour algorithm was performed based on age, gender, prior surgical history and year of operation. Categorical variables were analysed using chi-squared or Fisher's exact tests, whereas continuous variables were compared using Student's t-test or Mann-Whitney U test depending on distribution normality. RESULTS: Out of 897 eligible patients, 644 were included (median age: 26 years, body mass index [BMI]: 26.2 kg/m2, male-to-female ratio: 4:1). The number of sinuses/pits was 2-3 in both groups. Operating time was significantly longer in the laser group. Complications occurred in 6.8% of laser patients, whereas none were reported in the phenol group. Pain scores were higher in the laser group (2 [1-3] vs. 1 [0-2]). Median follow-up was 45 months (laser) and 40 months (phenol). Return to daily activities was delayed in the laser group, whereas complete healing was slower in the phenol group. Readmission, recurrence and recovery rates were comparable (85%-86%). CONCLUSION: Both treatments demonstrated low complication and recurrence rates with high recovery rates. Laser favoured faster healing and fewer sessions, whereas phenol allowed for shorter procedures and earlier return to daily life.", "provenance": [ { "field": "n", "quote": "644 were included" }, { "field": "population", "quote": "patients treated with laser or phenol were included" }, { "field": "intervention", "quote": "patients treated with laser or phenol were included" }, { "field": "comparator", "quote": "patients treated with laser or phenol were included" }, { "field": "primaryOutcome", "quote": "Return to daily activities was delayed in the laser group, whereas complete healing was slower in the phenol group." }, { "field": "result", "quote": "Laser favoured faster healing and fewer sessions, whereas phenol allowed for shorter procedures and earlier return to daily life." }, { "field": "followUp", "quote": "Median follow-up was 45 months (laser) and 40 months (phenol)." } ] }, { "id": "pmid:41094667", "pmid": "41094667", "doi": "10.1186/s12893-025-03222-y", "nctId": null, "pmcid": "PMC12529851", "title": "Future of pilonidal cyst surgery: a comparative review of traditional and laser techniques", "firstAuthor": "Jazi", "multipleAuthors": true, "journal": "BMC Surg", "year": 2025, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people with pilonidal cysts or sinuses near the tailbone", "intervention": "laser ablation treatment", "comparator": "traditional surgical excision and flap reconstruction techniques", "primaryOutcome": "effectiveness, recovery time, recurrence rates, complications, cosmetics and cost of treatment", "result": "laser techniques reduced hospital stay, pain, and recurrence, with healing rates up to 97%, but were less effective in severe cases and cost more", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a narrative comparison of existing studies without pooled statistics, and the authors themselves say more research is needed on long-term outcomes.", "directness": "indirect", "limitations": "Abstract notes laser methods may be less effective in severe or complicated cases and that long-term outcomes still need to be established.", "followUp": "", "plainFinding": "Laser surgery heals faster, fewer complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41094667/", "sourceText": "Pilonidal disease is a common sacrococcygeal cyst or sinus that can significantly impact patients' quality of life, necessitating an analysis of evolving treatments to optimize patient outcomes. This review compares traditional and minimally invasive techniques focusing on laser ablation, in treating pilonidal cysts, focusing on each method's effectiveness, recovery time, recurrence rates, complications, cosmetics, and costs. We conducted a comprehensive assessment of literature exploring PubMed, Scopus, Web of Science, Google Scholar, and Embase for studies comparing traditional surgical techniques including traditional excision with open and closed healing, flap reconstructions, with minimally invasive procedures focusing on laser-assisted. Although traditional surgical techniques were practical, but they were associated with a relatively high risk of wound complications, recurrence, extended healing periods, and poor cosmetics. 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. Laser-assisted techniques offer a less invasive option compared to traditional surgery, with greater patient fulfillment. However, additional research is needed to optimize laser procedures, especially in complex cases, and to establish long-term outcomes. For simpler pilonidal cysts, laser treatments are a promising option that could eventually replace traditional surgery as the standard of care.", "provenance": [ { "field": "population", "quote": "Pilonidal disease is a common sacrococcygeal cyst or sinus" }, { "field": "intervention", "quote": "minimally invasive procedures focusing on laser-assisted" }, { "field": "comparator", "quote": "traditional surgical techniques including traditional excision with open and closed healing, flap reconstructions" }, { "field": "primaryOutcome", "quote": "focusing on each method's effectiveness, recovery time, recurrence rates, complications, cosmetics, and costs" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:41074563", "pmid": "41074563", "doi": "10.1111/ans.70330", "nctId": null, "pmcid": "PMC13006718", "title": "Sacrococcygeal Pilonidal Sinus Disease: A Decade-In-Review of Patient-Reported Outcome Measures", "firstAuthor": "Nyandoro", "multipleAuthors": true, "journal": "ANZ J Surg", "year": 2026, "design": "retrospective", "n": 136, "nField": "reported", "population": "adults who had surgery for a long-term pilonidal cyst (pilonidal sinus disease) in Western Australia", "intervention": "different surgical repair techniques, including flap procedures (Karydakis flap, modified Karydakis flap, Limberg flap, modified Limberg flap, other flaps)", "comparator": "wound left open to heal on its own (secondary intention healing)", "primaryOutcome": "patient-reported outcomes such as body image, cosmetic appearance, confidence, return to normal activity and overall satisfaction", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective, mixed-methods design relying on mailed questionnaires and phone interviews, with patients split into six small technique subgroups.", "followUp": "", "plainFinding": "Flap surgery heals faster than open wound.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41074563/", "sourceText": "BACKGROUND: Sacrococcygeal pilonidal sinus disease (SPD) is a chronic inflammatory condition that can significantly impact quality of life. While recurrence and surgical site infection (SSI) rates are well documented, less is known about how different surgical techniques affect patient-reported outcome measures (PROMs). METHODS: This study employed mixed methods, including standardised mail questionnaires and telephone interviews (May-September 2020), to conduct a multi-centre retrospective decade follow-up review of definitive SPD surgery participants from Western Australia. 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). PROMs assessed included body image, cosmesis, confidence, functional recovery and overall satisfaction-secondary outcomes examined recurrence, SSI and other complications. RESULTS: A total of 136 patients met the inclusion criteria. 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). MKF and LF achieved the highest body image and cosmetic satisfaction scores (medians of 20 and 19), whereas SIT and OFT scored the lowest. MKF yielded the highest overall satisfaction (100%). 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. CONCLUSION: Flap-based techniques, particularly the MKF and MLF, offer an optimal balance of functional recovery, cosmetic outcomes and low recurrence rates. Incorporating PROMs into SPD surgical planning can better align treatment with patient priorities and the underlying pathophysiology of the disease.", "provenance": [ { "field": "n", "quote": "A total of 136 patients met the inclusion criteria." }, { "field": "population", "quote": "definitive SPD surgery participants from Western Australia" }, { "field": "intervention", "quote": "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)." }, { "field": "comparator", "quote": "secondary intention healing techniques (SIT)" }, { "field": "primaryOutcome", "quote": "PROMs assessed included body image, cosmesis, confidence, functional recovery and overall satisfaction-secondary outcomes examined recurrence, SSI and other complications." }, { "field": "result", "quote": "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)." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:40974390", "pmid": "40974390", "doi": "10.1007/s00384-025-04961-3", "nctId": null, "pmcid": "PMC12450213", "title": "Intra-operative ultrasound in the surgical treatment of complex and recurrent pilonidal disease: a retrospective, observational, single-center study", "firstAuthor": "Gallo", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2025, "design": "retrospective", "n": 19, "nField": "reported", "population": "patients with complex or recurrent pilonidal disease treated surgically", "intervention": "intraoperative ultrasound combined with endoscopic pilonidal sinus treatment (EPSiT)", "comparator": "none (single-arm study, no comparison group)", "primaryOutcome": "disease persistence (recurrence or incomplete wound healing) at 36 months", "result": "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.", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This was a small, single-center, retrospective study with no comparison group, so its findings carry limited weight.", "directness": "indirect", "limitations": "Retrospective design, single center, small sample size (19 patients), no control group for comparison.", "followUp": "36 months", "plainFinding": "Most healed; some recurrences treated successfully.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40974390/", "sourceText": "BACKGROUND: Pilonidal disease (PD) is frequently associated with high recurrence rates and delayed healing, particularly in complex or recurrent cases. While Endoscopic Pilonidal Sinus Treatment (EPSiT) has improved postoperative recovery and patient satisfaction, its effectiveness can be limited by incomplete identification of fistulous tracts. Intraoperative ultrasound (IUS) offers real-time visualization of subcutaneous structures and may aid in detecting hidden tracts during surgery. This study evaluates the clinical outcomes of combining IUS with EPSiT in the treatment of complex and recurrent PD. MATERIALS AND METHODS: 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. All patients had a minimum follow-up of 36 months. The study recorded the number of cases in which IUS identified additional fistulous tracts and led to a modification of the surgical strategy, as well as clinical outcomes including recurrence rate, time to wound healing, and incidence of incomplete wound healing. RESULTS: Nineteen patients were included (14 males, 73.7%; mean age of 35.4 ± 6.4 years). The mean operative time was 42 min, with IUS requiring an additional 6 min. IUS identified previously undetected fistulous tracts in 6 patients (31.5%), leading to modifications in the surgical strategy. 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. CONCLUSIONS: Intraoperative IUS identified previously undetected secondary tracts in 31.5% of patients, leading to a modification of the surgical approach. Further comparative studies are needed to validate its effectiveness and assess its potential role as a standard adjunct in the surgical management of pilonidal disease.", "provenance": [ { "field": "n", "quote": "Nineteen patients were included" }, { "field": "population", "quote": "patients with recurrent and complex PD treated between 2018 and 2021" }, { "field": "intervention", "quote": "Intraoperative ultrasound (IUS) offers real-time visualization of subcutaneous structures and may aid in detecting hidden tracts during surgery." }, { "field": "comparator", "quote": "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." }, { "field": "primaryOutcome", "quote": "recurrence rate, time to wound healing, and incidence of incomplete wound healing" }, { "field": "result", "quote": "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." }, { "field": "followUp", "quote": "All patients had a minimum follow-up of 36 months." } ] }, { "id": "pmid:40956974", "pmid": "40956974", "doi": "10.1097/ASW.0000000000000362", "nctId": null, "pmcid": null, "title": "Comparing Square Excision and Transposition Flap Versus Modified Limberg Flap in Sacrococcygeal Pilonidal Sinus Disease Surgery: A New Technique With Fewer Wound Issues", "firstAuthor": "Ertekin", "multipleAuthors": true, "journal": "Adv Skin Wound Care", "year": 2026, "design": "retrospective", "n": 102, "nField": "reported", "population": "patients who had surgery for pilonidal sinus disease (sacrococcygeal) between 2016 and 2022", "intervention": "square excision and transposition flap (SF) surgical technique", "comparator": "modified Limberg flap (LF) surgical technique", "primaryOutcome": "healing time, wound infection/dehiscence, return to work, recurrence", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, not randomized, and the abstract does not report numeric recurrence rates or statistical significance for recurrence or cosmetic satisfaction.", "followUp": "6-month follow-up", "plainFinding": "Faster healing, fewer wound problems with one flap.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40956974/", "sourceText": "OBJECTIVE: Pilonidal sinus disease (PSD) is a common disease that is an important health problem. Using new flap methods in defect closure in PSD surgery may be useful in obtaining ideal surgical outcomes. This study aimed to present the early outcomes of the square excision and transposition flap (SF) technique compared with the modified Limberg flap (LF). METHODS: Patients who underwent surgical intervention for PSD utilizing SF and LF techniques between January 2016 and January 2022 were evaluated. Demographics, comorbidity, clinical presentation, pain assessment, hospital stay duration, healing time, time to return to work, and recurrence status were compared between the SF and LF groups. RESULTS: There was no significant difference between the SF (53 patients) and LF (49 patients) groups regarding demographic and most clinical characteristics. 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). A lower incidence of wound infection was observed in the SF group (3.8%) compared with the LF group (16.3%) ( P =.035). Partial wound dehiscence was more observed in the LF group (18.4%), marking a significant difference ( P =.001). Regarding cosmetic satisfaction at the 6-month follow-up, the SF group reported higher satisfaction rates. The SF group had a lower recurrence rate. CONCLUSIONS: The SF method had lower wound dehiscence, shorter healing time, and shorter return-to-work time compared with the modified LF. Patients have more cosmetic satisfaction. The SF technique can be considered as an option in the surgical treatment of PSD.", "provenance": [ { "field": "n", "quote": "the SF (53 patients) and LF (49 patients) groups" }, { "field": "population", "quote": "Patients who underwent surgical intervention for PSD utilizing SF and LF techniques between January 2016 and January 2022 were evaluated." }, { "field": "intervention", "quote": "square excision and transposition flap (SF) technique" }, { "field": "comparator", "quote": "modified Limberg flap (LF)" }, { "field": "primaryOutcome", "quote": "hospital stay duration, healing time, time to return to work, and recurrence status" }, { "field": "result", "quote": "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)." }, { "field": "result", "quote": "A lower incidence of wound infection was observed in the SF group (3.8%) compared with the LF group (16.3%) ( P =.035)." }, { "field": "followUp", "quote": "Regarding cosmetic satisfaction at the 6-month follow-up, the SF group reported higher satisfaction rates." } ] }, { "id": "pmid:40931185", "pmid": "40931185", "doi": "10.1007/s00384-025-04921-x", "nctId": null, "pmcid": "PMC12423239", "title": "Investigating recurrence in pilonidal sinus disease: results of a nationwide, multicenter study in Turkey (PISI TURKEY)", "firstAuthor": "Yalcinkaya", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2025, "design": "retrospective", "n": 1662, "nField": "reported", "population": "Patients who had surgery for pilonidal sinus disease in Turkey", "intervention": "Surgical treatment of pilonidal sinus disease (index operation)", "comparator": "None (observational comparison of patients with vs without recurrence)", "primaryOutcome": "Recurrence of pilonidal sinus disease within 12 months after surgery", "result": "Recurrence occurred in 6.26% of patients within 12 months after surgery", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective database review; no information on natural history or duration of untreated cysts; focused on surgical recurrence only.", "followUp": "12 months", "plainFinding": "6% recurrence after surgery, 1 year.", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/40931185/", "sourceText": "PURPOSE: The purpose of this study is to investigate the recurrence rates for the treatment of pilonidal sinus disease (PSD) in Turkey and the factors associated with recurrence of PSD after surgery on a nationwide scale. METHODS: This national, multicenter, database review was conducted in Turkey by the PISI TURKEY Research Group, and included recipients of PSD surgery in 41 select hospitals in Turkey, between January 2019 and January 2020. Data were collected by completion of standardized data forms. Sociodemographic and anthropometric data, comorbidities, PSD type, previous PSD interventions, index PSD intervention, recurrence, and complications were collected from baseline to postoperative 12 months. RESULTS: The data of 1662 patients from 41 centers were analyzed. The median age was 25 (21-32) years, and 80.26% of the cases were male. The recurrence rate following index operations was 6.26% in the 12-month period. Age (p = 0.594) and sex distribution (p = 0.441) were similar in patients with and without recurrence. The recurrent group had significantly higher frequencies of type V PSD (p < 0.001), wound site infection (p < 0.001), and wound separation (p < 0.001), whereas the non-recurrent group had a significantly higher frequency of type III PSD (p < 0.001). Multivariable logistic regression revealed that prior recurrence, postoperative wound site infection, and postoperative wound separation were independently associated with recurrence. CONCLUSIONS: The recurrence rate after PSD surgery in Turkey was close to the lower ranges reported in prior literature. Turkish patients with a history of prior recurrence, postoperative wound site infection, or postoperative wound separation should be considered to have higher risks for recurrence.", "provenance": [ { "field": "n", "quote": "The data of 1662 patients from 41 centers were analyzed." }, { "field": "population", "quote": "included recipients of PSD surgery in 41 select hospitals in Turkey" }, { "field": "intervention", "quote": "index PSD intervention" }, { "field": "comparator", "quote": "Age (p = 0.594) and sex distribution (p = 0.441) were similar in patients with and without recurrence." }, { "field": "primaryOutcome", "quote": "recurrence, and complications were collected from baseline to postoperative 12 months" }, { "field": "result", "quote": "The recurrence rate following index operations was 6.26% in the 12-month period." } ] }, { "id": "pmid:40921262", "pmid": "40921262", "doi": "10.1016/j.jpedsurg.2025.162644", "nctId": null, "pmcid": null, "title": "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", "firstAuthor": "Bahadir", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2025, "design": "retrospective", "n": 104, "nField": "reported", "population": "children and adolescents with pilonidal sinus disease", "intervention": "endoscopic pilonidal sinus treatment combined with platelet-rich plasma (EPSIT + PRP)", "comparator": "excision with primary closure (EPC)", "primaryOutcome": "recurrence rate, hospital stay, and recovery/cosmetic outcomes", "result": "Hospital stay was shorter with EPSIT + PRP, recurrence rates were not significantly different between groups, and cosmetic satisfaction favored EPSIT + PRP", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective comparison of two historical, non-randomized patient groups treated in different time periods, which makes the results less reliable.", "directness": "indirect", "limitations": "Retrospective design comparing two different time-period cohorts (one retrospective, one prospective), not randomized, with differing follow-up durations between groups.", "followUp": "postoperative 1st year follow-up", "plainFinding": "No difference in recurrence, faster recovery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40921262/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a common condition in adolescents, often resulting in recurrence, prolonged recovery, and significant discomfort. Although multiple surgical approaches exist, the optimal treatment for pediatric patients remains unclear. This study aimed to compare the short-term outcomes of endoscopic pilonidal sinus treatment combined with platelet-rich plasma application (EPSIT + PRP) and excision with primary closure (EPC) in children and adolescents with PSD. MATERIAL AND METHODS: This retrospective comparative cohort study analyzed two historical cohorts of pediatric patients with pilonidal sinus disease treated during different time periods at the same institution. A total of 104 patients under 18 years of age were included. EPC was performed in 73 patients between 2010 and 2015, with data retrospectively analyzed. Starting in 2024, 31 newly diagnosed patients were prospectively treated with EPSIT + PRP. PRP was prepared by centrifuging 15 mL of autologous blood at 4000 rpm for 10 min. 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. RESULTS: Of the 104 patients, 65.4 % were male and 34.6 % female. Median age was 16 years in the EPC group and 17 years in the EPSIT + PRP group. 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). CONCLUSION: EPSIT + PRP appears to be a feasible and well-tolerated minimally invasive alternative to EPC in the treatment of PSD in children and adolescents. Despite differences in follow-up duration and study design, short-term outcomes suggest lower recurrence, faster recovery, and better cosmetic satisfaction with EPSIT + PRP.", "provenance": [ { "field": "n", "quote": "A total of 104 patients under 18 years of age were included." }, { "field": "population", "quote": "pediatric patients with pilonidal sinus disease" }, { "field": "intervention", "quote": "endoscopic pilonidal sinus treatment combined with platelet-rich plasma application (EPSIT + PRP)" }, { "field": "comparator", "quote": "excision with primary closure (EPC)" }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:40769774", "pmid": "40769774", "doi": "10.1002/wjs.70028", "nctId": null, "pmcid": "PMC12435601", "title": "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", "firstAuthor": "de Kort", "multipleAuthors": true, "journal": "World J Surg", "year": 2025, "design": "retrospective", "n": 72, "nField": "reported", "population": "adults with primary sacrococcygeal pilonidal sinus disease", "intervention": "phenolization of the sinus tract", "comparator": "sinus laser-assisted closure (SiLaC)", "primaryOutcome": "need for additional surgery and quality of life/symptom scores", "result": "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", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "not randomized; comparative cohort design with matching rather than randomization", "followUp": "47 months", "plainFinding": "No clear winner between two surgeries.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40769774/", "sourceText": "BACKGROUND: No consensus has been reached on the preferred minimally invasive technique for treating primary, chronic sacrococcygeal pilonidal sinus disease. This study will compare two extensively used minimally invasive techniques: phenolization of the sinus tract and sinus laser-assisted closure. METHODS: A comparative cohort study was conducted in two hospitals. Patients were matched on sex, age, number of sinus pits at surgery, and duration of follow-up. Patient records were examined for additional surgeries, and quality of life and symptoms were assessed with a questionnaire. RESULTS: After a mean follow-up of 47 months, 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. Pain as a symptom at the natal cleft was significantly lower in the phenolization group, though not clinically relevant. The question regarding general health compared to preoperatively was reported to be significantly better in the phenolization group. However, other quality of life outcomes, such as the VAS score and the SF-36, did not differ significantly between phenolization and SiLaC. CONCLUSION: Both phenolization and sinus laser-assisted closure appear to be feasible for patients with primary SPSD, with no clear superiority of either technique.", "provenance": [ { "field": "population", "quote": "primary, chronic sacrococcygeal pilonidal sinus disease" }, { "field": "intervention", "quote": "phenolization of the sinus tract" }, { "field": "comparator", "quote": "sinus laser-assisted closure" }, { "field": "primaryOutcome", "quote": "Patient records were examined for additional surgeries, and quality of life and symptoms were assessed with a questionnaire." }, { "field": "result", "quote": "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" }, { "field": "result", "quote": "other quality of life outcomes, such as the VAS score and the SF-36, did not differ significantly between phenolization and SiLaC" }, { "field": "n", "quote": "phenolization group (n = 36)" }, { "field": "n", "quote": "SiLaC group (n = 36)" }, { "field": "followUp", "quote": "After a mean follow-up of 47 months" } ] }, { "id": "pmid:40679024", "pmid": "40679024", "doi": "10.5604/01.3001.0055.0465", "nctId": null, "pmcid": null, "title": "Unveiling Observation Bias in Pilonidal Sinus Disease Studies: A Comparative Analysis of Study Designs and Follow-Up Protocols", "firstAuthor": "Doll", "multipleAuthors": true, "journal": "Pol Przegl Chir", "year": 2025, "design": "meta-analysis", "n": 135349, "nField": "reported", "population": "patients treated for pilonidal sinus disease across many published studies", "intervention": "studies using scheduled follow-up versus studies where patients only returned if their disease came back", "comparator": "non-randomized studies without a return-on-recurrence design (N trials)", "primaryOutcome": "recurrence rate at 5 and 10 years after treatment", "result": "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", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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", "followUp": "five-year", "plainFinding": "How follow-up is done changes reported recurrence", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40679024/", "sourceText": "<b>Introduction:</b> The extent of observation bias in long-term surgical outcomes due to inadequate or unplanned follow-up in pilonidal sinus disease (PSD) studies is unclear. We made a hypothesis on the high risk of underreported recurrence in studies relying on the patients returning in case of recurrent disease (return on recurrence; ROR).<b>Aim:</b> To investigate and quantify the amount of bias associated with regular <i>vs.</i> return-on-recurrence follow-up of patients.<b>Materials and methods:</b> A total of 5.485 retrievable PSD publications were screened for eligibility, yielding 1.222 PSD studies with 135.349 patients treated, published between 1833 and 2023, included for analysis. Of these, 139 were Randomized Controlled Trials (RCT), 54 were ROR trials, and 1,029 were non-RCT non-ROR (N) trials. Recurrence rates were compared between groups<b>Results:</b> The five-year recurrence rates across all treatments in PSD were 18.9% for RCTs, 10.4% for N trials, and 12.4% forROR trials. Recurrence rates in the N and the ROR trials were statistically indistinguishable at ten-year follow-up (p = 0.1),whereas RCTs show significantly higher recurrence rates than N or ROR at 10-year follow-ups (p<0.001, p<0.001). Comparingonly primary open treatment, the five-year recurrence rate was 18.6% for RCT trials, 11.5% for N trials, and 4.1% for ROR trials.The recurrence rates at 10-year follow-up in the ROR and N trials were 20.1% and 19.7%, respectively. Notably, there was nodata available for 10-year follow-up in RCTs.<b>Conclusions:</b> Observation bias seems to significantly impact the results of ROR studies. Implementing a well-structured, all-encompassing patient follow-up at specific time intervals can effectively mitigate this bias, which might otherwise compromise the validity of our findings.<b>Significance of work:</b> The extent of observation bias in ROR studies compared to RCTs and non-RCTs remains unknown. Ourscrutiny of excision and primary open therapy, the largest therapeutic cohort globally, reveals ROR recurrence rates potentiallydeflated by three to fourfold relative to RCTs or non-RCT findings.", "provenance": [ { "field": "n", "quote": "135.349 patients treated" }, { "field": "population", "quote": "1.222 PSD studies with 135.349 patients treated" }, { "field": "intervention", "quote": "patients returning in case of recurrent disease (return on recurrence; ROR)" }, { "field": "comparator", "quote": "1,029 were non-RCT non-ROR (N) trials" }, { "field": "primaryOutcome", "quote": "Recurrence rates were compared between groups" }, { "field": "result", "quote": "RCTs show significantly higher recurrence rates than N or ROR at 10-year follow-ups (p<0.001, p<0.001)" } ] }, { "id": "pmid:40524141", "pmid": "40524141", "doi": "10.1111/iwj.70689", "nctId": null, "pmcid": "PMC12170226", "title": "Our Experience With Four or More Crystallised Phenol Applications in Pilonidal Sinus Disease", "firstAuthor": "Yalçın", "multipleAuthors": true, "journal": "Int Wound J", "year": 2025, "design": "retrospective", "n": 53, "nField": "reported", "population": "adults aged 18 or older with pilonidal sinus disease", "intervention": "crystallised phenol applications (4-9 sessions) given in an outpatient clinic", "comparator": "no comparison group reported", "primaryOutcome": "treatment success rate after phenol therapy", "result": "92.45% of patients achieved treatment success, with recurrence in 1.9% and surgery needed in 5.7% due to failure", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, no comparator group, small single-center sample.", "followUp": "3-year follow-up", "plainFinding": "High success with phenol treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40524141/", "sourceText": "The aim of this study was to analyse the clinical outcomes of patients with pilonidal sinus who underwent daily phenol treatment in the local intervention room of the outpatient clinic. We retrospectively evaluated 53 patients (43 male, 10 female) aged ≥ 18 years who received 4-9 crystallised phenol applications for pilonidal sinus disease. The mean number of phenol applications was 4.84 sessions (range: 4-9). 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. Complications included skin necrosis (n = 2) and transient pain (n = 2). Phenol treatment is an effective and simple procedure compared to surgical methods, which can be easily applied in outpatient treatment. Therefore, we believe that it can be applied in many sessions to suitable patients without the need for aggressive surgical excision.", "provenance": [ { "field": "n", "quote": "We retrospectively evaluated 53 patients (43 male, 10 female) aged ≥ 18 years" }, { "field": "population", "quote": "patients with pilonidal sinus who underwent daily phenol treatment" }, { "field": "intervention", "quote": "received 4-9 crystallised phenol applications for pilonidal sinus disease" }, { "field": "comparator", "quote": "Phenol treatment is an effective and simple procedure compared to surgical methods" }, { "field": "primaryOutcome", "quote": "Treatment success was achieved in 92.45% of patients, with a 3-year follow-up." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:40522552", "pmid": "40522552", "doi": "10.1007/s10103-025-04525-5", "nctId": null, "pmcid": "PMC12170725", "title": "Evaluation of laser ablation for recurrent pilonidal sinus disease: treatment success, recurrence rates, and patient outcomes", "firstAuthor": "Emral", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2025, "design": "retrospective", "n": 37, "nField": "reported", "population": "patients with recurrent pilonidal sinus disease", "intervention": "laser ablation", "comparator": "", "primaryOutcome": "complete healing without recurrence of pilonidal sinus disease", "result": "70.3% of patients healed completely without recurrence, while 21.6% had recurrence over a mean follow-up of 9.6 months", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small retrospective study with no comparison group, so it can't reliably show how the disease would progress without treatment.", "directness": "indirect", "limitations": "Retrospective design, small sample size, no control group, and short follow-up.", "followUp": "9.6 months", "plainFinding": "Most healed without recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40522552/", "sourceText": "PURPOSE: Pilonidal sinus disease (PD) is a chronic, recurrent inflammatory condition primarily affecting the sacrococcygeal region, often resulting in discomfort, abscess formation, and recurrent disease. Various surgical interventions, including laser ablation, have been employed to treat recurrent PD. This study evaluates the efficacy of laser ablation in patients with recurrent PD, focusing on treatment success, recurrence rates, complications, and recovery outcomes. METHODS: A retrospective analysis of 37 patients with recurrent pilonidal sinus disease treated with laser ablation between January 2022 and January 2025 was conducted. Preoperative data, postoperative complications, healing time, Visual Analog Scale values, and return to normal activities were collected. RESULTS: 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. Five patients (13.5%) developed superficial infections, which were managed with local dressing. The median time for wound healing was 35 days, and patients returned to normal activities in an median of 1 day. Persistent disease was observed in 8 patients (21.6%), of whom 5 patients (62.5%) achieved full epithelialization after retreatment with laser ablation. CONCLUSION: The ease of application, avoidance of hospitalization, minimal postoperative care, and rapid return to daily activities make laser treatment a safe and effective therapeutic option for patients with recurrent pilonidal disease, supported by favorable outcomes and low morbidity.", "provenance": [ { "field": "n", "quote": "A retrospective analysis of 37 patients with recurrent pilonidal sinus disease treated with laser ablation between January 2022 and January 2025 was conducted." }, { "field": "population", "quote": "patients with recurrent pilonidal sinus disease" }, { "field": "intervention", "quote": "treated with laser ablation between January 2022 and January 2025" }, { "field": "primaryOutcome", "quote": "70.3% of patients achieved complete healing without recurrence" }, { "field": "result", "quote": "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." }, { "field": "followUp", "quote": "mean follow-up of 9.6 months" } ] }, { "id": "pmid:40515949", "pmid": "40515949", "doi": "10.1007/s00423-025-03776-8", "nctId": null, "pmcid": "PMC12167314", "title": "Long term results and quality of life after primary excision followed by Limberg plasty in pilonidal sinus disease", "firstAuthor": "König", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2025, "design": "retrospective", "n": 47, "nField": "reported", "population": "adults with pilonidal sinus disease who had surgery", "intervention": "primary excision followed by Limberg plasty", "comparator": "no comparison group (single treatment group)", "primaryOutcome": "rate of disease recurrence and quality of life after surgery", "result": "only one recurrence (2.4%) and significant improvement in quality of life", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, no control group, patients recalled by phone or written survey, single center.", "followUp": "86 months", "plainFinding": "Low recurrence after surgery, better quality of life.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40515949/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a frequently occurring condition that can have a significant impact on quality of life (QoL). In addition to severe pain, particularly with movement or while sitting, this disease imposes restrictions that affect one's professional and private life. These patients frequently suffer from recurrence requiring multiple interventions and hospital stays. METHODS: The study enrolled forty-seven patients who presented with PSD from August 2010 until June 2019 and underwent primary excision and LP at the Department of General, Visceral, and Vascular Surgery at University Hospital, Jena. Forty- one of these patients were questioned retrospectively in writing or by telephone interviews between July 2021 to September 2022. The data processed using SPSS software. RESULTS: The median follow-up for all patients was 86 months (range, 23-140 months). Only one recurrence (2.4%) was reported. While the participants' BMIs remained unchanged, they reported significant improvements in QoL, notably in five of the six activities of daily living that were evaluated. CONCLUSION: The low rate of recurrence suggests that LP is an effective option for post-excision surgical repair of pilonidal sinus. The use of this procedure has no impact on patient's BMI but can significantly improve patients' QoL.", "provenance": [ { "field": "n", "quote": "The study enrolled forty-seven patients who presented with PSD" }, { "field": "population", "quote": "forty-seven patients who presented with PSD from August 2010 until June 2019 and underwent primary excision and LP" }, { "field": "intervention", "quote": "underwent primary excision and LP at the Department of General, Visceral, and Vascular Surgery" }, { "field": "comparator", "quote": "Forty- one of these patients were questioned retrospectively in writing or by telephone interviews" }, { "field": "primaryOutcome", "quote": "Only one recurrence (2.4%) was reported." }, { "field": "result", "quote": "Only one recurrence (2.4%) was reported. While the participants' BMIs remained unchanged, they reported significant improvements in QoL" }, { "field": "followUp", "quote": "The median follow-up for all patients was 86 months (range, 23-140 months)." } ] }, { "id": "pmid:40498166", "pmid": "40498166", "doi": "10.1007/s10151-025-03159-7", "nctId": null, "pmcid": "PMC12158824", "title": "Prospective nationwide audit of short-term outcomes after surgery for chronic pilonidal sinus disease in the Netherlands", "firstAuthor": "Huurman", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2025, "design": "prospective-cohort", "n": 405, "nField": "reported", "population": "adults with chronic pilonidal sinus disease having surgery in Dutch hospitals", "intervention": "minimally invasive surgical techniques", "comparator": "excision with secondary wound healing", "primaryOutcome": "type of pilonidal disease and which surgical approach was used", "result": "minimally invasive surgery had a higher wound healing rate and healed faster than excision with open healing", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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", "directness": "indirect", "limitations": "short median follow-up of 42 days, observational design without randomization, and it studies surgical healing time rather than natural disease duration", "followUp": "42 days", "plainFinding": "Minimally invasive surgery healed faster.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40498166/", "sourceText": "BACKGROUND: The optimal surgical approach for chronic pilonidal sinus disease (PSD) remains unclear, resulting in variation in surgical practice. This study aimed to provide an overview of PSD subtypes and assess practice variation and short-term outcomes. METHODS: A nationwide prospective observational cohort study was conducted. All patients with PSD and who underwent surgery were included during a 3-month inclusion period between March 1, 2020 and March 1, 2021. Primary endpoints were PSD classification and type and frequency of surgical approach. Secondary endpoints included symptoms, complications, recurrent open wounds, wound healing rate, time to wound healing, time to resume daily activities, reasons for selecting therapy, antibiotic prophylaxis, type of anesthesia, and hospital admission. RESULTS: A total of 36 hospitals participated in the study, and 405 patients had chronic disease. The median follow-up period was 42 days. Mean age was 28 years and 335 (82.7%) patients were male. Simple (n = 213) and complex PSD (n = 192) was equally common. Twelve different treatment modalities were performed. Minimally invasive techniques were used the most (61.2%) and off-midline closure in only a small proportion of patients (5.7%). 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. They also had the shortest median time to resume daily activities (14 days). CONCLUSIONS: Simple and complex PSD were equally common. Practice variation in surgery is substantial. Minimally invasive techniques were most frequently performed and showed good short-term outcomes.", "provenance": [ { "field": "n", "quote": "405 patients had chronic disease" }, { "field": "population", "quote": "All patients with PSD and who underwent surgery were included" }, { "field": "intervention", "quote": "Minimally invasive techniques were used the most (61.2%)" }, { "field": "comparator", "quote": "compared to excision with secondary healing" }, { "field": "primaryOutcome", "quote": "Primary endpoints were PSD classification and type and frequency of surgical approach." }, { "field": "result", "quote": "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." }, { "field": "followUp", "quote": "The median follow-up period was 42 days." } ] }, { "id": "pmid:40407900", "pmid": "40407900", "doi": "10.1007/s00384-025-04883-0", "nctId": null, "pmcid": "PMC12102125", "title": "Impact of surgical case load on recurrence rates in pilonidal sinus disease: a cross-study data synthesis", "firstAuthor": "Doll", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2025, "design": "meta-analysis", "n": 130599, "nField": "reported", "population": "people with pilonidal sinus disease who had surgery", "intervention": "surgery done at centers with higher annual case volume (10 or more, especially 30+ operations per year)", "comparator": "surgery done at centers with lower annual case volume (fewer than 10 operations per year)", "primaryOutcome": "rate of pilonidal disease coming back after surgery over 5 years", "result": "Higher-volume centers had lower recurrence rates for most surgery types, but midline closure surgery stayed high regardless of volume", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Combines over a thousand studies of varying design (RCT and non-RCT), with inconsistent results depending on surgery type and caseload group definitions.", "followUp": "5 years", "plainFinding": "More surgeon experience, fewer recurrences (mostly).", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40407900/", "sourceText": "PURPOSE: A higher surgical caseload has been associated with better outcomes in various diseases. However, this relationship has not yet been studied for Pilonidal Sinus Disease (PSD). This study aimed to examine the impact of annual PSD surgery volumes on recurrence rates (RR). METHODS: A comparative cross-study data synthesis was conducted, including 1074 studies with 130,599 patients, focusing on PSD recurrence rates. Studies were categorized based on annual case load (ACL) into three groups: fewer than 10 operations per year (group 1), 10-30 operations per year (group 2), and 30 or more operations per year (group 3). Kaplan-Meier analyses were performed to evaluate recurrence rates, with additional stratification by study design (randomized controlled trial (RCT) or non-RCT) and surgical treatment type. RESULTS: In randomized controlled trials (RCTs) of primary open treatment, group 1 (< 10 surgeries/year) had a 5-year recurrence rate of 23.5%, while group 2 (10-30 surgeries/year) had a rate of 12.5% (p < 0.0001). No data was available for group 3. For primary midline closure (pmc), the 5-year recurrence rates were 14.8% for group 1, 26.3% for group 2, and 12.8% for group 3. Non-RCT studies generally showed decreasing recurrence rates with higher surgical caseloads for most treatment types. However, midline closure surgery showed no significant improvement in recurrence rates with increased caseloads. CONCLUSION: The study demonstrates that higher surgical caseloads significantly reduce PSD recurrence rates, with notable benefits observed for centers treating 30 or more patients annually. Specialization in high-volume centers may lead to improved outcomes for PSD, particularly in flap surgeries. However, midline closure surgery continues to show persistently high recurrence rates, regardless of caseload.", "provenance": [ { "field": "n", "quote": "130,599 patients" }, { "field": "population", "quote": "Pilonidal Sinus Disease (PSD)" }, { "field": "intervention", "quote": "annual PSD surgery volumes" }, { "field": "comparator", "quote": "fewer than 10 operations per year (group 1), 10-30 operations per year (group 2), and 30 or more operations per year (group 3)" }, { "field": "primaryOutcome", "quote": "recurrence rates (RR)" }, { "field": "result", "quote": "higher surgical caseloads significantly reduce PSD recurrence rates, with notable benefits observed for centers treating 30 or more patients annually" }, { "field": "result", "quote": "midline closure surgery continues to show persistently high recurrence rates, regardless of caseload" }, { "field": "followUp", "quote": "5-year recurrence rate" } ] }, { "id": "pmid:40401769", "pmid": "40401769", "doi": "10.1097/XCS.0000000000001454", "nctId": null, "pmcid": null, "title": "Standardized Classification System for Pilonidal Disease and Recurrence Rate after Treatment", "firstAuthor": "Chiu", "multipleAuthors": true, "journal": "J Am Coll Surg", "year": 2025, "design": "prospective-cohort", "n": 411, "nField": "reported", "population": "patients presenting with pilonidal disease at a specialized care center", "intervention": "pilonidal disease severity (PDS) staging assigned at initial presentation", "comparator": "different PDS stages (0, I, II, III) and presence of open wound or prior surgery", "primaryOutcome": "pilonidal disease recurrence at 1 and 2 years after treatment", "result": "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%", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "1- and 2-year follow-up", "plainFinding": "Higher stage, more recurrence after treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40401769/", "sourceText": "BACKGROUND: Current classification systems for pilonidal disease do not objectively profile disease severity, limiting their clinical applicability. This study aimed to validate a novel pilonidal disease severity (PDS) staging system by testing its correlation with disease recurrence. STUDY DESIGN: This was a prospective cohort study set at a high-volume, specialized pilonidal care center. All patients presenting with pilonidal disease were included. The main effector under study was PDS stage assigned at initial presentation. Secondary effector variables were an open wound greater than 1 cm on presentation (descriptor W) or previous surgical resection (descriptor R). The primary outcome was pilonidal disease recurrence at 1- and 2-year follow-up. RESULTS: A total of 411 patients met criteria, with 212 and 206 patients completing 1- and 2-year follow-up, respectively. Among patients who completed 1-year follow-up, 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, respectively (log-rank test, p = 0.017). 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). The presence of an open wound at initial presentation and previous surgical resection was not associated with risk of recurrence (W, p = 0.94; R, p = 0.98). CONCLUSIONS: This study described the first staging system for pilonidal disease that correlates with risk of recurrence. On further external validation, the PDS staging system may be used both clinically to tailor treatment regimens to risk of disease recurrence and in research to standardize disease severity when comparing different therapeutic interventions.", "provenance": [ { "field": "n", "quote": "A total of 411 patients met criteria" }, { "field": "population", "quote": "All patients presenting with pilonidal disease were included." }, { "field": "intervention", "quote": "The main effector under study was PDS stage assigned at initial presentation." }, { "field": "comparator", "quote": "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" }, { "field": "primaryOutcome", "quote": "The primary outcome was pilonidal disease recurrence at 1- and 2-year follow-up." }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:40329097", "pmid": "40329097", "doi": "10.1007/s10151-025-03143-1", "nctId": null, "pmcid": "PMC12055917", "title": "Efficacy of crystallized and liquid form phenol application in pilonidal sinus disease: a single-center retrospective study", "firstAuthor": "Demir", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2025, "design": "retrospective", "n": 80, "nField": "reported", "population": "young adults with pilonidal sinus disease", "intervention": "crystallized phenol application", "comparator": "liquid phenol application", "primaryOutcome": "recovery rate, complication rate, and recurrence after treatment", "result": "Both phenol forms led to similar recovery (90% vs 95%) and recurrence rates at 1 year, but the liquid form caused more early complications", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, no untreated comparison group, small sample size", "followUp": "1st year", "plainFinding": "Not about untreated cyst duration.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40329097/", "sourceText": "AIM AND OBJECTIVE: Pilonidal sinus is a frequently observed disease in young adult male patients. Although its treatment is traditionally surgical, the tendency to use minimally invasive interventions has increased over time. This study aims to compare the clinical results of the non-surgical treatment methods for pilonidal sinus: crystallized and liquid phenol applications. MATERIALS AND METHODS: We retrospectively analyzed the data of 102 patients treated with phenol application in the General Surgery Clinic of our hospital between July 2017 and July 2019. Eighty patients were included in the study: 40 treated with crystallized phenol and 40 with liquid phenol. In the 1st month following the application, the recovery rates, complication rates, persistence of complaints, and recurrence at the end of the 1st year were compared between the groups. RESULTS: The mean age was 25.60 ± 7.16 and 25.78 ± 7.83 years in the crystallized (group 1) and liquid phenol group (group 2), respectively. Complications observed up to the 3rd week of follow-up were considered early complications, while those observed after the 3rd week were considered late complications. Early complications were observed in 15% and 37.5% of patients in groups 1 and 2, respectively (p = 0.042). Early complications were significantly higher in the liquid phenol group compared to the crystallized phenol group. 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. CONCLUSION: In pilonidal sinus treatment, successful results are obtained with both crystallized and liquid phenol application. Both methods can be performed safely and easily as an alternative treatment method to surgery.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus is a frequently observed disease in young adult male patients." }, { "field": "n", "quote": "Eighty patients were included in the study: 40 treated with crystallized phenol and 40 with liquid phenol." }, { "field": "intervention", "quote": "40 treated with crystallized phenol" }, { "field": "comparator", "quote": "40 with liquid phenol" }, { "field": "primaryOutcome", "quote": "the recovery rates, complication rates, persistence of complaints, and recurrence at the end of the 1st year were compared between the groups" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:40288765", "pmid": "40288765", "doi": "10.1111/iwj.70194", "nctId": null, "pmcid": "PMC12034373", "title": "What is the Impact of Negative Pressure Wound Therapy on Healing in Patients Post Excision of Pilonidal Sinus? A Systematic Review and Meta-Analysis", "firstAuthor": "Morais", "multipleAuthors": true, "journal": "Int Wound J", "year": 2025, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "patients who had surgery to remove a pilonidal sinus (cyst)", "intervention": "negative pressure wound therapy (vacuum dressing) on the wound after surgery", "comparator": "other types of wound dressings", "primaryOutcome": "time to healing, recurrence, pain and patient satisfaction after surgery", "result": "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", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "The review itself rated the evidence as very low certainty due to small, mixed-quality studies.", "directness": "indirect", "limitations": "Very low certainty of evidence; small sample sizes; mix of study designs including retrospective and non-randomised studies.", "followUp": "", "plainFinding": "Uncertain benefit of vacuum dressing after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/40288765/", "sourceText": "This systematic review aimed to determine the impact of negative pressure wound therapy on healing in patients with pilonidal sinus following surgical excision. Using systematic review methodology, we included original research studies written in English. The search was conducted using CINAHL Plus, Ovid, PubMed, EBSCO Host and Cochrane databases. Quality appraisal was undertaken using the Cochrane Collaboration tool for assessing risk of bias and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Data were analysed using meta-analysis where appropriate; otherwise, the data are presented narratively. Ten studies were included with a mean sample size of 61 (SD: 33). Three studies were randomised control trials, four were retrospective studies, two were prospective cohort studies and one was pre-post study. 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. The evidence for the intervention is uncertain thus, it is unclear whether NPWT makes any difference when compared to any other dressings, on time to healing, recurrence, pain or patient's experience. Further high-quality research with larger sample sizes is recommended to clearly explore the impact of NPWT on PS healing, recurrence, pain and patient's satisfaction.", "provenance": [ { "field": "population", "quote": "patients with pilonidal sinus following surgical excision" }, { "field": "intervention", "quote": "negative pressure wound therapy" }, { "field": "comparator", "quote": "any other dressings" }, { "field": "primaryOutcome", "quote": "time to healing, recurrence, pain or patient's experience" }, { "field": "result", "quote": "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." }, { "field": "result", "quote": "it is unclear whether NPWT makes any difference when compared to any other dressings, on time to healing, recurrence, pain or patient's experience" }, { "field": "n", "quote": "Ten studies were included with a mean sample size of 61 (SD: 33)." } ] }, { "id": "pmid:40178497", "pmid": "40178497", "doi": "10.23736/S2724-5691.25.10615-1", "nctId": null, "pmcid": null, "title": "Endoscopic pilonidal sinus treatment versus excision with wound closure: a systematic review of the literature", "firstAuthor": "Agnesi", "multipleAuthors": true, "journal": "Minerva Surg", "year": 2025, "design": "systematic-review", "n": 595, "nField": "reported", "population": "adults with pilonidal disease undergoing surgery", "intervention": "endoscopic pilonidal sinus treatment (EPSIT), a minimally invasive procedure", "comparator": "excision of the cyst with wound closure", "primaryOutcome": "perioperative outcomes including operative time, hospital stay, complications, recurrence, and healing time", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Slower healing but fewer complications with minimally invasive surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40178497/", "sourceText": "INTRODUCTION: The aim of this systematic review was to compare minimally invasive procedures versus excision and wound closure for the treatment of pilonidal disease (PD) in terms of perioperative outcomes. EVIDENCE ACQUISITION: Search was performed in PubMed, Embase and Web of Science, founding 581 articles. EVIDENCE SYNTHESIS: Six articles published between 2018 and 2023, including 595 patients were included in the present systematic review. All of these studies presented endoscopic pilonidal sinus treatment (EPSIT) as the minimally invasive surgical technique for the treatment of pilonidal disease, while no articles meeting the inclusion and exclusion criteria addressed video-assisted ablation of pilonidal sinus. One hundred eighty-two patients (30.6%) underwent EPSIT (Group A), whereas 413 (69.4%) underwent excision and wound closure (Group B). 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). CONCLUSIONS: EPSIT requires approximately 9 additional days to fully heal, but it avoids the risk of wound dehiscence, and had fewer complications, along with a shorter hospital stay, compared to those treated with excision and wound closure. The choice of treatment should be personalized, considering the individual needs and specific risk factors for wound dehiscence.", "provenance": [ { "field": "n", "quote": "including 595 patients were included in the present systematic review" }, { "field": "population", "quote": "treatment of pilonidal disease (PD)" }, { "field": "intervention", "quote": "All of these studies presented endoscopic pilonidal sinus treatment (EPSIT) as the minimally invasive surgical technique for the treatment of pilonidal disease" }, { "field": "comparator", "quote": "excision and wound closure (Group B)" }, { "field": "primaryOutcome", "quote": "to compare minimally invasive procedures versus excision and wound closure for the treatment of pilonidal disease (PD) in terms of perioperative outcomes" }, { "field": "result", "quote": "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)" } ] }, { "id": "pmid:40108765", "pmid": "40108765", "doi": "10.1002/lsm.70008", "nctId": null, "pmcid": null, "title": "A Comparitive Study Between Early Outcomes of Laser and Lay-Open Technique in Management of Simple Pilonidal Sinus", "firstAuthor": "El Deen", "multipleAuthors": true, "journal": "Lasers Surg Med", "year": 2025, "design": "rct", "n": 40, "nField": "reported", "population": "patients with simple/chronic pilonidal sinus disease", "intervention": "laser therapy (SiLaT) for pilonidal sinus", "comparator": "lay-open technique (sinotomy) for pilonidal sinus", "primaryOutcome": "healing time, pain, hospital stay, operative time, recurrence", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Small randomized trial with only 40 patients and short-term follow-up, so results may not be reliable or lasting.", "directness": "indirect", "limitations": "Small sample size; only early postoperative outcomes assessed; authors call for long-term studies to evaluate effectiveness", "followUp": "", "plainFinding": "Faster healing with laser, similar recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40108765/", "sourceText": "BACKGROUND: Pilonidal sinus (PS) predominantly impacts adolescent and young adult males. This condition may be asymptomatically or escalate to painful acute abscesses and recurrent discharge. OBJECTIVE: To evaluate the early postoperative outcomes of laser therapy compared to the lay-open technique in the treatment of chronic pilonidal sinus disease. METHODS: Prospective randomized comparative study including 40 patients, divided into two equal groups: (a) The SiLaT group: PS treated with diode laser therapy (SiLaT) and (b) the lay-open group: PS treated with lay-open (sinotomy). Postoperative outcomes such as operative time, hospital stay, pain scores, healing time, complications, and recurrence rates were analyzed. RESULTS: Operative time was significantly shorter in the SiLaT group (18.4 ± 2.1 min vs. 26.2 ± 3.7 min, p = 0.022). Hospital stay was shorter in the SiLaT group (6.60 ± 1.47 h vs. 15.10 ± 5.52 h, p < 0.001). Pain scores were lower in the SiLaT group (2.30 ± 0.92 vs. 4.80 ± 1.01, p < 0.001). 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. CONCLUSION: Sinus laser therapy (SiLaT) demonstrated superior early outcomes, including faster recovery, reduced pain, and fewer complications with earlier resumption of daily activities compared to the lay-open technique. However, recurrence rates remain similar, necessitating long-term studies to evaluate its effectiveness as a first-line treatment. These findings support the use of SiLaT as a day-case surgical procedure, for treating simple PS disease, particularly in young active patients seeking rapid recovery with minimal morbidity.", "provenance": [ { "field": "n", "quote": "including 40 patients, divided into two equal groups" }, { "field": "population", "quote": "treatment of chronic pilonidal sinus disease" }, { "field": "intervention", "quote": "PS treated with diode laser therapy (SiLaT)" }, { "field": "comparator", "quote": "the lay-open group: PS treated with lay-open (sinotomy)" }, { "field": "primaryOutcome", "quote": "Postoperative outcomes such as operative time, hospital stay, pain scores, healing time, complications, and recurrence rates were analyzed." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:40100423", "pmid": "40100423", "doi": "10.1007/s10103-025-04409-8", "nctId": null, "pmcid": "PMC11920000", "title": "Is it beneficial to add laser ablation to curettage in the treatment of pilonidal sinus disease?", "firstAuthor": "Demir", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2025, "design": "rct", "n": 80, "nField": "reported", "population": "adults with pilonidal sinus disease having surgery", "intervention": "laser ablation plus sinus curettage", "comparator": "sinus curettage alone", "primaryOutcome": "wound healing problems and recurrence after surgery", "result": "no significant difference between the two treatments for wound healing or recurrence", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "small randomized trial with only non-significant differences, so it may be too small to detect a real benefit", "directness": "indirect", "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.", "followUp": "6 months", "plainFinding": "No difference between the two surgeries.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40100423/", "sourceText": "AIM: This study aimed to compare laser application with sinus curettage against only sinus curettage in the treatment of pilonidal sinus disease (PSD) in terms of postoperative complications, wound healing, and recurrence. Additionally, we aimed to investigate factors associated with wound healing and recurrence after PSD surgery. PATIENTS AND METHODS: This study included patients diagnosed with PSD between February 2019, and September 2022. The patients were randomly assigned to either the laser + curettage (L/C; n = 40) group or the curettage-only (C; n = 40) group. The following data were collected: demographic and anthropometric information, smoking status, comorbidities, number of PSD-related orifices, complicated or uncomplicated disease, prior recurrence, postoperative findings, wound healing problems within 30 days postoperatively, and recurrence within 6 months postoperatively. RESULTS: The L/C and C groups were similar in terms of age and sex distribution. The groups had similar results for postoperative pain, discharge, bleeding, wound healing problems at 30 days, and recurrence at 6 months. Multivariable logistic regression revealed that, high weight and higher orifice count were independently associated with wound healing problems. Additionally, high weight, higher orifice count and prior recurrence were independently associated with recurrence. CONCLUSION: Combined curettage and laser therapy showed non-significant but broad benefits over curettage alone, but statistical significance was not achieved in any of the adverse findings, as well as wound healing and recurrence. Higher body weight and higher orifice count were associated with both poor wound healing and recurrence, while prior recurrence was another factor associated with recurrence at 6 months.", "provenance": [ { "field": "n", "quote": "the laser + curettage (L/C; n = 40) group or the curettage-only (C; n = 40) group" }, { "field": "population", "quote": "This study included patients diagnosed with PSD between February 2019, and September 2022." }, { "field": "intervention", "quote": "laser application with sinus curettage" }, { "field": "comparator", "quote": "only sinus curettage" }, { "field": "primaryOutcome", "quote": "postoperative complications, wound healing, and recurrence" }, { "field": "result", "quote": "The groups had similar results for postoperative pain, discharge, bleeding, wound healing problems at 30 days, and recurrence at 6 months." } ] }, { "id": "pmid:39995244", "pmid": "39995244", "doi": "10.12659/MSM.947466", "nctId": null, "pmcid": "PMC11871746", "title": "Comparative Outcomes of Surgical Techniques for Pilonidal Sinus: A Turkish Retrospective Study", "firstAuthor": "Gojayev", "multipleAuthors": true, "journal": "Med Sci Monit", "year": 2025, "design": "retrospective", "n": 476, "nField": "reported", "population": "adults with pilonidal sinus disease who had surgery", "intervention": "different surgical techniques: primary midline closure, Karydakis flap, Limberg flap, laser pilonidotomy", "comparator": "the four surgical techniques compared against each other", "primaryOutcome": "surgical complications, recurrence, recovery time, and quality of life after surgery", "result": "Primary midline closure had more complications and recurrence; laser pilonidotomy had shorter hospital stay, faster recovery, and higher satisfaction; Karydakis flap had lower recurrence", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective study without randomization, so differences between groups could be due to other factors, not just the surgery type.", "directness": "indirect", "limitations": "Retrospective design; abstract itself calls for studies with larger samples and longer follow-up.", "followUp": "", "plainFinding": "Surgery removes it; technique affects recovery, not duration.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39995244/", "sourceText": "BACKGROUND Pilonidal sinus is a chronic or acute infectious disease in the intergluteal cleft. Various surgical treatments exist, but optimal management remains debated. This study compares outcomes of primary midline closure (PMC), Karydakis flap (KF), Limberg flap (LF), and laser pilonidotomy (LP) in adult patients with pilonidal sinus disease. MATERIAL AND METHODS The data of 476 patients who underwent surgery for pilonidal sinus disease in our clinic between January 2011 and September 2022 were retrospectively evaluated. After 54 patients were excluded, the remaining patients were divided into 4 groups: PMC (n=228), LF (n=82), KF (n=53), and LP (n=59). Patient characteristics, surgical findings, and quality of life outcomes were compared between the groups. RESULTS The operation time was significantly shorter in the LP group (P<0.001). Seroma (P=0.006), wound dehiscence (P<0.001), and postoperative recurrence (P=0.017) rates were significantly higher in the PMC group. Hospital stay was significantly shorter in the LP group (mean, 8 h; P<0.001). 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). According to the Likert scale, the satisfaction rate of the LP group was significantly higher (P<0.001). CONCLUSIONS The PMC method has a higher postoperative complication rate and a slower return to normal physical activity. The KF method appears to be more advantageous in terms of postoperative recurrence rate. Although the LP method seems to be more advantageous in terms of quality of life in selected patients, studies with larger samples and longer follow-up periods are needed.", "provenance": [ { "field": "n", "quote": "The data of 476 patients who underwent surgery for pilonidal sinus disease in our clinic between January 2011 and September 2022 were retrospectively evaluated." }, { "field": "population", "quote": "adult patients with pilonidal sinus disease" }, { "field": "intervention", "quote": "primary midline closure (PMC), Karydakis flap (KF), Limberg flap (LF), and laser pilonidotomy (LP)" }, { "field": "comparator", "quote": "compares outcomes of primary midline closure (PMC), Karydakis flap (KF), Limberg flap (LF), and laser pilonidotomy (LP) in adult patients with pilonidal sinus disease" }, { "field": "primaryOutcome", "quote": "Patient characteristics, surgical findings, and quality of life outcomes were compared between the groups." }, { "field": "result", "quote": "Seroma (P=0.006), wound dehiscence (P<0.001), and postoperative recurrence (P=0.017) rates were significantly higher in the PMC group." }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:39953215", "pmid": "39953215", "doi": "10.1007/s10103-025-04341-x", "nctId": null, "pmcid": null, "title": "Laser versus rhomboid flap for sacrococcygeal pilonidal sinus: multi-centre comparative study", "firstAuthor": "Alwadees", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2025, "design": "retrospective", "n": 374, "nField": "reported", "population": "people aged 16 to 70 with a first-time pilonidal sinus (cyst near the tailbone)", "intervention": "laser ablation treatment", "comparator": "open rhomboid flap surgery", "primaryOutcome": "rate of the cyst coming back (recurrence)", "result": "the laser group had a much higher recurrence rate than the open surgery group", "resultDirection": "harm", "quality": "low", "qualityWhy": "it compares two surgical groups without describing randomization or blinding, so bias cannot be ruled out.", "directness": "indirect", "limitations": "abstract does not describe randomization, blinding, or how patients were assigned to each group", "followUp": "4 weeks or 3 months", "plainFinding": "Laser had more recurrences than surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/39953215/", "sourceText": "Pilonidal sinus is a condition affecting young people. Several management methods are available. The two popular approaches are laser ablation and open techniques. This study aims to assess the recurrence rate after both techniques. This is a government and private hospital setting. Patients are included if they are diagnosed with pilonidal sinus, between the ages of 16 and 70, and have never had surgery before. Diabetic patients and patients with immune deficiency status who are younger than 16 or older than 70 are excluded. The operations are done by senior consultant surgeons. Patients are seen for 4 weeks or 3 months and discharged if there are no complications. 190 and 184 patients were selected for the laser and open groups, respectively. There are 142 men and 42 women in the open group compared to 140 men and 50 women in the laser group, with p-value: of 0.472. There was no significant difference in age, body mass index, or obesity between the two groups. There is a significantly higher recurrence rate in the laser group value: <0.00001. No significant difference in the recurrence rate for one or more than one opening disease within the open group. The laser technique is associated with a higher recurrence rate compared to the open rhomboid flap technique. One opening pilonidal sinus is significantly showing better results within the laser group but no significant difference in the open group.", "provenance": [ { "field": "n", "quote": "190 and 184 patients were selected for the laser and open groups, respectively." }, { "field": "population", "quote": "Patients are included if they are diagnosed with pilonidal sinus, between the ages of 16 and 70, and have never had surgery before." }, { "field": "intervention", "quote": "laser ablation" }, { "field": "comparator", "quote": "open rhomboid flap technique" }, { "field": "primaryOutcome", "quote": "This study aims to assess the recurrence rate after both techniques." }, { "field": "result", "quote": "There is a significantly higher recurrence rate in the laser group value: <0.00001." }, { "field": "followUp", "quote": "Patients are seen for 4 weeks or 3 months and discharged if there are no complications." } ] }, { "id": "pmid:39900551", "pmid": "39900551", "doi": "10.1002/wjs.12492", "nctId": null, "pmcid": null, "title": "Evaluation of Outcomes for Karydakis Operation for Pilonidal Sinus Disease-Comparison of Original Reports With Later Results", "firstAuthor": "Doll", "multipleAuthors": true, "journal": "World J Surg", "year": 2025, "design": "systematic-review", "n": 9878, "nField": "reported", "population": "patients who had pilonidal sinus disease treated with Karydakis flap surgery", "intervention": "Karydakis advancement flap surgery for pilonidal sinus disease", "comparator": "the original 1992 Karydakis report's recurrence results", "primaryOutcome": "rate of pilonidal sinus recurrence after surgery at 5 and 10 years", "result": "recurrence rates in later studies were much higher than in the original report", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "it combines many different studies of varying quality rather than a single controlled comparison, so the pooled recurrence numbers are less reliable.", "directness": "indirect", "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", "followUp": "5- and 10-year follow-ups", "plainFinding": "Surgery recurrence higher than first reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39900551/", "sourceText": "BACKGROUND: Karydakis published his advancement flap technique to treat pilonidal sinus disease (PSD) in 1973 (GEK73) and reported a very low recurrence rate in 1992 (GEK92) in a large series of cases. Since then, the procedure has been widely adapted without replicating his results. AIM: To compare the outcomes of the Karydakis 1992 report to the global literature and evaluate reasons for the major discrepancy in recurrence rates. METHODS: From an international database including all PSD studies, we identified 113 other studies encompassing 9878 patients undergoing the Karydakis advancement flap surgery. Recurrence rates at 5- and 10-year follow-ups were compared to the data presented in the Karydakis 1992 paper. RESULTS: The Karydakis 1992 study reports a recurrence rate < 1% with a follow-up ranging between 2 and 20 years. 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. CONCLUSION: The standard for recurrence rates after the Karydakis advancement flap set by Karydakis has not since been replicated in the global literature. For surgeons and patients alike it is important to have realistic expectations of short- and long-term outcomes.", "provenance": [ { "field": "n", "quote": "113 other studies encompassing 9878 patients undergoing the Karydakis advancement flap surgery" }, { "field": "population", "quote": "113 other studies encompassing 9878 patients undergoing the Karydakis advancement flap surgery" }, { "field": "intervention", "quote": "patients undergoing the Karydakis advancement flap surgery" }, { "field": "comparator", "quote": "Recurrence rates at 5- and 10-year follow-ups were compared to the data presented in the Karydakis 1992 paper." }, { "field": "primaryOutcome", "quote": "Recurrence rates at 5- and 10-year follow-ups were compared to the data presented in the Karydakis 1992 paper." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:39893840", "pmid": "39893840", "doi": "10.1016/j.jpedsurg.2025.162182", "nctId": null, "pmcid": "PMC11993338", "title": "Laser Hair Removal May Be a Primary Treatment of Pilonidal Disease: A Pilot Study", "firstAuthor": "Janek", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2025, "design": "prospective-cohort", "n": 22, "nField": "reported", "population": "patients ages 13-35 with moderate to severe pilonidal disease referred for surgical excision", "intervention": "laser hair removal (long-pulsed Alexandrite 755 nm laser) as primary treatment", "comparator": "no control group; outcomes compared before and after laser treatment, with some patients later needing surgery", "primaryOutcome": "resolution rates without surgical intervention and recurrence rates after surgery", "result": "40% of patients resolved without surgery, and 67% of those who had surgery resolved after one operation", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, single-arm pilot study without a comparison group, so it can't prove the laser caused the improvement.", "directness": "indirect", "limitations": "small sample size, no control group, some patients withdrew, single-center design", "followUp": "18 months", "plainFinding": "Laser hair removal helped some cysts heal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39893840/", "sourceText": "INTRODUCTION: Pilonidal disease is a chronic skin disorder of the gluteal cleft in adolescents and young adults. No treatment is universally effective, and the heterogeneity of the disease and variability in treatment response frustrates patients and clinicians alike. Surgical treatment strategies focus on the removal of the sinus tracts. Post-operative laser hair removal (LHR) has demonstrated promise to reduce disease recurrence following surgery. LHR has yet to be investigated as a primary treatment strategy and may offer additional benefits. METHODS: A single-center prospective pilot study investigated laser hair removal as the primary treatment for moderate to severe pilonidal disease. Patients ages 13-35 with moderate to severe disease who were referred for surgical excision were recruited. Participants underwent 3-8 treatment sessions with the long-pulsed--Alexandrite (755 nm) laser by a dermatologist until hair removal endpoints were met. Patients with persistent symptoms after LHR underwent subsequent excision. Patients were subsequently followed in the pediatric surgery clinic at 6, 9, 12 and 18 months following LHR to evaluate for disease recurrence. Primary outcomes included resolution rates without surgical intervention and recurrence rates following surgical resection. Secondary outcomes included the number of episodes of infection and impact on quality of life, as assessed by the Dermatology Life Quality Index (DLQI) in patients ≥16 years of age, and the Children's Dermatology Life Quality Index (CDLQI) in patients <16 years of age. RESULTS: Twenty-two patients were enrolled, of which 18 were initiated and 15 completed the LHR sessions in the study, designed to the endpoint of the absence of terminal hair in the gluteal cleft. One patient withdrew prior to completion of the LHR sessions, and two withdrew from the study due to the COVID-19 pandemic. Of the 15 patients who completed the LHR sessions, all demonstrated significant improvement in hair follicle density in the treatment area, with no adverse events. Median number of laser treatments was 6. 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. Quality of life scores improved after laser treatments (DLQI mean change -4.6, and Children's DLQI mean change -6.0) CONCLUSION: Laser hair removal was well tolerated, without adverse events and with improved quality of life, in a patient population with moderate to severe pilonidal disease. Nearly half of patients had disease resolution without the need for surgical intervention. These findings underscore the potential for laser hair removal to improve disease outcomes in pilonidal disease, reducing the need for surgical intervention. Based on these results, laser hair removal might provide an effective primary treatment strategy for some patients, and could improve outcomes for those who require surgical intervention. Further research is needed to determine which patients would most likely benefit from this treatment strategy. LEVEL OF EVIDENCE: Level III.", "provenance": [ { "field": "n", "quote": "Twenty-two patients were enrolled" }, { "field": "population", "quote": "Patients ages 13-35 with moderate to severe disease who were referred for surgical excision were recruited." }, { "field": "intervention", "quote": "Participants underwent 3-8 treatment sessions with the long-pulsed--Alexandrite (755 nm) laser by a dermatologist until hair removal endpoints were met." }, { "field": "comparator", "quote": "Patients with persistent symptoms after LHR underwent subsequent excision." }, { "field": "primaryOutcome", "quote": "Primary outcomes included resolution rates without surgical intervention and recurrence rates following surgical resection." }, { "field": "result", "quote": "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." }, { "field": "followUp", "quote": "Patients were subsequently followed in the pediatric surgery clinic at 6, 9, 12 and 18 months following LHR to evaluate for disease recurrence." } ] }, { "id": "pmid:39871414", "pmid": "39871414", "doi": "10.1111/codi.70003", "nctId": null, "pmcid": "PMC11772908", "title": "Gender-specific outcomes in pilonidal sinus disease: Female outcomes after cleft lift surgery in a large prospective Danish cohort", "firstAuthor": "Faurschou", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2025, "design": "prospective-cohort", "n": 560, "nField": "reported", "population": "people with pilonidal sinus disease who had cleft lift surgery, comparing women and men", "intervention": "Bascom's cleft lift surgery in female patients", "comparator": "Bascom's cleft lift surgery in male patients", "primaryOutcome": "risk of disease recurrence and prolonged wound healing after surgery", "result": "women had a 30% higher risk of recurrence (not statistically significant) and a 46% higher risk of prolonged healing than men", "resultDirection": "mixed", "quality": "low", "qualityWhy": "it is an observational cohort without randomization, and one of the two key differences (recurrence) was not statistically significant.", "directness": "indirect", "limitations": "observational design, no randomization, small subgroup of women (88 patients), focuses on surgical outcomes rather than natural disease duration", "followUp": "", "plainFinding": "Women healed slower after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39871414/", "sourceText": "AIM: Pilonidal sinus disease (PSD) is a common condition particularly affecting young men. Females affected by the condition account for about 20% of patients and are rarely mentioned, much less studied specifically. In this study we evaluate the surgical outcomes in a female population following Bascom's cleft lift (BCL) surgery in primary extensive disease, non-healing wounds after previous surgery and recurrent disease in a large Danish cohort from a high-volume centre. METHOD: The study is based on a prospective database established at Randers Regional Hospital in 2016. All patients undergoing BCL surgery from June 2016 until October 2022 were included in this study. RESULTS: In all, 560 patients underwent BCL surgery at our centre during this period. Eighty-eight (15.7%) were women. Only 10 (11.3%) were operated due to primary extensive manifestations. The rest presented with either non-healing wounds after previous surgery (47.7%) or recurrent PSD (41%). 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 (risk ratio 1.46, 95% CI 1.02-2.14). CONCLUSION: Female PSD patients may represent a subcategory of patients at higher risk of treatment failure and should be dealt with as such. Initially, few present with the need for extensive surgery. However, given the common occurrence of prolonged healing and recurrence, we recommend a minimal invasive approach when possible.", "provenance": [ { "field": "population", "quote": "we evaluate the surgical outcomes in a female population following Bascom's cleft lift (BCL) surgery" }, { "field": "intervention", "quote": "Bascom's cleft lift (BCL) surgery" }, { "field": "comparator", "quote": "Risk of recurrence in female patients was 30% higher than in male patients" }, { "field": "primaryOutcome", "quote": "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" }, { "field": "result", "quote": "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)" }, { "field": "n", "quote": "In all, 560 patients underwent BCL surgery at our centre during this period." } ] }, { "id": "pmid:39800555", "pmid": "39800555", "doi": "10.48095/ccachp2024120", "nctId": null, "pmcid": null, "title": "Limberg flap for previously recurrent complex sacrococcygeal pilonidal sinus surgeries", "firstAuthor": "Aljarrah", "multipleAuthors": true, "journal": "Acta Chir Plast", "year": 2024, "design": "case-series", "n": 10, "nField": "reported", "population": "patients with complex or recurrent pilonidal sinus disease near the tailbone", "intervention": "Limberg flap surgery (a rotational skin flap procedure)", "comparator": "no comparison group within this study (only mentioned vs open procedures in general)", "primaryOutcome": "wound infection, seroma, pain, recurrence, return to work, cosmetic result and satisfaction after surgery", "result": "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", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "3 months", "plainFinding": "No recurrence after flap surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39800555/", "sourceText": "OBJECTIVE: Limberg flap, is a rotational rhomboid flap. A procedure done for people who have either complex or recurrent pilonidal disease. This study has been performed to determine effects of the Limberg flap for sacrococcygeal pilonidal sinus, regarding the wound infection rate, seroma formation, postoperative pain relief, recurrence rates, return to work, its cosmetic final result and patients' satisfaction. METHODS: A total of 10 patients were operated from January 2022 to March 2023. Patients were selected according to the disease complexity and recurrence, so that the patients selected were classified as complex and at least of a second recurrence of the disease. RESULTS: Patients successfully underwent surgery, with mild to moderate postoperative pain, stayed in hospital for 3 days in average, returned to work after 6 weeks, with 5 patients having flap oedema, 1 patient had wound infection, no one had flap necrosis, and there were no recurrences so far for an average follow-up time of about 3 months. Patients with flap oedema took 2-3 weeks to heal with regular dressing only. Patient satisfaction and final cosmetic result were well accepted. Limberg flap for sacrococcygeal pilonidal sinus was found very useful in terms of recurrences. CONCLUSION: Better patients' acceptance and satisfaction despite the increased risk in postoperative pain, infection rates, and longer return to work in comparison to the open procedures.", "provenance": [ { "field": "n", "quote": "A total of 10 patients were operated from January 2022 to March 2023." }, { "field": "population", "quote": "patients selected were classified as complex and at least of a second recurrence of the disease" }, { "field": "intervention", "quote": "Limberg flap, is a rotational rhomboid flap" }, { "field": "comparator", "quote": "in comparison to the open procedures" }, { "field": "primaryOutcome", "quote": "regarding the wound infection rate, seroma formation, postoperative pain relief, recurrence rates, return to work, its cosmetic final result and patients' satisfaction" }, { "field": "result", "quote": "there were no recurrences so far for an average follow-up time of about 3 months" }, { "field": "followUp", "quote": "an average follow-up time of about 3 months" } ] }, { "id": "pmid:39792517", "pmid": "39792517", "doi": "10.1097/ASW.0000000000000220", "nctId": null, "pmcid": null, "title": "Evaluation of Clinical Outcomes and Quality of Life following the Karydakis Flap Procedure for Pilonidal Sinus Treatment", "firstAuthor": "Breidung", "multipleAuthors": true, "journal": "Adv Skin Wound Care", "year": 2024, "design": "retrospective", "n": 103, "nField": "reported", "population": "patients with pilonidal sinus who had surgery", "intervention": "Karydakis flap surgical procedure for pilonidal sinus", "comparator": "none reported (single-arm study)", "primaryOutcome": "postoperative complications, recurrence rate, wound healing time, and return to daily life", "result": "average wound healing time was 21.4 days after surgery, with a 6.8% recurrence rate within 59 months", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This was a retrospective single-surgeon study with no comparison group, so it cannot show whether the procedure is better than other options.", "directness": "indirect", "limitations": "Retrospective design, single surgeon, no control/comparator group, follow-up partly done by telephone.", "followUp": "59 months", "plainFinding": "Surgical wounds healed in about 3 weeks.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39792517/", "sourceText": "OBJECTIVE: To evaluate the clinical outcome of the Karydakis flap procedure performed by a single surgeon for the treatment of pilonidal sinus, focusing on postoperative complications, recurrence rate, wound healing time, and return to daily life. METHODS: Authors performed a retrospective data analysis of patients who underwent reconstruction of pilonidal sinus using the Karydakis technique at the Department of Plastic, Reconstructive and Hand Surgery, Center for Severe Burn Injuries of Paracelsus Medical University, Klinikum Nürnberg, Germany, between 2014 and 2021. All cases were performed by a single surgeon. Patients were requested to attend a follow-up appointment in person or, if this was not possible, by telephone. RESULTS: A total of 103 patients were enrolled in the study. The postoperative complication rate was 11.7%. Revision surgery was required in 4.9% of patients because of a complication. Wound healing time was on average 21.4 days postoperatively. A total of seven patients (6.8%) had a recurrence within 59 months postoperatively. CONCLUSIONS: The Karydakis flap is a robust reconstructive off-midline procedure for the treatment of pilonidal sinus. Relatively few postoperative complications and a low recurrence rate are advantages of the surgical procedure. Based on the results of quality-of-life factors, patients experience early functional return to daily life after the Karydakis flap procedure.", "provenance": [ { "field": "n", "quote": "A total of 103 patients were enrolled in the study." }, { "field": "population", "quote": "patients who underwent reconstruction of pilonidal sinus using the Karydakis technique" }, { "field": "intervention", "quote": "the Karydakis flap procedure performed by a single surgeon for the treatment of pilonidal sinus" }, { "field": "primaryOutcome", "quote": "focusing on postoperative complications, recurrence rate, wound healing time, and return to daily life" }, { "field": "result", "quote": "Wound healing time was on average 21.4 days postoperatively. A total of seven patients (6.8%) had a recurrence within 59 months postoperatively." }, { "field": "comparator", "quote": "Authors performed a retrospective data analysis of patients who underwent reconstruction of pilonidal sinus using the Karydakis technique" } ] }, { "id": "pmid:39699772", "pmid": "39699772", "doi": "10.1007/s10151-024-03058-3", "nctId": null, "pmcid": null, "title": "Sinus laser therapy versus Karydakis flap procedure in the management of pilonidal sinus disease: a comparative analysis of intraoperative parameters and postoperative outcome", "firstAuthor": "Akyol", "multipleAuthors": false, "journal": "Tech Coloproctol", "year": 2024, "design": "retrospective", "n": 106, "nField": "reported", "population": "adults with pilonidal sinus disease treated surgically", "intervention": "minimally invasive sinus laser therapy (SiLaT)", "comparator": "Karydakis flap surgery", "primaryOutcome": "operative time, pain, return-to-work time, complications and recurrence after surgery", "result": "Laser therapy had shorter operating time, less pain, and faster return to work, with similar complication and recurrence rates to flap surgery", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized comparison of two surgeries, so differences could be due to patient selection rather than the treatments themselves.", "directness": "indirect", "limitations": "Retrospective design without randomization; abstract does not report length of follow-up for recurrence.", "followUp": "", "plainFinding": "Laser surgery: faster, less painful recovery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39699772/", "sourceText": "BACKGROUND: This study aimed to investigate the utility of minimally invasive sinus laser therapy (SiLaT) versus flap surgery (Karydakis flap procedure) in terms of intraoperative parameters and postoperative outcome in patients with pilonidal sinus disease (PSD). METHODS: A total of 106 patients with PSD (mean ± SD age: 26.4 ± 7.0 years, 86.8% male) treated with Karydakis flap procedure (KF group; n = 63) or sinus laser therapy (SiLaT group; n = 43) were included in this retrospective study. Data on patient demographics, 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 were recorded in each patient and compared between KF and SiLaT groups. RESULTS: 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]. Although no significant difference was noted in complication and recurrence rates between the KF and SiLaT groups, 6.3% (wound infection only) and 3.2% of patients in the KF group but none of the patients in the SiLaT group developed complication and recurrence, respectively. CONCLUSIONS: SiLaT seems to be a promising minimally invasive technique for the management of PSD, being comparable to the KF procedure in terms of complications and recurrence, along with added advantages of shorter operative time, reduced postoperative pain, and earlier return to work.", "provenance": [ { "field": "n", "quote": "A total of 106 patients with PSD" }, { "field": "population", "quote": "patients with pilonidal sinus disease (PSD)" }, { "field": "intervention", "quote": "sinus laser therapy (SiLaT)" }, { "field": "comparator", "quote": "Karydakis flap procedure" }, { "field": "primaryOutcome", "quote": "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" }, { "field": "result", "quote": "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]." }, { "field": "result", "quote": "Although no significant difference was noted in complication and recurrence rates between the KF and SiLaT groups" } ] }, { "id": "pmid:39656288", "pmid": "39656288", "doi": "10.1007/s10151-024-03049-4", "nctId": null, "pmcid": null, "title": "Pediatric endoscopic pilonidal sinus treatment: lessons learned after 100 consecutive cases", "firstAuthor": "Pérez-Bertólez", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2024, "design": "retrospective", "n": 149, "nField": "reported", "population": "children and teens with a pilonidal sinus (cyst) needing surgery", "intervention": "endoscopic pilonidal sinus surgery (PEPSiT)", "comparator": "standard surgery - cutting it out and letting it heal naturally (EHSI) or cutting it out and stitching it closed (EPC)", "primaryOutcome": "how long it took to fully heal, pain, complications, and return to normal activity", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "patients were not randomly assigned to a treatment group, and the surgeon chose which technique to use, so other factors could explain the difference.", "directness": "indirect", "limitations": "not randomized, surgical technique was chosen by the surgeon rather than assigned, single institution", "followUp": "", "plainFinding": "Faster healing with endoscopic surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39656288/", "sourceText": "AIM: 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. The objective of our study was to evaluate the effectiveness and advantages of PEPSiT versus conventional surgery of pilonidal sinus in the pediatric population. METHODS: A quasi-experimental study was carried out in pediatric patients undergoing pilonidal sinus surgery at a single institution from 2019 to 2022. Excision and healing by secondary intention (EHSI), excision and primary closure (EPC), and PEPSiT were compared. The surgical technique chosen was surgeon-dependent. RESULTS: In total, 149 patients were studied-100 undergoing PEPSiT, 28 undergoing EHSI, and 21 undergoing EPC. 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). Pain on the visual analogue scale (VAS) and need for analgesics were lower in the PEPSiT group (p < 0.01). Mean time to return to normal life was shorter with PEPSiT-177 days earlier than EHSI (95% CI 124.7-230.2; p < 0,01) and 7.2 days earlier tan EPC (95% CI 20.2-138.6; p < 0,009). Complications with PEPSiT were 9.3 times lower tan EHSI [odds ratio (OR) 9.3; 95% confidence interval (CI) 3.5-24.7] and 8.5 times lower than ECP (OR = 8.5; 95% CI 2.9-24.4). EHSI had 5.3 times more probability of recurrence than PEPSiT (OR = 5.3; 95% CI 1.3-22.7), and ECP 15.2 times more (OR = 15.2; 95% CI 3.2-71.7). CONCLUSIONS: Endoscopic pilonidal sinus treatment is effective in medium-term follow-up, with fewer complications than classic techniques. It allows for an early return to normal life without restrictions.", "provenance": [ { "field": "population", "quote": "A quasi-experimental study was carried out in pediatric patients undergoing pilonidal sinus surgery at a single institution from 2019 to 2022." }, { "field": "intervention", "quote": "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." }, { "field": "comparator", "quote": "Excision and healing by secondary intention (EHSI), excision and primary closure (EPC), and PEPSiT were compared." }, { "field": "primaryOutcome", "quote": "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)." }, { "field": "result", "quote": "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)." }, { "field": "n", "quote": "In total, 149 patients were studied-100 undergoing PEPSiT, 28 undergoing EHSI, and 21 undergoing EPC." } ] }, { "id": "pmid:39578271", "pmid": "39578271", "doi": "10.1007/s10103-024-04239-0", "nctId": null, "pmcid": null, "title": "Does the holmium laser have a place in the treatment of pilonidal cysts? (Pilolas study)", "firstAuthor": "Darnis", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2024, "design": "retrospective", "n": null, "nField": "not-reported", "population": "patients treated for pilonidal cysts", "intervention": "holmium laser treatment", "comparator": "SiLaT laser treatment", "primaryOutcome": "healing (cure) rate at one month after treatment", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "It's a retrospective study without a concurrent control group, comparing to past results, which makes the findings less reliable.", "directness": "indirect", "limitations": "Retrospective design; comparison to SiLaT laser is indirect, not a randomized head-to-head trial; higher complication rates noted.", "followUp": "up to a year", "plainFinding": "Similar healing but more pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39578271/", "sourceText": "Recently, a minimally invasive procedure based on a laser technique (SiLaT) has been developed for the treatment of pilonidal cysts. Although less invasive and less painful than surgery, this solution is nevertheless limited by its high cost. Other more affordable laser devices, such as the holmium laser, are also used in minimally invasive surgery. The objective of this study was to evaluate the possibility of using the holmium laser instead of the SiLaT laser in the treatment of pilonidal cysts. Retrospective cohort study with the primary endpoint being the cure rate one month after treatment. Median duration of local care was 21 days (mean = 22 ± 7.5) and healing rate at 1 month was 90.7%. During follow-up, 102 patients (44.9%) experienced pain in the coccygeal region often exacerbated by sitting and significantly more common in people with a small frame, overwhelmingly female. A surgical site infection was reported in 36 patients (15.9%). Recurrence, occurred in 39 patients (17.2%), was related to cyst type (type 1 do not recur, type 3 recur twice three time than type 2). Holmium laser does not differ from SiLaT laser in the healing rate of pilonidal cysts after treatment. However, it is characterised by a moderately higher incidence of complications, foremost of which is the occurrence of pain that can persist for up to a year after the procedure and which could be related to an increase in heat inherent to the use of holmium. As a result, this procedure does not seem to represent an alternative to SiLaT.", "provenance": [ { "field": "population", "quote": "treatment of pilonidal cysts" }, { "field": "intervention", "quote": "holmium laser" }, { "field": "comparator", "quote": "SiLaT laser" }, { "field": "primaryOutcome", "quote": "the primary endpoint being the cure rate one month after treatment" }, { "field": "result", "quote": "healing rate at 1 month was 90.7%" }, { "field": "result", "quote": "102 patients (44.9%) experienced pain in the coccygeal region often exacerbated by sitting" }, { "field": "result", "quote": "pain that can persist for up to a year after the procedure" }, { "field": "result", "quote": "Holmium laser does not differ from SiLaT laser in the healing rate of pilonidal cysts after treatment" } ] }, { "id": "pmid:39551964", "pmid": "39551964", "doi": "10.1111/codi.17238", "nctId": null, "pmcid": null, "title": "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", "firstAuthor": "Pedersen", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2025, "design": "prospective-cohort", "n": 392, "nField": "reported", "population": "adults with pilonidal sinus disease, including new extensive disease, wounds that didn't heal after prior surgery, and recurrent disease", "intervention": "Bascom's cleft lift surgery", "comparator": "disease manifestation type (newly diagnosed extensive disease vs nonhealing wounds vs recurrent disease)", "primaryOutcome": "wound healing and recurrence rates after surgery", "result": "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%)", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "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.", "directness": "indirect", "limitations": "Single high-volume center, no comparator arm without surgery, and findings may not generalize to other settings.", "followUp": "60 months", "plainFinding": "Most healed by 3 months; some recurred later.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39551964/", "sourceText": "AIM: Pilonidal sinus disease (PSD) is a common condition particularly affecting the young population. The disease is incompletely understood, and optimal treatment is still debated. However, off-midline closure techniques have become the standard of care in more advanced cases. The literature is, however, lacking disease stratification in evaluation of surgical results. The aim of this study was to evaluate the surgical outcomes in a prospective cohort following Bascom's cleft lift (BCL) in primary extensive disease, nonhealing wounds after previous surgery and recurrence on a large Danish cohort from a high-volume centre. METHOD: The study is based on a prospective database established at Randers Regional Hospital in 2016. All patients undergoing BCL surgery from June 2016 until June 2020 were included in this study. RESULTS: Three hundred and ninety two patients (326 men/66 women) underwent BCL surgery over a 4-year period. Of these, 127 (32.4%) presented with primary extensive PSD, 136 (34.7%) with nonhealing wounds and 129 (33.9%) with recurrent PSD. 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%). CONCLUSION: Treatment of advanced PSD remains challenging with a high rate of wound complications and recurrences, stressing the need for dedicated care. Patients with either failed surgery or recurrence need particular attention.", "provenance": [ { "field": "n", "quote": "Three hundred and ninety two patients (326 men/66 women) underwent BCL surgery over a 4-year period." }, { "field": "population", "quote": "Of these, 127 (32.4%) presented with primary extensive PSD, 136 (34.7%) with nonhealing wounds and 129 (33.9%) with recurrent PSD." }, { "field": "intervention", "quote": "following Bascom's cleft lift (BCL) in primary extensive disease, nonhealing wounds after previous surgery and recurrence" }, { "field": "comparator", "quote": "the risk of recurrence was higher among patients with nonhealing wounds (20%) and recurrence (17%) compared with primary extensive manifestation (13%)" }, { "field": "primaryOutcome", "quote": "Overall, 87% healed uneventfully within the first 3 months, and 17% had recurrence at a median follow-up of 60 months (45-73 months)." }, { "field": "result", "quote": "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%)." } ] }, { "id": "pmid:39544170", "pmid": "39544170", "doi": "10.1177/00031348241300362", "nctId": null, "pmcid": null, "title": "Pathological Examination in Pilonidal Sinus Surgery: Evaluating Necessity and Cost-Effectiveness: A 10-Year Retrospective Analysis", "firstAuthor": "Kudaş", "multipleAuthors": true, "journal": "Am Surg", "year": 2025, "design": "retrospective", "n": 1505, "nField": "reported", "population": "patients who had surgery to remove a pilonidal sinus", "intervention": "routine pathological (microscopic) examination of the removed tissue", "comparator": "examination based only on patients' risk factors (age, disease duration)", "primaryOutcome": "rate of cancer (malignancy) found in the removed pilonidal tissue", "result": "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", "resultDirection": "unclear", "quality": "low", "qualityWhy": "It is a retrospective chart review with only two cancer cases, giving very wide confidence intervals and limited ability to draw firm conclusions.", "directness": "indirect", "limitations": "Retrospective design, very small number of malignant cases, missing data excluded without imputation, and it studies cancer risk rather than typical cyst duration.", "followUp": "2-year follow-up", "plainFinding": "Longer-lasting cysts linked to slightly higher cancer risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39544170/", "sourceText": "BackgroundMalignancy in pilonidal sinus disease (PSD) is rare, with squamous cell carcinoma (SCC) being the most common type. This study aims to assess the incidence of malignancy in PSD and identify risk factors to guide more targeted pathological examination strategies.MethodsA retrospective analysis was conducted on 1505 patients who underwent surgical excision of PSD between January 1, 2014, and December 31, 2023. Patients with incomplete or missing histopathological data were excluded, and no imputation methods were used for missing data. All specimens underwent histopathological examination to detect malignancies.ResultsTwo 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). Both cases were treated surgically and received adjuvant radiotherapy, with both patients being disease-free at the 2-year follow-up.ConclusionWhile malignancy in PSD is rare (0.13%), older age and prolonged disease duration are associated with increased risk. Selective pathological examination based on these risk factors could enhance cost-effectiveness by reducing unnecessary routine examinations.", "provenance": [ { "field": "n", "quote": "A retrospective analysis was conducted on 1505 patients who underwent surgical excision of PSD between January 1, 2014, and December 31, 2023." }, { "field": "population", "quote": "1505 patients who underwent surgical excision of PSD" }, { "field": "intervention", "quote": "All specimens underwent histopathological examination to detect malignancies." }, { "field": "comparator", "quote": "Selective pathological examination based on these risk factors could enhance cost-effectiveness by reducing unnecessary routine examinations." }, { "field": "primaryOutcome", "quote": "This study aims to assess the incidence of malignancy in PSD and identify risk factors to guide more targeted pathological examination strategies." }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:39427709", "pmid": "39427709", "doi": "10.1016/j.cireng.2024.10.002", "nctId": null, "pmcid": null, "title": "Short-term results of unroofing and marsupialization compared to the Karydakis technique in the treatment of pilonidal sinus. A randomized prospective study", "firstAuthor": "Baños", "multipleAuthors": true, "journal": "Cir Esp (Engl Ed)", "year": 2025, "design": "rct", "n": 122, "nField": "reported", "population": "adults with a symptomatic pilonidal sinus with no abscess, having surgery for the first time", "intervention": "unroofing and marsupialization surgery", "comparator": "Karydakis flap surgery", "primaryOutcome": "complications in the first 30 days after surgery", "result": "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", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "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.", "directness": "indirect", "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", "followUp": "90-day", "plainFinding": "Fewer complications but more recurrences.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39427709/", "sourceText": "INTRODUCTION: The treatment of pilonidal sinus (PS) is usually surgical, but no procedure is considered the gold standard. The Karydakis (K) technique is widely used, and unroofing and marsupialization (UM) is a simple surgery with good results. PRIMARY OBJECTIVE: To evaluate early postoperative complications (EPC) 30 days after UM surgery compared to the K technique. SECONDARY OBJECTIVES: To evaluate surgical time, postoperative pain, patient satisfaction, return to daily activity and early recurrence within 3 months. METHOD: Prospective, single-center, randomized study in patients who underwent surgery for primary PS with no abscess between June 2016 and November 2017. They were randomized using a computer-generated block method. To analyze the main objective, a non-inferiority analysis was performed. RESULTS: 122 patients with symptomatic primary PS were randomized: 60 in the K group and 62 in the UM group. Both groups were homogeneous. 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. CONCLUSIONS: UM is a simple, minimally invasive, easily reproducible technique that has a lower rate of early complications, with a shorter operative time and an earlier return to daily activity.", "provenance": [ { "field": "n", "quote": "122 patients with symptomatic primary PS were randomized: 60 in the K group and 62 in the UM group" }, { "field": "population", "quote": "patients who underwent surgery for primary PS with no abscess" }, { "field": "intervention", "quote": "unroofing and marsupialization (UM)" }, { "field": "comparator", "quote": "Karydakis (K) technique" }, { "field": "primaryOutcome", "quote": "To evaluate early postoperative complications (EPC) 30 days after UM surgery compared to the K technique." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:39422799", "pmid": "39422799", "doi": "10.1007/s00384-024-04742-4", "nctId": null, "pmcid": "PMC11489158", "title": "Phenolization of the sinus tract in recurrent sacrococcygeal pilonidal sinus disease: long-term results of a prospective cohort study", "firstAuthor": "de Kort", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2024, "design": "prospective-cohort", "n": 47, "nField": "reported", "population": "patients with recurrent SPSD", "intervention": "phenolization technique for recurrent SPSD", "comparator": "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.", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a single-arm study without a comparison treatment group, and almost a fifth of patients were lost to long-term follow-up.", "directness": "indirect", "limitations": "no control group, loss to follow-up of 17.5%, relies on patient questionnaire for long-term data", "followUp": "76 (SD 21.7) months", "plainFinding": "Low recurrence, improved symptoms long-term", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39422799/", "sourceText": "AIM: In recent years, the paradigm for the treatment of sacrococcygeal pilonidal sinus disease (SPSD) has shifted from surgical excision toward more minimally invasive techniques. Although extensive research has been conducted on the minimal invasive phenolization technique for primary SPSD, literature in recurrent SPSD is lacking. The purpose of this study was to report the long-term outcomes of the phenolization technique for recurrent SPSD. METHOD: This study included all 57 patients who were initially prospectively included in this study for short-term follow-up after phenolization for recurrent SPSD. A questionnaire was sent out to all patients to obtain long-term outcome. The primary endpoint was recurrence. Secondary endpoints included quality of life and symptoms related to SPSD. RESULTS: A total of 47 patients (82.5%) were available for long-term follow-up. Recurrence needing further surgery developed in 7 patients (14.9%) after a mean follow-up of 76 (SD 21.7) months. At follow-up, there was improvement in the quality of life compared to preoperative levels (82.0, IQR 75.0-90.0 versus 74.0 IQR 52.5-80.0, p = 0.024). Additionally, symptoms associated with SPSD, including pain, fluid discharge, and itching sensation, also showed significant improvement. A total of 42 patients (89.4%) would undergo the same treatment again. No significant association was found between known risk factors and recurrence. CONCLUSION: Phenolization for recurrent SPSD showed a recurrence rate of 14.9% with significant improvement of natal cleft symptoms and quality of life at long-term follow-up. Therefore, phenolization should be considered as a feasible option for patients with recurrent SPSD.", "provenance": [ { "field": "n", "quote": "A total of 47 patients (82.5%) were available for long-term follow-up." }, { "field": "population", "quote": "patients with recurrent SPSD" }, { "field": "intervention", "quote": "phenolization technique for recurrent SPSD" }, { "field": "comparator", "quote": "there was improvement in the quality of life compared to preoperative levels" }, { "field": "primaryOutcome", "quote": "The primary endpoint was recurrence." }, { "field": "result", "quote": "Recurrence needing further surgery developed in 7 patients (14.9%) after a mean follow-up of 76 (SD 21.7) months." }, { "field": "followUp", "quote": "mean follow-up of 76 (SD 21.7) months" } ] }, { "id": "pmid:39307596", "pmid": "39307596", "doi": "10.1016/j.jpedsurg.2024.161934", "nctId": null, "pmcid": null, "title": "Platelet-rich Plasma as an Adjuvant Therapy to Crystallized Phenol in the Treatment of Pediatric Pilonidal Sinus Disease: A Prospective Randomized Controlled Trial", "firstAuthor": "Azizoglu", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2025, "design": "rct", "n": 87, "nField": "reported", "population": "children with pilonidal sinus disease", "intervention": "crystallized phenol plus platelet-rich plasma injection", "comparator": "crystallized phenol alone", "primaryOutcome": "healing time after treatment", "result": "healing time was shorter with PRP added (19.4 days vs 30.7 days)", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but single-center with modest size and the abstract does not mention blinding of outcome assessors.", "directness": "indirect", "limitations": "single-center study, no mention of blinding, population is children undergoing a specific chemical treatment rather than studying natural duration of untreated cysts", "followUp": "", "plainFinding": "Faster healing with added PRP", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39307596/", "sourceText": "OBJECTIVE: This study aims to evaluate the safety and efficacy of platelet-rich plasma (PRP) as an adjuvant to crystallized phenol (CP) in treating pediatric pilonidal sinus disease (PSD). METHODS: A single-center randomized controlled trial was conducted at Istanbul Esenyurt Hospital. Eighty-seven patients aged 0-18 were randomly assigned to two groups: the CP group (n = 42) and the CP + PRP group (n = 45). Upon arrival at the clinic, patients began a regimen of manual shaving and, if necessary, laser epilation every 6-8 weeks. For those with pilonidal abscesses, incision, drainage, and antibiotics were given. The treatment area was sterilized and numbed with local anesthesia. Hair removal and curettage were performed, followed by the application of crystallized phenol. In CP + PRP group, PRP injections were also administered. The procedure concluded with wound dressing and thorough disinfection. The study was registered https://clinicaltrials.gov/ (NCT06324656). RESULTS: 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). The cosmetic score was higher in the CP + PRP group (7.42 ± 1.61) than in the CP group (6.11 ± 1.88, p = 0.001). CP + PRP group had lower VAS scores at measured all-time points after applications (p < 0.05 for each). Complications were comparable between the groups, with no significant differences in bleeding, infections, or skin burns (p > 0.05 for each comparison). No difference was found between groups in terms of total complication rate (p = 0.398). The success rate was higher in CP + PRP group (98%; n = 44) compared to CP group (86%; n = 36) (p = 0.039). Recurrence rates were lower in CP + PRP group (2%; n = 1) than CP group (14%; n = 6) (p = 0.039). CONCLUSION: The autologous PRP injection in pediatric PSD is safe. The addition of PRP to CP treatment for pediatric PSD significantly improves healing time, cosmetic outcomes, and overall success rates without increasing complication rates. This combined approach offers a promising alternative for effective and efficient treatment of PSD in children. TYPE OF THE STUDY: Randomized controlled trial. LEVEL OF EVIDENCE: Level I.", "provenance": [ { "field": "n", "quote": "Eighty-seven patients aged 0-18 were randomly assigned to two groups: the CP group (n = 42) and the CP + PRP group (n = 45)." }, { "field": "population", "quote": "pediatric pilonidal sinus disease (PSD)" }, { "field": "intervention", "quote": "In CP + PRP group, PRP injections were also administered." }, { "field": "comparator", "quote": "the CP group (n = 42)" }, { "field": "primaryOutcome", "quote": "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)." }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:39174833", "pmid": "39174833", "doi": "10.1007/s00423-024-03455-0", "nctId": null, "pmcid": "PMC11341738", "title": "Long-term follow-up of pilonidal sinus disease treated by radial laser surgery", "firstAuthor": "Karita", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2024, "design": "retrospective", "n": 83, "nField": "reported", "population": "patients with pilonidal sinus disease", "intervention": "radial laser surgery", "comparator": "none (single group, followed over time)", "primaryOutcome": "recurrence of pilonidal sinus disease after treatment", "result": "recurrence rate of 14.5%, with some needing repeat surgery", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, no comparator group, single center likely, relies on medical records.", "followUp": "median of 5.2 years, range 1.5 to 7.4 years", "plainFinding": "About 15% recurred after laser surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39174833/", "sourceText": "PURPOSE: Laser ablation is one of the newest and most advanced minimally invasive techniques in treating pilonidal sinus disease (PSD). Most studies on the subject have small sample sizes and relatively short follow-up times, making evaluation of long-term healing rates and recurrences difficult. Furthermore, long-term results for laser surgery of PSD are still lacking. The aim of this study was to retrospectively report long-term follow-up results for PSD treatment by radial laser surgery. METHODS: We retrospectively studied the medical records of 83 patients who underwent the radial laser procedure for PSD between January 2017 and September 2019. Our follow-up time was a median of 5.2 years, range 1.5 to 7.4 years. RESULTS: Twelve patients had a PSD recurrence after their laser procedure, which gives a recurrence rate of 14.5% (95% CI 8.2%-23.2%). These recurrences appeared at a median 12.2 months after the laser procedure, range 4.2 to 51 months. A total of 23 patients (27.7%; 95% CI 19.0-38.0) underwent a reoperation, 11 patients due to postoperative infection or prolonged recovery and 12 patients due to PSD recurrence. Recurrent PSD and spillage of pus during operation were statistically significantly associated with the need for a second operation. CONCLUSION: Radial laser surgery provides a minimally invasive treatment option with an acceptable recurrence rate in long-term follow-up.", "provenance": [ { "field": "n", "quote": "We retrospectively studied the medical records of 83 patients who underwent the radial laser procedure for PSD" }, { "field": "population", "quote": "83 patients who underwent the radial laser procedure for PSD between January 2017 and September 2019" }, { "field": "intervention", "quote": "radial laser procedure for PSD" }, { "field": "comparator", "quote": "The aim of this study was to retrospectively report long-term follow-up results for PSD treatment by radial laser surgery." }, { "field": "primaryOutcome", "quote": "Twelve patients had a PSD recurrence after their laser procedure, which gives a recurrence rate of 14.5%" }, { "field": "result", "quote": "recurrence rate of 14.5% (95% CI 8.2%-23.2%)" }, { "field": "followUp", "quote": "Our follow-up time was a median of 5.2 years, range 1.5 to 7.4 years." } ] }, { "id": "pmid:39145895", "pmid": "39145895", "doi": "10.1007/s00383-024-05821-x", "nctId": null, "pmcid": null, "title": "Management and outcomes of pilonidal patients with secondary sinuses-a cohort study", "firstAuthor": "Liang", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2024, "design": "prospective-cohort", "n": 105, "nField": "reported", "population": "young people (median age 17) with pilonidal disease and a secondary draining sinus", "intervention": "surgical excision of pilonidal disease and secondary sinus (Gips procedure)", "comparator": "regular hair removal (epilation) versus no regular epilation after surgery", "primaryOutcome": "recurrence of pilonidal disease or recurrent drainage from the sinus site", "result": "most patients did not have recurrent disease; a small number had recurrent drainage that often resolved without more surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a single-center cohort without a comparison group, so it describes outcomes after surgery but can't prove what causes recurrence.", "directness": "indirect", "limitations": "not randomized, no untreated comparison group, single surgical approach, so it does not describe the natural course of an untreated cyst.", "followUp": "367.0 days", "plainFinding": "Most healed, some had recurring drainage.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39145895/", "sourceText": "BACKGROUND: Patients with pilonidal disease (PD) can present with concurrent draining secondary sinus at the superior gluteal cleft. The natural disease course in the setting of this severe phenotype is poorly characterized. We present the largest cohort of patients with PD and concurrent secondary sinus. METHODS: Patients with PD and concurrent secondary sinus who underwent Gips procedure with secondary sinus excision from 2019 to 2023 were prospectively followed. Patient demographics, drainage recurrence, symptom resolution, treatment, and follow-up period were recorded. Recurrent drainage from previous secondary sinus site was defined as isolated painless serous drainage after the wound had closed for > 3 weeks; recurrent PD was characterized as recurrent pain and bloody drainage after excision. RESULTS: One hundred and five patients (seventy-one males) with a median age of 17.2 years [interquartile range (IQR):15.4-19.0] underwent excision of their disease and were followed for a median of 367.0 days (IQR: 173.2-658.8). 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. Eight patients (7.5%, six males, two females) had recurrent secondary sinus site drainage. Median time to recurrent drainage was 75.5 days (IQR: 65.2-216.2) after excision and for recurrent drainage to resolve was 72 days (IQR: 49-81). Recurrent secondary sinus site drainage was treated with antibiotics, silver nitrate, debridement, or no treatment. CONCLUSION: Patients who present with PD in the setting of concurrent secondary sinus have a unique, more severe disease phenotype. Excision can be complicated by recurrent drainage from the secondary sinus site that can resolve without repeat surgical excision.", "provenance": [ { "field": "n", "quote": "One hundred and five patients (seventy-one males) with a median age of 17.2 years" }, { "field": "population", "quote": "Patients with PD and concurrent secondary sinus who underwent Gips procedure with secondary sinus excision from 2019 to 2023 were prospectively followed." }, { "field": "intervention", "quote": "underwent Gips procedure with secondary sinus excision" }, { "field": "comparator", "quote": "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." }, { "field": "primaryOutcome", "quote": "drainage recurrence, symptom resolution, treatment, and follow-up period were recorded" }, { "field": "result", "quote": "Recurrent secondary sinus site drainage was treated with antibiotics, silver nitrate, debridement, or no treatment." }, { "field": "followUp", "quote": "followed for a median of 367.0 days (IQR: 173.2-658.8)" } ] }, { "id": "pmid:39141158", "pmid": "39141158", "doi": "10.1007/s10151-024-02972-w", "nctId": null, "pmcid": "PMC11324676", "title": "Adolescent pilonidal disease laser treatment (a-PiLaT): a pilot study", "firstAuthor": "Romanova", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2024, "design": "case-series", "n": 17, "nField": "reported", "population": "adolescents aged 10 to 17 years with pilonidal disease", "intervention": "pilonidal disease laser treatment (PiLaT)", "comparator": "none - single group, no comparison treatment", "primaryOutcome": "complication rate, recurrence rate, and scar appearance after laser treatment", "result": "24% had complications, 18% had recurrence, with average follow-up of about 24.5 months", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective analysis, small sample size, no control group, single-center pilot study.", "followUp": "24.5 ± 16.8 months", "plainFinding": "Laser treatment had modest recurrence rate.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39141158/", "sourceText": "BACKGROUND: Pilonidal disease (PD) is an acquired condition related to hair-induced mechanical forces on the skin surface of the intergluteal cleft, with subsequent abscess formation with or without a concomitant draining sinus (pit). While surgical management currently is the mainstay of treatment, pilonidal disease laser treatment (PiLaT) has recently been recognized as a promising treatment option for non-inflammatory diseases. Nonetheless, there is a paucity of available data on adolescent pilonidal disease laser treatment (a-PiLaT). METHODS: We describe our preliminary experience with PiLaT performed in adolescents aged 10-17 years at our tertiary paediatric surgical hospital from 2019 to 2023. Data on perioperative characteristics and clinical outcomes at follow-up were retrospectively analysed. RESULTS: A total of 17 consecutive patients (n = 12 female, 71%) underwent a-PiLaT. At the time of treatment, the patients' mean age and body mass index were 13.6 ± 1.6 years and 25.3 ± 5.6 kg m-2, respectively. The mean operative time was 21.5 ± 10.4 min, whereas the mean follow-up period was 24.5 ± 16.8 months, with a complication rate of 24% (n = 4) and recurrence rate of 18% (n = 3). With respect to postsurgical scar assessment, the mean Patient and Observer Scar Assessment Scale scores (score range 6-60, with higher scores indicating worse outcome) were 14.2 ± 6.5 (patients' evaluation) and 11.4 ± 4.7 (observers' evaluation). CONCLUSION: The a-PiLaT represents a novel approach for managing PD in adolescents. Our preliminary data on the outcomes of a small series of patients with pilonidal sinuses after a-PiLaT indicated complication and recurrence rates comparable to those reported in the literature for adults. This new minimally invasive technique has great potential and is therefore worthy of further research on a larger population.", "provenance": [ { "field": "n", "quote": "A total of 17 consecutive patients (n = 12 female, 71%) underwent a-PiLaT." }, { "field": "population", "quote": "PiLaT performed in adolescents aged 10-17 years at our tertiary paediatric surgical hospital" }, { "field": "intervention", "quote": "pilonidal disease laser treatment (PiLaT)" }, { "field": "comparator", "quote": "Data on perioperative characteristics and clinical outcomes at follow-up were retrospectively analysed." }, { "field": "primaryOutcome", "quote": "complication rate of 24% (n = 4) and recurrence rate of 18% (n = 3)" }, { "field": "result", "quote": "complication rate of 24% (n = 4) and recurrence rate of 18% (n = 3)" }, { "field": "followUp", "quote": "the mean follow-up period was 24.5 ± 16.8 months" } ] }, { "id": "pmid:39141128", "pmid": "39141128", "doi": "10.1007/s00383-024-05818-6", "nctId": null, "pmcid": null, "title": "Standardized pilonidal protocol as rescue therapy for excision-refractory pilonidal disease", "firstAuthor": "Emengo", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2024, "design": "prospective-cohort", "n": 34, "nField": "reported", "population": "patients with pilonidal disease that came back after previous surgery", "intervention": "a standardized minimally invasive protocol (regular hair removal, wound care, and selective debridement/pit removal)", "comparator": "no comparison group; outcomes tracked within the same patients after treatment", "primaryOutcome": "time to complete healing of the pilonidal disease", "result": "All patients achieved complete resolution after a median of 52 days, with 14.7% recurring", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "No control group, small sample size, all patients had already failed prior surgery so results may not reflect typical pilonidal disease course.", "followUp": "405 days", "plainFinding": "Healed in about 52 days with treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39141128/", "sourceText": "PURPOSE: Severe pilonidal diseases have refractory symptoms despite multiple surgeries and optimal therapy remains unclear. We hypothesized that standardized minimally invasive protocol could be an effective rescue treatment. METHODS: We prospectively collected data from symptomatic patients who underwent ≥ 1 pilonidal excision prior to presentation at our clinic 2019-2023. We treated these patients with standardized protocol incorporating local wound care, regular manual/laser epilation, and selective debridement/pit trephination. RESULTS: We treated 34 refractory patients (23 males) with median follow-up 405 days. Median age of first symptoms was 17.1 years; presentation to our clinic 20.0 years. Prior to our clinic, 27 received one surgery (cleft lift-2, excision no closure-1, excision primary closure-18, wound vac after excision-3, excision flap closure-3); 7 had two surgeries (excision without closure + cleft lift-1, primary closure after excision twice-3, flap closure after excision twice-2, excision primary closure + excision without closure-1). We treated all patients with regular epilation ± local wound care. 14 (41%) underwent trephination ± debridement. All patients achieved complete resolution after median 52 days. Five (14.7%) recurred and were treated with trephination + debridement-2 or wound care alone-3. Symptom length had no correlation with resolution time, skin type, hair amount. CONCLUSIONS: Standardized minimally invasive protocol requiring only selective surgical intervention can treat refractory pilonidal disease with low recurrence rate.", "provenance": [ { "field": "n", "quote": "We treated 34 refractory patients (23 males)" }, { "field": "population", "quote": "symptomatic patients who underwent ≥ 1 pilonidal excision prior to presentation at our clinic" }, { "field": "intervention", "quote": "standardized protocol incorporating local wound care, regular manual/laser epilation, and selective debridement/pit trephination" }, { "field": "comparator", "quote": "We treated 34 refractory patients" }, { "field": "primaryOutcome", "quote": "All patients achieved complete resolution after median 52 days" }, { "field": "result", "quote": "All patients achieved complete resolution after median 52 days. Five (14.7%) recurred" }, { "field": "followUp", "quote": "median follow-up 405 days" } ] }, { "id": "pmid:39140695", "pmid": "39140695", "doi": "10.1097/SLE.0000000000001316", "nctId": null, "pmcid": null, "title": "Results of Laser-assisted Closure (SiLaC) Surgery in Pilonidal Sinus Disease: Factors Associated With Success", "firstAuthor": "Yildirim", "multipleAuthors": true, "journal": "Surg Laparosc Endosc Percutan Tech", "year": 2024, "design": "retrospective", "n": 64, "nField": "reported", "population": "adults with pilonidal sinus disease treated with laser surgery", "intervention": "laser-assisted closure (SiLaC) surgery for pilonidal sinus", "comparator": "none (single group, compared recovered vs non-recovered patients)", "primaryOutcome": "recovery and recurrence rates after surgery", "result": "85.9% recovery rate, with higher BMI and advanced disease linked to treatment failure", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "No control group; retrospective design; single institution; does not address untreated disease duration.", "followUp": "17.0±8.06 months (range: 3 to 36)", "plainFinding": "Laser surgery cured most cases.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39140695/", "sourceText": "BACKGROUND: Pilonidal sinus treatment with sinus laser-assisted closure (SiLaC) method has produced promising results in a limited number of studies conducted in recent years. We aimed to examine the efficacy and safety of this method in a tertiary care training hospital to reveal the factors affecting failure and to share our first experiences. METHODS: All adult patients treated with this procedure between March 2020 and December 2023 were included in the study. Demographic and clinical data, complications, and recurrence rates of the patients were compared. Univariate analysis was performed between recovered and non-recovered patients to find the factors influencing successful treatment. Logistic regression analysis was performed using significant factors in the single variable analysis. RESULTS: The study cohort consisted of 64 patients. The mean follow-up period was 17.0±8.06 months (range: 3 to 36), and the mean time for return to work was 2.4±2.78 days (range: 0 to 14). Our recovery rate was 85.9%. The complication rate was 14%, and the majority (50%) were wound infections. High BMI and advanced disease were significant factors for recurrence in the comparison of patients with successful and unsuccessful treatment ( P <0.01 and 0.013, respectively). The same situation persisted in multivariate analysis ( P =0.026, 95% CI: 1.36-7.81, and P =0.004, 95% CI: 1.36-1.78, respectively). In the ROC Curve analysis for BMI, the cutoff point was 29 (sensitivity: 66.9%, specificity: 77.4%, AUC 0.809). Other parameters were not significant ( P >0.05). CONCLUSIONS: The SiLaC procedure may be the treatment of choice for pilonidal sinus disease as a safe and effective method with mild complications and reasonable recurrence rates. The success rate decreased in obese patients and patients with advanced disease.", "provenance": [ { "field": "n", "quote": "The study cohort consisted of 64 patients." }, { "field": "population", "quote": "All adult patients treated with this procedure between March 2020 and December 2023 were included in the study." }, { "field": "intervention", "quote": "Pilonidal sinus treatment with sinus laser-assisted closure (SiLaC) method" }, { "field": "comparator", "quote": "Univariate analysis was performed between recovered and non-recovered patients to find the factors influencing successful treatment." }, { "field": "primaryOutcome", "quote": "Demographic and clinical data, complications, and recurrence rates of the patients were compared." }, { "field": "result", "quote": "Our recovery rate was 85.9%." }, { "field": "followUp", "quote": "The mean follow-up period was 17.0±8.06 months (range: 3 to 36)" } ] }, { "id": "pmid:39136828", "pmid": "39136828", "doi": "10.1007/s10151-024-02973-9", "nctId": null, "pmcid": null, "title": "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", "firstAuthor": "Ram", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2024, "design": "prospective-cohort", "n": 51, "nField": "reported", "population": "adults with pilonidal sinus disease", "intervention": "minimally invasive trephine procedure plus RD2 Ver.02 whole blood clot instillation", "comparator": "none (single-arm study, no comparison group)", "primaryOutcome": "complete wound healing at 3, 6, and 12 months", "result": "82.4% healed at 3 months, 90.2% at 6 months, 82.4% at 12 months, with recurrence in 11.8% of patients", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Open-label, single-arm pilot study with no control group; authors state further comparative studies are needed.", "followUp": "12 months", "plainFinding": "Most healed by 12 months after treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39136828/", "sourceText": "BACKGROUND: PNS is caused by an infection in the sacrococcygeal area triggered by hair particle accumulation in skin tunnels, resulting in infection. Surgical options range from simple excision to complex flap constructions. Primary wound healing failure and recurrence rates contribute to the burden of PNS. RD2 Ver.02, a novel autologous whole-blood clot product, demonstrated safety and efficacy in treating complex cutaneous wounds and was investigated for the management of PNS. METHODS: A Phase II open-label, pilot, single-arm prospective study was conducted from May 2021 to May 2023 (Ethics Committee approval #7952-20). Patients with PNS underwent a minimally invasive trephine procedure under local anesthesia followed by RD2 Ver.02 instillation into the cavity. Primary healing was assessed at 3, 6, and 12 months. Secondary outcomes included the collection of adverse events. RESULTS: Overall, 51 patients participated in the study. At 3 months, 42/51 healed (82.4%), 7/51 (13.7%) were granulating but not completely healed, and 2/51 (3.9%) failed to heal. 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%). There were five adverse events (AEs) with no severe adverse events. CONCLUSION: RD2 Ver.02 is a safe and effective treatment of PNS when coupled with a minimally invasive trephine PNS procedure. Further comparative studies are needed to fully assess the role of this novel therapy for PNS.", "provenance": [ { "field": "n", "quote": "Overall, 51 patients participated in the study." }, { "field": "population", "quote": "Patients with PNS underwent a minimally invasive trephine procedure under local anesthesia" }, { "field": "intervention", "quote": "a minimally invasive trephine procedure under local anesthesia followed by RD2 Ver.02 instillation into the cavity" }, { "field": "comparator", "quote": "A Phase II open-label, pilot, single-arm prospective study" }, { "field": "primaryOutcome", "quote": "Primary healing was assessed at 3, 6, and 12 months." }, { "field": "result", "quote": "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%)." } ] }, { "id": "pmid:39115207", "pmid": "39115207", "doi": "10.1097/DCR.0000000000003402", "nctId": null, "pmcid": "PMC11477847", "title": "Postoperative Outcomes of Bascom Cleft Lift Versus Excision With Secondary Wound Healing for Pilonidal Sinus Disease: A Multicenter Retrospective Analysis", "firstAuthor": "Huurman", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2024, "design": "retrospective", "n": 272, "nField": "reported", "population": "patients with pilonidal sinus disease", "intervention": "Bascom cleft lift surgery", "comparator": "excision with secondary wound healing", "primaryOutcome": "rate of successful wound healing and time to heal", "result": "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%)", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective study with selection bias risk and a short follow-up period, as the authors themselves note.", "directness": "direct", "limitations": "Retrospective design prone to selection bias and residual confounding; short follow-up period; no patient satisfaction data collected.", "followUp": "12 months", "plainFinding": "Faster healing with cleft lift surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39115207/", "sourceText": "BACKGROUND: Pilonidal sinus disease impacts a patient's quality of life. In the Netherlands, it is often treated with excision and secondary wound healing, which is associated with high recurrence rates and poor wound healing. The Bascom cleft lift, an alternative technique, has shown favorable healing times and recurrence rates. OBJECTIVE: The present study compares successful wound healing, time to healing, complications, and recurrence rate between excision with secondary wound healing and Bascom cleft lift. DESIGN: This is a multicenter retrospective study. SETTINGS: Three institutions in the Rotterdam region of the Netherlands participated in the study. PATIENTS: Patients who underwent excision with secondary wound healing or Bascom cleft lift between July 2015 and August 2021 were included. MAIN OUTCOME MEASURES: Primary end points included the rate of successful wound healing and the time to achieve healing. Secondary end points included postoperative complications and the recurrence rate within 12 months after surgery. RESULTS: Of 272 patients, 128 underwent Bascom cleft lift and 144 patients underwent excision and secondary wound healing. Recurrent pilonidal sinus disease (47.7% vs 22.2%) and abscess history (53.1% vs 40.3%) were more common in the Bascom cleft lift group compared to excision with secondary wound healing. The median follow-up period at the outpatient clinic was 43 days. 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. CONCLUSIONS: This retrospective study shows that Bascom cleft lift is superior to excision and secondary wound healing, given the higher percentage of patients with successful wound healing within a shorter time. See Video Abstract . RESULTADOS POSOPERATORIOS DE LA ELEVACIN DE LA HENDIDURA TIPO BASCOM VERSUS LA ESCISIN CON CICATRIZACIN DE LA HERIDA POR SEGUNDA INTENSIN PARA LA ENFERMEDAD DE SENO PILONIDAL UN ANLISIS RETROSPECTIVO MULTICNTRICO: ANTECEDENTES:La enfermedad de seno pilonidal afecta la calidad de vida del paciente. En los Países Bajos, a menudo se trata con escisión y cicatrización por segunda intensión, lo que se asocia con altas tasas de recurrencia y mala cicatrización de las heridas. La elevación de la hendidura de Bascom, una técnica alternativa, ha mostrado tiempos de curación y tasas de recurrencia favorables.OBJETIVO:El presente estudio tiene como objetivo comparar la cicatrización exitosa de la herida, el tiempo de cicatrización, las complicaciones y la tasa de recurrencia entre la escisión con cicatrización secundaria de la herida y la elevación de hendidura tipo Bascom.DISEÑO:Este es un estudio retrospectivo multicéntrico.AJUSTES:Tres instituciones en la región de Rotterdam de los Países Bajos participaron en el estudio.PACIENTES:Se incluyeron pacientes sometidos a escisión con cicatrización secundaria o elecación de la hendidura tipo Bascom entre julio de 2015 y agosto de 2021.PRINCIPALES MEDIDAS DE RESULTADO:Los resultados primarios incluyeron la tasa de curación exitosa de la herida y el tiempo para lograr la curación. Los resultados secundarios incluyeron complicaciones posoperatorias y tasa de recurrencia dentro de los doce meses posteriores a la cirugía.RESULTADOS:De 272 pacientes, 128 se sometieron a elevación de hendidura tipo Bascom y 144 pacientes a escisión y cicatrización secundaria. La ESP recurrente (47.7% frente a 22.2%) y los abscesos (53.1% frente a 40.3%) fueron más comunes en el grupo de elevación tipo Bascom en comparación con la escisión con cicatrización secundaria de la herida. La mediana del período de seguimiento en la consulta externa fue de 43 días. La cicatrización de la herida fue del 84.4 % después del lifting de Bascom frente al 32.6 % después de la escisión y la cicatrización secundaria (p < 0.001), con una mediana de tiempo hasta la cicatrización de la herida de 55 días y 101 días, respectivamente (p < 0.001). Las complicaciones fueron del 28.9% para el lifting tipo Bascom frente al 13.2% para la escisión y cicatrización secundaria (p = 0.003). La enfermedad recurrente fue del 6.3% después del lifting de hendidura tipo Bascom y del 11.8% después de la escisión y cicatrización secundaria (p = 0.113).LIMITACIONES:Diseño retrospectivo que lo hace propenso a sesgos de selección y confusión residual. Adicionalmente, el corto período de seguimiento del estudio aumenta aún más estas limitaciones, ya que un seguimiento más prolongado puede identificar mejor las verdaderas tasas de recurrencia. Por último, una deficiencia es la ausencia de datos recopilados sobre la satisfacción del paciente, lo que hoy en día es un problema científico común.CONCLUSIONES:Este estudio retrospectivo muestra que la elevación de hendidura tipo Bascom es superior a la escisión y cicatrización secundaria dado el mayor porcentaje de pacientes con curación exitosa de la herida en un tiempo más corto. (Traducción-Dr. Jorge Silva Velazco ).", "provenance": [ { "field": "n", "quote": "Of 272 patients, 128 underwent Bascom cleft lift and 144 patients underwent excision and secondary wound healing." }, { "field": "population", "quote": "Patients who underwent excision with secondary wound healing or Bascom cleft lift between July 2015 and August 2021 were included." }, { "field": "intervention", "quote": "Bascom cleft lift" }, { "field": "comparator", "quote": "excision with secondary wound healing" }, { "field": "primaryOutcome", "quote": "Primary end points included the rate of successful wound healing and the time to achieve healing." }, { "field": "result", "quote": "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)." }, { "field": "limitations", "quote": "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." }, { "field": "followUp", "quote": "recurrence rate within 12 months after surgery" } ] }, { "id": "pmid:38948976", "pmid": "38948976", "doi": "10.47391/JPMA.9948", "nctId": null, "pmcid": null, "title": "Endoscopic pilonidal sinus treatment (EPSiT) for sacrococcygeal pilonidal sinus disease: A prospective long-term study", "firstAuthor": "Amir", "multipleAuthors": true, "journal": "J Pak Med Assoc", "year": 2024, "design": "prospective-cohort", "n": 67, "nField": "reported", "population": "people with pilonidal sinus disease (a cyst/tunnel near the tailbone)", "intervention": "endoscopic pilonidal sinus treatment (a minimally invasive surgery)", "comparator": "none; all patients received the same procedure", "primaryOutcome": "how long the wound took to heal, complications, ongoing discharge, and recurrence over 1 to 7 years", "result": "89.6% of patients had complete wound healing, while 10.4% had recurrence; median time off work was 2.5 days", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "No control/comparator group, single surgical team, and some patients had prior recurrent disease which may affect generalisability.", "followUp": "1-7 years", "plainFinding": "Most healed after keyhole surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38948976/", "sourceText": "OBJECTIVES: To assess short-term and long-term outcomes of endoscopic pilonidal sinus treatment for pilonidal sinus disease. METHODS: The prospective study was conducted at Shifa International Hospital, Islamabad, Pakistan, from July 2015 to July 2021, and comprised all pilonidal sinus cases undergoing minimal invasive endoscopic pilonidal sinus treatment who were treated by a single surgical team. The primary outcomes were duration of healing, post-operative morbidities, persistence of discharge and recurrence at 1-7 years. The secondary outcomes were operative time, return to work, cosmetic results and patient satisfaction. The patients were observed for wound healing and discharge on follow-up in the out-patient department at 1, 3, 6 and 24 weeks. They were further followed up every year through telephonic survey for persistence or recurrence of symptoms. Patient satisfaction was assessed using the 36-item Short Form Survey questionnaire filled at admission and then at 6 weeks post-surgery. Data was analysed using SPSS 23. RESULTS: Of the 67 patients, 55(82%) were males and 12(18%) were females. The overall mean age was 25.69±8.305 years. There were 13(19.4%) patients with a history of recurrent disease and previous procedures for pilonidal sinus, while 54(80.6%) had no previous surgery. The median operative time was 35 minutes (interquartile range: 20-45 minutes). Complete wound healing was achieved in 60(89.6%) patients, while recurrence was seen in 7(10.4%). The median time off work was 2.5 days (interquartile range: 1-3 days). Patient satisfaction with the procedure was significantly high (p<0.05). CONCLUSIONS: Endoscopic pilonidal sinus treatment appeared to be a good minimally invasive surgical technique for the treatment of pilonidal sinus disease in terms of both short-term and long-term outcomes.", "provenance": [ { "field": "n", "quote": "Of the 67 patients, 55(82%) were males and 12(18%) were females." }, { "field": "population", "quote": "comprised all pilonidal sinus cases undergoing minimal invasive endoscopic pilonidal sinus treatment" }, { "field": "intervention", "quote": "Endoscopic pilonidal sinus treatment appeared to be a good minimally invasive surgical technique" }, { "field": "comparator", "quote": "who were treated by a single surgical team" }, { "field": "primaryOutcome", "quote": "The primary outcomes were duration of healing, post-operative morbidities, persistence of discharge and recurrence at 1-7 years." }, { "field": "result", "quote": "Complete wound healing was achieved in 60(89.6%) patients, while recurrence was seen in 7(10.4%)." } ] }, { "id": "pmid:38885167", "pmid": "38885167", "doi": "10.1097/SAP.0000000000003973", "nctId": null, "pmcid": null, "title": "Propeller Flap Reconstruction Following Pilonidal Cyst Excision: A Single-Center Experience With Same-Day Discharge", "firstAuthor": "Towfighi", "multipleAuthors": true, "journal": "Ann Plast Surg", "year": 2024, "design": "retrospective", "n": 26, "nField": "reported", "population": "patients with pilonidal cyst disease who had propeller flap reconstruction after cyst removal", "intervention": "propeller flap reconstruction performed right after surgical removal of the pilonidal cyst", "comparator": "", "primaryOutcome": "flap survival, flap complications, and recurrence of pilonidal disease", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it is a small, single-center retrospective case series without a comparison group, so results may not generalize.", "directness": "indirect", "limitations": "retrospective design, small sample size, short average follow-up, and no control group for comparison", "followUp": "4.1 ± 5.4 months", "plainFinding": "Flap surgery worked well, low recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38885167/", "sourceText": "INTRODUCTION: Reconstruction following pilonidal cyst resection must balance risk of recurrence, healing time, and resumption of functional routine. Propeller flaps provide a reliable and effective reconstructive option. This study highlights our experience with propeller flap reconstruction following pilonidal cyst resection and demonstrates the efficacy of same-day discharge. METHODS: A single-institution retrospective chart review was performed for propeller flap reconstructions completed from March 2018 to July 2022. Patient demographics, pilonidal cyst details, operative details, and postoperative outcomes were collected. Primary outcomes included flap survival, flap complications, and pilonidal disease recurrence. RESULTS: Twenty-eight outpatient propeller flap reconstructions following pilonidal cyst resections were identified in 26 patients, with two patients receiving a second propeller flap due to recurrence. Most patients were male (n = 15, 57.7%) with a mean age at time of index operation of 25.5 ± 5.8 years and mean body mass index of 26.5 ± 4.1 kg/m2. Mean symptom duration prior to index surgery was 39.3 months. Mean skin defect size following resection was 28.3 ± 15.3 cm2, with a mean flap size of 44.7 ± 35.5 cm2. 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. Mean time to functional improvement was 24.0 ± 22.8 days. Pilonidal disease recurrence occurred in three patients (11.5%). Mean follow-up was 4.1 ± 5.4 months. CONCLUSIONS: Propeller flaps provide a successful and reliable reconstructive option for pilonidal disease defects. Because patients in our cohort experienced favorable outcomes and functional improvement, we advocate for same-day discharge in order to reduce hospital and patient burden.", "provenance": [ { "field": "n", "quote": "Twenty-eight outpatient propeller flap reconstructions following pilonidal cyst resections were identified in 26 patients" }, { "field": "population", "quote": "Twenty-eight outpatient propeller flap reconstructions following pilonidal cyst resections were identified in 26 patients" }, { "field": "intervention", "quote": "Propeller flap reconstruction following pilonidal cyst resection" }, { "field": "primaryOutcome", "quote": "Primary outcomes included flap survival, flap complications, and pilonidal disease recurrence." }, { "field": "result", "quote": "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." }, { "field": "result", "quote": "Pilonidal disease recurrence occurred in three patients (11.5%)." }, { "field": "followUp", "quote": "Mean follow-up was 4.1 ± 5.4 months." } ] }, { "id": "pmid:38725367", "pmid": "38725367", "doi": "10.23938/ASSN.1073", "nctId": null, "pmcid": "PMC11102778", "title": "A new midline closure technique without skin sutures: Long-term outcomes of primary repair of pilonidal sinus disease", "firstAuthor": "Tas", "multipleAuthors": true, "journal": "An Sist Sanit Navar", "year": 2024, "design": "rct", "n": 160, "nField": "reported", "population": "male patients with pilonidal sinus disease having surgery", "intervention": "excision with midline closure without skin sutures", "comparator": "excision and primary closure (standard stitched closure)", "primaryOutcome": "postoperative complications and recurrence of the cyst after surgery", "result": "the stitch-free midline closure had fewer complications and no recurrences, while the standard closure had a 6.2% recurrence rate", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized multicenter trial but included only male patients and did not address how long an untreated cyst lasts, only surgical outcomes.", "directness": "indirect", "limitations": "study only includes male patients, excludes recurrent/complicated cases, and focuses on surgical technique rather than natural disease course", "followUp": "five-year mean follow-up", "plainFinding": "New stitch-free surgery had fewer recurrences", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38725367/", "sourceText": "BACKGROUND: Currently, the focus regarding pilonidal sinus disease is put on the treatment techniques. The aim of the study is to compare postoperative long-term complications and recurrence of two surgical techniques. MATERIAL AND METHODS: From February 2015 to December 2020, male patients with pilonidal sinus disease attended at two general surgery outpatient centers were randomly assigned to either Group 1 (n=80; excision and primary closure) or Group 2 (n=80; excision and midline closure without skin sutures). Patients with recurrent or complicated pilonidal sinus or with prior surgical procedures were excluded from the study. Intergroup postoperative results and recurrence throughout the follow-up period were analyzed. RESULTS: Significant decrease (p<0.001) in the duration of the surgical procedure (35 to 25 minutes), length of hospital stay (one day to the day of the surgery), and of the time required to return to work (15 to 12 days) was seen for Group 2 patients. The complication rate (wound infection and seroma) was lower in Group 2 compared to Group 1 (n = 3; 3.7% vs n = 10; 12.5%; p = 0.014). During the five-year mean follow-up, five patients (6.2%) in Group 1 had recurrence compared to none in Group 2 (p = 0.023). CONCLUSIONS: Midline primary closure method without skin sutures - easy to learn and implement and has no complication or recurrence in the long-term follow-up - may be an ideal method in cases where excision and primary repair is planned, especially in patients with sinus orifices located in the midline.", "provenance": [ { "field": "population", "quote": "male patients with pilonidal sinus disease attended at two general surgery outpatient centers" }, { "field": "intervention", "quote": "excision and midline closure without skin sutures" }, { "field": "comparator", "quote": "excision and primary closure" }, { "field": "primaryOutcome", "quote": "postoperative long-term complications and recurrence of two surgical techniques" }, { "field": "result", "quote": "five patients (6.2%) in Group 1 had recurrence compared to none in Group 2 (p = 0.023)" }, { "field": "n", "quote": "Group 1 (n=80; excision and primary closure) or Group 2 (n=80; excision and midline closure without skin sutures)" }, { "field": "followUp", "quote": "five-year mean follow-up" } ] }, { "id": "pmid:38704463", "pmid": "38704463", "doi": "10.1007/s13304-024-01848-w", "nctId": null, "pmcid": null, "title": "Minimum energy laser pilonidotomy (MELPi): a multicenter study of a novel method in pilonidal disease", "firstAuthor": "Paz Oliveira", "multipleAuthors": true, "journal": "Updates Surg", "year": 2024, "design": "retrospective", "n": 47, "nField": "reported", "population": "adults with pilonidal disease treated at four centers in Brazil", "intervention": "minimum energy laser pilonidotomy", "comparator": "none (single-arm case series, no control group)", "primaryOutcome": "healing time, complications and recurrence after laser pilonidotomy", "result": "median healing time was 15 days, recurrence occurred in 10% of cases, and average disease duration before treatment was 3 years", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, no control group, small sample size, multiple centers may vary in technique and follow-up.", "followUp": "12 months", "plainFinding": "Average disease lasted about 3 years before treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38704463/", "sourceText": "Laser surgery, a minimally invasive procedure for the definitive approach to pilonidal disease (PD), has been frequently studied in recent years. This study aims to describe a new pilonidotomy method using minimal laser energy and evaluate its initial results. This is a retrospective multicenter study. We included 47 consecutive patients who underwent 50 \"minimal energy pilonidotomies (MELPi)\" between 2019 and 2023 in four centers in Brazil. Age, BMI, gender, smoking, diabetes, Guner classification, duration of illness, energy, hospitalization time, complications, recurrence, wound closure, pain, and return to activities were analyzed. The median age was 27; 61.7% were men, and 38.3% were women. The median BMI was 25.7. Smoking was evident in 14.9%, and diabetes in 2.1%. The average duration of the disease was 3 years. Most operations (36%) were performed on stage R disease. The median hospitalization time was 6 h, and the median healing time was 15 days. The average energy used in procedures was 433 J. The median postoperative pain was 2. Secretion occurred in 14% on the 60th day. Complications (cellulitis) occurred in 4% of cases. The median time to return to work was 7 days. The average following time was 12 months; recurrence occurred in 5 (10%)-in 3 patients, a second MELPi procedure was performed and was effective. MELPi shows promising initial results: low pain, low complication rates, and a fast activity return. It is a good option in recidivate cases and can be done more than once if necessary.", "provenance": [ { "field": "n", "quote": "We included 47 consecutive patients who underwent 50 \"minimal energy pilonidotomies (MELPi)\"" }, { "field": "population", "quote": "47 consecutive patients who underwent 50 \"minimal energy pilonidotomies (MELPi)\" between 2019 and 2023 in four centers in Brazil" }, { "field": "intervention", "quote": "This study aims to describe a new pilonidotomy method using minimal laser energy and evaluate its initial results." }, { "field": "comparator", "quote": "This is a retrospective multicenter study." }, { "field": "primaryOutcome", "quote": "Age, BMI, gender, smoking, diabetes, Guner classification, duration of illness, energy, hospitalization time, complications, recurrence, wound closure, pain, and return to activities were analyzed." }, { "field": "result", "quote": "The average duration of the disease was 3 years." }, { "field": "result", "quote": "the median healing time was 15 days" }, { "field": "result", "quote": "recurrence occurred in 5 (10%)" } ] }, { "id": "pmid:38554245", "pmid": "38554245", "doi": "10.1002/wjs.12167", "nctId": null, "pmcid": null, "title": "Recurrence rates of pilonidal sinus disease in the pediatric population following trephine surgery", "firstAuthor": "Dreznik", "multipleAuthors": true, "journal": "World J Surg", "year": 2024, "design": "retrospective", "n": 565, "nField": "reported", "population": "children and teens with pilonidal sinus disease who had surgery", "intervention": "Gips procedure (a minimally invasive trephine surgery) for pilonidal sinus", "comparator": "same surgical method used again for recurrence", "primaryOutcome": "rate of disease coming back after surgery", "result": "8.1% of patients had recurrence, and a second operation using the same method cured nearly all of them", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a single-center retrospective chart review without a comparison group, so it can show patterns but not prove cause and effect.", "directness": "indirect", "limitations": "Retrospective single-center design; no control group; focuses on surgical recurrence rather than natural course of the disease.", "followUp": "", "plainFinding": "Low recurrence after cyst surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38554245/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a common surgical disease. Multiple surgical methods exist in the literature, without clear consensus regarding which should be the first-line treatment. Minimally invasive methods such as the Gips procedure are gaining popularity in recent years. The aim of our study was to assess recurrence rates following the Gips procedure and to determine whether using the same surgical approach during re-operation is efficient and successful. METHODS: This is a single-center retrospective observational study of pediatric patients that underwent Gips procedure due to PSD between the years 2012-2022. RESULTS: 565 pediatric patients underwent an elective surgery for PSD in the study period. Recurrence rate was 8.1% (n = 46). In all the patients with recurrence, re-operation took place on average 9 months following the first surgery and using the same surgical method. Following the second surgery, only 8 patients (1%) had multiple recurrences. CONCLUSIONS: We found a relatively low recurrence rate in the pediatric population using the Gips method, and nearly 100% success rate following the second operation. Our findings set a new benchmark for pediatric recurrence following PSD operation, with clear recommendation to use the same method of surgery upon further recurrences as well.", "provenance": [ { "field": "n", "quote": "565 pediatric patients underwent an elective surgery for PSD in the study period" }, { "field": "population", "quote": "pediatric patients that underwent Gips procedure due to PSD between the years 2012-2022" }, { "field": "intervention", "quote": "minimally invasive methods such as the Gips procedure" }, { "field": "comparator", "quote": "re-operation took place on average 9 months following the first surgery and using the same surgical method" }, { "field": "primaryOutcome", "quote": "assess recurrence rates following the Gips procedure" }, { "field": "result", "quote": "Recurrence rate was 8.1% (n = 46)" }, { "field": "result", "quote": "Following the second surgery, only 8 patients (1%) had multiple recurrences" } ] }, { "id": "pmid:38530042", "pmid": "38530042", "doi": "10.1177/03000605241236057", "nctId": null, "pmcid": "PMC10967004", "title": "Efficacy of laser obliteration with limited excision of pilonidal sinus", "firstAuthor": "Gratiashvili", "multipleAuthors": true, "journal": "J Int Med Res", "year": 2024, "design": "prospective-cohort", "n": 152, "nField": "reported", "population": "patients with chronic pilonidal sinus disease", "intervention": "laser obliteration with limited excision", "comparator": "wide excision of the pilonidal sinus", "primaryOutcome": "complete wound healing, recurrence, and complication rate", "result": "Healing was faster with laser obliteration (6.5 weeks) than wide excision (14.5 weeks), with no significant difference in recurrence", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was an observational study without randomization, so other factors could explain the difference in healing time.", "directness": "indirect", "limitations": "Observational, non-randomized, cross-sectional design comparing two surgical techniques rather than tracking natural disease duration.", "followUp": "", "plainFinding": "Faster healing with laser surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38530042/", "sourceText": "OBJECTIVE: This study was performed to compare the effectiveness of laser obliteration with limited excision (LOLE) versus wide excision (WE) of the pilonidal sinus. METHODS: A prospective, cross-sectional observational study of 152 patients with chronic pilonidal sinus disease was performed from September 2019 to September 2022. Of the 152 patients, 76 underwent LOLE and 76 underwent WE. The main evaluation criteria were complete wound healing, recurrence, and the complication rate. RESULTS: Complete healing was achieved in 74 (97.4%) patients in the LOLE group and 76 (100%) patients in the WE group. 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). Recurrence developed in six (7.9%) patients in the LOLE group and one (1.3%) patient in the WE group, with no significant difference. CONCLUSION: According to our study and the data available in the literature, laser surgery should be included in the guidelines for the treatment and management of pilonidal disease.", "provenance": [ { "field": "n", "quote": "152 patients with chronic pilonidal sinus disease" }, { "field": "population", "quote": "152 patients with chronic pilonidal sinus disease" }, { "field": "intervention", "quote": "laser obliteration with limited excision (LOLE)" }, { "field": "comparator", "quote": "wide excision (WE) of the pilonidal sinus" }, { "field": "primaryOutcome", "quote": "complete wound healing, recurrence, and the complication rate" }, { "field": "result", "quote": "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)" }, { "field": "result", "quote": "Recurrence developed in six (7.9%) patients in the LOLE group and one (1.3%) patient in the WE group, with no significant difference" } ] }, { "id": "pmid:38512592", "pmid": "38512592", "doi": "10.1007/s00383-024-05668-2", "nctId": null, "pmcid": null, "title": "Pit excision with fibrin glue closure versus lateralizing flap procedures in the management of pilonidal sinus disease in adolescents: a 14-year cohort study", "firstAuthor": "Giles", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2024, "design": "retrospective", "n": 78, "nField": "reported", "population": "adolescents with chronic pilonidal sinus disease needing surgery", "intervention": "pit excision with fibrin glue closure", "comparator": "lateralizing flap surgery", "primaryOutcome": "disease recurrence and need for repeat surgery", "result": "lower recurrence, less repeat surgery, less wound breakdown with fibrin glue closure than flap surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, not randomized, and median follow-up only about 2 to 2.5 years.", "followUp": "2.21 and 2.52 years", "plainFinding": "Less recurrence after glue surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38512592/", "sourceText": "INTRODUCTION: Pilonidal sinus disease (PSD) arises in the hair follicles of the gluteal cleft with many cases occurring during adolescence. Early studies of pit excision with fibrin glue closure (PEF), a minimally invasive procedure for the management of chronic PSD, suggest it is safe and effective with similar results to traditional lateralizing flap procedures (LFP), without the need for extensive tissue excision and associated complications. However, these studies lack large sample sizes and prolonged follow-up. METHODOLOGY: All children undergoing primary operative procedures for chronic PSD from May 2009 to February 2022 received either a PEF or a LFP. Recurrence and complications rates alongside their demographic and disease severity data were compared using statistical and Kaplan-Meier analyses. RESULTS: Seventy-eight children had 33 primary PEF and 45 primary LFP procedures with a median follow-up of 2.21 and 2.52 years, respectively. Demographic and disease severity indicators were similar between groups (p > 0.05). 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). Kaplan-Meier analysis showed a reduction in the requirement of re-operation in the PEF cohort (p = 0.0340). Operative time was significantly decreased in the PEF cohort compared to the LFP cohort (p < 0.0001). Wound dehiscence was significantly decreased in the PEF cohort compared to the LFP cohort (3% vs 31%; p = 0.0026). CONCLUSION: This 14-year study is the largest pediatric-focused cohort utilizing PEF to manage PSD and demonstrated clinically relevant decreases in symptom recurrence alongside significantly decreased rates of complications and further surgical intervention compared to traditional LFP techniques. We conclude that PEF is a viable minimally invasive technique in the management of pediatric PSD.", "provenance": [ { "field": "n", "quote": "Seventy-eight children had 33 primary PEF and 45 primary LFP procedures" }, { "field": "population", "quote": "All children undergoing primary operative procedures for chronic PSD from May 2009 to February 2022" }, { "field": "intervention", "quote": "pit excision with fibrin glue closure (PEF)" }, { "field": "comparator", "quote": "traditional lateralizing flap procedures (LFP)" }, { "field": "primaryOutcome", "quote": "Recurrence and complications rates alongside their demographic and disease severity data were compared" }, { "field": "result", "quote": "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)." }, { "field": "followUp", "quote": "median follow-up of 2.21 and 2.52 years, respectively" } ] }, { "id": "pmid:38467936", "pmid": "38467936", "doi": "10.1007/s00423-024-03282-3", "nctId": null, "pmcid": null, "title": "A standardized treatment protocol for pilonidal disease can influence the health mindset of adolescents", "firstAuthor": "Mueller", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2024, "design": "prospective-cohort", "n": 207, "nField": "reported", "population": "adolescents with pilonidal disease", "intervention": "standardized treatment protocol for pilonidal disease", "comparator": "none; baseline mindset score compared with follow-up mindset score in the same patients", "primaryOutcome": "change in health mindset score over time", "result": "mindset score was higher at follow-up than at baseline", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "No control group, follow-up time varied widely (351 ± 327 days), and the study measures psychological mindset rather than disease duration or resolution.", "followUp": "351 ± 327 days", "plainFinding": "Mindset improved during treatment, not duration.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38467936/", "sourceText": "PURPOSE: Pilonidal disease (PD) significantly impacts patients' quality of life and requires regular maintenance behaviors to achieve cure. Health mindset is a psychological construct which can influence health behaviors and outcomes, with a growth mindset being associated with better outcomes than a fixed. We propose that participation in a standardized treatment protocol can affect the health mindset for adolescents with pilonidal disease. METHODS: PD patients' demographics, recurrence, and comorbidities were prospectively collected from 2019 to 2022. We assessed patients' mindset score at initial presentation using the validated Three-Item Mindset Scale (1-6) then reassessed during follow-up. t-test was used to compare baseline and follow-up mindset scores and stratified by recurrence or comorbidities. p ≤ 0.05 was considered significant. RESULTS: A total of 207 PD patients (108 males, 99 females) with mean age 18.2 ± 3.7 years were followed for 351 ± 327 days. Mean baseline mindset score (4.76 ± 1.27) was significantly lower than mean follow-up mindset score (5.03 ± 1.18, p = 0.049). Baseline mindset score was significantly lower among patients with PD recurrence (4.00 ± 0.66) compared to those without recurrence (4.8 ± 1.29, p = 0.05). Among patients with PD recurrence, mean baseline mindset score (4.00 ± 0.66) was significantly lower than mean follow-up mindset score (5.27 ± 0.93, p = 0.0038). Patient comorbidity did not affect the baseline or follow-up mindset score. CONCLUSIONS: Participation in a standardized treatment protocol is associated with the development of a stronger growth mindset over time for patients with PD. Furthermore, a growth mindset was linked to lower recurrence rate than a fixed mindset. Further investigations into how treatment approaches can work in concert with health mindset are proposed.", "provenance": [ { "field": "n", "quote": "A total of 207 PD patients (108 males, 99 females) with mean age 18.2 ± 3.7 years were followed for 351 ± 327 days." }, { "field": "population", "quote": "We propose that participation in a standardized treatment protocol can affect the health mindset for adolescents with pilonidal disease." }, { "field": "intervention", "quote": "participation in a standardized treatment protocol can affect the health mindset for adolescents with pilonidal disease" }, { "field": "comparator", "quote": "t-test was used to compare baseline and follow-up mindset scores" }, { "field": "primaryOutcome", "quote": "We assessed patients' mindset score at initial presentation using the validated Three-Item Mindset Scale (1-6) then reassessed during follow-up." }, { "field": "result", "quote": "Mean baseline mindset score (4.76 ± 1.27) was significantly lower than mean follow-up mindset score (5.03 ± 1.18, p = 0.049)." }, { "field": "followUp", "quote": "followed for 351 ± 327 days" } ] }, { "id": "pmid:38051512", "pmid": "38051512", "doi": null, "nctId": null, "pmcid": null, "title": "Comparison of crystallized phenol and Karidakis flap treatment in pilonidal sinus disease", "firstAuthor": "Tumer", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2023, "design": "retrospective", "n": 216, "nField": "reported", "population": "patients treated for pilonidal sinus disease", "intervention": "crystallized phenol treatment", "comparator": "Karidakis flap reconstruction (KFR) surgery", "primaryOutcome": "treatment success, recurrence, hospital stay, and return to work time", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective comparison without randomization, so differences between groups could be due to factors other than the treatment itself.", "directness": "indirect", "limitations": "Retrospective design; no mention of randomization or blinding; patient selection criteria for each treatment not detailed.", "followUp": "13.44 (11-16) months in the KFR group and 13.67 (11-16) months in the phenol group", "plainFinding": "Faster recovery with phenol, fewer recurrences with surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38051512/", "sourceText": "PURPOSE: In this study, we aimed to compare the results of Karidakis flap reconstruction with crystallized phenol in pilonidal sinus treatment. METHODS: 216 patients treated for pilonidal sinus disease with the researched methods between June 2016 and July 2019 were included in the study. RESULTS: 142 (65.7%) of the patients were treated with the KFR technique and 74 (34.3%) with the crystallized phenol method. Of the patients included in the study, 157 (72.7%) were male, and 59 (27.3%) were female. The mean age was calculated as 24.89 (± 8.4). The mean hospital stay in the KFR group was 1.21 (± 0.4) days. 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. 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. 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. CONCLUSİON: It is thought that phenol administration can be applied in selected single-pit cases with high success, low complications, hospitalization, and early return to work. While the KFR method's lower recurrence rates are advantageous, it was noteworthy that the complication rates were higher. KEY WORDS: Crystallized phenol, Karydakis flap reconstruction, Pilonidal sinus disease.", "provenance": [ { "field": "n", "quote": "216 patients treated for pilonidal sinus disease with the researched methods between June 2016 and July 2019 were included in the study." }, { "field": "population", "quote": "patients treated for pilonidal sinus disease" }, { "field": "intervention", "quote": "crystallized phenol method" }, { "field": "comparator", "quote": "Karidakis flap reconstruction with crystallized phenol in pilonidal sinus treatment" }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "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." }, { "field": "followUp", "quote": "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." } ] }, { "id": "pmid:37971236", "pmid": "37971236", "doi": "10.1097/SLE.0000000000001245", "nctId": null, "pmcid": null, "title": "Minimally Invasive Pilonidal Sinus Treatment: EPSIT Versus PEBAI Method", "firstAuthor": "Gulcu", "multipleAuthors": true, "journal": "Surg Laparosc Endosc Percutan Tech", "year": 2024, "design": "retrospective", "n": 288, "nField": "reported", "population": "patients with pilonidal sinus disease", "intervention": "endoscopic pilonidal sinus treatment (EPSIT)", "comparator": "pit/sinus punch needle excision, brushing, ablation and irrigation (PEBAI)", "primaryOutcome": "wound healing", "result": "wound closure time was earlier after EPSIT than PEBAI, but complete healing and recurrence rates were similar", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design comparing two active treatments, no untreated or placebo comparison group, so natural disease duration cannot be determined.", "followUp": "24 (12 to 34) months", "plainFinding": "Faster wound closure with one method, similar healing overall.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37971236/", "sourceText": "PURPOSE: We aimed to compare endoscopic pilonidal sinus treatment (EPSIT) and pit/sinus punch needle excision, brushing, ablation and irrigation (PEBAI) method that was performed with principles similar to EPSIT but without fistuloscope and vision in the treatment of pilonidal sinus disease (PSD). METHODS: Patients who underwent EPSIT and PEBAI methods for PSD in a single center between January 2020 and October 2021 were retrospectively analyzed. The primary endpoint was healing, the secondary endpoints were operative time, pain, wound closure, quality of life, cosmetic results, and cost. RESULTS: One hundred 4 patients who underwent EPSIT and 184 patients who underwent PEBAI were included in the study. Age ( P =0.871), sex ( P =0.669), BMI ( P =0.176), number of pits ( P =0.99) were similar in both groups. The operative time for PEBAI [20 min (18 to 32)] was shorter than EPSIT [32 min (24 to 44)] ( P <0.0000, u value=3096, z-score=-9.459). Postoperative first ( P =0.147) and 14th day( P =0.382) pain scores, postoperative analgesic requirements ( P =0.609), time to return to daily activities ( P =0.747), time to return to work ( P =0.345), and wound complications ( P =0.816) were similar, whereas the wound closure time was earlier after EPSIT [32 d (24 to 41)] than after PEBAI [37 d (26 to 58)] ( P <0.00001, u value=5344, z-score=6.22141). The median follow-up was 24 (12 to 34) months. 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. However, the cost of PEBAI [54.8 € (50.13 to 64.96)] was significantly lower than cost of EPSIT [147.36 € (132.53 to 169.60)] ( P <0.00001, u value=0, z-score=7.210). CONCLUSIONS: PEBAI method is a cheaper alternative to EPSIT with similar surgical principles and clinical outcomes.", "provenance": [ { "field": "n", "quote": "One hundred 4 patients who underwent EPSIT and 184 patients who underwent PEBAI were included in the study." }, { "field": "population", "quote": "Patients who underwent EPSIT and PEBAI methods for PSD in a single center between January 2020 and October 2021 were retrospectively analyzed." }, { "field": "intervention", "quote": "endoscopic pilonidal sinus treatment (EPSIT)" }, { "field": "comparator", "quote": "pit/sinus punch needle excision, brushing, ablation and irrigation (PEBAI) method" }, { "field": "primaryOutcome", "quote": "The primary endpoint was healing" }, { "field": "result", "quote": "the wound closure time was earlier after EPSIT [32 d (24 to 41)] than after PEBAI [37 d (26 to 58)] ( P <0.00001" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:37971129", "pmid": "37971129", "doi": "10.1590/1806-9282.20230740", "nctId": null, "pmcid": "PMC10645176", "title": "Use of the laser in the pilonidal sinus alone or in combination with phenol", "firstAuthor": "Şahin", "multipleAuthors": true, "journal": "Rev Assoc Med Bras (1992)", "year": 2023, "design": "retrospective", "n": null, "nField": "not-reported", "population": "patients with pilonidal sinus disease", "intervention": "laser treatment combined with phenol", "comparator": "laser treatment alone", "primaryOutcome": "recurrence and complete healing rates", "result": "laser-phenol group had lower recurrence and higher healing but difference was not statistically significant", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "This was a small retrospective study where the treatment groups did not differ by a statistically meaningful amount.", "directness": "indirect", "limitations": "Retrospective design and no statistically significant difference reported; abstract does not give exact total number of patients.", "followUp": "fourth month", "plainFinding": "No significant difference between treatments.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37971129/", "sourceText": "OBJECTIVE: We investigated the effectiveness of combining laser treatment with phenol in the management of pilonidal sinus. METHODS: We present here a retrospective analysis of patients with pilonidal sinus disease who were treated in the general surgery clinic of the Balikesir University Hospital between October 2019 and February 2022. RESULTS: 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. Notably, 22 (91.7%) patients in the laser treatment group and 21 (95.5%) patients in the laser-phenol treatment group had complete healing. CONCLUSION: Although not statistically significant, the laser-phenol treatment group exhibited a lower recurrence rate and a higher complete healing rate.", "provenance": [ { "field": "population", "quote": "patients with pilonidal sinus disease" }, { "field": "intervention", "quote": "laser-phenol treatment group" }, { "field": "comparator", "quote": "laser treatment group" }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "Although not statistically significant, the laser-phenol treatment group exhibited a lower recurrence rate and a higher complete healing rate." }, { "field": "followUp", "quote": "after the fourth month" } ] }, { "id": "pmid:37938854", "pmid": "37938854", "doi": "10.1001/jamasurg.2023.5526", "nctId": null, "pmcid": "PMC10633416", "title": "Laser Epilation as an Adjunct to Standard Care in Reducing Pilonidal Disease Recurrence in Adolescents and Young Adults: A Randomized Clinical Trial", "firstAuthor": "Minneci", "multipleAuthors": true, "journal": "JAMA Surg", "year": 2024, "design": "rct", "n": 302, "nField": "reported", "population": "adolescents and young adults aged 11 to 21 with pilonidal disease", "intervention": "laser hair removal plus standard care (improved hygiene and hair removal)", "comparator": "standard care alone (improved hygiene and mechanical or chemical hair removal)", "primaryOutcome": "rate of pilonidal disease coming back within 1 year", "result": "recurrence was significantly less common with laser hair removal added to standard care", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but many patients were lost to follow-up, especially in the laser group, which could bias the results.", "directness": "indirect", "limitations": "Only 63.6% of the laser group and 88.7% of the standard care group had 1-year follow-up data available.", "followUp": "1 year", "plainFinding": "Laser hair removal cut recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37938854/", "sourceText": "IMPORTANCE: Recurrence continues to be a significant challenge in the treatment and management of pilonidal disease. OBJECTIVE: To compare the effectiveness of laser epilation (LE) as an adjunct to standard care vs standard care alone in preventing recurrence of pilonidal disease in adolescents and young adults. DESIGN, SETTING, AND PARTICIPANTS: This was a single-institution, randomized clinical trial with 1-year follow-up conducted from September 2017 to September 2022. 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) or standard care alone. MAIN OUTCOMES AND MEASURES: The primary outcome was the rate of recurrence of pilonidal disease at 1 year. Secondary outcomes assessed during the 1-year follow-up included disability days, health-related quality of life (HRQOL), health care satisfaction, disease-related attitudes and perceived stigma, and rates of procedures, surgical excisions, and postoperative complications. RESULTS: A total of 302 participants (median [IQR] age, 17 [15-18] years; 157 male [56.1%]) with pilonidal disease were enrolled; 151 participants were randomly assigned to each intervention group. One-year follow-up was available for 96 patients (63.6%) in the LE group and 134 (88.7%) in the standard care group. 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). Over 1 year, there were no differences between groups in either patient or caregiver disability days, or patient- or caregiver-reported HRQOL, health care satisfaction, or perceived stigma at any time point. The LE group had significantly higher Child Attitude Toward Illness Scores (CATIS) at 6 months (median [IQR], 3.8 [3.4-4.2] vs 3.6 [3.2-4.1]; P = .01). There were no differences between groups in disease-related health care utilization, disease-related procedures, or postoperative complications. CONCLUSIONS AND RELEVANCE: LE as an adjunct to standard care significantly reduced 1-year recurrence rates of pilonidal disease compared with standard care alone. These results provide further evidence that LE is safe and well tolerated in patients with pilonidal disease. LE should be considered a standard treatment modality for patients with pilonidal disease and should be available as an initial treatment option or adjunct treatment modality for all eligible patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03276065.", "provenance": [ { "field": "n", "quote": "A total of 302 participants" }, { "field": "population", "quote": "Patients aged 11 to 21 years with pilonidal disease were recruited from a single tertiary children's hospital." }, { "field": "intervention", "quote": "LE and standard care (improved hygiene and mechanical or chemical depilation)" }, { "field": "comparator", "quote": "standard care alone" }, { "field": "primaryOutcome", "quote": "The primary outcome was the rate of recurrence of pilonidal disease at 1 year." }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:37930579", "pmid": "37930579", "doi": "10.1007/s10151-023-02870-7", "nctId": null, "pmcid": "PMC10638206", "title": "Non-excisional techniques for the treatment of intergluteal pilonidal sinus disease: a systematic review", "firstAuthor": "Huurman", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2023, "design": "systematic-review", "n": 8100, "nField": "reported", "population": "people with pilonidal sinus disease (both new and recurrent cases)", "intervention": "non-excisional treatments such as pit picking, laser or phenol, unroofing, endoscopic techniques, and gelatin matrix application", "comparator": "different non-excisional techniques compared with each other, and primary versus recurrent disease", "primaryOutcome": "how often the sinus came back, how often it healed, complications, healing time, and time to return to daily activities", "result": "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", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it pools many different studies and techniques without statistical combination, so the range of results is wide and hard to compare directly.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Fast recovery but recurrence common.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37930579/", "sourceText": "Non-excisional techniques for pilonidal sinus disease (PSD) have gained popularity over the last years. The aim of this study was to review short and long-term outcomes for non-excisional techniques with special focus on the additive effect of treatment of the inner lining of the sinus cavity and the difference between primary and recurrent PSD. A systematic search was conducted in Embase, Medline, Web of Science Core Collection, Cochrane and Google Scholar databases for studies on non-excisional techniques for PSD including pit picking techniques with or without additional laser or phenol treatment, unroofing, endoscopic techniques and thrombin gelatin matrix application. Outcomes were recurrence rates, healing rates, complication rates, wound healing times and time taken to return to daily activities. In total, 31 studies comprising 8100 patients were included. 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. The return to daily activities varied from one to nine days. Non-excisional techniques are associated with fast recovery and low morbidity but recurrence rates are high. Techniques that attempt to additionally treat the inner lining of the sinus have worse recurrence rates than pit picking alone. Recurrence rates do not differ between primary and recurrent disease.", "provenance": [ { "field": "n", "quote": "31 studies comprising 8100 patients were included" }, { "field": "population", "quote": "Recurrence rates do not differ between primary and recurrent disease." }, { "field": "intervention", "quote": "pit picking techniques with or without additional laser or phenol treatment, unroofing, endoscopic techniques and thrombin gelatin matrix application" }, { "field": "comparator", "quote": "the difference between primary and recurrent PSD" }, { "field": "primaryOutcome", "quote": "Outcomes were recurrence rates, healing rates, complication rates, wound healing times and time taken to return to daily activities." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:37906293", "pmid": "37906293", "doi": "10.1007/s00383-023-05577-w", "nctId": null, "pmcid": null, "title": "Regular epilation alone is an acceptable treatment for symptom-free pilonidal patients", "firstAuthor": "Adams", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2023, "design": "prospective-cohort", "n": 255, "nField": "reported", "population": "Symptom-free (asymptomatic) pediatric and young adult pilonidal disease patients, median age 17.3 years", "intervention": "Regular hair removal (epilation) alone", "comparator": "Surgical pit excision plus regular epilation", "primaryOutcome": "Recurrence/failure rate of pilonidal disease after treatment", "result": "Recurrence was similar between groups (9.4% with surgery plus epilation vs 12.6% with epilation alone, p>0.05)", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "612.5days", "plainFinding": "Epilation alone worked as well as surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37906293/", "sourceText": "INTRODUCTION: Patients with mild pilonidal disease often experience symptom resolution without excision. We hypothesized that treating symptom-free/asymptomatic pilonidal patients with regular epilation alone had similar recurrence rate as patients who were also treated surgically. METHOD: Patient data were prospectively collected 2/2019-11/2022 at our Pilonidal Clinic. All patients received regular epilation; all patients presented before 12/2020 also underwent pit excision using trephines. Starting 1/2021, only symptomatic patients underwent pit excision; symptom-free patients at presentation received only regular epilation. Recurrence rates were statistically analyzed. RESULTS: 255 patients (male:54.4%, female:45.6%), median age 17.3years (IQR:15.8-19.1) were followed for median 612.5days (IQR:367.5-847). 44.1% identified as Hispanic, 36.5% Caucasian, 17.1% Asian, 2.4% Black. Median symptom duration at presentation was 180.5days (IQR:44.5-542.5). 160 patients were initially treated with surgical excision and regular epilation, while 95 patients with regular epilation only. 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, after controlling for sex, race, age, comorbidities, skin type, hair color, hair thickness (p > 0.05). Patients who recurred after only undergoing regular epilation all underwent surgical excision, median 100days (IQR:59.5-123.5) after initial presentation. CONCLUSION: Regular epilation alone is an acceptable treatment for symptom-free pilonidal patients.", "provenance": [ { "field": "population", "quote": "symptom-free/asymptomatic pilonidal patients" }, { "field": "intervention", "quote": "regular epilation only" }, { "field": "comparator", "quote": "surgical excision and regular epilation" }, { "field": "primaryOutcome", "quote": "Recurrence rates were statistically analyzed." }, { "field": "result", "quote": "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" }, { "field": "n", "quote": "255 patients (male:54.4%, female:45.6%)" }, { "field": "followUp", "quote": "followed for median 612.5days (IQR:367.5-847)" } ] }, { "id": "pmid:37837259", "pmid": "37837259", "doi": "10.1111/ans.18738", "nctId": null, "pmcid": null, "title": "Postoperative results of modified Karydakis flap method for primary sacrococcygeal pilonidal sinus disease: short and long-term analysis", "firstAuthor": "Erdoğrul", "multipleAuthors": false, "journal": "ANZ J Surg", "year": 2024, "design": "retrospective", "n": 175, "nField": "reported", "population": "patients with sacrococcygeal pilonidal sinus disease", "intervention": "modified Karydakis flap surgery", "comparator": "none (single-arm case series)", "primaryOutcome": "complications and recurrence after surgery", "result": "no recurrence and low complication rate after surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, single surgeon, no control group for comparison.", "followUp": "39.21 ± 17.58 months", "plainFinding": "No recurrence after flap surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37837259/", "sourceText": "BACKGROUND: Sacrococcygeal pilonidal sinus is a common surgical condition that requires various treatment options. This study aims to investigate the short and long-term outcomes of the modified Karydakis flap method in patients with sacrococcygeal pilonidal sinus. METHODS: A retrospective analysis was conducted on 175 patients who underwent the modified Karydakis flap method for sacrococcygeal pilonidal sinus by a single surgeon between September 2015 and February 2021. The patients' demographics, operative time, hospitalization time and complications were recorded. RESULTS: Of the 175 patients, 125 (71.43%) were male and 50 (28.57%) were female, with a mean age of 24.93 ± 10.27 years. The mean operative time was 55.05 ± 12.33 min, the follow-up time was 39.21 ± 17.58 months, and the mean hospitalization time was 3.4 ± 1.65 days. Complications were observed in 12 (6.85%) patients, including seroma (5.14%) and wound infection (1.71%), with no observed cases of flap necrosis or recurrence. CONCLUSION: The modified Karydakis flap method appears to be a safe and effective treatment option for sacrococcygeal pilonidal sinus, with an acceptable complication rate and no observed cases of recurrence.", "provenance": [ { "field": "n", "quote": "A retrospective analysis was conducted on 175 patients" }, { "field": "population", "quote": "patients with sacrococcygeal pilonidal sinus" }, { "field": "intervention", "quote": "modified Karydakis flap method" }, { "field": "comparator", "quote": "A retrospective analysis was conducted on 175 patients who underwent the modified Karydakis flap method for sacrococcygeal pilonidal sinus by a single surgeon" }, { "field": "primaryOutcome", "quote": "Complications were observed in 12 (6.85%) patients" }, { "field": "result", "quote": "with no observed cases of flap necrosis or recurrence" }, { "field": "followUp", "quote": "the follow-up time was 39.21 ± 17.58 months" } ] }, { "id": "pmid:37691134", "pmid": "37691134", "doi": "10.1111/iwj.14353", "nctId": null, "pmcid": "PMC10784422", "title": "Simplified and modified Limberg flap plus vacuum-assisted closure for treatment of sacrococcygeal pilonidal sinus disease", "firstAuthor": "Xu", "multipleAuthors": true, "journal": "Int Wound J", "year": 2024, "design": "case-series", "n": 96, "nField": "reported", "population": "Young adults (ages 15-34) with sacrococcygeal pilonidal sinus disease", "intervention": "Simplified modified Limberg flap surgery combined with vacuum-assisted wound closure", "comparator": "None - single-arm study with no comparison group", "primaryOutcome": "Recurrence rate, wound complications, and time to return to normal activities after surgery", "result": "No recurrence, wound infection, seroma or hematoma occurred; 6.3% had wound dehiscence; average time to resume daily activities was 26.3 days", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a small single-arm study with no comparison group, and the publication itself has been retracted, so its findings cannot be trusted.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Surgery removed cysts, no recurrence seen.", "retracted": true, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37691134/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD), a chronic inflammatory disease, affects the sacrococcygeal soft tissue, especially in young adults. The ideal treatment for PSD remains divergence. This study evaluated the application of a simplified modified Limberg flap combined with vacuum-assisted closure for treating PSD. METHODS: This prospective study was conducted from 1 June 2017 to 31 March 2022 in Changhai Hospital, Naval Military Medical University, Shanghai, China. The study included 88 male patients (91.7%) and 8 female patients (8.3%). The 96 patients ranged in age from 15 to 34 years (mean ± SD, 23 ± 4.4). Under general anaesthesia, all patients underwent simplified modified Limberg flap reconstruction with vacuum-assisted closure. The patient's weight, surgical time, extubation time, hospital stay, time to return to normal life or work, wound infection, wound dehiscence and recurrence rate were recorded. The visual analogue scale (VAS) score and the Vancouver scar score were used to score patients' pain and scars in the surgical area. RESULTS: The volume of resected diseased tissue was 13.5-120 (mean ± SD, 34.993 ± 24.406) cm2 . The average surgical time during the treatment period was 97.68 ± 18.72 min, and the average extubation time was (6.36 ± 1.55) days, the mean hospital stay was 19.4 days; no patients were lost to follow-up. None of the patients experienced post-operative recurrence, wound infection, seroma or hematoma. Six patients (6.3%) experienced wound dehiscence at the flap tip around the natal cleft. The mean time to the resumption of daily activities was 26.3 days. The average VAS pain score was (6.00 ± 1.53) points, and the average Vancouver scar score was (5.96 ± 1.51) points, 12 patients (12.5%) were dissatisfied with their aesthetic results, and the average beauty satisfaction score is (6.64 ± 1.28) points. CONCLUSIONS: Simplified modified Limberg flap reconstruction with vacuum-assisted closure surgery is an effective and innovative method for the treatment of PSD, with a low recurrence rate and rapid recovery.", "provenance": [ { "field": "n", "quote": "The 96 patients ranged in age from 15 to 34 years" }, { "field": "population", "quote": "88 male patients (91.7%) and 8 female patients (8.3%)" }, { "field": "population", "quote": "The 96 patients ranged in age from 15 to 34 years (mean ± SD, 23 ± 4.4)." }, { "field": "intervention", "quote": "all patients underwent simplified modified Limberg flap reconstruction with vacuum-assisted closure" }, { "field": "comparator", "quote": "This prospective study was conducted from 1 June 2017 to 31 March 2022" }, { "field": "primaryOutcome", "quote": "wound infection, wound dehiscence and recurrence rate were recorded" }, { "field": "result", "quote": "None of the patients experienced post-operative recurrence, wound infection, seroma or hematoma." }, { "field": "result", "quote": "Six patients (6.3%) experienced wound dehiscence at the flap tip around the natal cleft." }, { "field": "result", "quote": "The mean time to the resumption of daily activities was 26.3 days." } ] }, { "id": "pmid:37597082", "pmid": "37597082", "doi": "10.1007/s10151-023-02846-7", "nctId": null, "pmcid": null, "title": "Five-year recurrence after endoscopic approach to pilonidal sinus disease: A multicentre experience", "firstAuthor": "Manigrasso", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2023, "design": "retrospective", "n": 290, "nField": "reported", "population": "patients with pilonidal sinus disease treated at referral centres", "intervention": "endoscopic sinusectomy", "comparator": "", "primaryOutcome": "recurrence of pilonidal sinus disease at 5 years", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "retrospective design, no control group, single intervention only, from a prospectively maintained database analysed retrospectively", "followUp": "5-year", "plainFinding": "About 1 in 4 recurred by 5 years.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37597082/", "sourceText": "PURPOSE: 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. METHODS: 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. RESULTS: Out of 290 patients (185 males versus 105 female, with a mean age of 25.5±6.9), 73 presented recurrence at 5-year follow-up with a recurrence rate of 25.2%. The number of pilonidal sinus with pits off the midline (p = 0.001) and the mean (SD) distance from the most lateral orifice to the midline (p = 0.001) were higher in the group of patients with recurrence at 5-year follow-up. Multivariate analysis demonstrated that the position of the pits off the midline (p = 0.001) and the distance of the most lateral orifice from the midline (p = 0.001) were independent risk factors for recurrence at 5-year follow-up. Receiver operating characteristic (ROC) curve analysis showed that the distance of lateral orifice from midline predicted an 82.2% possibility of recurrence at 5-year follow-up and Youden's test identified the best cut-off as 2 cm for this variable. Out of 195 cases with the most lateral orifice less than 2 cm from the midline, 13 presented recurrence at 5-year follow-up with a recurrence rate of 6.7%. 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%. CONCLUSIONS: This data may help guide which disease characteristics predict the optimal use of an endoscopic pilonidal sinus technique.", "provenance": [ { "field": "n", "quote": "Out of 290 patients (185 males versus 105 female, with a mean age of 25.5±6.9)" }, { "field": "population", "quote": "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." }, { "field": "intervention", "quote": "endoscopic sinusectomy" }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "73 presented recurrence at 5-year follow-up with a recurrence rate of 25.2%." }, { "field": "result", "quote": "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%." } ] }, { "id": "pmid:37553846", "pmid": "37553846", "doi": "10.1111/codi.16688", "nctId": null, "pmcid": null, "title": "Cleft closure (the Bascom cleft lift) for 714 patients-treatment of choice for complex and recurrent pilonidal disease (a cohort study)", "firstAuthor": "Ojo", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2023, "design": "retrospective", "n": 714, "nField": "reported", "population": "patients with extensive, complex, or recurrent pilonidal disease", "intervention": "cleft closure (Bascom cleft lift) surgery", "comparator": "", "primaryOutcome": "rate of primary healing, time to complete healing, and recurrence rate", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "No control group; single surgeon series; some patients lacked documented follow-up (714 enrolled vs 656 followed).", "followUp": "a median of 12 months", "plainFinding": "Most healed within 16 weeks after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37553846/", "sourceText": "AIM: Pilonidal disease is a benign condition that affects mainly the young. In existing literature, there is no consensus for best treatment, with multiple operative techniques described, some complex, resulting in a high proportion of failure and/or morbidity. The cleft closure (or cleft lift) described by Bascom and Bascom (Arch Surg, 137, 2002, 1146-50), by comparison, is a simple operation, resulting in healing in the majority and good cosmesis. METHOD: This is a single surgeon series, with the aim of evaluating outcomes for consecutive patients who underwent cleft closure surgery at two centres (St Mark's Hospital, London, and Queen Alexandra Hospital, Portsmouth) between 1995 and 2021 for either extensive, complex or recurrent pilonidal disease. Primary study outcomes that were measured included rate of primary healing, time to complete healing and rate of recurrence. RESULTS: Some 714 patients had a cleft closure of whom 656 had documented follow-up. Primary healing occurred in 60.7% (n = 398) rising to 88.5% by 12 weeks (n = 562) and 91.8% by 16 weeks. The remaining patients healed over the following weeks with only 19 wounds failing to heal completely (3%), requiring further surgery to achieve healing. After complete healing 5.3% of patients developed recurrent disease at a median of 12 months. CONCLUSION: Cleft closure is an effective operation for pilonidal disease. Overall, 97% of patients healed without further surgery. A 3% failure rate and 5.3% recurrence rate were observed. This technique could be considered as an alternative procedure to complex flaps or midline excision, in extensive, recurrent and unhealed pilonidal disease.", "provenance": [ { "field": "n", "quote": "Some 714 patients had a cleft closure of whom 656 had documented follow-up." }, { "field": "population", "quote": "extensive, complex or recurrent pilonidal disease" }, { "field": "intervention", "quote": "cleft closure (or cleft lift) described by Bascom and Bascom" }, { "field": "primaryOutcome", "quote": "Primary study outcomes that were measured included rate of primary healing, time to complete healing and rate of recurrence." }, { "field": "result", "quote": "Primary healing occurred in 60.7% (n = 398) rising to 88.5% by 12 weeks (n = 562) and 91.8% by 16 weeks." }, { "field": "result", "quote": "After complete healing 5.3% of patients developed recurrent disease at a median of 12 months." }, { "field": "followUp", "quote": "After complete healing 5.3% of patients developed recurrent disease at a median of 12 months." } ] }, { "id": "pmid:37494954", "pmid": "37494954", "doi": "10.1055/s-0043-1771224", "nctId": null, "pmcid": null, "title": "Outcomes of Pediatric Endoscopic Pilonidal Sinus Treatment: A Systematic Review", "firstAuthor": "Mentessidou", "multipleAuthors": true, "journal": "Eur J Pediatr Surg", "year": 2024, "design": "systematic-review", "n": 320, "nField": "reported", "population": "children and teenagers with pilonidal sinus disease (under 18 years)", "intervention": "endoscopic pilonidal sinus treatment (PEPSiT)", "comparator": "no direct control group; different endoscopic approaches compared with each other", "primaryOutcome": "time to healing and recurrence after treatment", "result": "treatment succeeded in most patients with healing averaging about 4 weeks, and recurrence in about 9% after an average of 4.6 months", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it pools results from small case series without a comparison group, so the findings can't be fully trusted.", "directness": "indirect", "limitations": "Comparison with conventional techniques, particularly off-midline flap and semi-closure procedures, is, however, lacking.", "followUp": "13.5 months", "plainFinding": "Healed in about a month.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37494954/", "sourceText": "Treatment of pilonidal sinus disease with conventional excision techniques is associated with recurrence up to 20 to 30% (primary closure) or with prolonged healing that might last months (closure by secondary intention). Endoscopic pilonidal sinus treatment (EPSiT) is gaining increasing popularity. This systematic review aims to summarize and evaluate the reported outcomes of pediatric EPSiT (PEPSiT) to date. Systematic search was performed for all studies on PEPSiT in patients younger than 18 years, pertaining to demographics, technique, and outcomes. Fisher's test was used to assess the associations between success/recurrence rates and different approaches (fistuloscope vs. cystoscope, different wound care protocols). 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. PEPSiT was successful in 290 patients (90.9%) with weighted mean time to healing of 4.1 weeks. Recurrence was reported in 29 patients (9.1%) with weighted mean time to recurrence of 4.6 months. Outcomes were not significantly altered by the use of fistuloscope versus pediatric cystoscope (p = 1.0), or with perioperative laser epilation (p = 0.06), or postoperative regular shaving, depilatory creams, light pulse, or laser (p = 0.31). The weighted mean operative time was 38 minutes and hospital stay was 16 hours. Summary of available evidence confirms that PEPSiT is safe and effective. Added to its noninvasiveness, PEPSiT's pooled outcomes appear superior to those of numerous conventional techniques. Comparison with conventional techniques, particularly off-midline flap and semi-closure procedures, is, however, lacking. The superiority of PEPSiT needs to be confirmed in future comparative studies, including cost-benefit analysis.", "provenance": [ { "field": "n", "quote": "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." }, { "field": "population", "quote": "Systematic search was performed for all studies on PEPSiT in patients younger than 18 years" }, { "field": "intervention", "quote": "Endoscopic pilonidal sinus treatment (EPSiT) is gaining increasing popularity." }, { "field": "comparator", "quote": "Fisher's test was used to assess the associations between success/recurrence rates and different approaches (fistuloscope vs. cystoscope, different wound care protocols)." }, { "field": "primaryOutcome", "quote": "PEPSiT was successful in 290 patients (90.9%) with weighted mean time to healing of 4.1 weeks." }, { "field": "result", "quote": "Recurrence was reported in 29 patients (9.1%) with weighted mean time to recurrence of 4.6 months." }, { "field": "followUp", "quote": "follow-up duration of 13.5 months" } ] }, { "id": "pmid:37440707", "pmid": "37440707", "doi": "10.24875/CIRU.22000461", "nctId": null, "pmcid": null, "title": "Comparison of the effectiveness of laser and crystallized phenol in the treatment of sacrococcygeal pilonidal sinus", "firstAuthor": "Taşkin", "multipleAuthors": true, "journal": "Cir Cir", "year": 2023, "design": "retrospective", "n": 80, "nField": "reported", "population": "patients with sacrococcygeal pilonidal sinus disease", "intervention": "crystallized phenol treatment", "comparator": "laser treatment", "primaryOutcome": "recurrence, pain, and patient satisfaction after treatment", "result": "no significant difference in recurrence and patient satisfaction between the groups, but laser had significantly lower pain scores and fewer complications", "resultDirection": "mixed", "quality": "low", "qualityWhy": "The study compares two treatments without mention of randomization and has a small sample size, so it carries limited weight.", "directness": "indirect", "limitations": "Abstract does not mention randomization, blinding, or exact follow-up duration.", "followUp": "", "plainFinding": "Similar recurrence, less pain with laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37440707/", "sourceText": "BACKGROUND: The aim of this study was to compare the effectiveness of crystallized phenol and laser in the treatment of sacrococcygeal pilonidal sinus (SPS) disease. RESULTS: A total of 80 patients (40 crystallized phenol, 40 laser) were included in the study. The procedure time was significantly shorter in the crystallized phenol group than in the laser group (543 and 837 s, p < 0.001). 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). There was no significant difference between the number of sinuses and recurrence, bleeding, pain, and patient satisfaction (p > 0.05). CONCLUSIONS: Crystallized phenol and laser used in the treatment of SPS disease have a low recurrence and similar long-term patient satisfaction. However, laser treatment has fewer intraoperative complications and post-operative pain severity than crystallized phenol.", "provenance": [ { "field": "n", "quote": "A total of 80 patients (40 crystallized phenol, 40 laser) were included in the study." }, { "field": "population", "quote": "The aim of this study was to compare the effectiveness of crystallized phenol and laser in the treatment of sacrococcygeal pilonidal sinus (SPS) disease." }, { "field": "intervention", "quote": "The aim of this study was to compare the effectiveness of crystallized phenol and laser in the treatment of sacrococcygeal pilonidal sinus (SPS) disease." }, { "field": "comparator", "quote": "The aim of this study was to compare the effectiveness of crystallized phenol and laser in the treatment of sacrococcygeal pilonidal sinus (SPS) disease." }, { "field": "result", "quote": "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)." }, { "field": "primaryOutcome", "quote": "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)." } ] }, { "id": "pmid:37419810", "pmid": "37419810", "doi": "10.1016/j.asjsur.2023.06.111", "nctId": null, "pmcid": null, "title": "A meta-analysis comparing phenol treatment with surgical excision for pilonidal sinus", "firstAuthor": "Gan", "multipleAuthors": true, "journal": "Asian J Surg", "year": 2024, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease (chronic cyst/inflammation near the tailbone)", "intervention": "phenol injection treatment", "comparator": "surgical excision", "primaryOutcome": "rate of disease coming back (recurrence) and wound complications", "result": "Recurrence rates were similar between phenol and surgery, but phenol had fewer wound complications, shorter operating time, faster return to work, and faster healing", "resultDirection": "mixed", "quality": "low", "qualityWhy": "It pools both randomized and non-randomized studies, which can introduce bias and makes the combined results less reliable.", "directness": "indirect", "limitations": "Included both RCTs and non-RCTs; abstract does not report risk of bias assessment or overall patient numbers.", "followUp": "", "plainFinding": "Phenol heals faster, fewer complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37419810/", "sourceText": "Pilonidal sinus is a chronic condition characterized by inflammation, swelling, and pain in the sacrococcygeal region. In recent years, the rate of recurrence and wound complications in PSD remains high, and no treatment is universally accepted. This study aimed to compare the efficacy of phenol treatment with surgical excision treatment for PSD through a meta-analysis of controlled clinical trials. We searched three electronic databases, PubMed, Embase, and Cochrane library, to comprehensively search the literature comparing phenol treatment and surgical treatment of pilonidal sinus. Fourteen publications were included, including five RCTs and nine non-RCTs. 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). As compared to the surgical group, 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]). Phenol treatment is effective for pilonidal sinus disease, and its recurrence rate is not significantly different from surgical treatment. The greatest advantage of phenol treatment is the low incidence of wound complications. Moreover, the time required for treatment and recovery are significantly lower than for surgical treatment.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus is a chronic condition characterized by inflammation, swelling, and pain in the sacrococcygeal region." }, { "field": "intervention", "quote": "phenol treatment" }, { "field": "comparator", "quote": "surgical excision treatment for PSD" }, { "field": "primaryOutcome", "quote": "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)." }, { "field": "result", "quote": "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])." } ] }, { "id": "pmid:37356014", "pmid": "37356014", "doi": "10.1007/s10151-023-02831-0", "nctId": null, "pmcid": null, "title": "Short- and mid-term results of diode laser treatment in pilonidal sinus disease and the role of endoscopic camera use on outcomes", "firstAuthor": "Bilgin", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2023, "design": "retrospective", "n": 106, "nField": "reported", "population": "patients with pilonidal sinus disease", "intervention": "diode laser treatment for pilonidal sinus, with or without use of an endoscopic camera", "comparator": "laser treatment with endoscopic camera versus without camera use", "primaryOutcome": "time to complete recovery, postoperative pain, complications, patient satisfaction, and recurrence", "result": "mean complete recovery time was 27.4 days, recurrence rate was 11.0%, and camera use made no difference to outcomes", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective study without a comparison group for the laser treatment itself, only comparing camera use within the same procedure.", "directness": "indirect", "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).", "followUp": "minimum of 1 year", "plainFinding": "Most healed within about a month", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37356014/", "sourceText": "PURPOSE: Nowadays, surgical treatment of pilonidal sinus disease (PSD) with novel techniques is a topic of interest since conventional methods are associated with longer return to daily life and higher complication and recurrence rates. Recently, use of laser as a minimally invasive approach has become popular in the surgical treatment of PSD. In this study, we analyze the short- and mid-term results after laser treatment and the effect of endoscopic camera use on outcomes. METHODS: A total of 106 patients with PSD who underwent laser treatment between November 2017 and September 2021 were included in this study. 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. Follow-up period was determined as a minimum of 1 year. Data were analyzed retrospectively. RESULTS: There were 80 (75%) male and 26 female patients. The median age was 26 (range 13-50) years. On the first postoperative day, 26 (26.5%) patients did not have any pain and 42(42.8%) patients reported low-grade pain. 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%. Neither history of previous surgery nor abscess was associated with recurrence. Use of an endoscopic camera had no effect on postoperative pain, complete recovery, complications, patient satisfaction, and recurrence (p < 0.05). CONCLUSION: Laser treatment for PSD is a promising approach with the advantages of less postoperative pain, early return to daily life, high patient satisfaction, and acceptable complication and recurrence rates. Nevertheless, further studies are needed to investigate the role of endoscopic camera use in this procedure since its possible advantages could not be clarified.", "provenance": [ { "field": "n", "quote": "A total of 106 patients with PSD who underwent laser treatment between November 2017 and September 2021 were included in this study." }, { "field": "population", "quote": "A total of 106 patients with PSD who underwent laser treatment" }, { "field": "intervention", "quote": "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." }, { "field": "comparator", "quote": "Endoscopic camera was used in 73 patients and results of these were compared with those in whom camera was not used." }, { "field": "primaryOutcome", "quote": "Eighty-six (87.8%) patients completely recovered and the mean complete recovery time was 27.4 ± 15.9 days." }, { "field": "result", "quote": "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%." }, { "field": "result", "quote": "Use of an endoscopic camera had no effect on postoperative pain, complete recovery, complications, patient satisfaction, and recurrence (p < 0.05)." }, { "field": "followUp", "quote": "Follow-up period was determined as a minimum of 1 year." } ] }, { "id": "pmid:37289117", "pmid": "37289117", "doi": null, "nctId": null, "pmcid": null, "title": "[Pilonidal disease: The revolution in minimally invasive surgery]", "firstAuthor": "Spindler", "multipleAuthors": true, "journal": "Rev Prat", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal disease (cysts near the tailbone)", "intervention": "minimally invasive techniques such as endoscopic and laser treatment", "comparator": "traditional lay-open excision and flap-based surgical repair", "primaryOutcome": "treatment failure/recurrence and healing time", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "1 year", "plainFinding": "Newer surgeries heal fast, recurrence unclear.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37289117/", "sourceText": "THE REVOLUTION IN MINIMALLY INVASIVE SURGERY. Pilonidal disease is a common suppurative condition and affects 0.7% of the population. Surgical excision is the standard treatment. In France, the most common procedure is lay-open excision with healing by secondary intention. This procedure has low recurrence rates, but involves daily nursing care, long healing time and long period of sick-leave. Excision and primary repair or flap-based procedures are good alternatives to reduce these negative aspects but they expose to higher recurrence rates than excision with healing by secondary intention. The goal of minimally invasive techniques is to eradicate the suppuration, obtain healing as quick as possible, and limit the morbidity as much as possible. Old minimally invasive approaches such as phenolization or pit-picking are associated with low morbidity but with higher recurrence rates. Currently, new minimally invasive techniques are being developed. 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. Complications are rare and minor. However, these interesting results need to be confirmed by better quality studies with longer follow-up.", "provenance": [ { "field": "population", "quote": "Pilonidal disease is a common suppurative condition and affects 0.7% of the population." }, { "field": "intervention", "quote": "Endoscopic and laser treatment of pilonidal disease have shown promising results" }, { "field": "comparator", "quote": "the most common procedure is lay-open excision with healing by secondary intention" }, { "field": "primaryOutcome", "quote": "failure rates of less than 10% at 1 year, few complications and low morbidity" }, { "field": "result", "quote": "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." }, { "field": "limitations", "quote": "these interesting results need to be confirmed by better quality studies with longer follow-up" } ] }, { "id": "pmid:37259676", "pmid": "37259676", "doi": "10.1111/iwj.14242", "nctId": null, "pmcid": "PMC10588333", "title": "Non-operative management of pilonidal sinus disease; classification and outcome", "firstAuthor": "Salih", "multipleAuthors": true, "journal": "Int Wound J", "year": 2023, "design": "prospective-cohort", "n": 3529, "nField": "reported", "population": "People aged 14 to 55 with pilonidal sinus disease", "intervention": "Non-operative treatment with Salih's preparation (a chemical with antimicrobial and scar-forming properties)", "comparator": "No comparison group; only one treatment group was studied", "primaryOutcome": "Recurrence of the pilonidal sinus after treatment", "result": "Recurrence was linked most strongly to having an abscess present, and patients could be grouped into three risk classes for recurrence", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "No control or surgical comparison group; only 3529 of 12123 treated patients were included in the analysis; follow-up was just 6 weeks.", "followUp": "6 weeks", "plainFinding": "Does not address how long cysts last", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37259676/", "sourceText": "The characteristics of the pilonidal sinus that are associated with recurrence have scarcely been investigated in the literature. This study aims to evaluate the outcomes of patients with sacrococcygeal pilonidal sinus disease who were managed by a non-operative technique using Salih's preparation. This study also tries to classify the patients according to the features that determine the outcome of the intervention. This is a single-group cohort study that enrolled consecutive patients that had pilonidal sinus. All the patients were managed using Salih's preparation. The patients were seen at the clinic 6 weeks after the intervention to record data of recurrence. The Statistical Package for the Social Sciences (SPSS) Version 25 was used for coding and analysing the data. Test of significance and odds ratio were calculated for all of the features. The total number of patients receiving Salih's preparation was 12 123 cases, of which only 3529 patients were included in this study. The mean age of the participants was 26.95 years, ranging from 14 to 55 years. The most significant factor related to the recurrence was the presence of an abscess. After summation of all odd ratios, the percentage of each one from the total was calculated, and accordingly, the patients were divided into three classes. Non-operative methods using a preparation with antimicrobial and sclerosing properties can be an alternative for surgical intervention with a lower risk of recurrence. Classification of patients based on specific criteria can give clinicians and even patients themselves a vision of the chance of recurrence and treatment success.", "provenance": [ { "field": "population", "quote": "The mean age of the participants was 26.95 years, ranging from 14 to 55 years." }, { "field": "intervention", "quote": "All the patients were managed using Salih's preparation." }, { "field": "comparator", "quote": "This is a single-group cohort study that enrolled consecutive patients that had pilonidal sinus." }, { "field": "primaryOutcome", "quote": "The patients were seen at the clinic 6 weeks after the intervention to record data of recurrence." }, { "field": "result", "quote": "The most significant factor related to the recurrence was the presence of an abscess." }, { "field": "n", "quote": "The total number of patients receiving Salih's preparation was 12 123 cases, of which only 3529 patients were included in this study." }, { "field": "followUp", "quote": "The patients were seen at the clinic 6 weeks after the intervention to record data of recurrence." } ] }, { "id": "pmid:37204438", "pmid": "37204438", "doi": "10.1007/s00268-023-07045-x", "nctId": null, "pmcid": "PMC10387461", "title": "Paediatric Pilonidal Sinus Disease: Early Recurrences Irrespective of the Treatment Approaches in a Retrospective Multi-centric Analysis", "firstAuthor": "Maasewerd", "multipleAuthors": true, "journal": "World J Surg", "year": 2023, "design": "retrospective", "n": 213, "nField": "reported", "population": "children and adolescents treated for pilonidal sinus disease", "intervention": "different surgical procedures (excision and primary closure, excision and open wound treatment, pit picking, flap procedures)", "comparator": "the different surgical approaches compared to each other", "primaryOutcome": "recurrence and complications after surgery", "result": "No procedure was better than another, and recurrences tended to happen early, at a median of about 6 months after surgery", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "This is a retrospective study with small subgroups, so its findings on recurrence timing are not very reliable.", "directness": "indirect", "limitations": "Retrospective design and small sample size in some subgroups, as stated by the authors.", "followUp": "", "plainFinding": "Recurrences happen early after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37204438/", "sourceText": "BACKGROUND: Incidences of pilonidal sinus disease are rising. Guidelines rarely consider children and adolescents and evidence for their treatment is rare. The literature is divided on the choice of the preferable surgical procedure. Therefore, we aimed to assess recurrences and complications following different treatment approaches in our multi-centric cohort. METHODS: We retrospectively assessed all patients treated for pilonidal sinus disease in the paediatric surgical departments of Bonn and Mainz between 01/01/2009 and 31/12/2020. Recurrences were defined according to the German national guidelines. The pre-specified analysis via logistic regression included the operative approach, age, sex, use of methylene blue, and obesity as independent predictors. RESULTS: We included 213 patients, of which 13.6% experienced complications and 16% a recurrence. Median time to recurrence was 5.8 months (95% confidence interval: 4.2-10.3), which was slightly higher in children than adolescents (10.3 months, 95% confidence interval: 5.3-16.2 vs. 5.5 months, 95% confidence interval: 3.7-9.7). 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. Of the independent predictors, only obesity was associated to complications (adjusted odds ratio: 2.86, 95% confidence interval: 1.05-7.79, P = 0.04). CONCLUSIONS: We did not find a difference between the investigated procedures, but our analysis is limited by the small sample size in some subgroups. Our data corroborates that recurrences in paediatric pilonidal sinus disease occur early. Factors linked to these differences remain unknown.", "provenance": [ { "field": "n", "quote": "We included 213 patients" }, { "field": "population", "quote": "patients treated for pilonidal sinus disease in the paediatric surgical departments of Bonn and Mainz" }, { "field": "intervention", "quote": "excision and primary closure, excision and open wound treatment, pit picking, and flap procedures" }, { "field": "comparator", "quote": "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" }, { "field": "primaryOutcome", "quote": "we aimed to assess recurrences and complications following different treatment approaches in our multi-centric cohort" }, { "field": "result", "quote": "Median time to recurrence was 5.8 months (95% confidence interval: 4.2-10.3)" }, { "field": "result", "quote": "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" } ] }, { "id": "pmid:37145226", "pmid": "37145226", "doi": "10.1007/s13304-023-01508-5", "nctId": null, "pmcid": "PMC10435587", "title": "Pediatric endoscopic pilonidal sinus treatment (PEPSiT): report of a multicentric national study on 294 patients", "firstAuthor": "Esposito", "multipleAuthors": true, "journal": "Updates Surg", "year": 2023, "design": "retrospective", "n": 294, "nField": "reported", "population": "children and teens up to 18 years old with pilonidal sinus disease", "intervention": "pediatric endoscopic pilonidal sinus treatment (PEPSiT) surgery", "comparator": "none (single group, before/after surgery outcomes)", "primaryOutcome": "time to full healing and recurrence after surgery", "result": "median time to full healing was 23.4 days, with a 95.2% success rate and 4.8% recurrence", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "retrospective chart review without a comparator group; only describes outcomes after a specific surgical procedure", "followUp": "", "plainFinding": "Healed in about 23 days after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37145226/", "sourceText": "This study aimed to report a multicentric national experience about the outcomes of pediatric endoscopic pilonidal sinus treatment (PEPSiT). The medical records of all pediatric patients, aged up to 18 years, who underwent PEPSiT in the period 2019-2021, were retrospectively reviewed. Patients' demographics, operative details, and post-operative outcomes were assessed. A total of 294 patients (182 boys), with median age of 14 years (range 10-18), receiving PEPSiT in the study period, were enrolled. Pilonidal sinus disease (PSD) was primary in 258 (87.8%) and recurrent in 36 (12.2%). The median operative time was 36 min (range 11-120). The median VAS pain score was 0.86 (range 0-3) and the median duration of analgesic use was 27 h (range 12-60). The overall success rate was 95.2% (280/294) and the median time to full healing was 23.4 days (range 19-50). Six/294 (2.0%) patients developed Clavien 2 post-operative complications. The recurrence rate was 4.8% (14/294) and all recurrences were re-operated using PEPSiT. Redo-surgery for wound debridement was performed in one (0.3%) patient with late healing. On multivariate analysis, hirsutism and typology of sinus (pits ≥ 2, paramedian and more proximal to the anus) were predictors of PSD recurrence (p = 0.001). To date, this is the largest series of PEPSiT published in the pediatric population. The outcomes reported after a 3 years experience confirm that PEPSiT is a safe, effective, and real minimally invasive procedure to treat adolescents with PSD. It provides patients quick and painless recovery, satisfactory success, and high quality of life.", "provenance": [ { "field": "population", "quote": "pediatric patients, aged up to 18 years, who underwent PEPSiT" }, { "field": "intervention", "quote": "pediatric endoscopic pilonidal sinus treatment (PEPSiT)" }, { "field": "comparator", "quote": "The medical records of all pediatric patients, aged up to 18 years, who underwent PEPSiT in the period 2019-2021, were retrospectively reviewed." }, { "field": "primaryOutcome", "quote": "the median time to full healing was 23.4 days (range 19-50)" }, { "field": "result", "quote": "The overall success rate was 95.2% (280/294) and the median time to full healing was 23.4 days (range 19-50)." }, { "field": "n", "quote": "A total of 294 patients (182 boys)" } ] }, { "id": "pmid:37118772", "pmid": "37118772", "doi": "10.1186/s12893-023-02014-6", "nctId": null, "pmcid": "PMC10142197", "title": "Long-term results for pit-picking and flap procedures in primary pilonidal sinus disease", "firstAuthor": "Koskinen", "multipleAuthors": true, "journal": "BMC Surg", "year": 2023, "design": "retrospective", "n": 113, "nField": "reported", "population": "adults who had surgery for pilonidal sinus disease for the first time", "intervention": "mini-invasive pit-picking surgery", "comparator": "asymmetrical excision with local flap surgery", "primaryOutcome": "wound healing and disease recurrence after surgery", "result": "both surgeries healed similarly at first follow-up, but long-term recurrence was much higher after pit-picking surgery than after flap surgery", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective chart review without randomization, so differences between groups could be due to patient selection rather than the surgery itself.", "directness": "indirect", "limitations": "Retrospective design, not randomized, and patients were not similarly selected for each surgery type.", "followUp": "median 9.3 years (range 5.4-10.6)", "plainFinding": "Pit-picking surgery recurs far more than flap surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37118772/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD), a common inflammatory condition of the natal cleft causing morbidity especially in young adults, is a heterogeneous disease group with no consensus regarding its best treatment. Our aim was to report long-term results for primary PSD surgery. METHODS: We retrospectively studied the medical records of 146 patients who underwent primary PSD surgery between November 2010 and October 2015. Of these, 113 underwent either the mini-invasive pit-picking surgery (PSS) (n = 55) or asymmetrical excision with local flap (AELF) (n = 58); we focused on the outcomes of these two subgroups. RESULTS: PSD patients who underwent mini-invasive PPS more often succeeded with day surgery (94.5% vs 32.8%, p < 0.001), had fewer postoperative complications (9.4% vs 36.2%, p = 0.002), and had shorter sick leave (median 14 days vs 21 days, p < 0.001) than did AELF patients. Nevertheless, at the first postoperative follow-up visit, both surgery methods healed similarly (75.0% vs 76.8%, p = 0.83). Our long-term follow-up, at a median of 9.3 years (range 5.4-10.6), revealed, however, that recurrence after PPS was markedly higher than after AELF (50.9% vs 10.3%, HR 6.65, p < 0.001). CONCLUSIONS: PPS, which is a mini-invasive surgical technique often performed under local anaesthesia, is suitable for primary PSD, despite the high recurrence rate in our study, bearing in mind that patient selection is an important factor to consider. Primary PSD with simple sinus formations may benefit from PPS. On the other hand, primary PSD with complex sinus formations may benefit from AELF regardless of the initial slow recovery in our study. Because PSD is a very heterogenous disease, and patients have different risk factors, it is mandatory for the surgeon to master several different surgical techniques. A classification system to aid the surgeon in selecting the right surgical technique for each patient is warranted.", "provenance": [ { "field": "n", "quote": "113 underwent either the mini-invasive pit-picking surgery (PSS) (n = 55) or asymmetrical excision with local flap (AELF) (n = 58)" }, { "field": "population", "quote": "146 patients who underwent primary PSD surgery between November 2010 and October 2015" }, { "field": "intervention", "quote": "mini-invasive pit-picking surgery (PSS)" }, { "field": "comparator", "quote": "asymmetrical excision with local flap (AELF)" }, { "field": "primaryOutcome", "quote": "both surgery methods healed similarly (75.0% vs 76.8%, p = 0.83)" }, { "field": "result", "quote": "recurrence after PPS was markedly higher than after AELF (50.9% vs 10.3%, HR 6.65, p < 0.001)" }, { "field": "followUp", "quote": "long-term follow-up, at a median of 9.3 years (range 5.4-10.6)" } ] }, { "id": "pmid:37070318", "pmid": "37070318", "doi": "10.7507/1002-1892.202301035", "nctId": null, "pmcid": "PMC10110742", "title": "[Effectiveness of fascial tissue flaps and skin flaps with layered sutures for repair of wounds after excision of sacrococcygeal pilonidal sinus]", "firstAuthor": "Chen", "multipleAuthors": true, "journal": "Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi", "year": 2023, "design": "case-series", "n": 9, "nField": "reported", "population": "patients with sacrococcygeal pilonidal sinus undergoing excision surgery", "intervention": "fascial tissue flap and skin flap with layered three-layer sutures to repair the wound after excision", "comparator": "no comparison group", "primaryOutcome": "wound healing, complications, and recurrence of the sinus tract after surgery", "result": "all incisions healed completely with no complications and no recurrence of the sinus tract during follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "3-36 months", "plainFinding": "Surgical wounds healed well, no recurrence", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37070318/", "sourceText": "OBJECTIVE: To investigate the feasibility and effectiveness of fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus. METHODS: Between March 2019 and August 2022, 9 patients with sacrococcygeal pilonidal sinus were admitted, including 7 males and 2 females with an average age of 29.4 years (range, 17-53 years). The disease duration ranged from 1 to 36 months, with a median of 6 months. There were 7 cases with obesity and dense hair, 3 cases with infection, and 2 cases with positive bacterial culture of sinus secretion. The wound area after excision ranged from 3 cm×3 cm to 8 cm×4 cm, with a depth of 3-5 cm, reaching the perianal or caudal bone; there were 2 cases with perianal abscess formation and 1 case with caudal bone inflammatory edema. Enlarged resection was performed during operation, and the fascial tissue flap and skin flap were designed and excised at both left and right sides of the buttock, ranging from 3.0 cm×1.5 cm to 8.0 cm×2.0 cm. A cross drainage tube was placed at the bottom of the wound, and 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. RESULTS: All 9 patients were followed up 3-36 months, with an average of 12 months. All incisions healed by first intention, and no complication such as incisional dehiscence or infection in the operative area occurred. 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. CONCLUSION: Fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus can effectively fill the cavity and reduce the incidence of poor incision healing, with the advantages of small trauma and simple operation.", "provenance": [ { "field": "n", "quote": "9 patients with sacrococcygeal pilonidal sinus were admitted" }, { "field": "population", "quote": "9 patients with sacrococcygeal pilonidal sinus were admitted, including 7 males and 2 females" }, { "field": "intervention", "quote": "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" }, { "field": "comparator", "quote": "Enlarged resection was performed during operation" }, { "field": "primaryOutcome", "quote": "All incisions healed by first intention, and no complication such as incisional dehiscence or infection in the operative area occurred." }, { "field": "result", "quote": "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." }, { "field": "followUp", "quote": "All 9 patients were followed up 3-36 months, with an average of 12 months." } ] }, { "id": "pmid:37023403", "pmid": "37023403", "doi": "10.1089/lap.2022.0564", "nctId": null, "pmcid": null, "title": "Endoscopic Treatment of Pilonidal Sinus Disease in Children: A Systematic Review", "firstAuthor": "Esposito", "multipleAuthors": true, "journal": "J Laparoendosc Adv Surg Tech A", "year": 2023, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "children with pilonidal sinus disease", "intervention": "endoscopic (minimally invasive) treatment of pilonidal sinus disease", "comparator": "excision and primary closure (EPC)", "primaryOutcome": "tolerance, postoperative conditions, recurrence and complications", "result": "endoscopic techniques were better tolerated and had fewer recurrences and complications than excision and primary closure", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Compares surgery types, not cyst duration.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37023403/", "sourceText": "Background: Pilonidal sinus disease (PSD) is a common inflammatory disease. PSD management in pediatric patients changed dramatically in the last few years especially when concerning the latest minimally invasive techniques. This article aims to identify clinical evidence about the reliability of the different techniques in managing PSD in children. Materials and Methods: We performed a PubMed search for articles published during the last 10 years, using the keywords \"pilonidal,\" \"sinus,\" \"disease,\" \"pediatric,\" \"surgery,\" and \"children.\" Results: We pooled 38 studies, 18 of these were excluded because they were either not relevant or concerned an adult population. Conclusions: Literature analysis shows that endoscopic techniques for PSD are superior to excision and primary closure (EPC) in terms of tolerance and postoperative conditions and, with the growing number of studies in the matter, important endpoints such as wound healing time and length of hospital stay will be proved to be superior. Pediatric Endoscopic pilonidal disease treatment showed to be a very promising alternative even from a statistical point of view, especially when considered that in this group, studies seemed to be more solid. Literature analysis showed that minimally invasive techniques were statistically superior to EPC in terms of recurrence and complications.", "provenance": [ { "field": "population", "quote": "PSD management in pediatric patients" }, { "field": "intervention", "quote": "endoscopic techniques for PSD" }, { "field": "comparator", "quote": "excision and primary closure (EPC)" }, { "field": "primaryOutcome", "quote": "tolerance and postoperative conditions" }, { "field": "result", "quote": "minimally invasive techniques were statistically superior to EPC in terms of recurrence and complications" } ] }, { "id": "pmid:37017164", "pmid": "37017164", "doi": null, "nctId": null, "pmcid": null, "title": "Surgical Outcome of Limberg's Flap Reconstruction in the Treatment of Pilonidal Sinus Disease in a Community Hospital", "firstAuthor": "Karki", "multipleAuthors": true, "journal": "Kathmandu Univ Med J (KUMJ)", "year": 2022, "design": "prospective-cohort", "n": 42, "nField": "reported", "population": "patients aged 16-31 with pilonidal sinus disease treated at a community hospital", "intervention": "Limberg's flap reconstruction surgery", "comparator": "", "primaryOutcome": "surgical complications, recurrence, hospital stay and return to work after flap surgery", "result": "low complication rate (9.52%) with no flap necrosis or recurrence, mean return to work 14.5 days", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "No control group for comparison; small sample size of 42 patients; single center study", "followUp": "", "plainFinding": "Surgery had few complications, no recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37017164/", "sourceText": "Background Pilonidal sinus disease is an acquired condition that commonly arises in the hair follicles of the gluteal cleft with male predominance. Different treatment modalities have been described in the literature ranging from simple incision and drainage, wide local excision to complex plastic flaps. Objective To evaluate the efficacy and outcome of Limberg's flap reconstruction in a community hospital. Method This is a prospective study conducted over two-year duration in forty-two patients in the department of Surgery at Dhulikhel Hospital Kathmandu University Hospital from January 2017 till December 2018. Result Total of 42 patients were operated ranging from 16-31 years with mean of 22.86 years, male to female ratio was 7.5:1, 52% were students and 19% were drivers. Mean operative duration was 61.86±25.3 minutes, length of hospital stay was 2.83±1.68 days, mean duration of drain in situ was 4±1.34 days, mean days for return to work was 14.5±5.7. 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. Conclusion It is a simple, easy to learn and safe procedure with good cosmetic results and low recurrence rate. It can be considered as an alternative to other flap and plasty procedures.", "provenance": [ { "field": "n", "quote": "Total of 42 patients were operated ranging from 16-31 years" }, { "field": "population", "quote": "Total of 42 patients were operated ranging from 16-31 years with mean of 22.86 years" }, { "field": "intervention", "quote": "To evaluate the efficacy and outcome of Limberg's flap reconstruction in a community hospital." }, { "field": "primaryOutcome", "quote": "To evaluate the efficacy and outcome of Limberg's flap reconstruction in a community hospital." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:36934004", "pmid": "36934004", "doi": "10.1016/j.jpedsurg.2023.02.054", "nctId": null, "pmcid": null, "title": "Increasing Amount of Hair Reduction using Laser Correlates with Lower Probability of Recurrence in Patients with Pilonidal Disease", "firstAuthor": "Salimi-Jazi", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2023, "design": "retrospective", "n": 198, "nField": "reported", "population": "patients with pilonidal disease, average age about 18 years, undergoing laser hair removal", "intervention": "laser hair removal sessions to reduce gluteal cleft hair", "comparator": "patients who achieved less hair reduction (fewer laser sessions)", "primaryOutcome": "recurrence of pilonidal disease", "result": "Greater hair reduction from laser was linked to much lower chance of the disease coming back", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective, uncontrolled study (Level IV evidence) without randomization, so it can't prove cause and effect.", "directness": "indirect", "limitations": "No control group, retrospective design, relies on photo comparisons for hair reduction estimates, and short follow-up.", "followUp": "217 days", "plainFinding": "More hair removal, less recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36934004/", "sourceText": "BACKGROUND: Hair at the gluteal cleft plays a key role in the development and recurrence of pilonidal disease (PD). We hypothesized that more hair reduction achieved using laser could correlate with lower chance of PD recurrence. METHODS: PD patients who underwent laser epilation (LE) were categorized by Fitzpatrick skin type, hair color, and hair thickness. Photos taken at LE sessions were compared to determine hair reduction amount. LE sessions completed prior to the recurrences were recorded. Groups were compared using multivariate T-test. RESULTS: 198 PD patients had mean age 18.1 ± 3.6 years. 21, 156, and 21 patients had skin types 1/2, 3/4, and 5/6, respectively. 47 patients had light- and 151 had dark-colored hair. 29 patients had fine hair, 129 medium, and 40 thick. Median follow-up was 217 days. 95%, 70%, 40%, and 19% of patients reached 20%, 50%, 75%, and 90% hair reduction after mean LE sessions of 2.6, 4.3, 6.6, 7.8 sessions, respectively. To reach 75% hair reduction, patients require a mean of 4.8-6.8 LE sessions, depending on different skin/hair characteristics. PD recurrence rate was 6%. Probability of recurrence after 20%, 50%, 75% hair reduction was decreased by 50%, 78%, 100%, respectively. Dark hair and skin type 5/6 were associated with higher recurrence rates. CONCLUSION: Patients with dark-color and thick hair require more LE sessions to achieve certain degree of hair reduction. Patients with dark hair and skin type 5/6 were more likely to recur; more hair reduction correlated with lower chance of recurrence. LEVEL OF EVIDENCE: Level IV.", "provenance": [ { "field": "n", "quote": "198 PD patients had mean age 18.1 ± 3.6 years." }, { "field": "population", "quote": "PD patients who underwent laser epilation (LE) were categorized by Fitzpatrick skin type, hair color, and hair thickness." }, { "field": "intervention", "quote": "more hair reduction achieved using laser" }, { "field": "comparator", "quote": "Probability of recurrence after 20%, 50%, 75% hair reduction was decreased by 50%, 78%, 100%, respectively." }, { "field": "primaryOutcome", "quote": "PD recurrence rate was 6%." }, { "field": "result", "quote": "more hair reduction correlated with lower chance of recurrence" }, { "field": "followUp", "quote": "Median follow-up was 217 days." } ] }, { "id": "pmid:36888964", "pmid": "36888964", "doi": "10.1089/lap.2022.0567", "nctId": null, "pmcid": null, "title": "Outcomes of Laser-Assisted Closure (SiLaC) Surgery for Chronic Pilonidal Sinus Disease", "firstAuthor": "Horesh", "multipleAuthors": true, "journal": "J Laparoendosc Adv Surg Tech A", "year": 2023, "design": "retrospective", "n": 91, "nField": "reported", "population": "patients with chronic pilonidal sinus disease", "intervention": "minimally invasive laser-assisted closure (SiLaC) surgery", "comparator": "none (single-group study; subgroup comparison of local vs general anesthesia for recurrence risk)", "primaryOutcome": "complete healing of the pilonidal sinus", "result": "81.3% of patients achieved complete healing after SiLaC surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, one patient lost to follow-up, no control group, and no information on natural disease duration without treatment.", "followUp": "", "plainFinding": "Most healed after laser surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36888964/", "sourceText": "Background: Management of pilonidal sinus (PNS) disease has changed notably in the past decade, with the introduction of novel surgical techniques and technological innovation. In this study, we summarized our initial experience with sinus laser-assisted closure (SiLaC) of pilonidal disease. Methods: A retrospective analysis of a prospective database of all patients who underwent minimally invasive surgery combined with laser therapy for PNS between September 2018 and December 2020 was performed. Patients' demographics, clinical and perioperative data, as well postoperative outcomes were recorded and analyzed. Results: A total of 92 patients (86 males, 93.4%) underwent SiLaC surgery for pilonidal sinus disease during the study period. Patients' median age was 22 (range 16-62 years), and 60.8% of them previously underwent abscess drainage due to PNS. SiLaC was performed under local anesthesia in 85.7% of cases (78 patients) with a median energy of 1081 J (range 13-5035 J). One patient was lost to follow-up, leaving 91 patients for final analysis. The primary outcome was complete healing rate, standing at 81.3% (74/91 patients). In 8 patients (8.8%), there was minor incomplete healing that did not require reintervention. Recurrent/nonhealing disease was seen in 9 patients (9.9%), requiring reoperation in 7 patients (8.4%). Of those, 4 patients underwent repeat SiLaC and 3 patients underwent wide excision. Analysis of risk factors for PNS recurrence demonstrated that general anesthesia (P = .02) was associated with increased risk for recurrence along with a trend for increased risk in patients with significant hairiness (P = .078). No differences were seen in age (P = .621), gender (P = .475), median sinus length (P = .397), and energy used (P = .904). Conclusion: Primary healing rate after SiLaC surgery for chronic PNS was >80% in our series. Ten percent of patients did not achieve complete healing but did not require surgery due to lack of symptoms.", "provenance": [ { "field": "n", "quote": "leaving 91 patients for final analysis" }, { "field": "population", "quote": "all patients who underwent minimally invasive surgery combined with laser therapy for PNS" }, { "field": "intervention", "quote": "sinus laser-assisted closure (SiLaC) of pilonidal disease" }, { "field": "comparator", "quote": "Analysis of risk factors for PNS recurrence demonstrated that general anesthesia (P = .02) was associated with increased risk for recurrence" }, { "field": "primaryOutcome", "quote": "The primary outcome was complete healing rate" }, { "field": "result", "quote": "standing at 81.3% (74/91 patients)" } ] }, { "id": "pmid:36800737", "pmid": "36800737", "doi": "10.47391/JPMA.4762", "nctId": null, "pmcid": null, "title": "A case report of sacrococcygeal foreign body presenting as pilonidal sinus", "firstAuthor": "Anjum", "multipleAuthors": true, "journal": "J Pak Med Assoc", "year": 2023, "design": "case-series", "n": 1, "nField": "reported", "population": "13-year-old female student with a pilonidal sinus in the tailbone area", "intervention": "crystalloid phenol treatment after removal of a foreign body (grass straw) from the sinus", "comparator": "no comparator; prior unresponsive treatments", "primaryOutcome": "complete healing of the pilonidal sinus", "result": "patient was completely fine by the end of the third week after treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single case report, which cannot show how long pilonidal cysts last in general or prove what caused improvement.", "directness": "indirect", "limitations": "only one patient, unusual cause (foreign body rather than typical hair-related case), no control group.", "followUp": "three weeks", "plainFinding": "Healed within three weeks after treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36800737/", "sourceText": "Pilonidal disease occurs most commonly in those males who have to sit long hours at their work place e.g. online office workers or drivers. It is caused by piercing of broken hairs into the sacrococcygeal region which causes localised inflammation. Inflammation in this area due to any other foreign body is very rare. Among many treatment options for pilonidal sinus, instillation of crystalloid phenol showed promising results in terms of low recurrence rates, low post-operative complications and less healing time. Here, we present the case of a 13-year-old female student who had pilonidal sinus in sacrococcygeal region for six months and was unresponsive to multiple treatments. Later, on exploration it was revealed to contain a small foreign body of 3cm of hard straw of grass. The patient was treated with crystalloid phenol and on regular follow-up she was completely fine by the end of the third week.", "provenance": [ { "field": "n", "quote": "the case of a 13-year-old female student" }, { "field": "population", "quote": "13-year-old female student who had pilonidal sinus in sacrococcygeal region for six months" }, { "field": "intervention", "quote": "The patient was treated with crystalloid phenol" }, { "field": "comparator", "quote": "unresponsive to multiple treatments" }, { "field": "primaryOutcome", "quote": "on regular follow-up she was completely fine by the end of the third week" }, { "field": "result", "quote": "on regular follow-up she was completely fine by the end of the third week" } ] }, { "id": "pmid:36700412", "pmid": "36700412", "doi": "10.1111/iwj.14096", "nctId": null, "pmcid": "PMC10333023", "title": "Randomised clinical trial to test the phenolization in sacrococcygeal pilonidal disease", "firstAuthor": "Elvira Lopez", "multipleAuthors": true, "journal": "Int Wound J", "year": 2023, "design": "rct", "n": 124, "nField": "reported", "population": "adults with uncomplicated sacrococcygeal pilonidal disease with a single midline opening", "intervention": "phenolization treatment", "comparator": "conventional surgery", "primaryOutcome": "recurrence of pilonidal disease", "result": "no recurrence in either group, but sick leave was shorter with phenolization", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "single-center trial with no recurrences in either arm, making it hard to judge differences in the main outcome.", "directness": "indirect", "limitations": "Single-center design, primary outcome (recurrence) had zero events in both groups limiting statistical power, and the abstract does not describe blinding.", "followUp": "493.8 days", "plainFinding": "Shorter sick leave, same recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36700412/", "sourceText": "To test the efficacy and safety of phenolization in uncomplicated Sacrococcygeal pilonidal disease (SPD) the phenolization in uncomplicated SPD is feasible and secure in selected patients in observational studies. The greatest benefits are obtained to reduce the length of sick leave (LSL) and complications. Single-center randomised controlled clinical trial. Patients were recruited at University Hospital of Tarragona Joan XXIII of Spain. Patients were randomised into two treatment groups. All patients with uncomplicated sacrococcygeal disease, localised in the midline and with only 1 fistulous orifice. The patients were randomly assigned to the phenolization group (PhG) or conventional-surgery group (CsG). Both groups were managed without admission. The main endpoint was the recurrence of sacrococcygeal disease. Secondary endpoints included time of sick leave, complications, and readmission. 124 patients were included in the study. No disease recurrence was observed in either group. Clinical follow-up was carried out with a mean of 493.8 days (SD 6.59). The LSL was shorter in the PhG (mean 19.63 days, SD 28.15) than in the CSG (43.95 days, SD 38.60). The LSL reduction was -24.31 days (P .002). The phenolization in selected SPD is a safe and feasible procedure in selected patients. This approach could become the standard of care for patients with selected Sacrococcygeal pilonidal.", "provenance": [ { "field": "n", "quote": "124 patients were included in the study." }, { "field": "population", "quote": "All patients with uncomplicated sacrococcygeal disease, localised in the midline and with only 1 fistulous orifice." }, { "field": "intervention", "quote": "the phenolization group (PhG)" }, { "field": "comparator", "quote": "conventional-surgery group (CsG)" }, { "field": "primaryOutcome", "quote": "The main endpoint was the recurrence of sacrococcygeal disease." }, { "field": "result", "quote": "No disease recurrence was observed in either group." }, { "field": "result", "quote": "The LSL was shorter in the PhG (mean 19.63 days, SD 28.15) than in the CSG (43.95 days, SD 38.60)." }, { "field": "followUp", "quote": "Clinical follow-up was carried out with a mean of 493.8 days (SD 6.59)." } ] }, { "id": "pmid:36550830", "pmid": "36550830", "doi": "10.1097/MD.0000000000031934", "nctId": null, "pmcid": "PMC9771332", "title": "Factors affecting the success of crystallized phenol treatment in sacrococcygeal pilonidal sinus disease", "firstAuthor": "Ulusoy", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2022, "design": "retrospective", "n": 92, "nField": "reported", "population": "patients with primary and recurrent sacrococcygeal pilonidal sinus disease", "intervention": "crystallized phenol treatment applied in outpatient clinic under local anesthesia", "comparator": "none; single-arm study comparing patient and disease factors", "primaryOutcome": "recurrence of pilonidal sinus disease after treatment", "result": "recurrence rate after the procedure was 20.7%, with hirsutism grade and pit number linked to recurrence", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, no control group, and it studies recurrence after a specific treatment rather than the natural course of untreated pilonidal cysts.", "followUp": "", "plainFinding": "About 1 in 5 recurred after treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36550830/", "sourceText": "There are 2 mainstays of sacrococcygeal pilonidal disease (SPD) treatment: non-operative and surgical. None of them was superior, and it was associated with some degree of recurrence. Crystallized phenol treatment is a non-operative procedure performed in outpatient settings. This retrospective study aimed to asses crystallized phenol treatment in patients with primary and recurrent SPD and the factors that influence disease recurrence. A total of 92 patients were included and followed up. Crystallized phenol was administered in an outpatient setting under local anesthesia. All demographic, patient, sinus features, procedure and outcome data were recorded and analyzed for treatment success and factors for recurrence were identified. Between January 2019 and December 2021, 92 patients (77 male and 15 female) with a mean age of 28.4 were treated with 1, 2, or 3 doses of crystallized phenol. Recurrence rate after the procedure was 20.7%. Univariate regression analysis showed that the grade of hirsutism, initial presence of abscess, pit number and number of showers per week had statistically significant effect on recurrence. Multivariate logistic regression analysis pointed on the hirsutism grade (P = .008) and the number of pit openings (P = .003) as a statistically significant factors for recurrence. Crystallized phenol application for primary and recurrent SPD is safe, inexpensive and efficient non-operative method with few minor complications, even when is repeated. Factors responsible for the recurrence of the procedure are grade of hirsutism and sinus pit number.", "provenance": [ { "field": "n", "quote": "A total of 92 patients were included and followed up." }, { "field": "population", "quote": "patients with primary and recurrent SPD" }, { "field": "intervention", "quote": "Crystallized phenol was administered in an outpatient setting under local anesthesia." }, { "field": "comparator", "quote": "There are 2 mainstays of sacrococcygeal pilonidal disease (SPD) treatment: non-operative and surgical. None of them was superior" }, { "field": "primaryOutcome", "quote": "factors that influence disease recurrence" }, { "field": "result", "quote": "Recurrence rate after the procedure was 20.7%." } ] }, { "id": "pmid:36542008", "pmid": "36542008", "doi": "10.1590/0102-672020220002e1713", "nctId": null, "pmcid": "PMC9767422", "title": "RADICAL VERSUS CONSERVATIVE METHODS IN ONE-STAGE PILONIDAL ABSCESS SURGERY: THE EXPERIENCE OF A TUNISIAN CENTER", "firstAuthor": "Mahjoubi", "multipleAuthors": true, "journal": "Arq Bras Cir Dig", "year": 2022, "design": "retrospective", "n": 57, "nField": "reported", "population": "patients operated on for pilonidal abscess", "intervention": "radical surgery (excision)", "comparator": "conservative surgery (incision with curettage or drainage)", "primaryOutcome": "recurrence of pilonidal disease after surgery", "result": "Excision had lower recurrence (19%) but longer recovery time; incision had faster wound healing but higher recurrence (54%)", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Small retrospective comparative study with no randomization, so differences between groups could be due to other factors.", "directness": "indirect", "limitations": "Retrospective design, small sample size, no randomization, reliance on medical records and patient interviews for recurrence data.", "followUp": "", "plainFinding": "Excision lowers recurrence, slows recovery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36542008/", "sourceText": "BACKGROUND: Surgical treatment for pilonidal abscess is the gold standard, but not yet well codified. Different techniques proposed can be conservative or radical. AIMS: The aim of our study was to compare postoperative outcomes of both methods in one-stage treatment strategy. METHODS: This is a comparative study including patients operated on for pilonidal abscess, with a satisfactory postoperative follow-up, over a period of 4 years. We looked for the occurrence of postoperative recurrence in the medical records or by interviewing reachable patients. RESULTS: We analyzed 57 patients: 33 males and 24 females. The mean age was 26.9±10 years. The type of operation was excision in 46 (81%) cases and incision in 11 (19%) cases associated with curettage in three cases and drainage in 1 case. There was no statistically significant relationship between the type of surgery and the occurrence of postoperative surgical complications (p=1) and hospital stay (p=0.4). Excision of pilonidal abscess was significantly associated with a longer time to return to activity (p=0.04). Conservative surgery was significantly associated with faster healing of the surgical wound (p<0.001). The recurrence rate was 19% in radical surgery and 54% in conservative surgery. Radical surgery was significantly associated with a lower recurrence rate than incision procedure (p=0.02). CONCLUSIONS: Excision of pilonidal abscess was the common technique in our series, with a significantly lower rate of recurrence of the disease than after incision. However, the long convalescence following excision and the longer operating time, particularly in an emergency context, may sometimes lead to choosing conservative surgery.", "provenance": [ { "field": "n", "quote": "We analyzed 57 patients" }, { "field": "population", "quote": "patients operated on for pilonidal abscess" }, { "field": "intervention", "quote": "Excision of pilonidal abscess" }, { "field": "comparator", "quote": "Conservative surgery" }, { "field": "primaryOutcome", "quote": "We looked for the occurrence of postoperative recurrence" }, { "field": "result", "quote": "The recurrence rate was 19% in radical surgery and 54% in conservative surgery." }, { "field": "result", "quote": "Conservative surgery was significantly associated with faster healing of the surgical wound (p<0.001)." }, { "field": "result", "quote": "Excision of pilonidal abscess was significantly associated with a longer time to return to activity (p=0.04)." } ] }, { "id": "pmid:36401803", "pmid": "36401803", "doi": "10.1111/codi.16420", "nctId": null, "pmcid": null, "title": "Long-term outcome after Bascom's cleft-lift procedure under tumescent local analgesia for pilonidal sinus disease: a cohort study", "firstAuthor": "Svarre", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2023, "design": "prospective-cohort", "n": 200, "nField": "reported", "population": "patients with complex pilonidal sinus disease needing surgery", "intervention": "Bascom's cleft-lift surgery done under local numbing medicine (tumescent local analgesia)", "comparator": "none - all patients received the same surgery, no comparison group", "primaryOutcome": "complete wound healing within 180 days of surgery or no recurrence over 10 years", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "median follow-up time of 8.5 (1.0-10.7) years", "plainFinding": "Most healed within a month after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36401803/", "sourceText": "AIM: Bascom's cleft-lift procedure for pilonidal sinus disease under tumescent local analgesia is feasible and well tolerated with favourable short-term outcomes. We aimed to assess the 10-year treatment success rate after cleft-lift under tumescent local analgesia. METHOD: This was a single-centre cohort study based on prospectively registered perioperative data and survey data with additional data from electronic medical records. The cleft-lift procedure was performed under tumescent local analgesia in a day-surgical setting at a tertiary referral hospital between 1 July 2008 and 31 March 2014. 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. Secondary outcomes were time to complete wound healing, persistent pain and cosmetic satisfaction. RESULTS: Two hundred patients with complex pilonidal sinus disease were included. Indication was incomplete wound healing after pilonidal sinus surgery in 43 (21.5%) patients, recurrence after previous intervention in 78 (39.0%) or moderate to complex sinuses assessed by a consultant surgeon in 79 (39.5%). 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%). No significant predictors were associated with recurrence, and 90% of patients experienced no persistent pain. CONCLUSION: Cleft-lift performed under tumescent local analgesia has an acceptable 10-year treatment failure rate, making the method feasible in a day-surgery setting.", "provenance": [ { "field": "n", "quote": "Two hundred patients with complex pilonidal sinus disease were included." }, { "field": "population", "quote": "Two hundred patients with complex pilonidal sinus disease were included." }, { "field": "intervention", "quote": "The cleft-lift procedure was performed under tumescent local analgesia in a day-surgical setting" }, { "field": "comparator", "quote": "This was a single-centre cohort study based on prospectively registered perioperative data" }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "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%)." }, { "field": "followUp", "quote": "median follow-up time of 8.5 (1.0-10.7) years" } ] }, { "id": "pmid:36397424", "pmid": "36397424", "doi": "10.1097/MD.0000000000031767", "nctId": null, "pmcid": "PMC9666099", "title": "Comparative analysis on the effect of the endoscopic versus conventional treatment for pilonidal sinus: A meta-analysis of controlled clinical trials", "firstAuthor": "Chen", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2022, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease needing surgery", "intervention": "endoscopic surgical treatment", "comparator": "conventional surgery (including excision with primary closure)", "primaryOutcome": "operation time, recurrence, complications, pain, and healing time", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "only six studies were pooled, with very high variability between studies and the authors say more rigorous large trials are needed.", "directness": "indirect", "limitations": "small number of included studies, very high heterogeneity (I2=99%) for the pain outcome, and the authors call for larger randomized trials", "followUp": "", "plainFinding": "Endoscopic surgery: less pain, fewer complications", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36397424/", "sourceText": "BACKGROUND: Pilonidal sinus is a common disease in the sacrococcygeal region. Although many treatments have been described in recent years, the recurrence of each method remains high. Surgeons did not reach a consensus on the preferred approach for pilonidal sinus. We carried out a meta-analysis of controlled clinical trials comparing the outcomes of endoscopic treatment versus conventional treatment for pilonidal sinus disease in this study. METHODS: We performed a systematic literature search, and we used electronic databases such as PubMed/Medline, Embase, and the Cochrane library to search for the relevant literature comparing endoscopic management to other conventional treatments for pilonidal sinus disease. The primary outcome parameters were operative time, recurrence, postoperative complications and pain, and total healing time. RESULTS: Six studies were included in the review. 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). Compared to the excision followed by the primary closure technique, the operation time, time to complete wound healing, and satisfaction were similar. CONCLUSIONS: Endoscopic pilonidal sinus treatment is a unique and potential method of sacrococcygeal pilonidal disease treatment. The foremost benefits of this technique are mild postoperative pain, lower complications rate, and return to routine for a shorter time. However, due to the limited number of articles, we need to conduct more rigorous large-sample prospective randomized controlled trials to clarify the efficiency of endoscopic treatment for pilonidal cysts.", "provenance": [ { "field": "n", "quote": "Six studies were included in the review." }, { "field": "population", "quote": "Pilonidal sinus is a common disease in the sacrococcygeal region." }, { "field": "intervention", "quote": "endoscopic treatment versus conventional treatment for pilonidal sinus disease" }, { "field": "comparator", "quote": "Compared to the excision followed by the primary closure technique, the operation time, time to complete wound healing, and satisfaction were similar." }, { "field": "primaryOutcome", "quote": "The primary outcome parameters were operative time, recurrence, postoperative complications and pain, and total healing time." }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:36348071", "pmid": "36348071", "doi": "10.1007/s00431-022-04678-3", "nctId": null, "pmcid": "PMC9829630", "title": "Quality of life of pediatric patients operated for pilonidal sinus disease", "firstAuthor": "Esposito", "multipleAuthors": true, "journal": "Eur J Pediatr", "year": 2023, "design": "retrospective", "n": 177, "nField": "reported", "population": "children who had surgery for pilonidal sinus disease", "intervention": "endoscopic pilonidal sinus treatment (PEPSIT)", "comparator": "open surgery", "primaryOutcome": "quality of life measures including healing time, hospital stay, return to activities, and recurrence", "result": "PEPSIT group had shorter hospital stay, faster healing, quicker return to sport/school/social life, and lower recurrence than open surgery group", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, unequal group sizes (20 vs 157), not randomized, and authors call for further prospective studies.", "followUp": "", "plainFinding": "Faster healing with endoscopic surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36348071/", "sourceText": "UNLABELLED: Quality of life (QOL) outcome is an ideal method for determining the efficacy of a surgical treatment. In children operated for pilonidal sinus disease (PSD), open procedures imply prolonged wound care, significant morbidity, and high recurrence rates. Endoscopic treatment (PEPSIT) overcomes these limitations. We report our experience in the management of PSD to evaluate the QOL of patients undergoing open and endoscopic treatment. The records of 177 patients undergoing surgery for PSD from 2008 to 2021 were retrospectively reviewed. Twenty patients were operated with open surgery (G1) and 157 with PEPSIT (G2). 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). Moreover, we used Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q) for a more subjective evaluation of life satisfaction. We found significant differences in all the analyzed criteria: HS varied from 3 to 7 days in G1 and from 1 to 2 days in G2; 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; RTSc from 9 to 15 days in G1 while from 2 to 4 days in G2; RSL from 13 to 20 days in G1 while from 2 to 5 days in G2; RRR was 25% in G1 and 4.4% in G2. CONCLUSION: Endoscopic treatment (PEPSIT) significantly improves the quality of life of patients operated for PSD. Compared to open surgery, PEPSIT presents shorter hospital stay, faster healing time, return to sport activities, return to school and resumption of a normal social life, and lower rates of recurrence and reoperation. In addition, PQ-LES-Q demonstrated a good overall quality of life and life satisfaction. Further prospective studies should be obtained to consider PEPSIT as the gold standard for the treatment of PSD in pediatric patients. WHAT IS KNOWN: • Many techniques have been proposed in the last 20 years for the surgical treatment of PSD. • PEPSIT is showing promising results in terms of safety and long-term efficacy. WHAT IS NEW: • The main impact in QOL of patients operated with PEPSIT is on their daily activity, including a shorter hospital stay, faster healing time, return to sport activities, return to school and resumption of a normal social life, lower rates of recurrence and reoperation. • After PEPSIT, children maintain a satisfactory quality of life according to the analysis of PQ-LES-Q.", "provenance": [ { "field": "n", "quote": "The records of 177 patients undergoing surgery for PSD from 2008 to 2021 were retrospectively reviewed." }, { "field": "population", "quote": "In children operated for pilonidal sinus disease (PSD), open procedures imply prolonged wound care, significant morbidity, and high recurrence rates." }, { "field": "intervention", "quote": "Endoscopic treatment (PEPSIT) overcomes these limitations." }, { "field": "comparator", "quote": "Twenty patients were operated with open surgery (G1) and 157 with PEPSIT (G2)." }, { "field": "primaryOutcome", "quote": "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)." }, { "field": "result", "quote": "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" }, { "field": "result", "quote": "RRR was 25% in G1 and 4.4% in G2." } ] }, { "id": "pmid:36268754", "pmid": "36268754", "doi": "10.1111/codi.16383", "nctId": null, "pmcid": null, "title": "Long-term outcome after Bascom's pit-pick procedure for pilonidal sinus disease: A cohort study", "firstAuthor": "Serup", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2023, "design": "retrospective", "n": 158, "nField": "reported", "population": "patients with simple pilonidal sinus disease who had the pit-pick surgery", "intervention": "Bascom's pit-pick procedure (minimally invasive surgery for pilonidal sinus)", "comparator": "", "primaryOutcome": "long-term risk of treatment failure, incomplete healing, recurrence, complications, pain and cosmetic satisfaction", "result": "10-year recurrence rate was 27%, treatment success was 68%, and most patients had no complications or chronic pain", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "No comparator group, follow-up relied on survey and telephone interviews with possible recall or response bias, single-centre design", "followUp": "7.98 (0.66, 10.96) years", "plainFinding": "About 1 in 4 recur after surgery by 10 years.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36268754/", "sourceText": "AIM: Previous studies have shown favourable short-term results after Bascom's pit-pick procedure for simple pilonidal sinus disease. A minimum 5-year follow-up is considered the gold standard but only a few long-term studies have previously been reported. Here, 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. METHODS: Medical records of patients registered in a local database after undergoing Bascom's pit-pick procedure were reviewed and follow-up data updated. The patients received an online survey including questions about demographics, lifestyle, complications, reintervention, pain, satisfaction with cosmetic appearance and supplemented with telephone interviews if no response was received. RESULTS: A total of 158 patients underwent Bascom's pit-pick procedure during the period August 2007 to March 2014. Median follow-up was 7.98 (0.66, 10.96) years. Twelve patients (8%) had reintervention due to incomplete wound healing. A total of 32 patients experienced a recurrence. In competing risk analyses, the 10-year cumulative recurrence rate was 27% (95% CI: 19%-35%) of patients with complete wound healing. Treatment success was 68%. Recurrence was associated with active smoking, HR of 5.30 (95% CI: 1.42-19.86; p = 0.01), and number of primary pits ≥3, HR of 5.11 (95% CI: 1.49-17.47; p = 0.01). More than 90% had no postoperative complications or chronic pain, and more than 70% reported a high satisfaction with the cosmetic appearance. CONCLUSION: Bascom's pit-pick seems to be adequate treatment for most patients with a simple pilonidal sinus.", "provenance": [ { "field": "n", "quote": "A total of 158 patients underwent Bascom's pit-pick procedure during the period August 2007 to March 2014." }, { "field": "population", "quote": "for simple pilonidal sinus disease" }, { "field": "intervention", "quote": "Bascom's pit-pick procedure" }, { "field": "primaryOutcome", "quote": "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" }, { "field": "result", "quote": "the 10-year cumulative recurrence rate was 27% (95% CI: 19%-35%) of patients with complete wound healing. Treatment success was 68%." }, { "field": "followUp", "quote": "Median follow-up was 7.98 (0.66, 10.96) years." } ] }, { "id": "pmid:36217688", "pmid": "36217688", "doi": "10.1111/codi.16361", "nctId": null, "pmcid": null, "title": "Endoscopic sinusectomy: 'a rose by any other name'. A systematic review of different endoscopic procedures to treat pilonidal disease", "firstAuthor": "Milone", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2023, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus/pilonidal disease treated with endoscopic surgery", "intervention": "endoscopic sinusectomy (video-assisted surgical techniques) for pilonidal disease", "comparator": "different endoscopic technique variants compared with each other, not with non-surgical care", "primaryOutcome": "stage of surgical innovation reached by each technique (IDEAL framework), plus reporting quality and complication/recurrence rates", "result": "Postoperative complications occurred in 0%-6% of cases, and recurrence rate varied from 0% to 22%; reporting of technical details was generally poor", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "1 to 60 months", "plainFinding": "Recurrence varied widely across techniques.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36217688/", "sourceText": "AIM: Pilonidal sinus or Pilonidal Disease (PD) is a relatively common, benign but challenging condition. Although commonly encountered in practice, its ideal treatment is controversial. One of the most validated treatments is video-assisted surgery. In this context, very similar endoscopic techniques have been published under different names. The aim of this systematic review is to assess the differences among these proposed techniques and their outcomes. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed during all stages of this systematic review. A systematic search of the English literature was performed on multiple databases from 1 January 2014 to 3 April 2022. The primary outcome measure was the IDEAL framework stage of innovation. The key secondary outcome measures were the adherence to the IDEAL reporting guidelines, the Blencowe framework and the core outcome set (COS) for studies evaluating the introduction and evaluation of novel surgical techniques, the qualitative assessment using appropriate tools, the procedural variations and outcomes of each technique. RESULTS: A total of 38 articles were included reporting a very similar technique under eight different acronyms. The number of patients varied from 9 to 250. Mean follow-up ranged from 1 to 60 months. There was only one published study of IDEAL 3. The majority (58%) were IDEAL 2a studies. 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. Half of COS domains were markedly underreported. 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. 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%. CONCLUSION: The study demonstrates that reporting on technical aspects of interventions for PD is poor, thus warranting a better-quality control of surgical techniques. It is advisable to group all endoscopic procedures under the umbrella term of 'endoscopic sinusectomy', thus embracing the two main principles of this technique, that is, video assistance and PD ablation.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus or Pilonidal Disease (PD) is a relatively common, benign but challenging condition." }, { "field": "intervention", "quote": "video-assisted surgery" }, { "field": "comparator", "quote": "reporting a very similar technique under eight different acronyms" }, { "field": "primaryOutcome", "quote": "The primary outcome measure was the IDEAL framework stage of innovation." }, { "field": "result", "quote": "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%." }, { "field": "followUp", "quote": "Mean follow-up ranged from 1 to 60 months." }, { "field": "qualityWhy", "quote": "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." } ] }, { "id": "pmid:36102853", "pmid": "36102853", "doi": "10.1097/DCR.0000000000002475", "nctId": null, "pmcid": null, "title": "Long-term Outcome of Radical Excision Versus Phenolization of the Sinus Tract in Primary Sacrococcygeal Pilonidal Sinus Disease: A Randomized Controlled Trial", "firstAuthor": "Pronk", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2022, "design": "rct", "n": 100, "nField": "reported", "population": "patients with primary pilonidal sinus disease", "intervention": "pit excision with phenolization of the sinus tract", "comparator": "radical excision with primary wound closure", "primaryOutcome": "recurrence, quality of life, and patient satisfaction after long-term follow-up", "result": "no significant difference in quality of life or recurrence rate between phenolization and excision, but treatment impact was lower with phenolization", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "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.", "directness": "direct", "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.", "followUp": "48.4 (±12.8) months for the phenolization group and 47.8 (±13.5) months for the excision group", "plainFinding": "Similar long-term recurrence and quality of life", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36102853/", "sourceText": "BACKGROUND: Phenolization of pilonidal sinus disease has been shown to have advantages over radical excision with regard to short-term outcome; however, long-term outcomes are essentially lacking. OBJECTIVE: The aim of this randomized controlled trial was to compare the long-term outcome of pit excision and phenolization of the sinus tracts vs radical excision with primary wound closure in pilonidal sinus disease. DESIGN: Single-center, randomized controlled trial. SETTINGS: A primary teaching hospital in the Netherlands. PATIENTS: The study population included patients with primary pilonidal sinus disease presented between 2013 and 2017. INTERVENTIONS: Patients were randomly assigned to either pit excision with phenolization of the sinus tract(s) or excision with primary off-midline wound closure. MAIN OUTCOME MEASURES: The main outcomes included recurrence, quality of life (Short-Form 36), and patient's satisfaction. RESULTS: A total of 100 patients were randomized. Seventy-four patients (77.1%) were available for long-term follow-up. 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. 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). 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. CONCLUSIONS: Because of the previously shown favorable short-term results and the currently reported comparable long-term recurrence rate and quality of life between phenolization and excision, phenolization should be considered the primary treatment option in patients with pilonidal sinus disease. See Video Abstract at http://links.lww.com/DCR/C27 . DUTCH TRIAL REGISTER ID: NTR4043. RESULTADO A LARGO PLAZO DE LA ESCISIN RADICAL FRENTE AL TRATAMIENTO CON FENOL DEL TRACTO SINUSAL EN LA ENFERMEDAD DEL SENO PILONIDAL SACRO COCCGEO PRIMARIO UN ENSAYO ALEATORIO CONTROLADO: ANTECEDENTES:El tratamiento con fenol de la enfermedad del seno pilonidal ha demostrado tener ventajas sobre la escisión radical con respecto al resultado a corto plazo; sin embargo, los resultados a largo plazo aún se encuentran escasos.OBJETIVO:El objetivo de este ensayo aleatorio controlado fue comparar el resultado a largo plazo de la escisión de la fosa del quiste y el tratamiento con fenol de los trayectos sinusales frente a la escisión radical con cierre primario de la herida en la enfermedad del seno pilonidal.DISEÑO:Ensayo aleatorio controlado de un solo centro.AJUSTES:Hospital de enseñanza primaria en los Países Bajos.PACIENTES:Pacientes con enfermedad primaria del seno pilonidal presentados entre 2013 y 2017.INTERVENCIONES:Los pacientes fueron asignados de manera aleatoria a la escisión de la fosa del quiste y posterior administración de fenol de los tractos sinusales o a la escisión con cierre primario de la herida fuera de la línea media.PRINCIPALES MEDIDAS DE RESULTADO:Recurrencia, calidad de vida (Short-Form 36) y satisfacción del paciente.RESULTADOS:Un total de 100 pacientes con enfermedad primaria del seno pilonidal fueron aleatorizados; 50 pacientes fueron sometidos al tratamiento con fenol y 50 a la escisión radical. Eventualmente, 74 pacientes (77,1%) estuvieron disponibles para seguimiento a largo plazo; 36 pacientes después del uso del fenol y 38 después de la escisión. El tiempo medio (± desviación estándar) de seguimiento fue de 48,4 (± 12,8) y 47,8 (± 13,5) meses, respectivamente. No hubo diferencia significativa entre ambos grupos con respecto a la calidad de vida. En el grupo tratado con fenal, dos pacientes (5,6%) desarrollaron recurrencia y un paciente (2,6%) en el grupo de escisión ( p = 0,604). El impacto de todo el tratamiento fue significativamente menor después del uso del fenol (p = 0,010).LIMITACIONES:La tasa de respuesta fue de casi el 80% en esta población de pacientes jóvenes, los pacientes y los evaluadores no estaban cegados por el tipo de cirugía, los resultados son solo aplicables a la enfermedad primaria del seno pilonidal.CONCLUSIONES:Debido a los resultados favorables a corto plazo descritos y a la tasa de recurrencia a largo plazo y la calidad de vida comparables actualmente informadas entre la administración de fenol y la escisión con cierre primario de la herida para la enfermedad primaria del seno pilonidal, la administración de fenol del tracto sinusal debe considerarse como opción de tratamiento primario en pacientes con enfermedad del seno pilonidal. Consulte Video Resumen en http://links.lww.com/DCR/C27 . (Traducción-Dr. Osvaldo Gauto )Registro de prueba holandés-ID:NTR4043.", "provenance": [ { "field": "n", "quote": "A total of 100 patients were randomized." }, { "field": "population", "quote": "The study population included patients with primary pilonidal sinus disease presented between 2013 and 2017." }, { "field": "intervention", "quote": "pit excision with phenolization of the sinus tract(s)" }, { "field": "comparator", "quote": "excision with primary off-midline wound closure" }, { "field": "primaryOutcome", "quote": "The main outcomes included recurrence, quality of life (Short-Form 36), and patient's satisfaction." }, { "field": "result", "quote": "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)." }, { "field": "followUp", "quote": "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." } ] }, { "id": "pmid:36102566", "pmid": "36102566", "doi": "10.1097/XCS.0000000000000356", "nctId": null, "pmcid": null, "title": "Resolution of Mild Pilonidal Disease in Adolescents Without Resection", "firstAuthor": "Check", "multipleAuthors": true, "journal": "J Am Coll Surg", "year": 2022, "design": "case-series", "n": 102, "nField": "reported", "population": "adolescents and young adults with mild pilonidal disease", "intervention": "improved hygiene, excision of midline pits under local anesthesia, and laser hair removal", "comparator": "no surgical removal of the cyst (resection)", "primaryOutcome": "resolution of pilonidal disease", "result": "77 of 78 patients who continued treatment had their pilonidal disease resolve", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "direct", "limitations": "24 of 102 patients were lost to follow up; no control group for comparison; single clinic experience.", "followUp": "30 ± 19 weeks", "plainFinding": "Resolved without surgery for most.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36102566/", "sourceText": "BACKGROUND: Pilonidal disease is a common condition of the gluteal crease, affecting around 1 in 2,000 adolescents and young adults. 1 Traditional options for management of pilonidal disease include improved hygiene with or without hair removal or resection of the nidus. Given a high recurrence rate associated with hygiene alone, nidus resection is often recommended, even for patients with mild pilonidal disease, despite significant postoperative morbidity. We present a consecutive series of patients with mild pilonidal disease managed in a dedicated Pilonidal Care Clinic using an alternate approach directed toward source control: 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. 2. STUDY DESIGN: Data on demographics, disease severity, symptom scoring, treatments provided, and outcome for consecutive new patients presenting to an outpatient pilonidal care clinic with mild disease between August 2017 and September 2020 were analyzed. RESULTS: One hundred two patients presented; their mean age was 16.3 years, 56 (55%) were female, and 42 (41%) had undergone prior nidus incision and drainage. 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. CONCLUSION: Mild pilonidal disease may be resolved with improved hygiene, pit excision, and laser epilation with minimal morbidity and no activity restrictions. Adoption of this approach may keep a large number of patients with pilonidal disease from undergoing unindicated resection.", "provenance": [ { "field": "population", "quote": "Pilonidal disease is a common condition of the gluteal crease, affecting around 1 in 2,000 adolescents and young adults." }, { "field": "intervention", "quote": "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" }, { "field": "comparator", "quote": "nidus resection is often recommended, even for patients with mild pilonidal disease, despite significant postoperative morbidity" }, { "field": "primaryOutcome", "quote": "resolution of their pilonidal disease" }, { "field": "result", "quote": "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." }, { "field": "n", "quote": "One hundred two patients presented" } ] }, { "id": "pmid:35963978", "pmid": "35963978", "doi": "10.1007/s10151-022-02683-0", "nctId": null, "pmcid": null, "title": "Injection of freshly collected autologous adipose tissue in complicated pilonidal disease: a prospective pilot study", "firstAuthor": "Sophie", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2022, "design": "prospective-cohort", "n": 30, "nField": "reported", "population": "patients with pilonidal sinus disease that failed to heal after surgery, or with pilonidal disease near the anus", "intervention": "injection of the patient's own fat tissue after surgical revision", "comparator": "none (single-group study)", "primaryOutcome": "time until the wound healed completely", "result": "25 of 30 patients (83.3%) healed completely, with a median time to healing of 159 days", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Small pilot study, no control group, so results may not generalise and cannot isolate the effect of the fat injection itself.", "followUp": "", "plainFinding": "Most healed within about 5 months.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35963978/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a frequent disorder. Treatment failure and recurrence are common, leading to significant morbidity. The aim of this study was to investigate the impact and need for repeated treatment of injected autologous adipose tissue into non-healing PSD wounds and primary anal-near PSD or anal-near recurrence. METHODS: At the Department of Surgery, Randers Regional Hospital, Denmark, a prospective pilot study was conducted on 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 from December 2018 to March 2020. The primary endpoint was time to healing. Autologous adipose tissue was harvested from the patients and injected into the lesions after surgical revision. Patients were examined 2 and 12 weeks after surgery. Patients with lack of healing after 12 weeks (undermining or no skin coverage) were offered re-injection. RESULTS: We included 30 patients [26 men and 4 women, median age 24 years (range 18-59 years)]. 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. The mean operation time was 70.6 ± 23.7 min and the mean amount of injected autologous adipose tissue was 19 ± 10 ml. There were no major complications. CONCLUSION: Freshly collected autologous adipose tissue injected into chronic non-healing or primary and recurrent PSD lesions near the anal verge is safe and efficient.", "provenance": [ { "field": "n", "quote": "We included 30 patients" }, { "field": "population", "quote": "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" }, { "field": "intervention", "quote": "Autologous adipose tissue was harvested from the patients and injected into the lesions after surgical revision." }, { "field": "comparator", "quote": "a prospective pilot study was conducted on consecutive PSD patients" }, { "field": "primaryOutcome", "quote": "The primary endpoint was time to healing." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:35856614", "pmid": "35856614", "doi": "10.1097/01.ASW.0000833608.27136.d1", "nctId": null, "pmcid": null, "title": "Factors Associated with the Occurrence and Healing of Umbilical Pilonidal Sinus: A Rare Clinical Entity", "firstAuthor": "Isik", "multipleAuthors": true, "journal": "Adv Skin Wound Care", "year": 2022, "design": "retrospective", "n": 82, "nField": "reported", "population": "patients with pilonidal sinus located at the belly button (umbilicus), not the more common tailbone area", "intervention": "three treatment approaches: conservative treatment, surgical treatment, and silver nitrate application", "comparator": "the three treatment methods compared against each other", "primaryOutcome": "rate of the sinus coming back (recurrence) after treatment", "result": "no significant difference in recurrence rate between the three treatment methods, though smoking was linked to recurrence", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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", "followUp": "", "plainFinding": "No duration data reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35856614/", "sourceText": "OBJECTIVE: Pilonidal sinus disease (PSD) is a chronic inflammatory condition of skin that is thought to be related to implanted loose hair. Although PSD is most frequently seen in the sacrococcygeal region, it can also occur at the axilla, perineum, suprapubic regions, hands, and umbilicus. The aim of this project was to find factors influencing the development and treatment of umbilical PSD. METHODS: In this retrospective study, the authors evaluated 82 patients (19 women, 63 men) with a history of umbilical PSD between 2012 and 2020 to determine predisposing factors and treatment modalities. RESULTS: There was a 20% concordance with intergluteal PSD. Smoking was the only modifying factor for recurrence. The three different treatment methods studied (conservative treatment, surgical treatment, silver nitrate) did not differ in recurrence rate (P = .57). CONCLUSIONS: Because of its rare nature, umbilical PSD can be misdiagnosed or underdiagnosed. Key aspects of treatment include smoking cessation and a conservative approach.", "provenance": [ { "field": "n", "quote": "the authors evaluated 82 patients (19 women, 63 men) with a history of umbilical PSD" }, { "field": "population", "quote": "umbilical PSD" }, { "field": "intervention", "quote": "The three different treatment methods studied (conservative treatment, surgical treatment, silver nitrate)" }, { "field": "comparator", "quote": "did not differ in recurrence rate (P = .57)" }, { "field": "primaryOutcome", "quote": "did not differ in recurrence rate (P = .57)" }, { "field": "result", "quote": "Smoking was the only modifying factor for recurrence." } ] }, { "id": "pmid:35842877", "pmid": "35842877", "doi": "10.1007/s00383-022-05175-2", "nctId": null, "pmcid": null, "title": "Burden of pilonidal disease and improvement in quality of life after treatment in adolescents", "firstAuthor": "Salimi-Jazi", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2022, "design": "retrospective", "n": 101, "nField": "reported", "population": "Adolescents with pilonidal disease who underwent minimally invasive treatment", "intervention": "Minimally invasive treatment (laser hair removal with or without trephination)", "comparator": "Patients' own quality-of-life scores before treatment compared with after treatment", "primaryOutcome": "Impact of pilonidal disease on quality of life (daily activities, sports, school/work attendance, socializing)", "result": "After treatment, far fewer patients reported their daily activities, sports, school/work, and socializing being affected, with the difference being statistically significant", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study of one treatment group with no comparison group, relying on patient-reported questionnaires and missing data for some patients.", "directness": "indirect", "limitations": "30 patients with incomplete data were excluded, no untreated control group, retrospective design, single-center study", "followUp": "", "plainFinding": "Less daily-life disruption after treatment", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35842877/", "sourceText": "PURPOSE: Pilonidal Disease (PD) affects adolescents in different aspects. We hypothesized that patients with different gender, ethnicity, and age have different quality of life (QOL) measurements which could improve with minimally invasive treatment (MIT). METHODS: 131 PD patients underwent MIT (laser epilation ± trephination) from 2019 to 2021. Patients' demographics were recorded. Before and after MIT, patients received QOL questionnaire consisting of four categories: daily activities, sports participation, school/work attendance, and socializing. Data were analyzed using Student and multivariate t test. P < 0.05 was considered statistically significant. RESULTS: 101 (51 male, 50 female) patients were included. 30 patients with incomplete data were excluded. 54% of patients were < 18 years old. 47.5% were Hispanic. Median symptom duration prior to presentation was 5.4 (1.3-15) months. Prior to MIT, patients' ability to perform daily activities, participate in sports, attend school/work, and socialize was moderately or severely impacted in 66%, 57%, 45%, and 23% of respondents, respectively; after MIT, only 7%, 8%, 2%, and 4% were affected (p < 0.01). Recurrence rate was 6%. Pre-MIT, older patients and non-Hispanics reported worse impact on their QOL. Symptom duration or PD recurrence did not correlate with patient's pre- or post-MIT QOL. CONCLUSION: Patients' ethnicity and age impacted QOL in PD. All patients' QOL significantly improved with MIT. Considering the importance of socializing, playing sports, and school/work attendance in adolescents, our study highlights importance of early treatment of PD.", "provenance": [ { "field": "n", "quote": "101 (51 male, 50 female) patients were included." }, { "field": "population", "quote": "Pilonidal Disease (PD) affects adolescents in different aspects." }, { "field": "intervention", "quote": "131 PD patients underwent MIT (laser epilation ± trephination) from 2019 to 2021." }, { "field": "comparator", "quote": "Before and after MIT, patients received QOL questionnaire consisting of four categories: daily activities, sports participation, school/work attendance, and socializing." }, { "field": "primaryOutcome", "quote": "QOL questionnaire consisting of four categories: daily activities, sports participation, school/work attendance, and socializing." }, { "field": "result", "quote": "after MIT, only 7%, 8%, 2%, and 4% were affected (p < 0.01)." } ] }, { "id": "pmid:35779104", "pmid": "35779104", "doi": "10.1007/s00383-022-05162-7", "nctId": null, "pmcid": null, "title": "Long-term results of EPSiT in children and adolescents: still the right way to go", "firstAuthor": "Erculiani", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2022, "design": "retrospective", "n": 99, "nField": "reported", "population": "children and teenagers who had pilonidal cyst surgery", "intervention": "endoscopic pilonidal sinus treatment (EPSiT)", "comparator": "comparing short-term (12 months) versus long-term (over 36 months) follow-up after the same surgery", "primaryOutcome": "rate of cyst coming back (recurrence) after surgery", "result": "15% of patients followed for over 3 years had the cyst return, happening on average 19 months after surgery", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, no control group, and not all patients had long-term follow-up (59 of 99).", "followUp": "median follow-up of 49 months (36-61 months)", "plainFinding": "Cyst often returns years later", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35779104/", "sourceText": "INTRODUCTION: Endoscopic pilonidal sinus treatment (EPSiT) has been advocated promising excellent outcomes with low rates of complications and recurrences. In this study, we aimed at reporting long-term results of a unicentric series of pediatric patients who underwent EPSiT during a 5-year period. MATERIALS AND METHODS: We retrospectively reviewed patients who underwent EPSiT between January 2017 and December 2021. Patients under 18 years of age at first surgery were included. Details regarding demographic data, surgical procedure, and recurrences were recorded. Patients were also divided into short-term (follow-up of 12 months) and long-term (follow-up longer than 36 months) to compare results and detect all possible delayed recurrences. RESULTS: A total of 99 patients underwent 115 EPSiT procedures in a 5-year period. Median age was 16 years (8-19 years). Median length of surgery was 32 min (25 to 50 min). Eighty-three of these patients were assessed for short-term results and reported an 8% incidence of recurrences occurring after a mean of 6 months. 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. All patients who recurred required a redo EPSiT. Infections occurred in 5 (2 recurred) and bleeding in 1 (no recurrence). CONCLUSIONS: Recent reports underlined impressive results and an extremely low recurrence rate of EPSiT. Our retrospective study addressed the long-term results and seems not to support these expectations. Even so, EPSiT remains easy, straightforward, allows rapid recovery and is, therefore, to be considered as one of the most promising surgical techniques available for pilonidal disease. EPSiT is here to stay and to remain.", "provenance": [ { "field": "n", "quote": "A total of 99 patients underwent 115 EPSiT procedures in a 5-year period." }, { "field": "population", "quote": "Patients under 18 years of age at first surgery were included." }, { "field": "intervention", "quote": "Endoscopic pilonidal sinus treatment (EPSiT)" }, { "field": "comparator", "quote": "Patients were also divided into short-term (follow-up of 12 months) and long-term (follow-up longer than 36 months) to compare results" }, { "field": "primaryOutcome", "quote": "Details regarding demographic data, surgical procedure, and recurrences were recorded." }, { "field": "result", "quote": "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." }, { "field": "followUp", "quote": "median follow-up of 49 months (36-61 months)" } ] }, { "id": "pmid:35678224", "pmid": "35678224", "doi": "10.1111/ans.17838", "nctId": null, "pmcid": null, "title": "Minimally invasive treatment of pilonidal sinus disease in a paediatric population: comparison of two techniques", "firstAuthor": "Fernandes", "multipleAuthors": true, "journal": "ANZ J Surg", "year": 2022, "design": "retrospective", "n": 106, "nField": "reported", "population": "children and teenagers with pilonidal disease (median age 16)", "intervention": "sinusectomy (SE) minimally invasive surgery", "comparator": "pit-picking plus laser ablation (PPL)", "primaryOutcome": "time to healing, complication and recurrence rates after treatment", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a retrospective comparison without randomization, so differences between groups could be influenced by other factors besides the treatment itself.", "directness": "indirect", "limitations": "Retrospective design, no randomization, single center", "followUp": "", "plainFinding": "Faster healing with sinusectomy than laser", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35678224/", "sourceText": "BACKGROUND: Pilonidal disease (PD) is a common and debilitating inflammatory condition with significant impact on quality of life. Minimally invasive techniques (MIT) have shown promising results comparing to traditional excision. Herein we present a comparison of two MIT techniques -sinusectomy (SE) and pit-picking plus laser ablation (PPL). METHODS: All cases of paediatric PD treated by PPL and SE at our center between August 2018 and August 2020 were retrospectively reviewed. RESULTS: One-hundred and six patients were included, with a median age of 16 years (IQR 15-16). PPL was the procedure of choice in 36 patients (34%) and the remaining underwent SE (66%). 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). CONCLUSIONS: MIT techniques are promising solutions in PD treatment. Although similarly easy and fast to perform, SE technique showed better healing profile and lower complication rate but no significant difference on recurrence rates was observed.", "provenance": [ { "field": "population", "quote": "All cases of paediatric PD treated by PPL and SE at our center between August 2018 and August 2020 were retrospectively reviewed." }, { "field": "population", "quote": "median age of 16 years (IQR 15-16)" }, { "field": "intervention", "quote": "sinusectomy (SE)" }, { "field": "comparator", "quote": "pit-picking plus laser ablation (PPL)" }, { "field": "n", "quote": "One-hundred and six patients were included" }, { "field": "primaryOutcome", "quote": "Median healing time was significantly lower in SE group (20 days), comparing to PPL (30 days) (p = 0.002)." }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:35593897", "pmid": "35593897", "doi": "10.1002/14651858.CD013439.pub2", "nctId": null, "pmcid": "PMC9121912", "title": "Dressings and topical agents for the management of open wounds after surgical treatment for sacrococcygeal pilonidal sinus", "firstAuthor": "Herrod", "multipleAuthors": true, "journal": "Cochrane Database Syst Rev", "year": 2022, "design": "systematic-review", "n": 932, "nField": "reported", "population": "adults who had surgery for a pilonidal sinus and were left with an open wound to heal", "intervention": "various wound dressings and topical treatments (e.g. negative pressure therapy, platelet-rich plasma, creams, hydrogel, zinc oxide mesh)", "comparator": "conventional wound care, placebo dressings, or other dressing types", "primaryOutcome": "how long the wound took to heal", "result": "Evidence for any dressing or topical agent improving healing time was low to very low certainty, with inconsistent or weak results across comparisons", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "Most comparisons came from single small trials with high risk of bias, so the findings are very uncertain.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "No clear best dressing for healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35593897/", "sourceText": "BACKGROUND: Sacrococcygeal pilonidal sinus disease is a common debilitating condition that predominantly affects young adults, with a profound impact on their activities of daily living. The condition is treated surgically, and in some cases the wound in the natal cleft is left open to heal by itself. Many dressings and topical agents are available to aid healing of these wounds. OBJECTIVES: To assess the effects of dressings and topical agents for the management of open wounds following surgical treatment for sacrococcygeal pilonidal sinus in any care setting. SEARCH METHODS: In March 2021, we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and we scanned reference lists of included studies, reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We included parallel-group randomised controlled trials (RCTs) only. We included studies with participants who had undergone any type of sacrococcygeal pilonidal sinus disease surgery and were left with an open wound. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We included 11 RCTs comprising 932 participants. Two studies compared topical negative pressure wound therapy (TNPWT) with conventional open wound healing, two studies compared platelet-rich plasma with sterile absorbent gauze, and the other seven studies compared various dressings and topical agents. All studies were at high risk of bias in at least one domain, whilst one study was judged to be at low risk of bias in all but one domain. All studies were conducted in secondary care. Mean participant ages were between 20 and 30 years, and nearly 80% of participants were male. No studies provided data on quality of life, cost-effectiveness, pain at first dressing change or proportion of wounds healed at 6 or 12 months, and very few adverse effects were recorded in any study. It is unclear whether TNPWT reduces time to wound healing compared with conventional open wound healing (comparison 1), as the certainty of evidence is very low. The two studies provided conflicting results, with one study showing benefit (mean difference (MD) -24.01 days, 95% confidence interval (CI) -35.65 to -12.37; 19 participants), whilst the other reported no difference. It is also unclear whether TNPWT has any effect on the proportion of wounds healed by 30 days (risk ratio (RR) 3.60, 95% CI 0.49 to 26.54; 19 participants, 1 study; very low-certainty evidence). Limited data were available for our secondary outcomes time to return to normal daily activities and recurrence rate; we do not know whether TNPWT has any effect on these outcomes. Lietofix cream may increase the proportion of wounds that heal by 30 days compared with an iodine dressing (comparison 4; RR 8.06, 95% CI 1.05 to 61.68; 205 participants, 1 study; low-certainty evidence). The study did not provide data on time to wound healing. We do not know whether hydrogel dressings reduce time to wound healing compared with wound cleaning with 10% povidone iodine (comparison 5; MD -24.54 days, 95% CI -47.72 to -1.36; 31 participants, 1 study; very low-certainty evidence). The study did not provide data on the proportion of wounds healed. It is unclear whether hydrogel dressings have any effect on adverse effects as the certainty of the evidence is very low. Platelet-rich plasma may reduce time to wound healing compared with sterile absorbent gauze (comparison 6; MD -19.63 days, 95% CI -34.69 to -4.57; 210 participants, 2 studies; low-certainty evidence). No studies provided data on the proportion of wounds healed. Platelet-rich plasma may reduce time to return to normal daily activities (MD -15.49, 95% CI -28.95 to -2.02; 210 participants, 2 studies; low-certainty evidence). Zinc oxide mesh may make little or no difference to time to wound healing compared with placebo (comparison 2; median 54 days in the zinc oxide mesh group versus 62 days in the placebo mesh group; low-certainty evidence). We do not know whether zinc oxide mesh has an effect on the proportion of wounds healed by 30 days as the certainty of the evidence is very low (RR 2.35, 95% CI 0.49 to 11.23). It is unclear whether gentamicin-impregnated collagen sponge reduces time to wound healing compared with no dressing (comparison 7; MD -1.40 days, 95% CI -5.05 to 2.25; 50 participants, 1 study; very low-certainty evidence). The study did not provide data on the proportion of wounds healed. Dialkylcarbamoyl chloride (DACC)-coated dressings may make little or no difference to time to wound healing compared with alginate dressings (comparison 8; median 69 (95% CI 62 to 72) days in the DACC group versus 71 (95% CI 69 to 85) days in the alginate group; 1 study, 246 participants; low-certainty evidence). One study compared a polyurethane foam hydrophilic dressing with an alginate dressing (comparison 3) whilst another study compared a hydrocolloid dressing with an iodine dressing (comparison 9). It is unclear whether either intervention has any effect on time to wound healing as the certainty of evidence is very low. AUTHORS' CONCLUSIONS: At present, 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. There is low-certainty evidence on the benefit on wound healing of platelet-rich plasma from two studies and of Lietofix cream and hydrogel dressings from single studies. Further studies are required to investigate these interventions further.", "provenance": [ { "field": "n", "quote": "We included 11 RCTs comprising 932 participants." }, { "field": "population", "quote": "participants who had undergone any type of sacrococcygeal pilonidal sinus disease surgery and were left with an open wound" }, { "field": "intervention", "quote": "dressings and topical agents for the management of open wounds following surgical treatment for sacrococcygeal pilonidal sinus" }, { "field": "comparator", "quote": "the other seven studies compared various dressings and topical agents" }, { "field": "primaryOutcome", "quote": "It is unclear whether TNPWT reduces time to wound healing compared with conventional open wound healing" }, { "field": "result", "quote": "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" } ] }, { "id": "pmid:35546704", "pmid": "35546704", "doi": "10.29271/jcpsp.2022.05.652", "nctId": null, "pmcid": null, "title": "Comparing Crystallized Phenol and Surgical Excision Treatments in Pilonidal Sinus Disease", "firstAuthor": "Gozukucuk", "multipleAuthors": true, "journal": "J Coll Physicians Surg Pak", "year": 2022, "design": "retrospective", "n": 319, "nField": "reported", "population": "Children and teens (average age 15.5) with pilonidal sinus disease", "intervention": "Crystallized phenol application", "comparator": "Surgical excision (Karydakis flap method)", "primaryOutcome": "Treatment success, complications, hospital stay and recurrence", "result": "Phenol group returned to school much faster than surgery group, with similar success and recurrence rates", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a non-randomized comparison of two treatments with uneven group sizes, not a study of how long cysts last on their own.", "directness": "indirect", "limitations": "Abstract does not report randomization, blinding, or how patients were allocated to each treatment", "followUp": "", "plainFinding": "Faster recovery with phenol than surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35546704/", "sourceText": "OBJECTIVE: To compare the results of commonly used treatments (Karydakis Flap method and crystallized phenol application) in the treatment of pilonidal sinus. STUDY DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Adana Seyhan State Hospital, Adana City Hospital, and Hisar Intercontinental Hospital Pediatric Surgery Clinic, from January 2016 to December 2020. METHODOLOGY: Patients who were treated for pilonidal Sinus and treated with surgical repair (karydakis flap method) and crystallized phenol method were included in the study. The efficacy and complications of both treatments were compared. RESULTS: Of the patients, 111 (34.7%) were treated with surgical repair, and 208 (65.3%) with the crystallized phenol method. Of the patients included in the study, 166 (52%) were male and 153 (48%) were female. The mean age was calculated as 15.5 (± 1.4). The mean hospital stay in the surgery group was 1.6 ± 0.4 days. 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. Despite the third session of phenol application, recovery could not be achieved in 12 (5.7%) patients. Among those who had surgery, recurrence occurred in 7 (6.3%) patients and they had to be operated once more. CONCLUSION: Crystallized Phenol application can be applied in uncomplicated cases due to high success, low complication, rapid recovery, early return to daily activities. KEY WORDS: Crystallized phenol, Surgical treatment, Pilonidal sinus disease.", "provenance": [ { "field": "n", "quote": "111 (34.7%) were treated with surgical repair, and 208 (65.3%) with the crystallized phenol method" }, { "field": "population", "quote": "The mean age was calculated as 15.5 (± 1.4)" }, { "field": "intervention", "quote": "crystallized phenol method" }, { "field": "comparator", "quote": "surgical repair (karydakis flap method)" }, { "field": "primaryOutcome", "quote": "The efficacy and complications of both treatments were compared." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:35446708", "pmid": "35446708", "doi": "10.1308/rcsann.2022.0005", "nctId": null, "pmcid": "PMC9889171", "title": "Pilonidal sinus laser-assisted closure (PiLAC) - a low-morbidity alternative to excision with excellent long-term outcomes", "firstAuthor": "Johnson", "multipleAuthors": true, "journal": "Ann R Coll Surg Engl", "year": 2023, "design": "case-series", "n": 35, "nField": "reported", "population": "adults with primary or recurrent pilonidal sinus disease treated as day-case surgery", "intervention": "laser-assisted closure of the pilonidal sinus (PiLAC)", "comparator": "none (single group, no comparison treatment)", "primaryOutcome": "complete healing or recurrence of the pilonidal sinus after treatment", "result": "89.3% of patients with long-term follow-up had healed with no recurrence", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "mean 407 days (range 67-887 days)", "plainFinding": "High healing rate after laser treatment", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35446708/", "sourceText": "INTRODUCTION: Recurrence after surgery for pilonidal sinus disease is a recognised problem and patients often re-present months after discharge. We routinely treat primary and recurrent pilonidal sinus disease with Pilonidal sinus Laser-Assisted Closure (PiLAC). Long-term outcomes following PiLAC surgery was examined following clinical and telephone review. METHODS: All patients undergoing PiLAC as a day-case between April 2016 and July 2019 were included. Patients were followed up in a nurse-led clinic until complete healing or recurrence. A prospective database and retrospective audit of notes combined with longer-term follow-up by telephone were used. RESULTS: A total of 35 patients underwent PiLAC, median age 28 (18-53 years), 28 males:7 females. A total of 28 patients had long-term (>60 days) follow-up, mean 407 days (range 67-887 days); 25/28 patients (89.3%) had healed with no recurrence on long-term follow-up. Of these 28 patients, 11 were first presentation of pilonidal disease and underwent PiLAC as their first treatment, with a 91% heal rate long term. A total of 15 patients had seton drainage prior to PiLAC, with a 93% heal rate versus no seton (83%). Fisher's exact test showed no significant difference between sex, new/recurrent pilonidal disease and seton placement (p>0.05). CONCLUSIONS: Healing after PiLAC for the treatment of primary and recurrent pilonidal sinus disease is preserved with excellent long-term outcomes. We recommend it as an alternative to surgical excision.", "provenance": [ { "field": "n", "quote": "A total of 35 patients underwent PiLAC" }, { "field": "population", "quote": "All patients undergoing PiLAC as a day-case between April 2016 and July 2019 were included." }, { "field": "intervention", "quote": "Pilonidal sinus Laser-Assisted Closure (PiLAC)" }, { "field": "comparator", "quote": "We recommend it as an alternative to surgical excision." }, { "field": "primaryOutcome", "quote": "Patients were followed up in a nurse-led clinic until complete healing or recurrence." }, { "field": "result", "quote": "25/28 patients (89.3%) had healed with no recurrence on long-term follow-up." }, { "field": "followUp", "quote": "mean 407 days (range 67-887 days)" } ] }, { "id": "pmid:35347830", "pmid": "35347830", "doi": "10.1111/ans.17666", "nctId": null, "pmcid": null, "title": "Long-term efficacy of endoscopic pilonidal sinus treatment: a single-centre Australian experience", "firstAuthor": "Hinksman", "multipleAuthors": true, "journal": "ANZ J Surg", "year": 2022, "design": "retrospective", "n": 137, "nField": "reported", "population": "patients with pilonidal sinus disease, some who had prior surgery", "intervention": "endoscopic pilonidal sinus treatment (EPSiT), a minimally invasive procedure using a video fistuloscope", "comparator": "", "primaryOutcome": "whether the sinus healed and how long healing took", "result": "72.2% of patients healed completely without further treatment, at a median of 6 weeks; some had recurrence or failed to heal", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "56.2 months", "plainFinding": "Healed in about 6 weeks with treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35347830/", "sourceText": "BACKGROUND: Endoscopic pilonidal sinus treatment (EPSiT) is a novel minimally invasive technique for treating pilonidal sinus disease (PSD) involving endoscopic assessment and treatment. This retrospective, non-randomized, observational study is the first Australian study of EPSiT and its largest long-term study to date. METHODS: From January 2014 to November 2019, 137 patients with PSD underwent EPSiT. Seventy-two had undergone previous surgery for PSD. Specialized Karl Storz video equipment (fistuloscope) was used. The rigid fistuloscope allowed direct visualization of cavities and secondary tracts. Cavities and tracts were then curetted endoscopically to remove all granulation tissues and hair/follicles. Ablation was then carried out under direct vision along with removal of debris. Patients were then followed up for a mean 56.2 months. RESULTS: 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. Of the recurrence/non-healing groups, 20/35 underwent repeat EPSiT with healing occurring in 18/20 patients at a median of 7 weeks. The balance of patients (n = 15) underwent other definitive procedures. The mean operating time was 34 min. There were no major complications and 85% of patients were discharged the same day. Eleven patients were lost to follow-up. CONCLUSION: EPSiT combines high efficacy of treatment for PSD along with relatively low rates of recurrence. The minimally invasive nature of the procedure means repeat procedures can be performed (where necessary) with low morbidity and a reasonable rate of success.", "provenance": [ { "field": "n", "quote": "137 patients with PSD underwent EPSiT" }, { "field": "population", "quote": "137 patients with PSD underwent EPSiT. Seventy-two had undergone previous surgery for PSD." }, { "field": "intervention", "quote": "Endoscopic pilonidal sinus treatment (EPSiT) is a novel minimally invasive technique for treating pilonidal sinus disease (PSD) involving endoscopic assessment and treatment." }, { "field": "primaryOutcome", "quote": "72.2% (n = 91) of patients undergoing EPSiT achieved primary healing (needing nil further intervention) at a median of 6 weeks" }, { "field": "result", "quote": "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." }, { "field": "followUp", "quote": "Patients were then followed up for a mean 56.2 months." } ] }, { "id": "pmid:35344244", "pmid": "35344244", "doi": "10.1111/codi.16126", "nctId": null, "pmcid": "PMC9541250", "title": "The impact of experience on recurrence rates after biopsy punch excision for pilonidal disease", "firstAuthor": "Basso", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2022, "design": "case-series", "n": 848, "nField": "reported", "population": "patients with pilonidal disease, mostly men, median age about 26 years", "intervention": "a surgical technique called biopsy punch excision (a mix of two established minimally invasive methods)", "comparator": "the same procedure performed by surgeons with increasing experience over three separate time periods (2011-12, 2013-14, 2015-16)", "primaryOutcome": "rate of cyst recurrence after surgery at 1, 2 and 5 years", "result": "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", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "12, 24 and 60 months", "plainFinding": "Recurrence risk grew over time after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35344244/", "sourceText": "AIM: We present the outcomes and the recurrences of 848 patients with pilonidal disease (PD) treated by biopsy punch excision (BPE) and we weigh our results against progressively obtained operative experience. BPE is a modified 'merged' version of both the Bascom 'pit picking' procedure and the Gips procedure. It employs biopsy punches of different calibre, depending on whether treatment is in the natal cleft (calibre as small as possible) or lateral (larger calibre punches or even small incision). Sometimes this procedure is referred to as the Bascom-Gips procedure. METHODS: In all, 848 consecutive patients with PD were treated from January 2011 until December 2016 (sex 622 [73.4%] men and 226 [26.6%] women; median age 26.2 years, mean age 24.6 ± 28.99 [range 14-55] years, men 25.1 years, women 24.8 years). Of these 848 patients, 287 were operated in 2011-2012, 301 in 2013-2014 and 260 in 2015-2016. The recurrence rates were recorded 12, 24 and 60 months after surgery both cumulatively and by examining the outcomes of the three biennia individually (years of treatment 2011-2012 or group A, 2013-2014 or group B, 2015-2016 or group C). RESULTS: The mean operating time was 34 ± 24.45 min. Postoperative complications included early (<24 h; n = 22 or 2.6%) and delayed (>24 h; n = 26 or 3.1%) postoperative bleeding. Postoperative fluid collections (<2 weeks) occurred in 83/848 patients (9.8%) and included haematoma (n = 25) and seroma (n = 58). Full recovery was obtained after a mean of 21 ± 12.72 days and work/school/university activities were resumed after a mean of 4 ± 12.02 days. Twelve-, 24- and 60-month follow-ups were possible in 725 (85.5%), 682 (80.4%) and 595 (70.2%) patients out of 848. An overall significant (ꭓ2 = 16.87, P = 0.0002) difference was found in the recurrence rates: 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. However, when subgrouping patients in three 24-month subsets, the recurrence rates showed a steady and progressive decrease in the three biennia 2011-2012 (group A), 2013-2014 (group B) and 2015-2016 (group C) at 12-, 48- and 60-month follow-ups. Recurrences after 12 months were 29/225 (12.9%), 19/285 (6.7%) and 11/215 (5.1%) (ꭓ2 = 8.53, P = 0.014) in groups A, B and C respectively; after 24 months, 36/226 (15.9%), 31/242 (12.8%) and 22/214 (10.2%) (ꭓ2 = 2.38, P = 0.30 N.S.) in groups A, B and C respectively; after 60 months, 38/194 (19.5%), 36/215 (16.7%) and 24/186 (12.9%) (ꭓ2 = 2.23, P = 0.32) in groups A, B and C respectively. CONCLUSIONS: BPE is an effective, disease-targeted, minimally invasive and inexpensive way to treat PD. Its results are influenced by the experience of the team involved, especially regarding early recurrences/failure of surgery. At least 5-year follow-ups are needed to ascertain the outcome of surgery for PD.", "provenance": [ { "field": "n", "quote": "848 consecutive patients with PD were treated" }, { "field": "population", "quote": "sex 622 [73.4%] men and 226 [26.6%] women; median age 26.2 years" }, { "field": "intervention", "quote": "treated by biopsy punch excision (BPE)" }, { "field": "comparator", "quote": "the three biennia 2011-2012 (group A), 2013-2014 (group B) and 2015-2016 (group C)" }, { "field": "primaryOutcome", "quote": "The recurrence rates were recorded 12, 24 and 60 months after surgery" }, { "field": "result", "quote": "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" }, { "field": "result", "quote": "the recurrence rates showed a steady and progressive decrease in the three biennia" } ] }, { "id": "pmid:35187898", "pmid": "35187898", "doi": null, "nctId": null, "pmcid": null, "title": "Trephine Minimally Invasive Procedure for Pilonidal Sinus", "firstAuthor": "Zoarets", "multipleAuthors": true, "journal": "Isr Med Assoc J", "year": 2022, "design": "retrospective", "n": 113, "nField": "reported", "population": "patients with pilonidal sinus who had the trephine surgical procedure, median age 20", "intervention": "trephine minimally invasive surgical procedure for pilonidal sinus", "comparator": "none - single group, no comparison treatment", "primaryOutcome": "long-term recurrence of pilonidal sinus after surgery", "result": "45.1% of patients had the condition come back after a median follow-up of 29 months, and about a third needed another operation", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective single-center study without a comparison group, relying partly on phone interviews, so the findings are not very reliable.", "directness": "indirect", "limitations": "Retrospective design, no control group, follow-up data obtained partly by telephone interview, and only 113 of 169 original patients were followed up.", "followUp": "29 months", "plainFinding": "Nearly half recurred after surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35187898/", "sourceText": "BACKGROUND: Pilonidal sinus is a chronic, inflammatory condition. Controversy exists regarding the best surgical management for pilonidal sinus, including the extent of excision and type of closure of the surgical wound. OBJECTIVES: To assess the short- and long-term outcomes and success rate of the trephine procedure for the treatment of pilonidal sinus. METHODS: A retrospective observational cohort study was conducted at a single center. Patients who underwent trephine procedure between 2011 and 2015 were included. Data collection included medical records review and a telephone interview to establish long-term follow-up. RESULTS: A total of 169 patients underwent the trephine technique for the repair of pilonidal sinus. Follow-up included 113 patients, median age 20 years. Initial postoperative period, 35.6% recalled no pain and 58.6% reported a mild to moderate pain. Postoperative complications included local infection (7.5%) and mild bleeding (15.1%). On early postoperative follow-up, 47.1% recalled no impairment in quality of life, and 25%, 21.2 %, and 6.7% had mild, moderate and sever disturbance respectively. The median time to return to work or school was 10 days. 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 Overweight, smoking, and family history were associated with higher recurrence rate. CONCLUSIONS: The trephines technique has a significant long-term recurrence rate. Short-term advantages include low morbidity, enhanced recovery, and minimal to mild postoperative impairment to quality of life. The trephine procedure may be justified as a first treatment of pilonidal disease.", "provenance": [ { "field": "n", "quote": "Follow-up included 113 patients, median age 20 years." }, { "field": "population", "quote": "Patients who underwent trephine procedure between 2011 and 2015 were included." }, { "field": "intervention", "quote": "To assess the short- and long-term outcomes and success rate of the trephine procedure for the treatment of pilonidal sinus." }, { "field": "comparator", "quote": "A total of 169 patients underwent the trephine technique for the repair of pilonidal sinus." }, { "field": "primaryOutcome", "quote": "recurrence rate was 45.1% (51/113), and 38 (33.9%) of the patients underwent another surgical procedure" }, { "field": "result", "quote": "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" }, { "field": "followUp", "quote": "median follow-up of 29 months (IQR 19-40)" } ] }, { "id": "pmid:35187897", "pmid": "35187897", "doi": null, "nctId": null, "pmcid": null, "title": "Minimal Pilonidal Surgery vs. Common Wide Excision Operations: Better Well-Being and Comparable Recurrence Rates", "firstAuthor": "Gips", "multipleAuthors": true, "journal": "Isr Med Assoc J", "year": 2022, "design": "retrospective", "n": 1260, "nField": "reported", "population": "patients with primary pilonidal disease who had surgery", "intervention": "minimal trephine (minimally invasive) surgery", "comparator": "wide excision surgery (primary closure or lay-open)", "primaryOutcome": "rate of pilonidal disease recurrence", "result": "no significant difference in recurrence rates between minimal and wide excision surgeries, though minimal surgery caused less pain", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "It is a retrospective study where each surgeon only performed one type of surgery, so patient selection wasn't random and could bias results.", "directness": "indirect", "limitations": "Retrospective design; each of 53 surgeons performed only one surgery type regardless of patient characteristics or disease severity, which could confound comparisons.", "followUp": "7.2 years", "plainFinding": "Similar recurrence, less pain with minimal surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35187897/", "sourceText": "BACKGROUND: Pilonidal disease in the natal cleft is treated traditionally by a wide and deep excision of the affected area. There is growing awareness, however, to the advantages of minimally invasive surgeries. OBJECTIVES: To compare the efficacy of wide excision operations and minimal trephine surgery in patients with primary pilonidal disease. METHODS: In this retrospective study we examined surgical and inpatient records of 2039 patients who underwent surgery for primary pilonidal disease in five private hospitals between 2009 and 2012. Most procedures were of lay-open, primary midline closure, and minimal surgery types. Pilonidal recurrence rates were evaluated in a subset of 1260 patients operated by 53 surgeons each performing one type of surgery, regardless of patient characteristics or disease severity. RESULTS: With a mean follow-up of 7.2 years, 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. Minimal surgeries were usually performed under local anesthesia and involved lower pain levels, less need for analgesics, and shorter hospital stays than wide excision operations, which were normally performed under general anesthesia. The use of drainage, antibiotics, or methylene blue had no effect on recurrence of pilonidal disease. CONCLUSIONS: Minimally invasive surgeries have the advantage of reducing the extent of surgical injury and preserving patient's quality of life. They should be the treatment of choice for primary pilonidal disease.", "provenance": [ { "field": "n", "quote": "Pilonidal recurrence rates were evaluated in a subset of 1260 patients operated by 53 surgeons" }, { "field": "population", "quote": "patients with primary pilonidal disease" }, { "field": "intervention", "quote": "minimal trephine surgery" }, { "field": "comparator", "quote": "wide excision operations" }, { "field": "primaryOutcome", "quote": "Pilonidal recurrence rates were evaluated" }, { "field": "result", "quote": "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" }, { "field": "followUp", "quote": "With a mean follow-up of 7.2 years" } ] }, { "id": "pmid:35043571", "pmid": "35043571", "doi": "10.1111/iwj.13752", "nctId": null, "pmcid": "PMC9493221", "title": "The role of alginate dressings in wound healing and quality of life after pilonidal sinus resection: A randomised controlled trial", "firstAuthor": "Mamaloudis", "multipleAuthors": true, "journal": "Int Wound J", "year": 2022, "design": "rct", "n": 65, "nField": "reported", "population": "patients who had surgery to remove a pilonidal cyst", "intervention": "alginate dressings with silver and high-G cellulose after cyst removal surgery", "comparator": "simple gauze dressings after cyst removal surgery", "primaryOutcome": "time for the wound to heal", "result": "no difference in healing time between dressing types", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "small trial with an admitted suboptimal sample size and other limitations, so results are not very reliable.", "directness": "indirect", "limitations": "Suboptimal sample size and several study limitations, as stated by the authors.", "followUp": "", "plainFinding": "No faster healing with alginate dressing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35043571/", "sourceText": "In this trial, we evaluated the role of alginate dressings in the secondary intention wound healing and quality of life (QoL) after pilonidal sinus resection. The study was designed as a prospective randomised controlled trial (RCT). In the experimental group, alginate dressings with silver and high-G cellulose were introduced after elective pilonidal cyst excision, whereas in the control group, simple gauges were used. The primary end point was the difference in terms of the wound healing period. Blinding existed at the level of the investigator. Overall, 65 patients were included during the study period. Wound healing duration was comparable between the two groups (P = .381). No difference in postoperative pain scores or recovery outcomes was found. The experimental group was associated with reduced wound secretions at specific time end points. Similarly, no effect was identified, on overall Wound-QoL or SF-36 scores. Alginate dressings do not accelerate wound healing or improve QoL. Due to suboptimal sample size and several study limitations, further RCTs are required to confirm our findings.", "provenance": [ { "field": "n", "quote": "Overall, 65 patients were included during the study period." }, { "field": "population", "quote": "after elective pilonidal cyst excision" }, { "field": "intervention", "quote": "alginate dressings with silver and high-G cellulose were introduced after elective pilonidal cyst excision" }, { "field": "comparator", "quote": "in the control group, simple gauges were used" }, { "field": "primaryOutcome", "quote": "The primary end point was the difference in terms of the wound healing period." }, { "field": "result", "quote": "Wound healing duration was comparable between the two groups (P = .381)." } ] }, { "id": "pmid:34840296", "pmid": "34840296", "doi": "10.1097/DCR.0000000000002227", "nctId": null, "pmcid": null, "title": "Unroofing Curettage Versus Modified Limberg Flap in Pilonidal Disease: A Retrospective Cohort Study", "firstAuthor": "Sahin", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2022, "design": "retrospective", "n": 278, "nField": "reported", "population": "patients having surgery for pilonidal disease", "intervention": "unroofing curettage surgery", "comparator": "modified Limberg flap surgery", "primaryOutcome": "recurrence rate", "result": "recurrence was lower with unroofing curettage but not statistically significant; healing took longer with unroofing curettage (35.3 vs 23.2 days)", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized comparison of two surgeries, which cannot reliably show cause and effect.", "directness": "indirect", "limitations": "The retrospective study design was a limitation of this study.", "followUp": "60-month median follow-up period", "plainFinding": "Healing took about 35 days.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34840296/", "sourceText": "BACKGROUND: Sacrococcygeal pilonidal disease (estimated incidence, 25/100,000) is a chronic inflammatory condition that commonly affects young adults. However, the ideal surgical treatment for this disease remains undetermined. OBJECTIVE: This study aimed to compare the results of the unroofing curettage and those of the modified Limberg flap surgical technique. DESIGN: This is a retrospective cohort study. SETTINGS: Procedures were performed by 2 surgeons between January 2013 and January 2017. PATIENTS: The data of 278 patients who underwent surgery for the treatment of pilonidal disease were analyzed. INTERVENTIONS: Unroofing curettage was performed under local or spinal anesthesia, whereas spinal anesthesia was used for the modified Limberg flap procedure. MAIN OUTCOME MEASURES: The primary outcome was recurrence rate. Secondary outcomes included adverse events, limitation of daily activities, and healing time. RESULTS: Between the 2 groups (unroofing curettage, n = 135; modified Limberg flap, n = 143), 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). The duration of surgery and length of hospital stay were shorter in the unroofing curettage group (11.44 ± 3.56 minutes vs 52.47 ± 7.92 minutes and 0.27 ± 0.45 days vs 1.07 ± 0.26 days, p < 0.001). Postoperative complications were significantly higher in the modified Limberg flap group (9.8% vs 2.2%, p = 0.009). The time required to return to work or school was shorter in the unroofing curettage group (8.6 ± 7.8 days vs 25.01 ± 6.3 days, p < 0.001). 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). LIMITATIONS: The retrospective study design was a limitation of this study. CONCLUSIONS: Unroofing curettage provided more clinical benefits than the modified Limberg flap approach. Unroofing curettage should be considered as the first choice of surgical treatment for pilonidal disease. See Video Abstract at http://links.lww.com/DCR/B824 . DESTECHAMIENTO Y CURETAJE VERSUS COLGAJO DE LIMBERG MODIFICADO EN LA ENFERMEDAD PILONIDAL UN ESTUDIO DE COHORTE RETROSPECTIVE: ANTECEDENTES:La enfermedad pilonidal sacrococcígea (incidencia estimada, 25 / 100.000) es una enfermedad inflamatoria crónica que comúnmente afecta a adultos jóvenes. Sin embargo, el tratamiento quirúrgico ideal para esta enfermedad permanece indeterminado.OBJETIVO:Comparar los resultados del destechamiento y curetaje y los de la técnica quirúrgica con colgajo de Limberg modificado.DISEÑO:Estudio de cohorte retrospectivo.ENTORNO CLINICO:Los procedimientos fueron realizados por dos cirujanos, entre enero del 2013 y enero del 2017.PACIENTES:Se analizaron datos de 278 pacientes intervenidos quirúrgicamente para el tratamiento de la enfermedad pilonidal.INTERVENCIONES:Se realizó destechamiento y curetaje con anestesia local o raquídea, mientras que para el procedimiento de colgajo de Limberg modificado se utilizó anestesia raquídea.PRINCIPALES MEDIDAS DE RESULTADO:El resultado principal fue la tasa de recurrencia. Los resultados secundarios incluyeron eventos adversos, limitación de las actividades diarias y tiempo de curación.RESULTADOS:Entre los dos grupos (destechamiento y curetaje, n = 135; colgajo de Limberg modificado, n = 143), la recurrencia fue menor en el grupo con destechamiento y curetaje después de un período de seguimiento medio de 60 meses, pero la diferencia no fue estadísticamente significativa (1,5% vs 4,2%, p = 0,45). La duración de la cirugía y la estancia hospitalaria fueron más cortas en el grupo de destechamiento y curetaje (11,44 ± 3,56 min vs a 52,47 ± 7,92 min y 0,27 ± 0,45 días vs 1,07 ± 0,26 días, p < 0,001). Las complicaciones posoperatorias fueron significativamente mayores en el grupo de colgajo de Limberg modificado (9,8% vs 2,2%, p = 0,009). El tiempo necesario para regresar al trabajo o la escuela fue menor en el grupo de destechamiento y curetaje (8,6 ± 7,8 días vs 25,01 ± 6,3 días, p < 0,001). El tiempo de cicatrización completo fue mayor en el grupo de destechamiento y curetaje (35,3 ± 9,2 días vs 23,2 ± 5,4 días, p < 0,001).LIMITACIONES:El diseño del estudio retrospectivo.CONCLUSIONES:El destechamiento y curetaje proporcionó más beneficios clínicos que el abordaje con colgajo de Limberg modificado. El destechamiento y curetaje debe considerarse como la primera opción de tratamiento quirúrgico para la enfermedad pilonidal. Consulte Video Resumen en http://links.lww.com/DCR/B824 . (Traducción- Dr. Francisco M. Abarca-Rendon ).", "provenance": [ { "field": "n", "quote": "unroofing curettage, n = 135; modified Limberg flap, n = 143" }, { "field": "population", "quote": "The data of 278 patients who underwent surgery for the treatment of pilonidal disease were analyzed." }, { "field": "intervention", "quote": "Unroofing curettage was performed under local or spinal anesthesia" }, { "field": "comparator", "quote": "spinal anesthesia was used for the modified Limberg flap procedure" }, { "field": "primaryOutcome", "quote": "The primary outcome was recurrence rate." }, { "field": "result", "quote": "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)" }, { "field": "result", "quote": "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)." }, { "field": "followUp", "quote": "60-month median follow-up period" }, { "field": "limitations", "quote": "The retrospective study design was a limitation of this study." } ] }, { "id": "pmid:34689133", "pmid": "34689133", "doi": "10.1556/650.2021.32246", "nctId": null, "pmcid": null, "title": "[Fistuloscopy in the management of pediatric pilonidal sinus disease]", "firstAuthor": "Fadgyas", "multipleAuthors": true, "journal": "Orv Hetil", "year": 2021, "design": "case-series", "n": 28, "nField": "reported", "population": "children and teenagers with pilonidal sinus disease", "intervention": "PEPSiT (pediatric endoscopic pilonidal sinus treatment)", "comparator": "none; single group before-after study", "primaryOutcome": "wound healing time, recurrence, return to daily activity", "result": "average healing time was 5.9 weeks, with 6 recurrences out of 31 operations and return to activity in 1.37 days", "resultDirection": "mixed", "quality": "low", "qualityWhy": "small single-group study without a comparison group, so it can't show if this is better than other treatments.", "directness": "indirect", "limitations": "No control group, small number of patients, only pediatric patients who had this specific surgical technique.", "followUp": "", "plainFinding": "Healed in about 6 weeks.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34689133/", "sourceText": "UNLABELLED: Összefoglaló. Bevezetés: A sinus pilonidalis nehezen kezelhető, sok szövődménnyel és recidívával járó betegség. A legtöbb műtéti eljárás többnapos kórházi kezelést, munkából vagy iskolából való hiányzást követel. Célkitűzés: Munkánk célja, hogy a PEPSiT- (pediatric endoscopic pilonidal sinus treatment) műtétek eredményességét vizsgálja. Módszer: Intézetünkben 2019-2020-ban PEPSiT-műtéten átesett, 18 év alatti betegeket válogattunk be a vizsgálatba. Kizártuk a cisztoszkóppal operált és kontrollra nem jelentkező betegeket. A szövődmények, recidívák számát, a kórházi tartózkodás hosszát, a sebgyógyulás és a hétköznapi aktivitáshoz való visszatérés idejét vizsgáltuk. Eredmények: Betegeink többsége fiú (24 fiú, 4 lány), átlagéletkoruk 15,6 év volt. 28 betegen 31 PEPSiT-beavatkozást végeztünk (3 re-PEPSiT), 6 recidíva, 1 sebgennyedés alakult ki. A betegek egy része egynapos ellátás keretében, míg a többség egy éjszaka bentfekvés után tért haza (1,74 nap ápolási idő). A hétköznapi aktivitáshoz 1,37 nap után tértek vissza, a gyógyulási idő 5,9 hét volt átlagosan. Megbeszélés: A PEPSiT-beavatkozás minimálisan invazív lehetőség, igen rövid kórházi tartózkodással. A betegek hamar térnek vissza a szokott aktivitásukhoz, a korábbi sipolyon kívül újabb műtéti seb nem alakul ki. A recidívaarány hasonló az egyéb technikákéhoz. Következtetés: A PEPSiT-beavatkozás jól alkalmazható, a recidívaarány csökkentése fontos. Orv Hetil. 2021; 162(43): 1740-1743. INTRODUCTION: The treatment of pilonidal disease is often challenging, due to frequent recurrences and adverse events. Most operative treatments require a lengthy hospital stay, and absence from school or work. OBJECTIVE: We aimed towards assessing the effectivity of PEPSiT (pediatric endoscopic pilonidal sinus treatment). METHOD: In this study, we included patients subjected to PEPSiT from 2019 to 2020 between ages 0-18 years. Patients operated via cystoscope and patients who did not attend follow-up examinations were excluded. Adverse events, recurrences, length of hospital stay, wound healing time and return to everyday activity were assessed. RESULTS: The majority of our patients were male (24 male, 4 female), the mean age was 15.6 years. 31 PEPSiT operations were recorded on 28 patients (3 were redo surgeries). 6 recurrences and 1 wound suppuration were documented. Some patients were treated within the confines of one-day surgery, while most of them stayed one night (mean length of stay was 1.74 days). Return to everyday activity was an average 1.37 days, and mean wound healing time was 5.9 weeks. DISCUSSION: PEPSiT is a minimally invasive operative approach with a very short hospital stay. Patients return to everyday activity faster. New operative scarring does not happen apart from the preexisting fistula opening. Recurrence rate is similar to that of other treatment techniques. CONCLUSION: PEPSiT technique is applicable, however, reduction of the recurrence rate is important. Orv Hetil. 2021; 162(43): 1740-1743.", "provenance": [ { "field": "population", "quote": "patients subjected to PEPSiT from 2019 to 2020 between ages 0-18 years" }, { "field": "intervention", "quote": "PEPSiT (pediatric endoscopic pilonidal sinus treatment)" }, { "field": "comparator", "quote": "Recurrence rate is similar to that of other treatment techniques." }, { "field": "primaryOutcome", "quote": "Adverse events, recurrences, length of hospital stay, wound healing time and return to everyday activity were assessed." }, { "field": "result", "quote": "mean wound healing time was 5.9 weeks" }, { "field": "result", "quote": "6 recurrences and 1 wound suppuration were documented" }, { "field": "result", "quote": "Return to everyday activity was an average 1.37 days" }, { "field": "n", "quote": "31 PEPSiT operations were recorded on 28 patients" } ] }, { "id": "pmid:34670534", "pmid": "34670534", "doi": "10.1186/s12893-021-01370-5", "nctId": null, "pmcid": "PMC8529773", "title": "Platelet-rich plasma treatment improves postoperative recovery in patients with pilonidal sinus disease: a randomized controlled clinical trial", "firstAuthor": "Boztug", "multipleAuthors": true, "journal": "BMC Surg", "year": 2021, "design": "rct", "n": null, "nField": "not-reported", "population": "adults over 18 with chronic pilonidal sinus disease", "intervention": "platelet-rich plasma (PRP) applied after surgery", "comparator": "open surgery with moist dressings (no PRP)", "primaryOutcome": "pain reduction, return to daily activities, quality of life, and wound healing time after surgery", "result": "PRP groups had lower pain scores, faster return to daily activities, and improved quality of life compared with the non-PRP group", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it is a randomized trial but does not report participant numbers or other key details needed to judge its reliability.", "directness": "indirect", "limitations": "The abstract does not report sample size, blinding, or long-term recurrence outcomes.", "followUp": "", "plainFinding": "PRP sped healing and recovery after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34670534/", "sourceText": "BACKGROUND: Pilonidal sinus is a common health problem. The current study aimed to 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. METHODS: Patients who were over 18 years old and had chronic PS disease between March 2018 and January 2019 were enrolled and randomly divided into three groups. Open surgery and moist dressings were applied to patients in group A. Open surgery followed by PRP application was performed on patients in group B. Group C underwent curettage of the sinus cavity followed by application of PRP. In this prospective randomized controlled study, patients completed questionnaires (including the Nottingham Health Profile (NHP), Short Form-36 (SF-36) and clinical information) before and after surgery. Demographics, preoperative characteristics, healing parameters, and quality-of-life scores were evaluated and calculated before and after surgery. RESULTS AND CONCLUSION: The cavity volume and wound-healing time were compared among the groups on postoperative days 0, 2, 3, 4, and 21. Each patient was followed up throughout the process of wound healing, and follow-up was continued afterward to monitor the patients for recurrence. Due to the nature of the treatment that group C received, this group achieved shorter healing times and smaller cavity volume than the other groups. In contrast, the recovery time per unit of cavity volume was significantly faster in group B than in the other groups. 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) and showed different time courses among the groups. In the treatment of PS disease, PRP application improves postoperative recovery in that it speeds patients' return to daily activities, reduces their pain scores and increases their quality of life. Trial registration The current study is registered on the public website ClinicalTrials.gov (ClinicalTrials.gov identifier number: NCT04697082; date: 05/01/2021).", "provenance": [ { "field": "population", "quote": "Patients who were over 18 years old and had chronic PS disease between March 2018 and January 2019 were enrolled" }, { "field": "intervention", "quote": "Open surgery followed by PRP application was performed on patients in group B." }, { "field": "comparator", "quote": "Open surgery and moist dressings were applied to patients in group A." }, { "field": "primaryOutcome", "quote": "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" }, { "field": "result", "quote": "PRP application improves postoperative recovery in that it speeds patients' return to daily activities, reduces their pain scores and increases their quality of life." }, { "field": "result", "quote": "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)" } ] }, { "id": "pmid:34629430", "pmid": "34629430", "doi": "10.1097/DCR.0000000000002082", "nctId": null, "pmcid": null, "title": "Comparison of Curettage Plus Platelet-Rich Plasma Gel and Curettage Plus Phenol Application in Treatment of Pilonidal Sinus Disease: A Randomized Trial", "firstAuthor": "Sevinç", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2022, "design": "rct", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease", "intervention": "curettage plus platelet-rich plasma gel", "comparator": "curettage plus phenol application", "primaryOutcome": "time to achieve healing", "result": "median healing time was 6 days with platelet-rich plasma versus 10 days with phenol, and recurrence was 4% versus 12%", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it was a randomized trial but neither patients nor investigators were blinded and the total number of patients is not stated.", "directness": "indirect", "limitations": "neither the patients nor the investigators were blinded", "followUp": "43.1 months", "plainFinding": "Faster healing with platelet-rich plasma treatment", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34629430/", "sourceText": "BACKGROUND: As a chronic condition, pilonidal disease affects a young population, and recovery after the surgical procedures performed to treat this condition require time off from work. Therefore, the search for an ideal treatment is still ongoing. OBJECTIVE: The aim of this study was to compare early and late results of 2 minimally invasive treatment options used to treat pilonidal disease. DESIGN: This study was designed as a parallel group randomized clinical trial. SETTINGS: This study took place at an outpatient clinic in Turkey. PATIENTS: Patients with pilonidal disease were evaluated for the study and were enrolled if they met the inclusion criteria and gave informed consent. INTERVENTIONS: Patients in the platelet-rich plasma group were treated using curettage + platelet-rich plasma gel. Patients in the phenol group were treated by using curettage + crystallized phenol. MAIN OUTCOME MEASURES: The primary study end point was the time to achieve healing; the secondary outcome was recurrence rate. RESULTS: In the platelet-rich plasma group, 96% of patients achieved healing after 1 application. In the phenol group, only 53% patients achieved healing after 1 application. The median healing time was shorter in the platelet-rich plasma group: 6 (4-14) vs 10 (5-42) days (p < 0.001). The mean difference in healing was 5.8 days (95% CI, 4.27-7.38). After a mean follow-up of 43.1 months, there was a 4% recurrence rate in the platelet-rich plasma group in comparison with a 12% recurrence rate in the phenol group (95% CI, 0.024-0.251). LIMITATIONS: Despite the randomized prospective nature of the study, neither the patients nor the investigators were blinded. CONCLUSIONS: The curettage + platelet-rich plasma method can be safely applied with an improved healing time, low recurrence rate, and minimal time off work. See Video Abstract at http://links.lww.com/DCR/B722.Clinical Trial Registration: NCT03070028. COMPARACIN DE CURETAJE MS GEL DE PLASMA RICO EN PLAQUETAS Y LA APLICACIN DE CURETAJE MS FENOL EN EL TRATAMIENTO DE LA ENFERMEDAD DEL SENO PILONIDAL ENSAYO ALEATORIZADO: ANTECEDENTES:Como condición crónica, la enfermedad pilonidal afecta a una población joven y los procedimientos quirúrgicos que se realizan para tratar esta condición requieren un tiempo de recuperación con baja laboral. Por lo tanto, la búsqueda del tratamiento ideal aún está en curso.OBJETIVO:El objetivo de este estudio es comparar los resultados tempranos y tardíos de dos opciones de tratamiento mínimamente invasivos utilizados para tratar la enfermedad pilonidal.DISEÑO:Este estudio está diseñado como un ensayo clínico aleatorizado de dos grupos paralelos.ENTORNO CLÍNICO:El estudio consta de dos grupos: curetaje + plasma rico en plaquetas y curetaje + fenol.PACIENTES:Los pacientes con enfermedad pilonidal fueron evaluados para el estudio y se inscribieron si cumplían con los criterios de inclusión y dieron su consentimiento informado.INTERVENCIONES:Los pacientes del grupo de plasma rico en plaquetas fueron tratados con curetaje + gel de plasma rico en plaquetas. En el grupo de fenol, los pacientes fueron tratados con curetaje + fenol cristalizado.PRINCIPALES MEDIDAS DE RESULTADO: El principal criterio de valoración del estudio fue el tiempo para lograr la curación; el resultado secundario fue la tasa de recurrencia.RESULTADOS:En el grupo de plasma rico en plaquetas, el 96% de los casos logró la curación después de una aplicación. En el grupo de fenol, solo el 53% de los casos lograron la curación después de una aplicación. La mediana del tiempo de curación fue más corta en el grupo de plasma rico en plaquetas; 6 (4-14) vs 10 (5-42) días (p < 0,001). La diferencia media en la curación fue de 5,8 días (IC del 95%: 4,27-7,38). Después de un seguimiento medio de 43,1 meses, hubo una tasa de recurrencia del 4% en el grupo de plasma rico en plaquetas en comparación con una tasa de recurrencia del 12% en el grupo de fenol (IC del 95%: 0.024-0.251).LIMITACIONES:A pesar de la naturaleza prospectiva aleatorizada del estudio, ni los pacientes ni los investigadores fueron cegados.CONCLUSIONES:El método de legrado + plasma rico en plaquetas se puede aplicar de forma segura con un mejor tiempo de curación, una tasa de recurrencia baja y un tiempo de baja laboral mínimo. Consulte Video Resumen en http://links.lww.com/DCR/B722 (Traducción-Dr. Yazmin Berrones-Medina).Este ensayo se registró para ensayos clínicos con ID: NCT03070028. El protocolo completo se puede encontrar en https://clinicaltrials.gov/ct2/show/NCT03070028.", "provenance": [ { "field": "population", "quote": "Patients with pilonidal disease were evaluated for the study" }, { "field": "intervention", "quote": "Patients in the platelet-rich plasma group were treated using curettage + platelet-rich plasma gel." }, { "field": "comparator", "quote": "Patients in the phenol group were treated by using curettage + crystallized phenol." }, { "field": "primaryOutcome", "quote": "The primary study end point was the time to achieve healing" }, { "field": "result", "quote": "The median healing time was shorter in the platelet-rich plasma group: 6 (4-14) vs 10 (5-42) days (p < 0.001)." }, { "field": "result", "quote": "there was a 4% recurrence rate in the platelet-rich plasma group in comparison with a 12% recurrence rate in the phenol group" }, { "field": "followUp", "quote": "After a mean follow-up of 43.1 months" }, { "field": "limitations", "quote": "neither the patients nor the investigators were blinded" } ] }, { "id": "pmid:34602433", "pmid": "34602433", "doi": null, "nctId": null, "pmcid": null, "title": "Effect of propolis on wound healing in sacrococcygeal pilonidal disease: A randomized controlled clinical trial", "firstAuthor": "Kubat", "multipleAuthors": true, "journal": "Pak J Pharm Sci", "year": 2021, "design": "rct", "n": 33, "nField": "reported", "population": "patients with sacrococcygeal pilonidal disease treated with marsupialization surgery", "intervention": "propolis applied to the surgical wound", "comparator": "control group without propolis", "primaryOutcome": "time to complete wound healing after marsupialization", "result": "wound healing was faster and the complete recovery score was significantly lower in the propolis group", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Small trial of only 33 patients looking at post-surgical wound healing, not the natural course of an untreated cyst.", "directness": "indirect", "limitations": "Abstract does not report blinding, exact recovery times in days, or detail on randomization method.", "followUp": "", "plainFinding": "Propolis sped up surgical wound healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34602433/", "sourceText": "Wound healing and recurrence are the leading problems encountered in sacrococcygeal pilonidal sinus disease. Propolis has a place in both traditional and complementary medicine, and in vitro and in vivo studies have reported its anti-inflammatory, anti-oxidant, anti-bacterial, anti-fungal and immunostimulant properties. In the present study, we discuss the effect of propolis on wound healing in sacrococcygeal pilonidal diseases treated with marsupialization. Patients who were admitted to our clinic with sacrococcygeal pilonidal disease were analyzed prospectively, with a total of 33 patients divided into study and control groups. All patients underwent marsupialization surgery, and the wound areas were analyzed post-operatively, on the 0, 7th, 14th, 28th days and on the day of complete recovery. 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. Propolis can be used to accelerate wound healing when the marsupialization method is preferred in patients diagnosed with uncomplicated sacrococcygeal pilonidal cyst due to its low cost, good patient compliance, low side effect profile, lack of toxicity and high efficacy.", "provenance": [ { "field": "n", "quote": "a total of 33 patients divided into study and control groups" }, { "field": "population", "quote": "Patients who were admitted to our clinic with sacrococcygeal pilonidal disease" }, { "field": "intervention", "quote": "the effect of propolis on wound healing in sacrococcygeal pilonidal diseases treated with marsupialization" }, { "field": "comparator", "quote": "a total of 33 patients divided into study and control groups" }, { "field": "primaryOutcome", "quote": "the wound areas were analyzed post-operatively, on the 0, 7th, 14th, 28th days and on the day of complete recovery" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:34455675", "pmid": "34455675", "doi": "10.1111/codi.15890", "nctId": null, "pmcid": null, "title": "Negative pressure wound therapy following excision of pilonidal sinus disease: A retrospective review", "firstAuthor": "Hannan", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2021, "design": "retrospective", "n": 61, "nField": "reported", "population": "patients with pilonidal sinus disease", "intervention": "complete surgical excision followed by negative pressure wound therapy", "comparator": "none (single-group study, no comparison treatment)", "primaryOutcome": "cyst recurrence and whether the wound failed to heal", "result": "all wounds healed, with a median healing time of 28 days and only 1.6% recurrence", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Wounds healed in about a month.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34455675/", "sourceText": "AIM: There is no agreed definitive surgical treatment for pilonidal sinus disease (PSD) with several techniques in use with varying success. Negative pressure wound therapy (NPWT) is used to accelerate wound healing but literature in the context of PSD remains sparse. The aim of this study was to evaluate outcomes in patients with PSD treated by a standardised technique of complete surgical excision followed by the application of NPWT. METHODS: A retrospective observational cohort study of all patients with PSD managed by complete surgical excision followed by application of NPWT was performed over a five year period. The primary endpoints were PSD recurrence and failed wound healing. RESULTS: Sixty-one patients underwent treatment during the study period. There was 100% compliance with NPWT. 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. Two patients (3.3%) developed postoperative wound infections. Five patients, who had been managed previously by other operative approaches and subsequently developed recurrence, were successfully managed by this technique. Most patients (52.4%) were managed as a day case procedure. CONCLUSIONS: Surgery for PSD should have low recurrence rates, prompt wound healing, minimal complications, short inpatient lengths of stay and be tolerated by the patient. Our results demonstrate that our technique meets these criteria. To our knowledge, this study contains the largest number of patients with PSD managed by excision and NPWT in the literature.", "provenance": [ { "field": "n", "quote": "Sixty-one patients underwent treatment during the study period." }, { "field": "population", "quote": "patients with PSD managed by complete surgical excision followed by application of NPWT" }, { "field": "intervention", "quote": "complete surgical excision followed by the application of NPWT" }, { "field": "comparator", "quote": "A retrospective observational cohort study of all patients with PSD managed by complete surgical excision followed by application of NPWT was performed" }, { "field": "primaryOutcome", "quote": "The primary endpoints were PSD recurrence and failed wound healing." }, { "field": "result", "quote": "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." } ] } ], "faqs": [ { "q": "How long does a pilonidal cyst last?", "a": "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." }, { "q": "How long does a pilonidal cyst flare-up last?", "a": "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." }, { "q": "How long does pilonidal cyst pain last?", "a": "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." }, { "q": "Should I just wait it out instead of seeing a doctor?", "a": "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." }, { "q": "Does a pilonidal cyst go away without surgery?", "a": "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." } ], "searchedAs": [ "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" ], "patientTakeaway": "There's no solid research telling you exactly how many days a pilonidal cyst or flare-up will last if you leave it alone — the available studies measure how fast treatments work, not the natural course. If you have ongoing pain, swelling, or drainage, especially for more than a few weeks, get it checked rather than waiting indefinitely: simple steps like good hygiene and hair removal help some people avoid surgery, but disease that lingers for years has been linked to a small increased risk of a rare skin cancer in the tissue.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "\"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])" }, "pubmedQueryTranslation": "\"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])", "searchedOn": "2026-10-13", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "How Long Does a Pilonidal Cyst Last?", "description": "134 studies on pilonidal cysts mostly measure treatment healing time — none tracked how long an untreated cyst or flare-up actually lasts." }, "lastChecked": "2026-10-13", "lastChanged": "2026-10-13", "nextCheckDue": "2026-11-13", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-13" }, "status": "published" }