{ "slug": "how-long-does-a-pilonidal-cyst-take-to-heal", "question": "How long does a pilonidal cyst take to heal?", "shortTitle": "Pilonidal Cyst Healing Time", "clinicalQuestion": "In patients who have had a pilonidal cyst/sinus drained, excised, or otherwise surgically treated, how long does the resulting wound take to heal and how long until return to normal activity?", "questionKind": "course", "pico": { "population": "People who have undergone treatment (incision and drainage, surgical excision, or open wound management) for a pilonidal cyst/sinus", "intervention": "Pilonidal cyst/sinus after treatment (drainage, excision, or open wound healing)", "comparator": "", "outcomes": [ "time to complete wound healing (days/weeks)", "time to return to work or normal activity", "wound healing time after incision and drainage versus after excision", "recurrence rate", "time to wound closure for open vs closed surgical techniques" ], "excludes": [ "Untreated pilonidal cyst natural course without any intervention", "Hidradenitis suppurativa", "Perianal or perirectal abscess unrelated to pilonidal disease" ] }, "category": "anorectal", "relatedConditions": [ "pilonidal-cyst" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "How long a pilonidal cyst wound takes to heal depends almost entirely on which treatment was used — small keyhole or laser procedures typically close in 2 to 4 weeks, while an open wound left to heal on its own after excision often takes 6 to 14 weeks or longer.", "detail": "Studies that tracked minimally invasive procedures (laser, endoscopic, pit-picking) report median healing of roughly 2 to 4 weeks. Studies of open excision left to heal by itself (secondary intention) report median or average healing of roughly 8 to 15 weeks, with some wounds still open at 3-4 months. Every one of these studies followed people who had already been treated — none followed someone with an untreated cyst to see how it behaves if left completely alone.", "studyIds": [ "pmid:41999968", "pmid:40498166", "pmid:39115207", "pmid:38226663", "pmid:37930579", "pmid:35593897", "pmid:33336345" ] }, "strength": { "level": "high", "why": "A good-quality systematic review of studies in patients answers this question directly.", "override": null }, "direction": { "level": "not-applicable", "why": "This question asks how a condition behaves over time, not whether a treatment works, so there is no benefit-or-harm verdict.", "override": null, "signOff": null, "withheld": null }, "counts": { "recordsRetrieved": 828, "recordsScreened": 200, "included": 175, "rcts": 16, "systematicReviews": 22, "observational": 110, "participants": 58224, "yearFrom": 2020, "yearTo": 2026, "registeredTrialsWithoutResults": 1, "direct": 40 }, "excluded": [], "outcomes": [ { "name": "Time to complete healing after minimally invasive treatment (laser, endoscopic/EPSiT/PEPSiT, pit-picking)", "status": "improvement", "note": "Consistently found across many studies to be faster than open surgery, with median or mean healing times clustering around 2 to 4 weeks (examples: 14 days, 15 days, 20 days, 23.4 days, 24.6 days, 4 weeks, 4.1 weeks).", "studyIds": [ "pmid:42128975", "pmid:41964736", "pmid:40498166", "pmid:39578271", "pmid:38849230", "pmid:38704463", "pmid:37145226", "pmid:34021885", "pmid:37494954" ] }, { "name": "Time to complete healing after open excision left to heal on its own (secondary intention)", "status": "improvement", "note": "Consistently found to be much longer than closed techniques — figures range from an average of about 8 weeks to as long as 98-108 days, with nearly all wounds closed by around 3 months but some taking longer.", "studyIds": [ "pmid:41999968", "pmid:39115207", "pmid:35593897", "pmid:33336345", "pmid:40498166", "pmid:34254748" ] }, { "name": "Time to complete healing after flap or stitched-closure surgery (Karydakis, Limberg, keystone, etc.)", "status": "improvement", "note": "Consistently faster than open healing, with reported times mostly between about 13 and 36 days depending on the specific flap technique.", "studyIds": [ "pmid:42700095", "pmid:42098544", "pmid:40956974", "pmid:39792517", "pmid:36802113", "pmid:35289848" ] }, { "name": "Time to return to work or normal daily activity", "status": "improvement", "note": "Consistently reported to be shorter after minimally invasive or flap procedures (often 1 to 21 days) than after open wound care (reported as taking 34+ days longer in one large cohort).", "studyIds": [ "pmid:41854814", "pmid:41074563", "pmid:39699772", "pmid:39140695", "pmid:37356014", "pmid:35344244", "pmid:35187898", "pmid:39045854" ] }, { "name": "Healing time after simple incision and drainage versus excision", "status": "insufficient", "note": "Only one small retrospective study compared these directly; it found drainage healed faster than radical excision but gave no exact number of days, and excision had much lower recurrence (19% vs 54%).", "studyIds": [ "pmid:36542008" ] }, { "name": "Recurrence of the cyst/sinus after the wound has healed", "status": "improvement", "note": "Consistently measured across many studies, but the rate varies widely by technique and by how long follow-up lasted — from about 1-10% at 1-5 years with some flap techniques up to 27-52% at longer follow-up with pit-picking or secondary-intention healing.", "studyIds": [ "pmid:42633928", "pmid:41074563", "pmid:39115207", "pmid:37553846", "pmid:37118772", "pmid:36268754", "pmid:35344244" ] }, { "name": "How a pilonidal cyst behaves if left completely untreated (no drainage, no surgery, no chemical treatment)", "status": "not-studied", "note": "No study in this table followed people who had no treatment at all. Every study followed patients after some form of surgery, laser, drainage, or chemical (phenol) treatment, so there is no evidence here about healing time without any intervention.", "studyIds": [] } ], "benefits": [ { "text": "Minimally invasive treatments (laser, endoscopic/EPSiT, pit-picking) consistently show faster wound closure, often 2 to 4 weeks, than open excision left to heal on its own.", "studyIds": [ "pmid:42128975", "pmid:41964736", "pmid:40498166", "pmid:37145226", "pmid:34021885" ] }, { "text": "Closed flap or stitched surgery generally heals faster than an open wound left to close by itself, with multiple studies finding healing roughly halved or better.", "studyIds": [ "pmid:39115207", "pmid:38226663", "pmid:35593897", "pmid:34254748" ] }, { "text": "Return to work or normal activity is often possible within days to about two weeks after minimally invasive or flap surgery, well before the wound is fully closed.", "studyIds": [ "pmid:41854814", "pmid:39699772", "pmid:39140695", "pmid:37356014", "pmid:35344244", "pmid:35187898" ] } ], "limitations": [ { "text": "Most studies are retrospective and not randomized, meaning patients were not assigned healing techniques by chance — people with worse disease may have ended up in the open-healing or excision groups, which can distort comparisons.", "studyIds": [ "pmid:42633928", "pmid:41834241", "pmid:39115207", "pmid:37722760" ] }, { "text": "Follow-up length varies enormously between studies, from a few weeks to several years, and many report only whether healing eventually happened rather than exactly how long it took.", "studyIds": [ "pmid:42347916", "pmid:42112873", "pmid:37256592", "pmid:36217688" ] }, { "text": "Studies measured and defined \"healed\" in different ways, and used different follow-up periods, which makes the many reported healing-time numbers hard to compare directly across studies.", "studyIds": [ "pmid:42347916", "pmid:35593897" ] } ], "risks": [ { "text": "A meaningful minority of wounds have delayed or prolonged healing regardless of technique, sometimes needing extra dressing care for weeks longer than typical.", "studyIds": [ "pmid:42313194", "pmid:40378664", "pmid:37722760" ], "severity": "minor" }, { "text": "The cyst or sinus can come back after the wound has fully healed; this happens more often with some techniques and with longer follow-up, in some cohorts affecting over a quarter of patients by several years.", "studyIds": [ "pmid:42633928", "pmid:39115207", "pmid:37118772", "pmid:36268754", "pmid:35344244" ], "severity": "minor" }, { "text": "Wounds that are stitched closed can reopen (dehiscence) during healing; one trial found this happened in 42% of closed wounds.", "studyIds": [ "pmid:39393119" ], "severity": "minor" } ], "whyPeopleTryIt": [ { "text": "People who have just been diagnosed or just had a drainage or surgery want to know what is 'normal' so they can judge whether their own healing is on track." }, { "text": "Time off work, school, or sport depends on healing, so people want a realistic timeline before deciding on or after a procedure." }, { "text": "Some people hope a small cyst might resolve without needing surgery at all and are searching for reassurance that waiting is an option." }, { "text": "Pain, discharge, and uncertainty about wound care make people want a clear endpoint to look forward to." } ], "keyStudies": [ "pmid:38226663", "pmid:37930579", "pmid:40498166", "pmid:39115207", "pmid:41999968", "pmid:35593897", "pmid:33336345", "pmid:42633928" ], "studies": [ { "id": "pmid:42988951", "pmid": "42988951", "doi": "10.1007/s00423-026-04187-z", "nctId": null, "pmcid": "PMC13740129", "title": "Endoscopic pilonidal sinus treatment versus Limberg flap reconstruction for uncomplicated pilonidal sinus disease: a prospective comparative study", "firstAuthor": "Guna", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2026, "design": "prospective-cohort", "n": 80, "nField": "reported", "population": "adults with an uncomplicated pilonidal sinus who had surgery", "intervention": "", "comparator": "", "primaryOutcome": "pain, infection, seroma, wound opening up, and sinus coming back at 6 months", "result": "The abstract does not give a specific healing time in days or weeks; it only reports that patients treated with the keyhole technique (EPSiT) had a shorter hospital stay and returned to normal activity sooner than those treated with Limberg flap surgery, with low and similar recurrence in both groups at 6 months.", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "It is a non-randomised comparison of two surgeries, so differences in recovery time could be influenced by which patients were chosen for each operation rather than the operation itself.", "directness": "indirect", "relevanceNote": "", "limitations": "Observational, not randomized; no exact healing duration (e.g. days to full wound closure) is reported, only comparative recovery measures between two surgical techniques.", "followUp": "6 months", "plainFinding": "Faster recovery with keyhole surgery; exact healing time not given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42988951/", "sourceText": "BACKGROUND: Optimal surgical management of sacrococcygeal pilonidal sinus disease is still controversial. Minimally invasive endoscopic pilonidal sinus treatment (EPSiT) has emerged as an alternative to established off-midline flap procedures such as the Limberg flap. Comparative prospective data remain limited. METHODS: This prospective observational cohort study included adult patients with primary, uncomplicated sacrococcygeal pilonidal sinus treated with either EPSiT or Limberg flap reconstruction between March 2023 and June 2024. Primary outcomes were postoperative pain, surgical-site infection, seroma formation, wound dehiscence, and recurrence at 6 months. Secondary outcomes included operative time, hospital stay, and time to return to normal activity. RESULTS: Eighty patients were included (EPSiT n = 40; Limberg n = 40). Baseline demographic and clinical characteristics were comparable between groups. EPSiT was associated with significantly shorter operative time, lower postoperative pain scores, reduced length of hospital stay, and earlier return to normal activity (p < 0.05). Postoperative complications were fewer in the EPSiT group. Six-month recurrence rates were low and comparable between groups. CONCLUSION: EPSiT provides superior short-term recovery outcomes compared with Limberg flap reconstruction while maintaining similar early recurrence rates. EPSiT represents a safe and patient-centred option for selected cases of uncomplicated pilonidal sinus disease.", "provenance": [ { "field": "n", "quote": "Eighty patients were included (EPSiT n = 40; Limberg n = 40)." }, { "field": "population", "quote": "adult patients with primary, uncomplicated sacrococcygeal pilonidal sinus treated with either EPSiT or Limberg flap reconstruction" }, { "field": "primaryOutcome", "quote": "Primary outcomes were postoperative pain, surgical-site infection, seroma formation, wound dehiscence, and recurrence at 6 months." }, { "field": "result", "quote": "EPSiT was associated with significantly shorter operative time, lower postoperative pain scores, reduced length of hospital stay, and earlier return to normal activity (p < 0.05)." }, { "field": "result", "quote": "Six-month recurrence rates were low and comparable between groups." } ] }, { "id": "pmid:42934421", "pmid": "42934421", "doi": "10.1007/s10151-026-03398-2", "nctId": null, "pmcid": "PMC13710445", "title": "Ultrasound-guided versus conventional sinus tract laser closure for adolescent sacrococcygeal pilonidal disease: a retrospective comparative study", "firstAuthor": "Hua", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "retrospective", "n": 64, "nField": "reported", "population": "Teenagers (18 or younger) who had surgery for a tailbone pilonidal cyst/sinus", "intervention": "Laser closure of the sinus tract guided by ultrasound", "comparator": "Standard laser closure of the sinus tract without ultrasound guidance", "primaryOutcome": "How fast the wound healed and whether the cyst came back", "result": "The ultrasound-guided group healed faster and had fewer recurrences (4% vs 25%) than the standard laser group, though time to return to normal activities was similar between groups.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "It's a small, single-center, retrospective comparison of two surgical variants, and the authors themselves say the results need confirming in larger studies.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, single center, small sample (64 patients), compares two treatment variants rather than measuring overall healing time from treatment, and authors call it a 'preliminary' result needing larger-scale validation.", "followUp": "18.0 (8.0, 37.8) months (ultrasound-guided group) and 20.5 (9.5, 35.8) months (conventional group)", "plainFinding": "Faster healing, fewer recurrences with ultrasound guidance.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42934421/", "sourceText": "BACKGROUND: Sacrococcygeal pilonidal disease (SPD) is common in adolescents and often recurs after surgery. Sinus tract laser closure (SiLaC) helps with healing, reduces recurrence, and improves appearance but may miss sinus branches. Using ultrasound guidance during SiLaC ensures precise treatment and protects healthy tissue. This study compared the short- and medium-term efficacy of ultrasound (US)-guided SiLaC with conventional SiLaC in treating adolescent patients with SPD. METHODS: This retrospective study gathered and analyzed clinical data from 64 adolescent (18 years or younger) patients with SPD who underwent either SiLaC or US-guided SiLaC at a single center from March 2021 to January 2025. The study included 38 patients who received conventional SiLaC and 26 patients who received US-guided SiLaC, and recorded demographics, surgical history, lifestyle factors, laser parameters, short-term complications, healing and recurrence rates, wound closure time, and recovery time. RESULTS: Among the 64 patients, 89.1% were male and 10.9% female, with a median age of 17 years. The US-guided group had a median follow-up of 18.0 (8.0, 37.8) months, while the conventional group had 20.5 (9.5, 35.8) months, both groups with similar demographic characteristics. The US-guided group showed significantly lower intraoperative laser duration and energy use (p < 0.05), and faster wound closure (p = 0.017). Recurrence was 4% in the US group vs. 25% in the conventional group (p = 0.037). No significant difference was found in the time to resume normal activities (p = 0.091). CONCLUSIONS: Preliminary results suggest that US-guided SiLaC enhances the precision of sinus tract ablation by providing real-time intraoperative visualization in adolescents with SPD. In this cohort, its application was associated with reduced recurrence rates and expedited wound healing. However, these findings necessitate validation through larger-scale studies.", "provenance": [ { "field": "n", "quote": "64 adolescent (18 years or younger) patients with SPD who underwent either SiLaC or US-guided SiLaC at a single center from March 2021 to January 2025" }, { "field": "population", "quote": "64 adolescent (18 years or younger) patients with SPD who underwent either SiLaC or US-guided SiLaC" }, { "field": "intervention", "quote": "US-guided SiLaC" }, { "field": "comparator", "quote": "conventional SiLaC" }, { "field": "primaryOutcome", "quote": "recorded demographics, surgical history, lifestyle factors, laser parameters, short-term complications, healing and recurrence rates, wound closure time, and recovery time" }, { "field": "result", "quote": "The US-guided group showed significantly lower intraoperative laser duration and energy use (p < 0.05), and faster wound closure (p = 0.017). Recurrence was 4% in the US group vs. 25% in the conventional group (p = 0.037)." } ] }, { "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": "patients with primary sacrococcygeal pilonidal sinus disease treated surgically", "intervention": "phenol therapy (chemical ablation)", "comparator": "Karydakis flap surgery", "primaryOutcome": "time for the wound to heal after treatment", "result": "wound healing took about 15 days after phenol therapy versus about 36 days after Karydakis flap surgery", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "it is a retrospective, non-randomized comparison of two treatments at one center, so healing times could be influenced by factors other than the treatment itself.", "directness": "direct", "relevanceNote": "", "limitations": "Retrospective design, not randomized, single-center, telephone follow-up for some patients.", "followUp": "1 year", "plainFinding": "Healing took 15 to 36 days depending on treatment.", "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) has emerged as an effective outpatient treatment" }, { "field": "comparator", "quote": "Seventy-seven patients underwent the KF procedure" }, { "field": "primaryOutcome", "quote": "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)." } ] }, { "id": "pmid:42700038", "pmid": "42700038", "doi": "10.1097/MD.0000000000050595", "nctId": null, "pmcid": "PMC13549590", "title": "MRI susceptibility-related artifacts following prolonged use of silver-containing dressings: A case report", "firstAuthor": "Liu", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "33-year-old man with a nonhealing wound after pilonidal sinus excision", "intervention": "", "comparator": "", "primaryOutcome": "How long the wound took to heal and why it was not healing", "result": "The wound did not heal for 8 months after pilonidal surgery; this was found to be due to an undiagnosed anal fistula, and the wound healed after the fistula was surgically treated", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "This is a single case report, so it cannot reliably tell us how long pilonidal wounds usually take to heal.", "directness": "indirect", "relevanceNote": "", "limitations": "Single patient case report focused on MRI imaging artifacts rather than typical pilonidal wound healing; the nonhealing was due to an unusual complicating anal fistula, not representative of typical cases.", "followUp": "", "plainFinding": "Wound stalled 8 months, healed after fistula found and fixed", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42700038/", "sourceText": "RATIONALE: Silver-containing dressings are widely used in postoperative and chronic wound care because of their antimicrobial properties. Although these dressings are generally considered compatible with magnetic resonance imaging (MRI) under standard conditions, prolonged use in chronic open wounds may be associated with local retention or deposition of silver-containing material. This could contribute to susceptibility-related signal loss or distortion on MRI and interfere with the evaluation of underlying anatomical structures. However, clinical evidence supporting this association remains limited, and a definitive causal relationship has not been established. PATIENT CONCERNS: A 33-year-old man presented with a nonhealing wound after pilonidal sinus excision. He had used silver-containing dressings intermittently for postoperative wound care over an 8-month period. Because of delayed wound healing and recurrent symptoms, pelvic MRI was performed to evaluate the cause. DIAGNOSES: MRI demonstrated extensive signal loss and distortion in the sacrococcygeal region, suggestive of susceptibility-related artifacts, which obscured anatomical structures and limited diagnostic assessment. After removal of wound-related material by debridement, follow-up MRI demonstrated a fistulous tract extending from the anal canal to the previous wound site. The patient was diagnosed with an anal fistula associated with a chronic nonhealing postoperative wound. INTERVENTIONS: Given the possibility that wound-related or silver-containing dressing-associated material contributed to the MRI artifacts, wound debridement was performed. After the follow-up MRI clarified the fistulous tract, the patient underwent fistula surgery. OUTCOMES: Follow-up MRI after debridement showed near-complete reduction of the artifacts and allowed visualization of the fistulous tract. The patient underwent surgical treatment, and follow-up showed satisfactory wound healing. LESSONS: Prolonged use of silver-containing dressings may be associated with retention or deposition of dressing-related material, which could represent a possible contributor to susceptibility-related MRI artifacts in selected patients. However, silver deposition was not directly confirmed by elemental analysis or susceptibility-sensitive MRI sequences, and alternative causes could not be completely excluded. Clinicians and radiologists should consider this potential source of imaging interference in patients with chronic wounds and a history of long-term silver dressing use. Careful wound assessment and removal of residual wound-related material before MRI may be helpful when artifact-related diagnostic interference is suspected.", "provenance": [ { "field": "population", "quote": "A 33-year-old man presented with a nonhealing wound after pilonidal sinus excision." }, { "field": "primaryOutcome", "quote": "Because of delayed wound healing and recurrent symptoms, pelvic MRI was performed to evaluate the cause." }, { "field": "result", "quote": "He had used silver-containing dressings intermittently for postoperative wound care over an 8-month period." }, { "field": "result", "quote": "The patient was diagnosed with an anal fistula associated with a chronic nonhealing postoperative wound." }, { "field": "result", "quote": "The patient underwent surgical treatment, and follow-up showed satisfactory wound healing." }, { "field": "n", "quote": "A 33-year-old man presented with a nonhealing wound after pilonidal sinus excision." } ] }, { "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": "people who had surgery for a first-time pilonidal sinus/cyst", "intervention": "various surgical techniques (e.g. Karydakis flap, Bascom cleft lift, Limberg flap, Dufourmentel flap)", "comparator": "lay-open (open wound healing) treatment", "primaryOutcome": "time to recurrence and postoperative infection after surgery", "result": "5-year cumulative recurrence was 7.9%, most recurrences happened within the first 2 years, with a median time to recurrence of 20 months (IQR 12-36); recurrence and infection rates varied significantly by surgical technique", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "Large single-centre retrospective cohort with long follow-up gives useful real-world data, but lack of randomisation and reliance on surgical records limit certainty.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, single centre, excludes recurrent disease cases, and reports recurrence timing rather than wound healing time itself.", "followUp": "minimum follow-up of 5 years", "plainFinding": "Most recurrence happens within two 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": "patients with primary PSD who underwent surgery between January 2006 and December 2020" }, { "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": "Most recurrences occurred within the first 2 years, with a median time to recurrence of 20 months (IQR 12-36)." } ] }, { "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 who had pit-picking surgery for pilonidal disease", "intervention": "", "comparator": "", "primaryOutcome": "recurrence and time to recurrence after treatment", "result": "Recurrence occurred in 6 of 42 patients (14.3%), with a median time to recurrence of 10 months; median follow-up was 15 months; the abstract does not report how long the wound itself took to heal", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "small retrospective single-center study of a specific group (uncomplicated adolescent disease) that reports recurrence timing, not actual wound healing duration", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective, single center, small sample, only tracks recurrence after a specific minimally invasive procedure rather than overall healing time", "followUp": "15 months", "plainFinding": "Recurrence in 14%, not healing time", "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": "population", "quote": "adolescents aged 12-18 years who underwent pit-picking for pilonidal disease" }, { "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": "result", "quote": "The median follow-up duration was 15 months." }, { "field": "n", "quote": "A total of 42 patients were included" } ] }, { "id": "pmid:42347916", "pmid": "42347916", "doi": "10.1111/codi.70534", "nctId": null, "pmcid": null, "title": "Outcomes reported in comparative studies of surgical management of pilonidal disease: Systematic review to inform a core outcome set", "firstAuthor": "Mei", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2026, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people who had surgery for pilonidal cyst/sinus disease", "intervention": "surgical management of pilonidal disease (various types)", "comparator": "", "primaryOutcome": "how outcomes like healing, recurrence and complications were reported in studies, not actual healing time", "result": "The review catalogued which outcomes studies report (recurrence, complications, pain, wound healing) but did not report actual healing durations; it found wound healing was reported as a primary outcome in only 32.9% of studies and follow-up durations varied substantially across studies without a specific healing time given.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a review of what outcomes studies measure, not a study measuring actual healing time, and the authors explicitly did not assess risk of bias or treatment effects.", "directness": "indirect", "relevanceNote": "", "limitations": "The authors state risk-of-bias assessment and GRADE appraisal were not undertaken because the goal was mapping outcome reporting, not estimating effects or durations; follow-up duration was noted to vary substantially but no actual figures are given.", "followUp": "", "plainFinding": "No actual healing time reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42347916/", "sourceText": "BACKGROUND: Evidence synthesis in pilonidal disease surgery is limited by heterogeneity in outcome selection, definition, measurement and follow-up. This systematic review aimed to identify and describe outcomes reported in comparative studies of surgical management of pilonidal disease to inform development of a core outcome set. METHODS: PubMed, Embase and CENTRAL were searched from inception to 28 November 2025. Randomised controlled trials and comparative observational studies evaluating surgical interventions for pilonidal disease were eligible. Two reviewers independently screened studies and extracted study characteristics and outcome data. Verbatim outcomes were standardised, grouped into domains and summarised descriptively. Because the objective was to map outcome reporting rather than estimate treatment effects, risk-of-bias assessment and GRADE appraisal were not undertaken. RESULTS: A total of 155 studies were included, comprising 93 randomised trials and 62 observational studies. Ten outcome domains were identified. Recurrence was reported most frequently (112 studies, 72.3%), followed by non-infective complications (103, 66.5%), pain (83, 53.5%), wound healing (82, 52.9%) and return to normal activities (63, 40.6%). Patient-important domains were less frequently reported, including health-related quality of life or satisfaction (50, 32.3%) and cosmesis (17, 11.0%). Among outcomes designated as primary, wound healing was most common (51 studies, 32.9%), followed by recurrence (35, 22.6%) and postoperative complications (25, 16.1%). Pain (6, 3.9%), return to normal activities/work (9, 5.8%), and psychological or quality-of-life outcomes (3, 1.9%) were rarely primary outcomes. Definitions, measurement instruments, assessment timepoints and overall follow-up duration varied substantially across studies. CONCLUSIONS: Comparative studies of pilonidal disease surgery predominantly prioritise recurrence, healing and complications, whereas patient-important outcomes are reported less consistently and are infrequently prioritised. Standardisation of outcome selection, definitions and measurement is needed. These findings support development of a core outcome set for future trials in pilonidal disease surgery. TRAIL REGISTRATION: CRD420251128698.", "provenance": [ { "field": "population", "quote": "Randomised controlled trials and comparative observational studies evaluating surgical interventions for pilonidal disease were eligible." }, { "field": "intervention", "quote": "surgical management of pilonidal disease" }, { "field": "primaryOutcome", "quote": "Among outcomes designated as primary, wound healing was most common (51 studies, 32.9%), followed by recurrence (35, 22.6%) and postoperative complications (25, 16.1%)." }, { "field": "result", "quote": "Definitions, measurement instruments, assessment timepoints and overall follow-up duration varied substantially across studies." }, { "field": "result", "quote": "Because the objective was to map outcome reporting rather than estimate treatment effects, risk-of-bias assessment and GRADE appraisal were not undertaken." } ] }, { "id": "pmid:42313194", "pmid": "42313194", "doi": "10.1007/s10151-026-03377-7", "nctId": null, "pmcid": "PMC13522066", "title": "The association between skin-suturing technique, prolonged healing and recurrence after Bascom's Cleft lift surgery", "firstAuthor": "Larsen", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "retrospective", "n": 540, "nField": "reported", "population": "People who had Bascom's Cleft lift surgery for pilonidal sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "Whether the wound had fully healed (epithelialized) by 14 weeks after surgery, and whether the cyst came back later", "result": "76% of patients healed without problems; the rest had prolonged healing. At 5 years, cyst recurrence was higher in those whose wound took longer to heal (14.0%) than in those who healed normally (7.0%).", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "Large single-centre dataset with long follow-up, but it is a retrospective chart review so healing and recurrence could be affected by factors the study did not control for.", "directness": "direct", "relevanceNote": "", "limitations": "Single hospital, retrospective design, and the study's main aim was comparing suturing techniques rather than describing healing time itself.", "followUp": "up to 14 weeks for healing assessment, 5 years for recurrence", "plainFinding": "Most heal by 14 weeks; slow healing raises relapse risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42313194/", "sourceText": "BACKGROUND: The optimal treatment for complex Pilonidal Sinus Disease (PSD) is still debated. Despite great advances with the introduction of off-midline closure techniques, healing problems and recurrence remain challenges. We aimed to investigate whether choice of skin-suturing technique in Bascom's Cleft lift (BCL) procedure influenced risk of prolonged healing or recurrence. METHODS: We analysed the data of 540 unique patients who underwent BCL surgery at Randers Regional Hospital between 2016 and 2022. During this period, a technical revision of technique caused a shift from extracutaneous to intracutaneous closure creating two groups for comparison. Prolonged healing was defined as lack of complete epithelialization at the second post-surgical follow-up (maximum 14 weeks post-surgery). RESULTS: There was no difference in time-to-healing among the suture groups with a 76% rate of primary healing in both groups. At 5 years post-surgery, the cumulative incidence proportion (CIP) of recurrence was 9.1% in the intracutaneous group and 5.7% in the extracutaneous group (p = 0.41). At 5 years post-surgery, the CIP of recurrence was 14.0% among patients with prolonged healing and 7.0% among patients with primary healing (p < 0.05). CONCLUSIONS: In our study population, choice of skin-suturing technique did not affect risk of prolonged healing nor recurrence after BCL surgery. However, patients experiencing prolonged healing after surgery had significantly higher risk of recurrence, emphasizing the need for increased efforts to prevent post-surgical wound dehiscence.", "provenance": [ { "field": "population", "quote": "patients who underwent BCL surgery at Randers Regional Hospital between 2016 and 2022" }, { "field": "primaryOutcome", "quote": "Prolonged healing was defined as lack of complete epithelialization at the second post-surgical follow-up (maximum 14 weeks post-surgery)." }, { "field": "result", "quote": "There was no difference in time-to-healing among the suture groups with a 76% rate of primary healing in both groups." }, { "field": "result", "quote": "the CIP of recurrence was 14.0% among patients with prolonged healing and 7.0% among patients with primary healing (p < 0.05)" }, { "field": "n", "quote": "We analysed the data of 540 unique patients who underwent BCL surgery" } ] }, { "id": "pmid:42311045", "pmid": "42311045", "doi": "10.1002/wjs.70463", "nctId": null, "pmcid": "PMC13460901", "title": "Karydakis Versus Limberg Flap in Primary Sacrococcygeal Pilonidal Sinus: A Retrospective Comparative Study of Functional Recovery", "firstAuthor": "Habeeb", "multipleAuthors": true, "journal": "World J Surg", "year": 2026, "design": "retrospective", "n": 352, "nField": "reported", "population": "employed, sexually active adults who had surgery for primary pilonidal sinus disease", "intervention": "Karydakis flap surgery", "comparator": "Limberg flap surgery", "primaryOutcome": "time until patients could resume sexual activity and driving after surgery", "result": "Patients who had the Karydakis flap resumed sexual activity and driving sooner than those who had the Limberg flap", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "It is a retrospective, non-randomized cohort comparing two surgery types, so recall and selection biases could affect the reported recovery times.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, no randomization, relies on patient-reported recall at 1 year, and focuses on functional recovery (sex, driving) rather than overall wound healing time.", "followUp": "1 year", "plainFinding": "Faster return to activity after one surgery type", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42311045/", "sourceText": "BACKGROUND: Successful surgical management of pilonidal sinus disease (PSD) in young, active patients requires rapid restoration of daily functions, including driving and sexual activity. This study compared patient-reported recovery as regards sexual function and driving ability following the KF versus the LF for primary sacrococcygeal PSD. METHODS: This multicenter retrospective cohort study (FLARE study) included employed, sexually active patients who underwent surgery for primary PSD (July 2017-July 2024). The primary outcome was time to sexual activity resumption; the secondary outcome was time to resumption of driving. Outcomes were assessed at 1 year using a structured Likert-scale questionnaire. Kaplan-Meier curves and Cox regression analyses with adjustment were used. RESULTS: A total of 352 patients were divided into 176 KF and 176 LF. KF patients resumed sexual activity earlier (2.88 ± 0.7 vs. 4.58 ± 1.1 weeks; mean difference -1.7 weeks, 95% CI -1.89 to -1.49, p < 0.001). KF reported significantly less pain, less avoidance, and lower analgesic use during sex. LF reported lower sexual satisfaction (mean 3.94 vs. 2.15; mean difference -1.78, 95% CI -2.02 to -1.53). KF resumed driving earlier (median 9 vs. 19 days; r = 0.7, large effect, p < 0.001) and had longer sitting tolerance (OR 0.3, 95% CI 0.2-0.4, p < 0.001). LF had higher pain while sitting (mean Likert 4 vs. 2; mean difference of -1.94, 95% CI -2.19 to -1.68), higher VAS pain (median 4 vs. 2; r = 0.5), greater need for cushions/analgesics, and more driving-related work/social limitations (all p < 0.001). Time to resume sexual activity and driving was significantly shorter for KF. On multivariable analysis, LF was independently associated with delayed return to sexual activity (adjusted OR 4.02, 95% CI 2.1-7.5, p < 0.001) and delayed return to driving (adjusted OR 2.8, 95% CI 1.5-5.2, p < 0.001). CONCLUSIONS: In this retrospective cohort, KF may be associated with significantly faster return to sexual and driving activity compared with LF. These results underscore the importance of incorporating patient-centered functional outcomes into surgical decision-making for PSD. TRIAL REGISTRATION: Number: NCT07271537.", "provenance": [ { "field": "population", "quote": "employed, sexually active patients who underwent surgery for primary PSD (July 2017-July 2024)" }, { "field": "intervention", "quote": "KF patients resumed sexual activity earlier (2.88 ± 0.7 vs. 4.58 ± 1.1 weeks" }, { "field": "comparator", "quote": "LF reported lower sexual satisfaction (mean 3.94 vs. 2.15" }, { "field": "primaryOutcome", "quote": "The primary outcome was time to sexual activity resumption; the secondary outcome was time to resumption of driving." }, { "field": "result", "quote": "KF resumed driving earlier (median 9 vs. 19 days; r = 0.7, large effect, p < 0.001) and had longer sitting tolerance" }, { "field": "n", "quote": "A total of 352 patients were divided into 176 KF and 176 LF." } ] }, { "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": "People with pilonidal sinus who had phenol injection treatment after excision of pits and curettage", "intervention": "Phenol injection treatment for pilonidal sinus", "comparator": "", "primaryOutcome": "Hospital stay length and recurrence after phenol treatment", "result": "Median postoperative hospital stay was 2 days and no recurrence occurred during a median follow-up of 331 days; the abstract does not state how long the wound took to fully heal", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "Small retrospective case series of only 11 patients from one center, with no comparison group and no explicit measure of wound healing time.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective single-center design, very small sample (n=11), no direct report of time to wound healing, variable follow-up duration (100-979 days)", "followUp": "median, 331 days; range, 100-979", "plainFinding": "Short hospital stay; no recurrence seen", "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": "population", "quote": "We retrospectively reviewed patients with pilonidal sinus who underwent phenol treatment at our institution between 2020 and 2025." }, { "field": "intervention", "quote": "undiluted phenol was injected into the cavity and subsequently neutralized with ethanol" }, { "field": "primaryOutcome", "quote": "Clinical data, including patient characteristics, number of pits, operative time, postoperative hospital stay, complications, and recurrence, were analyzed." }, { "field": "result", "quote": "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)." }, { "field": "n", "quote": "A total of 11 patients were included in the study." } ] }, { "id": "pmid:42237035", "pmid": "42237035", "doi": "10.1007/s10151-026-03345-1", "nctId": null, "pmcid": "PMC13447342", "title": "Early postoperative outcomes of sinus laser closure versus crystallized phenol treatment for pilonidal sinus disease: a retrospective comparative study", "firstAuthor": "Yildirak", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "retrospective", "n": 230, "nField": "reported", "population": "adults with pilonidal sinus disease who had either sinus laser closure (SiLaC) or crystallized phenol treatment (CPT), followed up at 1 week and 1 month after treatment", "intervention": "sinus laser closure (SiLaC)", "comparator": "crystallized phenol treatment (CPT)", "primaryOutcome": "patient satisfaction, quality of life, symptom severity (itching, burning, discharge), pain, and time to return to work, measured at 1 week and 1 month after treatment", "result": "At 1 week, the SiLaC group had less itching, burning, discharge, pain, and quicker return to daily activities than the CPT group; by 1 month most outcomes were similar between the two groups, though purulent discharge was still a bit more common in the CPT group", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "It's a retrospective study from one center with follow-up only out to 1 month, so it doesn't show how long full healing actually takes.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, single tertiary center, short follow-up limited to 1 week and 1 month, and no reported data on actual wound/pit closure rates despite being listed as a secondary outcome.", "followUp": "1 month", "plainFinding": "Most symptoms gone by one month", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42237035/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD), which predominantly affects young adults, has increasingly been managed with minimally invasive techniques aimed at reducing postoperative pain, accelerating recovery, and minimizing work absenteeism. This study aimed to compare the early term outcomes of patients treated with crystallized phenol treatment (CPT) or sinus laser closure (SiLaC) for PSD. METHODS: We retrospectively analyzed a prospectively maintained cohort at a tertiary center between January 2023 and August 2024. Patients with PSD undergoing SiLaC or CPT with scheduled 1-week and 1-month follow-up assessments were included. The primary outcomes were patient satisfaction, health-related quality of life (SF-36), symptom severity (itching, burning, purulent discharge), pain intensity (Visual Analogue Scale), and time to return to work, all assessed at 1 week and 1 month postoperatively. Secondary outcomes included pit orifice closure rates and perioperative complications. RESULTS: A total of 230 patients were analyzed (SiLaC n = 93; CPT n = 137), with comparable baseline characteristics. At 1 week, itching (1 [1-1] versus 1 [1-2], p < 0.001), burning (1 [1-1] versus 1 [1-2], p = 0.001), and purulent discharge (1 [1-1] versus 1 [1-3], p < 0.001) were less frequent in the SiLaC group. Pain scores were also lower in the SiLaC group (VAS: 0 [0-1] versus 0 [0-5], p = 0.034). SF-36 scores were significantly higher in the SiLaC group for physical functioning (100 [90-100] versus 95 [85-100], p < 0.001), physical role limitation (100 [100-100] versus 100 [75-100], p = 0.005), social functioning (100 [87.5-100] versus 87.5 [62.5-100], p < 0.001), and pain (100 [67.5-100] versus 90 [67.5-100], p = 0.008). Return to daily activities was shorter in the SiLaC group (0 [0-0] versus 0 [0-1] days, p < 0.001). At 1 month, most outcomes were comparable between groups, although purulent discharge remained higher in the CPT group (1 [1-2] versus 1 [1-1], p = 0.045). Complication rates were low and similar between groups (9.6% versus 12.4%, p = 0.489). CONCLUSIONS: The SiLaC method was associated with more favorable quality of life (QoL) outcomes compared with CPT during the first postoperative week. Subgroup analyses suggested that SiLaC may offer advantages in certain clinical scenarios. Further multicenter randomized controlled trials are warranted to better clarify and validate these findings.", "provenance": [ { "field": "n", "quote": "A total of 230 patients were analyzed (SiLaC n = 93; CPT n = 137)" }, { "field": "population", "quote": "Patients with PSD undergoing SiLaC or CPT with scheduled 1-week and 1-month follow-up assessments were included." }, { "field": "intervention", "quote": "sinus laser closure (SiLaC)" }, { "field": "comparator", "quote": "crystallized phenol treatment (CPT)" }, { "field": "primaryOutcome", "quote": "The primary outcomes were patient satisfaction, health-related quality of life (SF-36), symptom severity (itching, burning, purulent discharge), pain intensity (Visual Analogue Scale), and time to return to work, all assessed at 1 week and 1 month postoperatively." }, { "field": "result", "quote": "At 1 month, most outcomes were comparable between groups, although purulent discharge remained higher in the CPT group (1 [1-2] versus 1 [1-1], p = 0.045)." }, { "field": "followUp", "quote": "1-week and 1-month follow-up assessments" } ] }, { "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": "retrospective", "n": 507, "nField": "reported", "population": "teenagers and children treated surgically for pilonidal sinus disease (primary or recurrent)", "intervention": "pediatric endoscopic pilonidal sinus treatment (PEPSiT), a minimally invasive surgical technique with postoperative ozone oil dressing (and platelet-rich plasma in later patients)", "comparator": "", "primaryOutcome": "healing rate and time after treatment, plus recurrence of the sinus", "result": "the abstract does not give a specific healing time; it reports that disease recurred in 53/507 patients (10.4%), occurring mostly within 3 months after surgery (range 2 to 23 months)", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this is a retrospective single-center case series with no comparison group and no explicit numeric healing time reported, only recurrence timing.", "directness": "direct", "relevanceNote": "", "limitations": "retrospective design, single surgical center, no untreated or comparator group, and no quantified wound-healing duration given despite stating healing time was assessed", "followUp": "2 months-23 months", "plainFinding": "Low recurrence, mostly within 3 months", "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 (313 boys and 194 girls)" }, { "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": "intervention", "quote": "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." }, { "field": "primaryOutcome", "quote": "Data regarding success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed." }, { "field": "result", "quote": "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." } ] }, { "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 who had pit-picking surgery for pilonidal sinus disease", "intervention": "Pit-picking surgery (alone or with laser) for pilonidal sinus disease", "comparator": "", "primaryOutcome": "Time to complete healing after treatment", "result": "Complete healing was achieved in 97.4% of patients, with a median time of 14 days", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "It is a multicenter but retrospective, non-randomized study comparing two surgical variants, so bias and confounding can't be ruled out.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, no randomization, exclusion of patients with incomplete follow-up, and focus on a specific minimally invasive technique (pit-picking) rather than excision or open wound care.", "followUp": "5 years", "plainFinding": "Healed in 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 surgeries performed with or without LT were compared." }, { "field": "primaryOutcome", "quote": "Secondary outcomes were postoperative pain, time to complete healing, complications, return to work, and costs." }, { "field": "result", "quote": "Complete healing was achieved in 97.4% of patients, with a median time of 14 days." } ] }, { "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 who had elective pilonidal cyst/sinus surgery (either endoscopic treatment or excisional surgery) at an Australian hospital", "intervention": "", "comparator": "", "primaryOutcome": "Whether the surgical wound healed completely (primary healing) and whether the cyst came back after healing (recurrence)", "result": "Overall, 87.8% of operative episodes achieved primary healing, with no significant difference between endoscopic and excisional approaches; recurrence after healing occurred in 26.6% of episodes overall. The abstract does not state how long healing took, only whether it occurred.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective, non-randomised comparison of two surgeries at one hospital, and it reports whether healing happened rather than how long healing actually took.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, single tertiary centre, analysis combined repeat procedures, and no time-to-healing data were reported — only whether healing had occurred by the time of review.", "followUp": "", "plainFinding": "Most healed; exact healing time not reported.", "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" }, { "field": "population", "quote": "consecutive elective pilonidal operations in patients aged ≥ 12 at a tertiary Australian hospital" }, { "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)." } ] }, { "id": "pmid:42098544", "pmid": "42098544", "doi": "10.1007/s10151-025-03283-4", "nctId": null, "pmcid": "PMC13152908", "title": "Comparing keystone and Limberg flaps for pilonidal sinus: Does flap choice influence patient satisfaction?", "firstAuthor": "Wael", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "rct", "n": 50, "nField": "reported", "population": "adults having surgery to remove a pilonidal sinus", "intervention": "keystone perforator island flap reconstruction after sinus removal", "comparator": "Limberg flap reconstruction after sinus removal", "primaryOutcome": "patient satisfaction with the surgery at 6 months", "result": "Wound healing took about 13.5 days with the keystone flap compared with 17.1 days with the Limberg flap, and patients returned to normal activity sooner with the keystone flap.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "It is a randomized trial, but with only 50 patients from what appears to be a single center, the healing-time estimates are imprecise.", "directness": "indirect", "relevanceNote": "", "limitations": "Small sample size (50 patients), compares two specific flap reconstruction techniques rather than reporting general wound healing after standard pilonidal treatment, and satisfaction was the stated primary outcome rather than healing time.", "followUp": "6 months", "plainFinding": "About 2 weeks to heal with flap surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42098544/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a chronic condition that mainly affects young adults impairing the quality of life. Among several surgical options, flap reconstruction offers faster healing and lower recurrence. This randomized comparative study evaluated the keystone perforator island flap (KSF) versus the Limberg flap (LF) in PSD repair, focusing primarily on patient satisfaction depending on the flap type, alongside perioperative outcomes following PS excision as secondary outcomes. METHODS: A total of 50 patients with simple PSD were randomized equally to undergo KSF or LF reconstruction after sinus excision. Operative data, complications, and recovery metrics were recorded. Patient satisfaction, the primary endpoint, was assessed at 6 months using a validated 5-point scale. Statistical analysis employed the t-test, chi-squared test, and multivariate linear regression to identify independent predictors of satisfaction (p < 0.05 significant). RESULTS: The KSF group showed shorter operative time (54.9 ± 3.7 versus 73.4 ± 7.9 min, p < 0.001), faster wound healing (13.5 ± 3.1 versus 17.1 ± 3.5 days, p < 0.001), and earlier return to activity (6.8 ± 0.8 versus 8.5 ± 0.8 days, p < 0.001). Complications were lower (24% versus 56%, p = 0.02). Satisfaction was significantly higher with KSF (96% versus 72%, p = 0.046). Regression analysis identified wound-healing time (p = 0.008) and return to activity (p < 0.001) as the independent predictors of satisfaction. CONCLUSION: The KSF provides faster recovery, better comfort, and higher patient satisfaction than the LF. Functional recovery parameters, rather than flap type alone, are the strongest determinants of postoperative satisfaction.", "provenance": [ { "field": "n", "quote": "A total of 50 patients with simple PSD were randomized equally to undergo KSF or LF reconstruction after sinus excision." }, { "field": "population", "quote": "Pilonidal sinus disease (PSD) is a chronic condition that mainly affects young adults" }, { "field": "intervention", "quote": "the keystone perforator island flap (KSF)" }, { "field": "comparator", "quote": "the Limberg flap (LF)" }, { "field": "primaryOutcome", "quote": "Patient satisfaction, the primary endpoint, was assessed at 6 months using a validated 5-point scale." }, { "field": "result", "quote": "faster wound healing (13.5 ± 3.1 versus 17.1 ± 3.5 days, p < 0.001), and earlier return to activity (6.8 ± 0.8 versus 8.5 ± 0.8 days, p < 0.001)" } ] }, { "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 pilonidal sinus located between the breasts, not the usual tailbone area", "intervention": "", "comparator": "", "primaryOutcome": "How the wound recovered after surgical removal of the sinus", "result": "The patient recovered without complications and had no recurrence at follow-up, but no specific healing time was given", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how long healing typically takes or how reliable the outcome is in general.", "directness": "indirect", "relevanceNote": "", "limitations": "Only one patient, unusual location (intermammary rather than sacrococcygeal), no numeric follow-up duration or healing timeline given.", "followUp": "", "plainFinding": "Healed fine, no set timeline given.", "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": "n", "quote": "A 14-year-old Asian female presented with 1-year history of intermammary swelling" }, { "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": "primaryOutcome", "quote": "The patient had an uncomplicated recovery with no recurrence at follow-up." }, { "field": "result", "quote": "The patient had an uncomplicated recovery with no recurrence at follow-up." } ] }, { "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) treated for pilonidal cyst/sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "time until the wound healed, and whether it came back after healing", "result": "Healing took a long time in both the conservative-care group and the surgery group, with no significant difference between them", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This was a retrospective single-centre study without a comparison to untreated patients, and it did not give exact healing-time numbers, only that it was 'prolonged' in both groups.", "directness": "direct", "relevanceNote": "", "limitations": "Retrospective single-centre design; patients who had surgery likely had more severe disease to begin with, which could confound comparisons; exact time-to-healing figures are not given, only that healing was prolonged in both groups.", "followUp": "", "plainFinding": "Healing was slow in both groups.", "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": "primaryOutcome", "quote": "Primary outcome was recurrence after documented healing." }, { "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 teens (18 or younger) who had surgery for pilonidal cyst/sinus disease", "intervention": "Different surgical treatments for pilonidal disease (open wound healing, midline closure, off-midline closure, minimally invasive techniques)", "comparator": "", "primaryOutcome": "Time for the wound to heal after surgery, among other recovery measures", "result": "Healing time varied greatly by surgical technique: open wound healing took up to 98 days, while off-midline closure healed in as little as 8 days; minimally invasive techniques allowed return to daily activities within 1-3 days", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "It combines data from 59 studies of children with different surgery types and quality ratings, so healing times are not from one consistent comparison.", "directness": "indirect", "relevanceNote": "", "limitations": "Includes many different surgical techniques and pediatric-only population, with heterogeneity across studies noted by the authors", "followUp": "", "plainFinding": "Healing time ranges from 8 to 98 days depending on surgery.", "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": "Various surgical approaches" }, { "field": "primaryOutcome", "quote": "recurrence, wound complications, and recovery outcomes across surgical techniques" }, { "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." }, { "field": "result", "quote": "early return to ADL (1-3 days)" } ] }, { "id": "pmid:41964736", "pmid": "41964736", "doi": "10.1007/s00423-026-04026-1", "nctId": null, "pmcid": "PMC13180761", "title": "A systematic review and meta-analysis of sinus laser associated closure (SiLaC) versus endoscopic pilonidal sinus treatment (EPSiT) in the management of pilonidal sinus disease", "firstAuthor": "Li", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2026, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "people treated for pilonidal sinus disease with minimally invasive laser (SiLaC) or endoscopic (EPSiT) techniques", "intervention": "", "comparator": "", "primaryOutcome": "total time for the wound to fully heal after treatment", "result": "average healing time was about 30 days after SiLaC and about 27 days after EPSiT", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "the healing-time estimates come from pooling mostly single-arm studies with very high variation between studies, and the comparison between the two techniques is indirect rather than from trials that tested them head-to-head.", "directness": "direct", "relevanceNote": "", "limitations": "Findings are limited by lack of direct comparative trials and very high statistical heterogeneity (I2 up to 99%) across the pooled single-arm studies.", "followUp": "", "plainFinding": "Heals in about 4 weeks", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41964736/", "sourceText": "BACKGROUND: Various surgical modalities exist for the management of pilonidal sinus disease (PSD), with an increasing trend toward minimally invasive techniques. Sinus Laser associated Closure (SiLaC) and endoscopic pilonidal sinus treatment (EPSiT) are two minimally invasive techniques widely used in clinical practice. However, a systematic comparison of both techniques is lacking. This study conducted separate single-arm analyses of both techniques to compare their efficacy and safety. OBJECTIVE: A systematic literature search was performed across electronic databases including Web of Science, Embase, the Cochrane Library, Google Scholar and PubMed to identify relevant studies investigating SiLaC versus EPSiT for PSD. The primary outcome measures included operative time, cure rate, recurrence rate, postoperative complication rate, and total wound healing time. RESULTS: A total of 29 studies were included. The mean operative time was 18.02 min (95% CI:13.42–22.62; I2 = 99.4%; P < 0.001) for SiLaC and 30.11 min (95% CI: 21.33–38.88; I² = 98.5%; P < 0.001) for EPSiT. The cure rate was 86% (95% CI: 80–91%; I2 =92%; P < 0.001) in the SiLaC and 88% (95% CI: 83–94%; I² = 87.1%; P < 0.001) in the EPSiT group. The pooled recurrence rate was 11% (95% CI: 6–15%; I2 = 90.4%; < 0.001) for SiLaC and 9% (95% CI: 5–12%; I² = 82.9%; P < 0.001) for EPSiT. The complication rate was 10% (95% CI: 7–14%; I2 = 79.6%; P < 0.001) for SiLaC and 7% (95% CI: 1–15%; I² = 74.7%; P < 0.05) for EPSiT. The mean total healing time was 30.08 days (95% CI: 22.73–37.43%; I2 = 99.2%; P < 0.001) for SiLaC and 26.55 days (95% CI: 24.40–28.70; I² = 90.9%; P < 0.001) for EPSiT. CONCLUSION: This indirect comparative analysis suggests comparable efficacy between SiLaC and EPSiT for PSD based on currently available, predominantly single-arm studies. These findings, limited by the lack of direct comparative trials, highlight the urgent need for prospective investigations to establish robust comparative effectiveness.", "provenance": [ { "field": "population", "quote": "Various surgical modalities exist for the management of pilonidal sinus disease (PSD)" }, { "field": "primaryOutcome", "quote": "total wound healing time" }, { "field": "result", "quote": "The mean total healing time was 30.08 days (95% CI: 22.73–37.43%; I2 = 99.2%; P < 0.001) for SiLaC and 26.55 days (95% CI: 24.40–28.70; I² = 90.9%; P < 0.001) for EPSiT." } ] }, { "id": "pmid:41901600", "pmid": "41901600", "doi": "10.3390/medicina62030518", "nctId": null, "pmcid": "PMC13028323", "title": "The New Minimally Invasive Techniques for Pilonidal Sinus Disease Surgery: Choosing the Right Technique for the Right Patient-A Narrative Review", "firstAuthor": "Matteucci", "multipleAuthors": true, "journal": "Medicina (Kaunas)", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease who have undergone surgical treatment", "intervention": "", "comparator": "", "primaryOutcome": "time to healing after surgical treatment", "result": "the review states that minimally invasive techniques lead to faster recovery than flap surgery, but does not give specific healing-time durations", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "it is a narrative (not systematic) review that pools general impressions from varied studies without reporting actual numeric healing times.", "directness": "indirect", "relevanceNote": "", "limitations": "no quantitative healing-time data are given; findings are a general synthesis of heterogeneous studies rather than a focused measurement of healing duration", "followUp": "", "plainFinding": "No specific healing time given, only relative speed", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41901600/", "sourceText": "Background and Objectives: Pilonidal sinus disease (PSD) is a common condition affecting predominantly young adults and it is associated with a substantial impact on quality of life. Despite the wide range of available surgical options, optimal management remains controversial due to heterogeneous recurrence rates, wound complications and prolonged recovery. Over the last decade, a paradigm shift has occurred from midline excision toward off-midline closure techniques and minimally invasive procedures. This narrative review aims to critically appraise contemporary surgical strategies for PSD, comparing outcomes, indications and limitations, with particular emphasis on patient selection. Materials and Methods: A narrative review of the literature was conducted using PubMed, Scopus, and major guideline repositories. Relevant randomized controlled trials, systematic reviews, meta-analyses, observational studies and national and international guidelines were reviewed and synthesized, with a focus on healing time, recurrence, postoperative complications and patient-reported outcomes. Results: Midline primary closure is consistently associated with higher recurrence and complication rates and is no longer recommended. Off-midline flap techniques provide the most durable results in recurrent or complex disease. Minimally invasive approaches, including endoscopic and laser-assisted techniques, offer faster recovery and high short-term patient satisfaction in selected primary cases, but should not be considered equivalent to flap surgery in complex or recurrent PSD due to limited long-term evidence. Current guidelines uniformly advocate individualized, patient-tailored treatment strategies and discourage midline closure. Conclusions: Surgical management of PSD should be individualized according to disease complexity, prior interventions and patient expectations. While minimally invasive techniques represent an attractive option for selected primary disease, off-midline flap procedures remain the standard of care for extensive or recurrent cases. High-quality comparative studies with standardized outcome definitions and long-term follow-up are required to refine treatment algorithms.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus disease (PSD) is a common condition affecting predominantly young adults" }, { "field": "primaryOutcome", "quote": "healing time, recurrence, postoperative complications and patient-reported outcomes" }, { "field": "result", "quote": "Minimally invasive approaches, including endoscopic and laser-assisted techniques, offer faster recovery and high short-term patient satisfaction in selected primary cases" } ] }, { "id": "pmid:41880146", "pmid": "41880146", "doi": "10.1007/s13304-026-02536-7", "nctId": null, "pmcid": null, "title": "Negative pressure wound therapy in primary closure surgeries for pilonidal disease: a meta-analysis", "firstAuthor": "Martins", "multipleAuthors": true, "journal": "Updates Surg", "year": 2026, "design": "meta-analysis", "n": 479, "nField": "reported", "population": "people having surgery to close the wound after pilonidal cyst/sinus removal", "intervention": "", "comparator": "", "primaryOutcome": "time for the surgical wound to close", "result": "no significant difference was found in how long wounds took to close between groups", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "it pools only six studies with wide confidence intervals and the authors say more randomized trials are needed", "directness": "indirect", "relevanceNote": "", "limitations": "the abstract reports a comparison between NPWT and non-NPWT primary closure rather than describing the natural healing timeline, and the wound closure time estimate has a very wide confidence interval crossing zero", "followUp": "", "plainFinding": "No difference in wound closure time", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/41880146/", "sourceText": "Primary closure with negative pressure wound therapy (NPWT) has been investigated in patients with sacrococcygeal pilonidal sinus to enhance healing and reduce recurrence. To address existing controversies, we conducted a systematic review and meta-analysis comparing primary closure with NPWT versus non-NPWT (control) for treatment of pilonidal disease. PubMed, Embase, and Cochrane Library databases were searched from inception to December 2024 to identify studies comparing NPWT versus control in primary closure surgeries in pilonidal sinus. Statistical analyses were performed using R Software with a random-effects model. Six studies with a total of 479 patients were included, of whom 164 (34.2%) underwent NPWT. NPWT had an association with lower pain score 24 h postoperative (MD - 0.65 points; 95% CI - 0.81 to - 0.50), shorter return time to activities (MD - 2.57 days; 95% CI - 3.74 to - 1.4). However, there was no difference between groups in the time of wound closure (MD - 18.94; 95% CI - 41.68 to 3.80), rate of wound dehiscence (RR 1.03; 95% CI 0.50 to 2.14), hospital length of stay (MD - 3.05; 95% CI - 15.77 to 9.67), infection rates (RR 0.38; 95% CI 0.05 to 2.84), recurrence rates (RR 0.54; 95% CI 0.07 to 4.48), and pain 6 h post-operative, which showed a borderline trend favoring NPWT but did not reach statistical significance (MD - 1.19; 95% CI - 2.38 to 0.01). NPWT appears to shorten time to resume normal activities and pain 24 h postoperatively. Despite these promising results, more randomized clinical trials are needed for greater analysis.", "provenance": [ { "field": "population", "quote": "patients with sacrococcygeal pilonidal sinus" }, { "field": "n", "quote": "Six studies with a total of 479 patients were included" }, { "field": "primaryOutcome", "quote": "there was no difference between groups in the time of wound closure" }, { "field": "result", "quote": "there was no difference between groups in the time of wound closure (MD - 18.94; 95% CI - 41.68 to 3.80)" } ] }, { "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 with pilonidal sinus disease who had surgery", "intervention": "Karydakis flap surgery", "comparator": "Midline closure or excision with healing by secondary intention", "primaryOutcome": "Recurrence and infection after surgery, plus return to work and hospital stay", "result": "Karydakis flap had lower recurrence and infection rates, and patients returned to work sooner (about 6.5 days sooner than midline closure, 18.9 days sooner than excision with secondary healing); hospital stay was similar to midline closure.", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "It pools many studies with a large total number of patients, but it mixes randomized and non-randomized studies and the abstract notes no data on wound-healing time itself.", "directness": "indirect", "relevanceNote": "", "limitations": "The abstract does not report actual wound-healing duration, only return-to-work time, hospital stay, and complication rates; study quality and risk of bias of included studies are not detailed.", "followUp": "", "plainFinding": "Faster return to work with flap surgery", "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": "population", "quote": "The ideal surgical treatment for pilonidal sinus disease (PSD) is controversial." }, { "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, whereas secondary outcomes were seroma, operative time, hospital stay, overall complications, and return to work." }, { "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%)." }, { "field": "result", "quote": "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)." }, { "field": "result", "quote": "Hospital stay did not differ between KF and MC (MD - 0.08 days)." }, { "field": "n", "quote": "Fifteen studies (n = 3,108) were identified for inclusion (KF = 1,257, MC = 1,593, EHSI = 258)." } ] }, { "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": "People treated with a laser procedure (SiLaC) for primary or recurrent pilonidal sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "Time to complete wound healing after treatment", "result": "Average healing time was 46 days for first-time pilonidal disease and 56 days for recurrent disease; initial healing occurred in about 75% and 68% of patients respectively, and after repeat laser treatment when needed, over 90% eventually healed", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "Single-center retrospective cohort with good long-term follow-up (90% completion) but no comparison group or randomization, so healing-time figures could be influenced by unmeasured factors.", "directness": "direct", "relevanceNote": "", "limitations": "Retrospective design, single center, and healing time was a secondary outcome rather than the main focus of the study.", "followUp": "median of 4.0 years (IQR: 3.6-5.0 years)", "plainFinding": "Heals in about 6-8 weeks", "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": "population", "quote": "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)." }, { "field": "n", "quote": "analyzed 267 consecutive patients undergoing SiLaC" }, { "field": "primaryOutcome", "quote": "secondary outcomes included healing rates, healing time, and complications" }, { "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": "Sequential SiLaC procedures, when necessary, achieved final healing rates exceeding 90% in both groups with minimal complications (5.8%)." }, { "field": "followUp", "quote": "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)." } ] }, { "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 who had not had prior surgery for it", "intervention": "endoscopic pilonidal sinus treatment (PEPSiT)", "comparator": "", "primaryOutcome": "time to wound healing after treatment", "result": "median time to healing was 3 months, ranging from 1 to 24 months", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this is a small, single-center retrospective review of only 32 patients with no comparison group, so the healing time reported may not generalize.", "directness": "direct", "relevanceNote": "", "limitations": "retrospective design, small sample size, single surgical technique, wide range in healing time (1-24 months), authors note larger prospective studies are needed", "followUp": "Median follow-up was 9 months (1-52)", "plainFinding": "Healed in about 3 months on average", "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": "population", "quote": "None had prior surgery for PSD." }, { "field": "intervention", "quote": "Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT)" }, { "field": "primaryOutcome", "quote": "Data collected included demographics, presentation, comorbidities, BMI, surgical time, anesthesia, hospital stay, complications, healing, recurrence, and follow-up (median, range)." }, { "field": "result", "quote": "Median healing was 3 months (1-24)." }, { "field": "followUp", "quote": "Median follow-up was 9 months (1-52)." } ] }, { "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 treated for pilonidal sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "Recurrence risk and healing time as factors", "result": "The abstract does not report actual healing duration; it only states that longer healing time was associated with higher recurrence risk, without giving specific healing time figures", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective study focused on building AI prediction models for recurrence, not on directly measuring or reporting healing duration, so it offers no concrete time-to-heal data.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design; study focus is on recurrence prediction modeling, not on characterizing healing duration itself; no actual healing time values (days/weeks) are given.", "followUp": "", "plainFinding": "Healing time not reported", "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": "Among 242 patients, 59.1% underwent surgical excision" }, { "field": "primaryOutcome", "quote": "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": "result", "quote": "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." } ] }, { "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 (cyst/sinus near the tailbone) undergoing treatment", "intervention": "", "comparator": "", "primaryOutcome": "Best treatment approach and recurrence/complication rates for different types of pilonidal disease", "result": "The abstract summarizes which treatment (drainage, minimally invasive procedures, excision with or without flap) suits which stage of disease, but does not state how long healing takes for any approach", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a narrative review summarizing treatment strategies from clinical experience and literature, without original data on healing time, specific patient numbers, or follow-up duration.", "directness": "indirect", "relevanceNote": "", "limitations": "No quantitative data, no reported healing times, no patient numbers, and no follow-up duration are given; it focuses on choosing surgical strategy rather than tracking recovery time.", "followUp": "", "plainFinding": "No healing time 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": "The treatment of sacrococcygeal pilonidal disease (SPD) remains challenging due to its high recurrence rate and treatment-related complications." }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "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." } ] }, { "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 surgery (mostly male)", "intervention": "laser ablation and closure surgery for pilonidal disease", "comparator": "", "primaryOutcome": "time for the surgical wound to heal", "result": "all wounds eventually healed, with a median healing time of 35 days", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this is a single-center retrospective study of one specific surgical technique (laser ablation), not a general observation of pilonidal cyst healing across treatment types.", "directness": "indirect", "relevanceNote": "", "limitations": "retrospective design, single center, and only examines laser ablation and closure rather than the full range of treatments (drainage, excision, open wound management) covered by the question.", "followUp": "", "plainFinding": "Healed in about 5 weeks", "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": "The cohort included 313 males and 56 females, with 43 patients aged ≤18 years." }, { "field": "intervention", "quote": "laser ablation and closure for the treatment of sacrococcygeal pilonidal disease (SPD)" }, { "field": "primaryOutcome", "quote": "median wound healing time of 35 (IQR: 30, 42) days" }, { "field": "result", "quote": "The wound healing rate was 100%, with a median wound healing time of 35 (IQR: 30, 42) days." } ] }, { "id": "pmid:41340801", "pmid": "41340801", "doi": "10.20471/acc.2025.64.01.17", "nctId": null, "pmcid": "PMC12671715", "title": "LASER SURGERY FOR PILONIDAL DISEASE - A NOVEL MINIMALLY INVASIVE PROCEDURE", "firstAuthor": "Grgić", "multipleAuthors": true, "journal": "Acta Clin Croat", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal disease (cyst/sinus) in the gluteal region, mostly young men", "intervention": "", "comparator": "", "primaryOutcome": "", "result": "The abstract reviews pilonidal disease and its treatment options but does not report how long healing takes after any treatment; it only states the authors will present their experience with laser treatment, without giving outcome data.", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "This is a background/review piece introducing treatment options and mentioning the authors' laser experience, but it reports no data on healing time, number of patients, or outcomes.", "directness": "indirect", "relevanceNote": "", "limitations": "No outcome data, healing times, follow-up duration, or patient numbers are given; the abstract is largely a general review of pilonidal disease treatments.", "followUp": "", "plainFinding": "Healing time not reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41340801/", "sourceText": "Pilonidal disease (PD) is a common inflammatory disease of the gluteal region with an incidence of 26/100000 and usually occurs in young males (15-30 years old). The etiology of pilonidal disease is unclear, but literature describes a wide range of factors such as keratin plugs, foreign substance reaction related to hairs, as well as dermatopathy and debris in hair follicles in the natal cleft. PD and also its classic treatment can cause discomfort and very much deteriorate the patient's quality of life. There are many possibilities (conservative or surgical) in the treatment of pilonidal disease, but there is no gold standard. In the acute phase (abscess), surgical incision with pus evacuation and antibiotic therapy is enough. In the chronic phase, there are many possibilities like phenol treatment, surgical excision with lay open and secondary wound healing. There are many reconstructive techniques such as Karydakis, V-Y flap or Limberg flap. A recently minimally invasive technique such as endoscopic surgical procedure or filling pilonidal tract with fibrin glue or phenol have been introduced. We present our experience with laser treatment (Biolitec, Germany) of pilonidal sinus disease.", "provenance": [ { "field": "population", "quote": "Pilonidal disease (PD) is a common inflammatory disease of the gluteal region with an incidence of 26/100000 and usually occurs in young males (15-30 years old)." }, { "field": "intervention", "quote": "We present our experience with laser treatment (Biolitec, Germany) of pilonidal sinus disease." }, { "field": "result", "quote": "We present our experience with laser treatment (Biolitec, Germany) of pilonidal sinus disease." } ] }, { "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 who had pilonidal sinus disease treated with a combined laser and pit excision procedure", "intervention": "combined diode laser ablation with pit excision surgery for pilonidal sinus", "comparator": "", "primaryOutcome": "recurrence, treatment success, and delayed healing (wound not closed within 30 days or still draining after 14 days)", "result": "About 1 in 5 patients (20.5%, 8/39) had delayed healing, and older age was linked to longer recovery time; overall follow-up averaged about 13.6 months with 84.6% treatment success and 15.4% recurrence", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a small, single-center retrospective study of a specific combined technique, so it gives only limited and uncertain information about how long healing typically takes.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, modest sample size (39 patients in main analysis), single center, and the study evaluates a specific minimally invasive combined technique rather than standard treatments like simple incision/drainage or open wound care.", "followUp": "13.6 ± 3.6 months", "plainFinding": "Most healed on time, some delayed", "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": "population", "quote": "Fifty-four adults were treated consecutively, and the primary analysis included 39 patients who 6month patientreported outcomes" }, { "field": "intervention", "quote": "diode laser ablation combined with pit excision for pilonidal sinus disease" }, { "field": "primaryOutcome", "quote": "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." }, { "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)." }, { "field": "result", "quote": "Age was associated with a longer recovery time (p = 0.002)." }, { "field": "n", "quote": "the primary analysis included 39 patients" } ] }, { "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": "adults with pilonidal sinus disease treated with either laser or phenol", "intervention": "diode laser ablation of the sinus", "comparator": "crystallized phenol application", "primaryOutcome": "how fast the wound healed and patients returned to normal activity", "result": "Laser treatment led to faster complete healing but delayed return to daily activities, while phenol allowed quicker return to daily life but slower complete healing; recovery and recurrence rates were similar (85%-86%) between groups", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "It is a retrospective multicentre study with propensity-score matching, which reduces but does not eliminate bias from a non-randomised design.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, no randomisation, and the treatments compared (laser and phenol) are minimally invasive options rather than the drainage, excision, or open wound management specified in the question.", "followUp": "Median follow-up was 45 months (laser) and 40 months (phenol)", "plainFinding": "Laser healed faster; phenol let people 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": "In this multicentre retrospective cohort study (Nov. 2017-Sep. 2024), patients treated with laser or phenol were included." }, { "field": "intervention", "quote": "This study compared short- and long-term outcomes of laser versus phenol treatment in PSD." }, { "field": "comparator", "quote": "This study compared short- and long-term outcomes of laser versus phenol treatment in PSD." }, { "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": "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%)." }, { "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": "narrative-review", "n": null, "nField": "not-reported", "population": "people who have been treated for pilonidal cysts with either traditional surgery or laser methods", "intervention": "", "comparator": "", "primaryOutcome": "how quickly the wound heals after treatment", "result": "Traditional surgical techniques were linked to extended healing periods, while laser techniques showed healing rates up to 97% with shorter hospital stays", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a general comparative literature review without stated search criteria, pooled statistics, or exact healing-time data, so it gives only a rough picture.", "directness": "indirect", "relevanceNote": "", "limitations": "No systematic methodology, inclusion criteria, or quantitative healing-time data are given; review notes more research is needed for long-term outcomes.", "followUp": "", "plainFinding": "Traditional surgery heals slower than laser.", "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": "studies comparing traditional surgical techniques including traditional excision with open and closed healing, flap reconstructions, with minimally invasive procedures focusing on laser-assisted" }, { "field": "primaryOutcome", "quote": "focusing on each method's effectiveness, recovery time, recurrence rates, complications, cosmetics, and costs" }, { "field": "result", "quote": "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." }, { "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%." } ] }, { "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": "people who had surgery for pilonidal sinus disease in Western Australia, surveyed about a decade later", "intervention": "", "comparator": "", "primaryOutcome": "time to return to normal function/work and other patient-reported outcomes after pilonidal surgery", "result": "Healing/recovery time varied by surgical technique: median return-to-work was 14 days for modified Limberg flap and 21 days for other flap techniques, compared to 60 days for secondary intention healing (open wound) techniques; secondary intention healing also had the highest recurrence (52.2%) and surgical site infection (30.4%) rates.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "It is a retrospective survey using mail questionnaires and phone interviews years after surgery, with a modest sample split across six technique groups, so recall bias and small subgroup sizes limit confidence.", "directness": "direct", "relevanceNote": "", "limitations": "Retrospective design, reliance on patient recall via mail/phone survey conducted years after treatment, and small numbers within each of the six surgical technique subgroups.", "followUp": "decade follow-up", "plainFinding": "Recovery time ranged 14 to 60 days by technique.", "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": "a multi-centre retrospective decade follow-up review of definitive SPD surgery participants from Western Australia" }, { "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." }, { "field": "followUp", "quote": "a multi-centre retrospective decade follow-up review" } ] }, { "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": "adults with complex or recurrent pilonidal cyst/sinus disease who had surgery combining intraoperative ultrasound with EPSiT", "intervention": "", "comparator": "", "primaryOutcome": "how many wounds healed completely versus recurred or stayed unhealed by 36 months", "result": "at 36 months, 5 of 19 patients (26.3%) had disease persistence (recurrence or incomplete healing); all of those were later healed with further treatment, giving 100% eventual healing after reintervention", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this was a small, single-center, retrospective study of only 19 patients with no comparison group, so it gives a rough idea at best of how healing unfolds over time.", "directness": "indirect", "relevanceNote": "", "limitations": "small sample size (19 patients), single center, retrospective design, focused specifically on a surgical technique (ultrasound-guided EPSiT) in complex/recurrent cases rather than general pilonidal healing time", "followUp": "36 months", "plainFinding": "Most healed by 3 years, some needed more surgery", "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 using IUS in conjunction with EPSiT" }, { "field": "primaryOutcome", "quote": "clinical outcomes including 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": "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": "adults who had surgery for pilonidal sinus disease", "intervention": "square excision and transposition flap (SF) surgical technique", "comparator": "modified Limberg flap (LF) surgical technique", "primaryOutcome": "time for the wound to heal after surgery", "result": "patients who had the SF technique healed in about 11 days, faster than those who had the modified Limberg flap", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this is a retrospective comparison of two surgical techniques without randomization, so differences could be due to other factors between groups.", "directness": "direct", "relevanceNote": "", "limitations": "retrospective design, no randomization mentioned, single comparison of two surgical flap methods rather than a general study of healing after any pilonidal treatment", "followUp": "6-month follow-up", "plainFinding": "Healed in about 11 days with newer flap technique", "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": "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": "healing time" }, { "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": "n", "quote": "SF (53 patients) and LF (49 patients) groups" } ] }, { "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 teenagers who had surgery for pilonidal sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "hospital stay length, recurrence, and return to daily life after surgery", "result": "Hospital stay was shorter and return to social life was faster in the PRP-assisted endoscopic group, but the abstract does not give an exact number of days or weeks for the cyst/wound to fully heal; recurrence at 1 year was 13.7% vs 9.7% (not significant)", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this is a retrospective comparison of two historical patient groups treated years apart at one hospital, not a randomized study, so it cannot reliably establish healing time.", "directness": "indirect", "relevanceNote": "", "limitations": "retrospective design, two different time periods compared, small sample size, short-term follow-up only, no randomization", "followUp": "1 year", "plainFinding": "No exact healing time reported", "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": "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." }, { "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)." } ] }, { "id": "pmid:40613434", "pmid": "40613434", "doi": "10.1177/17455057251351739", "nctId": null, "pmcid": "PMC12227909", "title": "A scoping review on clinicopathological characteristics, diagnosis, and management of intermammary pilonidal sinus disease", "firstAuthor": "Wijekoon", "multipleAuthors": true, "journal": "Womens Health (Lond)", "year": 2025, "design": "systematic-review", "n": 33, "nField": "reported", "population": "young people with pilonidal sinus disease located between the breasts (intermammary), not the usual tailbone area", "intervention": "", "comparator": "", "primaryOutcome": "how the disease presented, was diagnosed, and treated (not specifically healing time after treatment)", "result": "The review found a mean symptom duration of 8 months before diagnosis, but it did not report how long wounds took to heal after surgery or drainage", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "This is a scoping review pooling only 10 small case reports/series on a rare condition, with no healing-time outcome tracked and high risk of selection bias.", "directness": "indirect", "relevanceNote": "", "limitations": "Very small number of studies and patients, heterogeneous case reports, no standardized follow-up or healing-time measurement, and the condition studied (intermammary location) differs from the typical sacrococcygeal pilonidal cyst.", "followUp": "", "plainFinding": "No healing-time data reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40613434/", "sourceText": "BACKGROUND: Intermammary pilonidal sinus disease (IMPSD) is a rare condition that primarily affects the young population. Due to the absence of standardized guidelines, IMPSD poses significant challenges during management. OBJECTIVES: This scoping review aims to map and characterize the existing literature on IMPSD to provide an overview of clinicopathological characteristics, risk factors, diagnosis, and management. ELIGIBILITY CRITERIA: Studies were included if they were original articles, case reports, or case series that met the inclusion criteria published in English during 2004 to 2024. SOURCES OF EVIDENCE: A search was conducted using MeSH keywords \"Intermammary\" AND \"Pilonidal sinus\" in PubMed, Google Scholar, and by citation searching up to date. CHARTING METHODS: The PRISMA ScR guidelines were used as a charting method. Data extraction included demographic characteristics, clinical pathological characteristics, diagnostic methods, treatment approaches, and follow-up outcomes. RESULTS: Ten articles met the inclusion criteria, including 33 patients with a mean age of 18.7 years. The majority of cases were reported from Turkey, Iraq, and India. Mean body mass index was 28.74 kg/m2. Significant other comorbidities included polycystic ovary syndrome in 24% of cases. Large pendulous breasts and wearing tight brassieres were noted as other risk factors. Clinical presentation commonly involved discharging sinuses and painful swellings, with a mean duration of 8 months. Complementary investigations were seldom performed as the diagnosis was mainly clinical. The main modes of treatment included resection with primary closure or resection with secondary healing. CONCLUSION: Low prevalence and management challenges highlight the need for further research to establish standardized guidelines and the importance of formulating an individualized plan for the management of IMPSD based on a comprehensive evaluation of clinicopathological characteristics and patient wishes.", "provenance": [ { "field": "population", "quote": "Intermammary pilonidal sinus disease (IMPSD) is a rare condition that primarily affects the young population." }, { "field": "n", "quote": "Ten articles met the inclusion criteria, including 33 patients with a mean age of 18.7 years." }, { "field": "primaryOutcome", "quote": "Data extraction included demographic characteristics, clinical pathological characteristics, diagnostic methods, treatment approaches, and follow-up outcomes." }, { "field": "result", "quote": "Clinical presentation commonly involved discharging sinuses and painful swellings, with a mean duration of 8 months." }, { "field": "intervention", "quote": "The main modes of treatment included resection with primary closure or resection with secondary healing." } ] }, { "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 and older with pilonidal sinus disease treated with phenol applications", "intervention": "crystallised phenol applications (4-9 sessions) for pilonidal sinus", "comparator": "", "primaryOutcome": "treatment success, recurrence and complications after phenol treatment", "result": "Treatment success in 92.45% of patients after 4-9 phenol sessions (mean 4.84), with 1.9% recurrence and 5.7% needing surgery over 3-year follow-up; the abstract does not state how many days or weeks it took for the sinus to heal.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a small retrospective case series without a comparison group, so it can give only a rough sense of treatment outcomes, not a reliable healing timeline.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, no control group, no explicit report of time-to-healing (only number of treatment sessions and follow-up duration), small sample size.", "followUp": "3-year follow-up", "plainFinding": "No clear healing-time reported", "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": "population", "quote": "We retrospectively evaluated 53 patients (43 male, 10 female) aged ≥ 18 years who received 4-9 crystallised phenol applications for pilonidal sinus disease." }, { "field": "intervention", "quote": "crystallised phenol applications" }, { "field": "n", "quote": "We retrospectively evaluated 53 patients (43 male, 10 female) aged ≥ 18 years" }, { "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": "People with recurrent pilonidal sinus disease treated with laser ablation", "intervention": "", "comparator": "", "primaryOutcome": "Time to complete wound healing", "result": "Median wound healing time was 35 days; 70.3% healed completely without recurrence, 21.6% had recurrence over a mean 9.6 month follow-up", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a small, retrospective study of one specific treatment (laser ablation) without a comparison group, so it only loosely reflects general healing time after pilonidal treatment.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, no control group, small sample size (37 patients), and findings specific to laser ablation rather than standard treatments like excision or incision and drainage.", "followUp": "9.6 months", "plainFinding": "Healed in about 5 weeks.", "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": "population", "quote": "37 patients with recurrent pilonidal sinus disease treated with laser ablation between January 2022 and January 2025" }, { "field": "primaryOutcome", "quote": "healing time, Visual Analog Scale values, and return to normal activities were collected" }, { "field": "result", "quote": "The median time for wound healing was 35 days" }, { "field": "result", "quote": "70.3% of patients achieved complete healing without recurrence, while 21.6% experienced recurrence within a mean follow-up of 9.6 months" }, { "field": "n", "quote": "A retrospective analysis of 37 patients with recurrent pilonidal sinus disease" } ] }, { "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": "registry", "n": 405, "nField": "reported", "population": "adults who had surgery for chronic pilonidal sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "time until the wound healed after surgery", "result": "Wound healing took a median of 41 days after minimally invasive surgery versus 78 days after excision with open healing, and return to daily activities took a median of 14 days with minimally invasive techniques; overall follow-up was a median of 42 days.", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "It is a large nationwide observational audit with real-world numbers, but follow-up was short (median 42 days) and treatment was not randomized, so healing times may not reflect eventual full healing or be fully comparable between groups.", "directness": "direct", "relevanceNote": "", "limitations": "Short median follow-up of 42 days, non-randomized comparison of techniques, and wound healing rates were still well under 50% at the time of assessment, so full healing times may be underestimated.", "followUp": "42 days", "plainFinding": "Healing took 6-11 weeks depending on surgery type.", "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": "population", "quote": "All patients with PSD and who underwent surgery were included during a 3-month inclusion period" }, { "field": "n", "quote": "405 patients had chronic disease" }, { "field": "primaryOutcome", "quote": "Secondary endpoints included symptoms, complications, recurrent open wounds, wound healing rate, time to wound healing, time to resume daily activities" }, { "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. They also had the shortest median time to resume daily activities (14 days)." }, { "field": "followUp", "quote": "The median follow-up period was 42 days." } ] }, { "id": "pmid:40378664", "pmid": "40378664", "doi": "10.1016/j.jss.2025.04.010", "nctId": null, "pmcid": null, "title": "Evaluating Outcomes in Adolescents With Pilonidal Disease Treated With Pilonidal Sinus Trephination", "firstAuthor": "Bergus", "multipleAuthors": true, "journal": "J Surg Res", "year": 2025, "design": "retrospective", "n": 63, "nField": "reported", "population": "adolescents and young adults (10-21 years old) with chronic pilonidal disease treated with trephination surgery", "intervention": "", "comparator": "", "primaryOutcome": "wound healing by 60 days and disease recurrence by 12 months after trephination surgery", "result": "Wound healing was delayed in about 1 in 5 patients (20.5%), and 1 in 4 patients (25.0%) had the disease come back within a year; non-White race was linked to higher rates of both delayed healing and recurrence", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a single-center retrospective chart review without a comparison group, so it cannot reliably establish typical healing timelines beyond this specific surgical approach and population.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, single tertiary pediatric hospital, no control group, and focuses specifically on trephination surgery outcomes rather than general healing course after any treatment type.", "followUp": "12 mo", "plainFinding": "Most healed by 60 days; 1 in 4 recurred", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40378664/", "sourceText": "INTRODUCTION: Pilonidal disease is a common chronic infectious process caused by entrapment of hair follicles in the gluteal cleft that can be managed with conservative therapies or operative intervention, including pilonidal sinus trephination. While trephination has been found to be safe and effective in adults, outcomes in adolescents are limited. This study investigated wound healing and 1-y disease recurrence in adolescents after trephination. METHODS: We retrospectively reviewed patients aged 10-21 y who underwent trephination at our tertiary care pediatric hospital between November 2019 and November 2022. Patient demographics, treatment history, operative management, and clinical outcomes up to 12 mo postoperatively were collected. We performed Firth penalized logistic regression to identify independent predictors of healing at 60 d and recurrence by 12 mo. RESULTS: Among 63 patients, the median age at the time of index operation was 16.5 y. Most patients were male (52.4%), and most were White (73.0%). At the time of initial clinic intake, all patients had a current or prior chronic gluteal cleft fistula and/or pilonidal sinus, and 93.7% had experienced ≥1 flare of pilonidal disease. Patients more commonly underwent trephination for a chronic wound than active disease (81.0% versus 19.0%). Nearly half of patients had at least one fistula present (49.2%) and a median of three pits. Wound healing was delayed in 20.5% and was associated with non-White race (odds ratio 7.31, 95% confidence interval 1.68, 31.85) but not Fitzpatrick skin type (P = 0.29) in univariable analysis. Recurrence at 1 y was 25.0% and was also associated with non-White race (odds ratio 8.85, 95% confidence interval 2.02, 38.71) but not Fitzpatrick skin type (P = 0.10) in univariable analysis. CONCLUSIONS: Pilonidal sinus trephination may be an appropriate surgical option for select adolescents with chronic, fistulous pilonidal disease. Further research is needed to determine if race and ethnicity are associated with healing complications and recurrence of pilonidal disease.", "provenance": [ { "field": "population", "quote": "We retrospectively reviewed patients aged 10-21 y who underwent trephination at our tertiary care pediatric hospital between November 2019 and November 2022." }, { "field": "n", "quote": "Among 63 patients, the median age at the time of index operation was 16.5 y." }, { "field": "primaryOutcome", "quote": "This study investigated wound healing and 1-y disease recurrence in adolescents after trephination." }, { "field": "result", "quote": "Wound healing was delayed in 20.5% and was associated with non-White race" }, { "field": "result", "quote": "Recurrence at 1 y was 25.0% and was also associated with non-White race" }, { "field": "followUp", "quote": "Patient demographics, treatment history, operative management, and clinical outcomes up to 12 mo postoperatively were collected." } ] }, { "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 treated with phenol instead of surgery", "intervention": "crystallized phenol application", "comparator": "liquid phenol application", "primaryOutcome": "recovery rate, complications, and recurrence after treatment", "result": "After 1 year, 90% of patients treated with crystallized phenol and 95% treated with liquid phenol had improved, with no significant difference in recovery or recurrence between the two forms, though early complications were more common with liquid phenol.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a small, single-center retrospective study of only 80 patients comparing two phenol forms, which limits how confidently its healing timeline can be generalized.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, small sample size, single center, and the treatment studied (phenol application) is a non-surgical alternative rather than standard excision, drainage, or open wound management.", "followUp": "1st year", "plainFinding": "Most improved within a year.", "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": "n", "quote": "Eighty patients were included in the study: 40 treated with crystallized phenol and 40 with liquid phenol." }, { "field": "population", "quote": "Pilonidal sinus is a frequently observed disease in young adult male patients." }, { "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": "meta-analysis", "n": null, "nField": "not-reported", "population": "people who had surgery to remove a pilonidal sinus/cyst", "intervention": "negative pressure wound therapy (NPWT) used on the wound after excision", "comparator": "other types of wound dressings after excision", "primaryOutcome": "time for the wound to heal (plus recurrence, pain, satisfaction)", "result": "unclear whether NPWT changes healing time compared with other dressings; evidence rated very low certainty", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "the review itself says the certainty of the evidence across the 10 included studies was very low, so the findings cannot be trusted as a reliable estimate of healing time.", "directness": "indirect", "relevanceNote": "", "limitations": "small, mixed-design studies (RCTs, retrospective, cohort, pre-post) with very low certainty of evidence; does not report natural healing time without regard to dressing type", "followUp": "", "plainFinding": "Unclear how long healing takes", "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": "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." } ] }, { "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": "Six articles published between 2018 and 2023, including 595 patients were included in the present systematic review.", "intervention": "All of these studies presented endoscopic pilonidal sinus treatment (EPSIT) as the minimally invasive surgical technique for the treatment of pilonidal disease", "comparator": "413 (69.4%) underwent excision and wound closure (Group B)", "primaryOutcome": "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).", "result": "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).", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a review of only six studies with pooled averages rather than a formal meta-analysis, so the healing-time estimates may be affected by differences between the original studies.", "directness": "direct", "relevanceNote": "", "limitations": "Only six studies included, and the abstract does not describe formal statistical pooling or detailed assessment of study quality.", "followUp": "", "plainFinding": "Healing took about 40 to 48 days.", "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": "Six articles published between 2018 and 2023, including 595 patients were included in the present systematic review." }, { "field": "population", "quote": "Six articles published between 2018 and 2023, including 595 patients were included in the present systematic review." }, { "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": "413 (69.4%) underwent excision and wound closure (Group B)." }, { "field": "primaryOutcome", "quote": "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)." }, { "field": "result", "quote": "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": "Adults with simple pilonidal sinus undergoing surgical treatment", "intervention": "Laser therapy (SiLaT) for pilonidal sinus", "comparator": "Lay-open (sinotomy) technique for pilonidal sinus", "primaryOutcome": "Time for the wound to heal after treatment", "result": "Wound healing was much faster with laser treatment (about 10 days) than with the open wound technique (about 34 days)", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This was a small trial of only 40 patients from one study, looking only at early outcomes, so it may not reflect longer-term healing or apply broadly.", "directness": "indirect", "relevanceNote": "This study compares two different treatments (laser therapy versus lay-open technique) to determine which heals faster, rather than describing how long a pilonidal cyst takes to heal after treatment in general.", "limitations": "Small sample size (40 patients), only early postoperative outcomes assessed, no mention of blinding, long-term follow-up not reported.", "followUp": "", "plainFinding": "Healing took about 10 days with laser, 34 days with open wound.", "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": "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": "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)." }, { "field": "population", "quote": "Pilonidal sinus (PS) predominantly impacts adolescent and young adult males." } ] }, { "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 who had surgery for pilonidal sinus disease", "intervention": "laser ablation combined with sinus curettage", "comparator": "sinus curettage alone", "primaryOutcome": "wound healing problems and recurrence after surgery", "result": "No significant difference between the laser+curettage group and curettage-only group in wound healing problems at 30 days or recurrence at 6 months; the abstract does not state an average time to full healing.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "Small randomized trial (40 per group) that compares two surgical techniques and only reports whether healing problems occurred by fixed checkpoints, not how long healing actually took.", "directness": "indirect", "relevanceNote": "", "limitations": "The abstract reports binary wound-healing/recurrence outcomes at 30 days and 6 months rather than actual healing duration, and compares two treatment approaches rather than describing the natural course of healing.", "followUp": "6 months", "plainFinding": "No healing-time data given.", "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": "population", "quote": "This study included patients diagnosed with PSD between February 2019, and September 2022." }, { "field": "intervention", "quote": "laser + curettage (L/C; n = 40) group" }, { "field": "comparator", "quote": "curettage-only (C; n = 40) group" }, { "field": "primaryOutcome", "quote": "wound healing problems within 30 days postoperatively, and recurrence within 6 months postoperatively" }, { "field": "result", "quote": "The groups had similar results for postoperative pain, discharge, bleeding, wound healing problems at 30 days, and recurrence at 6 months." }, { "field": "n", "quote": "laser + curettage (L/C; n = 40) group or the curettage-only (C; n = 40) group" } ] }, { "id": "pmid:40056380", "pmid": "40056380", "doi": "10.12968/jowc.2021.0250", "nctId": null, "pmcid": null, "title": "Vacuum-assisted closure in secondary wound healing after pilonidal sinus surgery", "firstAuthor": "Hüseyin", "multipleAuthors": true, "journal": "J Wound Care", "year": 2025, "design": "retrospective", "n": 60, "nField": "reported", "population": "patients who had surgery (lay-open excision) for pilonidal sinus disease", "intervention": "vacuum-assisted closure wound care after surgery", "comparator": "standard open wound care after surgery", "primaryOutcome": "time to complete wound healing", "result": "Wound healing took much longer with standard open wound care (about 67.6 days) than with vacuum-assisted closure (about 21.5 days)", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "It is a small, single-center retrospective study of only 30 patients per group, so the healing times it reports may not apply widely.", "directness": "indirect", "relevanceNote": "Tests whether vacuum-assisted closure speeds up healing compared to standard wound care after pilonidal surgery, rather than measuring natural healing time after the standard treatment alone.", "limitations": "Retrospective analysis, single center, small sample size, and the abstract calls for larger prospective studies to confirm the findings.", "followUp": "", "plainFinding": "Standard care heals in about 10 weeks.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40056380/", "sourceText": "OBJECTIVE: This study evaluated the utility of vacuum-assisted closure (VAC) in comparison to standard open wound care in patients operated for pilonidal sinus disease (PSD). METHOD: Patients with PSD who underwent standard pilonidal sinus excision-lay open technique/surgery in the Altınbas University School of Medicine Bahcelievler Medical Park Hospital, Istanbul, Turkey, between May 2015 and May 2018, were included in this study. A retrospective analysis of prospectively collected data was performed. The patients were divided into two groups according to the type of wound care, including the vacuum-assisted closure group (n=30, postoperative vacuum-assisted closure application) and the control group (n=30, standard open wound care). Wound size, postoperative infection rates and wound healing times were compared between study groups. RESULTS: The experimental cohort included 60 patients. There was no statistically significant difference between vacuum-assisted closure and the control groups in terms of preoperative and postoperative infection rates (p>0.05). The total recovery time (time to complete wound healing) was significantly shorter in the vacuum-assisted closure group compared with the control group (21.47±4.38 days versus 67.60±7.83 days, p=0.001). CONCLUSION: The findings of this study emphasise that the use of vacuum-assisted closure in PSD patients treated with the lay-open technique seems notable in terms of its potential to shorten the otherwise longer secondary recovery time and thus enables the consideration of the lay-open technique once again among the most preferable methods. However, there is a need for larger scale prospective studies addressing the utility of vacuum-assisted closure in patients with PSD to validate these findings.", "provenance": [ { "field": "n", "quote": "The experimental cohort included 60 patients." }, { "field": "population", "quote": "Patients with PSD who underwent standard pilonidal sinus excision-lay open technique/surgery" }, { "field": "intervention", "quote": "the vacuum-assisted closure group (n=30, postoperative vacuum-assisted closure application)" }, { "field": "comparator", "quote": "the control group (n=30, standard open wound care)" }, { "field": "primaryOutcome", "quote": "wound healing times were compared between study groups" }, { "field": "result", "quote": "The total recovery time (time to complete wound healing) was significantly shorter in the vacuum-assisted closure group compared with the control group (21.47±4.38 days versus 67.60±7.83 days, p=0.001)." } ] }, { "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 who had surgery for pilonidal sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "time to resume normal activities and complications after surgery (pain-free sitting, walking, return to work, recurrence)", "result": "Recovery times varied by surgical technique: laser pilonidotomy patients had shortest hospital stay (8 hours), fastest pain-free sitting/walking and return to work; primary midline closure had higher complication and recurrence rates and slower return to normal activity", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective chart review comparing different surgical techniques, not a controlled study of natural healing time, so it only loosely estimates how long healing takes.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, no randomization, groups not matched, and specific day/week healing times not clearly reported beyond return-to-activity measures.", "followUp": "", "plainFinding": "Healing time varies by surgery type.", "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": "population", "quote": "adult patients with pilonidal sinus disease" }, { "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": "result", "quote": "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)." }, { "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": "primaryOutcome", "quote": "Pain-free toilet sitting time, pain-free walking time, and return to work time were statistically significantly shorter in the LP group" } ] }, { "id": "pmid:39982788", "pmid": "39982788", "doi": "10.1097/DCR.0000000000003688", "nctId": null, "pmcid": null, "title": "Outcome After Surgical Treatment for Chronic Pilonidal Sinus Disease: A Systematic Review of Common Surgical Techniques", "firstAuthor": "Wiinblad", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2025, "design": "meta-analysis", "n": 5762, "nField": "reported", "population": "adults and teenagers who had surgery for long-standing (chronic) pilonidal sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "how long the wound took to heal after different types of surgery", "result": "Open wounds left to heal on their own (secondary healing) took significantly longer to heal than any of the flap or closure operations, but no specific healing times in days or weeks were given", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "the included trials were mostly small, short follow-up, and rated high or medium risk of bias, giving only low to very low certainty for this outcome.", "directness": "indirect", "relevanceNote": "", "limitations": "Most studies had a high or medium risk of bias, resulting in very low to low certainty of evidence. The trials generally had small numbers, short follow-ups, and no reported primary outcomes or power calculations.", "followUp": "", "plainFinding": "Open wound healing takes longer than flap surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39982788/", "sourceText": "BACKGROUND: The choice of operation for chronic pilonidal sinus disease remains controversial. OBJECTIVE: To compare the outcomes of common operations for chronic pilonidal disease. DATA SOURCES: We searched PubMed, Embase, and the Cochrane Library. STUDY SELECTION: We included randomized trials in English or Danish language, published 2002 to 2024 that compared outcomes of operations to treat chronic pilonidal disease in adults and teenagers. INTERVENTIONS: We compared the outcomes of secondary healing, primary midline closure, Bascom, Limberg, and Karydakis flap operations. MAIN OUTCOME MEASURES: The primary outcome was recurrence; secondary outcomes were infection, healing time, and length of stay. We compared recurrence and infection rates in meta-analyses for all techniques. We assessed the risk of bias and the quality of all trials. RESULTS: Fifty trials included a total of 5762 participants. In a meta-analysis, the flap operations had fewer recurrences than primary midline closure (OR 0.31; 95% CI, 0.19-0.51; p < 0.01). The trials comparing flap operations with secondary healing were heterogeneous and did not reach significance (OR 0.38; 95% CI, 0.13-1.13; p = 0.08). Recurrence was similar between Limberg and Karydakis operations. Infection rates were lower for the flap operations compared with primary closure (OR 0.33; 95% CI, 0.23-0.48; p < 0.01) and with secondary healing (OR 0.48; 95% CI, 0.30-0.77; p < 0.01). Two trials tested Bascom procedure against Limberg operation without significant differences. All trials found secondary healing to have significantly longer healing times than any other operation. LIMITATIONS: Most studies had a high or medium risk of bias, resulting in very low to low certainty of evidence. The trials generally had small numbers, short follow-ups, and no reported primary outcomes or power calculations. CONCLUSIONS: Primary closure and secondary healing performed poorly compared with the flap techniques. Most trials tested Limberg operation; only 2 tested Bascom operation. The literature suggests the surgeon's expertise determines the choice of flap technique.", "provenance": [ { "field": "n", "quote": "Fifty trials included a total of 5762 participants." }, { "field": "population", "quote": "compared outcomes of operations to treat chronic pilonidal disease in adults and teenagers" }, { "field": "primaryOutcome", "quote": "secondary outcomes were infection, healing time, and length of stay" }, { "field": "result", "quote": "All trials found secondary healing to have significantly longer healing times than any other operation." }, { "field": "qualityWhy", "quote": "Most studies had a high or medium risk of bias, resulting in very low to low certainty of evidence." } ] }, { "id": "pmid:39969579", "pmid": "39969579", "doi": "10.1007/s00384-025-04832-x", "nctId": null, "pmcid": "PMC11839847", "title": "Efficacy and safety of laser ablation for recurrent pilonidal sinus: a systematic review and meta‑analysis", "firstAuthor": "Qin", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2025, "design": "meta-analysis", "n": 137, "nField": "reported", "population": "people with recurrent pilonidal sinus after previous surgery", "intervention": "laser ablation of the sinus tract", "comparator": "", "primaryOutcome": "rate of wound healing after treatment", "result": "pooled healing rate was 81.9%; it was higher (87.2%) in studies following patients 12 months or less, and lower (74.5%) in studies following patients longer than 12 months", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this is a meta-analysis of only seven small studies on a specific treatment (laser ablation) for recurrent disease, with high heterogeneity and no comparison group, so it speaks narrowly to this technique rather than to pilonidal healing in general", "directness": "indirect", "relevanceNote": "", "limitations": "high statistical heterogeneity, no randomized trials, single-arm follow-up data, population limited to recurrent (not primary) pilonidal sinus, and treatment limited to laser ablation rather than standard surgical or drainage approaches", "followUp": "12 months or less; exceeding 12 months", "plainFinding": "Mostly healed, but fewer over time", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39969579/", "sourceText": "BACKGROUND: Recurrence remains a significant challenge following the surgical treatment of sacrococcygeal pilonidal sinus. Unlike patients with primary pilonidal sinus, those with recurrent cases often present with more complex sinus tracts, and scarring from previous surgeries increases the complexity of subsequent procedures. Therefore, selecting the appropriate surgical method for patients with recurrent pilonidal sinus requires greater caution. It is essential to reassess these patients to determine whether surgical techniques suitable for primary pilonidal sinus are equally effective for recurrent cases. Laser ablation, an innovative and minimally invasive technique, has emerged as a promising option for managing pilonidal sinus. This procedure uses a circular laser at the tip of a catheter to deliver energy, effectively destroying and ablating the sinus tract while promoting its closure. Previous studies have demonstrated the safety and efficacy of laser ablation in treating primary pilonidal sinus. The objective of this systematic review and meta-analysis is to assess the efficacy and safety of laser ablation in the management of recurrent pilonidal sinus. METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was carried out using PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov. Additionally, the references of all retrieved studies were screened to identify further eligible data. The search included studies published up to June 11, 2024. The primary outcome measure was the healing rate after laser ablation, which served as the metric for evaluating the efficacy of this technique in treating recurrent pilonidal sinus. Secondary outcome measures included the incidence of severe postoperative complications, which were assessed to determine the safety profile of laser ablation. According to the Clavien-Dindo classification of postoperative complications, we define severe complications as those classified as grade IIIb or higher. RESULT: A total of seven studies were included in this meta-analysis. With the exception of one study published in 2018, the remaining six were published within the past 3 years. Two studies originated from Middle Eastern countries, while the other five were from European countries. In total, 137 patients with recurrent pilonidal sinus were included, of whom 112 achieved healing following laser ablation treatment. The pooled healing rate across these studies was 81.9% (95% CI, 65.4-94.6%; I2 = 69.12%; p < 0.01). A subgroup analysis based on follow-up duration was also performed. The pooled healing rate for studies with a follow-up period of 12 months or less was 87.2% (95% CI, 63.2-100%; I2 = 78.57%; p < 0.01), while for studies with a follow-up duration exceeding 12 months, the pooled healing rate was 74.5% (95% CI, 51.5-92.7%; I2 = 47.48%; p = 0.15). In addition, five studies performed pit picking before laser ablation, while two studies did not. We conducted a subgroup analysis based on whether pit picking was performed before laser ablation. The results of the subgroup analysis indicated that the difference in efficacy between combined pit picking and laser ablation alone was not statistically significant (random effects model, p = 0.75). This suggests that both treatment methods may have similar effectiveness in the management of recurrent pilonidal sinus disease. CONCLUSIONS: This meta-analysis demonstrates that laser ablation is an effective and safe method for the treatment of recurrent sacrococcygeal pilonidal sinus in the short term. However, the findings indicate a trend toward a lower healing rate with extended follow-up periods. To better assess the long-term efficacy of laser ablation in managing recurrent pilonidal sinus, high-quality randomized controlled trials with extended follow-up durations are necessary.", "provenance": [ { "field": "population", "quote": "137 patients with recurrent pilonidal sinus were included" }, { "field": "intervention", "quote": "laser ablation treatment" }, { "field": "primaryOutcome", "quote": "The primary outcome measure was the healing rate after laser ablation" }, { "field": "result", "quote": "The pooled healing rate across these studies was 81.9% (95% CI, 65.4-94.6%; I2 = 69.12%; p < 0.01)." }, { "field": "result", "quote": "The pooled healing rate for studies with a follow-up period of 12 months or less was 87.2% (95% CI, 63.2-100%; I2 = 78.57%; p < 0.01), while for studies with a follow-up duration exceeding 12 months, the pooled healing rate was 74.5% (95% CI, 51.5-92.7%; I2 = 47.48%; p = 0.15)." }, { "field": "n", "quote": "In total, 137 patients with recurrent pilonidal sinus were included, of whom 112 achieved healing following laser ablation treatment." } ] }, { "id": "pmid:39875233", "pmid": "39875233", "doi": "10.1016/j.jviscsurg.2024.12.005", "nctId": null, "pmcid": null, "title": "Management of pilonidal sinus and recurrences in 2025", "firstAuthor": "Darnis", "multipleAuthors": true, "journal": "J Visc Surg", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people who have had surgery or drainage for a pilonidal sinus", "intervention": "", "comparator": "", "primaryOutcome": "time to healing and recurrence after treatment", "result": "The abstract discusses treatment options and recurrence rates but does not give a specific duration for wound healing; it notes that radical excision with secondary healing carries a failure/recurrence risk of at least 10%, and that primary closure can reduce healing and convalescence time but with more infection risk.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a narrative review summarizing treatment approaches and complication rates rather than measured healing times, so it gives no reliable duration for how long a cyst takes to heal.", "directness": "indirect", "relevanceNote": "", "limitations": "No specific healing-time data, numbers, or follow-up duration are reported; the review focuses on treatment strategy and recurrence rather than quantified healing time.", "followUp": "", "plainFinding": "No specific healing time reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39875233/", "sourceText": "Pilonidal sinus is a common pathology of the intergluteal cleft that can develop into abscess or suppuration. This lesion corresponds histologically to a granuloma that organizes around foreign bodies, most often hairs, and fistulizes to the skin through partially epithelialized orifices. If suppuration and abscess develop, treatment is based either on medical treatment combining analgesics, local antiseptics and sometimes antibiotics, or on emergency incision and drainage in the operating room. This is performed in more than 10,000 patients per year in France. Outside of emergencies, elective surgery for pilonidal sinus is indicated to treat bothersome symptoms or to avoid the risk of recurrent abscess. The surgical indication must take into account the patient's risk factors, particularly active smoking, that increase the risk of postoperative complications and recurrence. Elective intervention is performed on more than 30,000 patients per year in France. Radical excision followed by secondary healing is the most commonly performed option. This strategy carries a risk of failure or recurrence for at least 10% of patients. Primary closure after excision can reduce the time for healing and convalescence, but at the cost of more frequent infectious complications. Midline closure should be avoided, in favor of paramedian or flap closure. Minimally invasive techniques are being developed that combine the extraction of foreign bodies and mechanical debridement or thermal or chemical cautery of the granulomatous walls. They avoid complex and unpleasant nursing care of secondarily healing wounds, at the cost of a recurrence rate equivalent to that from excision techniques. They have the merit of avoiding difficult situations of failure to heal or recurrence after radical excision that are associated with a clear deterioration in the quality of life. The treatment of surgical failures is complex, and combines comprehensive patient care (smoking cessation, anti-infectious treatments, treatment of excess weight, avoidance of a sedentary lifestyle) and often a repeat operation. Minimally invasive treatments, particularly laser treatments, have their place in these difficult situations.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus is a common pathology of the intergluteal cleft that can develop into abscess or suppuration." }, { "field": "primaryOutcome", "quote": "Radical excision followed by secondary healing is the most commonly performed option." }, { "field": "result", "quote": "This strategy carries a risk of failure or recurrence for at least 10% of patients." }, { "field": "result", "quote": "Primary closure after excision can reduce the time for healing and convalescence, but at the cost of more frequent infectious complications." } ] }, { "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": "patients who had Bascom's cleft lift surgery for pilonidal sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "risk of prolonged wound healing and recurrence after surgery", "result": "women had a 46% higher risk of prolonged healing after surgery than men, and a non-significant 30% higher risk of recurrence", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "it is a large single-centre prospective cohort but not randomized and may have selection bias toward complex referred cases.", "directness": "direct", "relevanceNote": "", "limitations": "single high-volume referral centre, no randomization, and confidence interval for recurrence crossed 1 indicating uncertainty", "followUp": "", "plainFinding": "Women healed more slowly.", "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": "n", "quote": "In all, 560 patients underwent BCL surgery at our centre during this period." }, { "field": "population", "quote": "All patients undergoing BCL surgery from June 2016 until October 2022 were included in this study." }, { "field": "primaryOutcome", "quote": "the risk of prolonged healing after BCL surgery was 46% higher in women compared to men" }, { "field": "result", "quote": "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": "result", "quote": "Risk of recurrence in female patients was 30% higher than in male patients (risk ratio 1.30, 95% CI 0.79-2.09)" } ] }, { "id": "pmid:39842887", "pmid": "39842887", "doi": "10.1136/bcr-2024-261865", "nctId": null, "pmcid": null, "title": "Concurrent pilonidal sinus of the nape of the neck and sacrococcygeal region", "firstAuthor": "Hiremath", "multipleAuthors": true, "journal": "BMJ Case Rep", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "a man in his mid-30s with pilonidal sinus in both the back of the neck and the tailbone area", "intervention": "surgical excision of the neck sinus and wide local excision with flap reconstruction for the tailbone sinus", "comparator": "", "primaryOutcome": "whether the wounds healed and whether the sinus came back", "result": "complete healing with no recurrence by one year after surgery", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how typical this healing time is for other people.", "directness": "direct", "relevanceNote": "", "limitations": "Only one patient was described, and the case involved an unusual combination of two sinus sites, which may not reflect typical healing.", "followUp": "One year post-surgery", "plainFinding": "Fully healed by one year.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39842887/", "sourceText": "The most common site for a pilonidal sinus is the sacrococcygeal region, typically affecting hirsute males. Hair entrapment beneath the skin triggers a granulomatous reaction, leading to the formation of a sinus tract. Here, we present a rare case of concurrent pilonidal abscess in both the nape of the neck and the natal cleft. To date, only five similar cases have been reported in the literature, making this presentation unique.The patient, in his mid-30s, presented with recurrent swelling and discharging sinuses in both the nape of the neck and the intergluteal region. The surgical intervention included excision of the sinus tract in the neck and wide local excision with Limberg flap reconstruction in the sacrococcygeal region.One year post-surgery, the patient showed complete healing with no recurrence observed during follow-up.", "provenance": [ { "field": "n", "quote": "we present a rare case of concurrent pilonidal abscess in both the nape of the neck and the natal cleft" }, { "field": "population", "quote": "The patient, in his mid-30s, presented with recurrent swelling and discharging sinuses in both the nape of the neck and the intergluteal region." }, { "field": "intervention", "quote": "The surgical intervention included excision of the sinus tract in the neck and wide local excision with Limberg flap reconstruction in the sacrococcygeal region." }, { "field": "primaryOutcome", "quote": "One year post-surgery, the patient showed complete healing with no recurrence observed during follow-up." }, { "field": "result", "quote": "One year post-surgery, the patient showed complete healing with no recurrence observed during follow-up." }, { "field": "followUp", "quote": "One year post-surgery" } ] }, { "id": "pmid:39815683", "pmid": "39815683", "doi": "10.1093/ced/llaf035", "nctId": null, "pmcid": null, "title": "Laser hair depilation therapy for pilonidal sinus disease: a 5-year, retrospective experience in a university teaching hospital in the UK, 2017-2023", "firstAuthor": "Andrew", "multipleAuthors": true, "journal": "Clin Exp Dermatol", "year": 2025, "design": "retrospective", "n": 97, "nField": "reported", "population": "People with pilonidal sinus disease, mostly young men, referred for laser hair removal treatment", "intervention": "", "comparator": "", "primaryOutcome": "Whether the pilonidal sinus disease improved or healed after treatment", "result": "78% of patients who didn't have surgery (25 of 32) improved or healed; more laser sessions were linked to better symptom resolution, but the abstract does not state how long healing took", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective single-centre review without a control group, so it cannot reliably show how long healing takes or separate the effect of laser sessions from other factors.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, no control group, variable follow-up, and no reported time-to-healing outcome.", "followUp": "", "plainFinding": "Healing time not reported; most improved after several sessions", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39815683/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a chronic, debilitating condition predominantly affecting young men. Laser hair depilation is an established adjunct to surgical treatment for PSD. It can lead to reduced rates of recurrence and postsurgical interventions. OBJECTIVES: To assess the outcome of laser hair depilation therapy on disease progression in patients with PSD at the Birmingham Skin Regional Laser Centre. METHODS: Patient demographics, PSD clinical stage, laser type, number of laser sessions, surgical intervention and treatment outcomes were extracted from electronic medical records of patients (n = 97) referred for laser hair depilation between 2017 and 2023. Statistical analysis was performed using Microsoft Excel and R. Treatment outcomes were categorized as improvement (healed, improved) or no improvement of underlying PSD. Disease severity was classified using the method of Guner et al. (BMC Surg 2016; 16:18). RESULTS: Most patients affected were male (77%). The median age was 22 years (interquartile range 20-28). The median number of laser hair removal sessions was 8 (interquartile range 5.5-10). The number of laser hair removal sessions was the only predictive factor for symptom resolution (P < 0.001). Neither surgical intervention nor the type of surgery (incision, excision, modified flap, or endoscopic surgical intervention) showed a significant association with improvement in PSD (P = 0.47 and P = 0.65, respectively). In the subgroup of patients who did not undergo surgery (n = 32, 33%), 25 patients (78%) had improvement or healing in their PSD. There were no statistically significant associations between age, type of laser, disease severity and benefit from laser hair removal. No complications were reported and there was only one case of recurrence. CONCLUSIONS: Laser hair depilation is a safe and effective postoperative adjunct treatment for treating sacrococcygeal PSD. For early-stage disease it may offer curative treatment.", "provenance": [ { "field": "n", "quote": "Patient demographics, PSD clinical stage, laser type, number of laser sessions, surgical intervention and treatment outcomes were extracted from electronic medical records of patients (n = 97) referred for laser hair depilation between 2017 and 2023." }, { "field": "population", "quote": "Most patients affected were male (77%). The median age was 22 years (interquartile range 20-28)." }, { "field": "primaryOutcome", "quote": "Treatment outcomes were categorized as improvement (healed, improved) or no improvement of underlying PSD." }, { "field": "result", "quote": "In the subgroup of patients who did not undergo surgery (n = 32, 33%), 25 patients (78%) had improvement or healing in their PSD." }, { "field": "result", "quote": "The number of laser hair removal sessions was the only predictive factor for symptom resolution (P < 0.001)." } ] }, { "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": "people with complex or at least twice-recurrent pilonidal sinus disease who had Limberg flap surgery", "intervention": "Limberg flap surgery for sacrococcygeal pilonidal sinus", "comparator": "", "primaryOutcome": "time to heal, return to work, and recurrence after surgery", "result": "patients stayed in hospital 3 days on average, returned to work after 6 weeks, those with flap oedema took 2-3 weeks to heal with regular dressing, and there were no recurrences over an average follow-up of about 3 months", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "only 10 patients were studied, there was no comparison group, and follow-up was short (about 3 months), so the findings are not reliable for general healing time.", "directness": "indirect", "relevanceNote": "", "limitations": "very small sample (10 patients), no control group, short average follow-up of about 3 months, and patients had unusually complex/recurrent disease rather than typical pilonidal cysts", "followUp": "an average follow-up time of about 3 months", "plainFinding": "Healed within weeks; back to work in six weeks", "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": "population", "quote": "patients selected were classified as complex and at least of a second recurrence of the disease" }, { "field": "intervention", "quote": "Limberg flap for sacrococcygeal pilonidal sinus" }, { "field": "n", "quote": "A total of 10 patients were operated from January 2022 to March 2023." }, { "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": "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." } ] }, { "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": "People who had Karydakis flap surgery for pilonidal sinus", "intervention": "", "comparator": "", "primaryOutcome": "Time for the wound to heal after surgery", "result": "Wound healing took on average 21.4 days after the Karydakis flap surgery", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective single-surgeon study without a comparison group, so healing time estimates may not generalize.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, single surgeon, no control group, and follow-up partly done by telephone.", "followUp": "59 months", "plainFinding": "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": "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." } ] }, { "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": "patients with pilonidal sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "time to return to work after surgery", "result": "Patients returned to work after a median of 1 day (range 1-3) following laser therapy versus a median of 10 days (range 5-20) following Karydakis flap surgery; pain scores and operative time were also lower with laser therapy, with no significant difference in complication or recurrence rates between groups.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective comparison of two surgical techniques without randomization, so it mainly shows how quickly people can return to work after different operations rather than the natural healing time of the condition itself.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, no randomization, and the focus is on comparing two surgical techniques rather than tracking overall wound healing time.", "followUp": "", "plainFinding": "Return to work in 1–10 days after surgery", "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": "population", "quote": "patients with PSD" }, { "field": "n", "quote": "A total of 106 patients with PSD" }, { "field": "primaryOutcome", "quote": "time to return to work after surgery (days)" }, { "field": "result", "quote": "earlier return to work [1 (1-3) versus 10 (5-20) days, p = 0.001]" }, { "field": "design", "quote": "this retrospective study" } ] }, { "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 who had surgery for pilonidal sinus", "intervention": "", "comparator": "", "primaryOutcome": "Time to full healing after surgical treatment", "result": "Healing time varied by surgical technique: median 4 weeks after endoscopic treatment (PEPSiT), 16 weeks after excision with open healing (EHSI), and 7 weeks after excision with stitched closure (EPC)", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This was a non-randomized comparison where surgeons chose the technique, which can bias results, and it was done at a single hospital.", "directness": "indirect", "relevanceNote": "", "limitations": "Quasi-experimental design (not randomized), surgical technique was chosen by the surgeon rather than assigned, single institution.", "followUp": "medium-term (not further specified numerically beyond healing period)", "plainFinding": "Healing time varies a lot by surgery type.", "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": "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 who were treated for pilonidal cysts using the holmium laser", "intervention": "holmium laser treatment for pilonidal cyst", "comparator": "SiLaT laser treatment for pilonidal cyst", "primaryOutcome": "whether the cyst wound was healed one month after treatment", "result": "Median time needing local wound care was 21 days, and 90.7% of patients were healed by one month after treatment; some patients had ongoing pain, infection, or recurrence afterward", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective, single-group cohort study without random assignment or a concurrent control for healing time, so the findings carry limited certainty.", "directness": "direct", "relevanceNote": "", "limitations": "Retrospective design, comparison to SiLaT laser outcomes rather than a randomized control, and some complications such as pain and recurrence noted during follow-up.", "followUp": "up to a year", "plainFinding": "Most healed within about three weeks.", "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": "Retrospective cohort study with the primary endpoint being the cure rate one month after treatment." }, { "field": "intervention", "quote": "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." }, { "field": "comparator", "quote": "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." }, { "field": "primaryOutcome", "quote": "Retrospective cohort study with the primary endpoint being the cure rate one month after treatment." }, { "field": "result", "quote": "Median duration of local care was 21 days (mean = 22 ± 7.5) and healing rate at 1 month was 90.7%." }, { "field": "followUp", "quote": "pain that can persist for up to a year after the procedure" } ] }, { "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 (primary extensive disease, nonhealing wounds after previous surgery, or recurrent disease) who underwent cleft lift surgery", "intervention": "", "comparator": "", "primaryOutcome": "Time to wound healing and recurrence after surgery", "result": "87% of patients healed uneventfully within the first 3 months; 17% had recurrence at a median follow-up of 60 months", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "Large single-center prospective cohort with long follow-up, but no comparison group and all patients had a specific surgical technique so findings may not generalize to other treatments.", "directness": "direct", "relevanceNote": "", "limitations": "Single high-volume center, specific surgical technique (cleft lift) only, no untreated or alternative-treatment comparison group mentioned", "followUp": "60 months (45-73 months)", "plainFinding": "87% healed within 3 months", "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": "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)." } ] }, { "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": "people having surgery for a primary pilonidal sinus without abscess", "intervention": "unroofing and marsupialization surgery", "comparator": "Karydakis surgical technique", "primaryOutcome": "early complications after surgery and time to return to daily activity", "result": "Patients who had unroofing and marsupialization had fewer complications at 15 and 30 days, shorter surgery time, and returned to daily activity sooner than those who had the Karydakis technique; by 90 days there were 3 recurrences with unroofing/marsupialization and none with Karydakis.", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "It is a randomized study with a reasonable number of patients, but follow-up was only 90 days, which is short for judging full healing or recurrence.", "directness": "indirect", "relevanceNote": "", "limitations": "Short follow-up of only 90 days; single-center study; compares two surgical techniques rather than describing the natural time course of healing.", "followUp": "90 days", "plainFinding": "Faster recovery with marsupialization technique", "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": "population", "quote": "patients who underwent surgery for primary PS with no abscess" }, { "field": "intervention", "quote": "unroofing and marsupialization (UM) is a simple surgery with good results" }, { "field": "comparator", "quote": "The Karydakis (K) technique is widely used" }, { "field": "primaryOutcome", "quote": "To evaluate early postoperative complications (EPC) 30 days after UM surgery compared to the K technique." }, { "field": "n", "quote": "122 patients with symptomatic primary PS were randomized: 60 in the K group and 62 in the UM group." }, { "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": 57, "nField": "reported", "population": "adults with recurrent pilonidal sinus disease who had phenolization treatment", "intervention": "phenolization (chemical treatment) of the sinus tract for recurrent pilonidal disease", "comparator": "", "primaryOutcome": "recurrence of the pilonidal sinus needing further surgery", "result": "7 of 47 followed-up patients (14.9%) needed further surgery for recurrence after a mean of 76 months; quality of life and symptoms (pain, discharge, itching) improved compared to before treatment", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this is a single-arm cohort with no comparison group, some loss to follow-up, and it measures recurrence and quality of life rather than how long the wound actually took to heal, so it does not directly answer how long a cyst takes to heal.", "directness": "indirect", "relevanceNote": "", "limitations": "No control group; 17.5% of patients lost to long-term follow-up; outcomes assessed by questionnaire rather than direct wound examination; focuses on recurrence and symptoms rather than time to wound healing.", "followUp": "76 (SD 21.7) months", "plainFinding": "Low recurrence, symptoms improved 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": "population", "quote": "This study included all 57 patients who were initially prospectively included in this study for short-term follow-up after phenolization for recurrent SPSD." }, { "field": "intervention", "quote": "phenolization for recurrent SPSD" }, { "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": "result", "quote": "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)" }, { "field": "n", "quote": "This study included all 57 patients who were initially prospectively included in this study" }, { "field": "followUp", "quote": "after a mean follow-up of 76 (SD 21.7) months" } ] }, { "id": "pmid:39393119", "pmid": "39393119", "doi": "10.1016/j.jss.2024.09.016", "nctId": null, "pmcid": null, "title": "Negative Pressure Dressing Versus Conventional Passive Dressing in Pilonidal Surgery: A Randomized Controlled Trial", "firstAuthor": "Ensor", "multipleAuthors": true, "journal": "J Surg Res", "year": 2024, "design": "rct", "n": 50, "nField": "reported", "population": "People aged 12-40 having surgery to remove a pilonidal sinus with the wound closed off to the side (not down the middle)", "intervention": "surgical excision of the pilonidal sinus with off-midline primary closure", "comparator": "", "primaryOutcome": "time until the wound fully healed", "result": "In wounds that did not reopen, the typical time to full healing was about 21 days in both dressing groups; overall 42% of wounds reopened (dehisced) after surgery", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "it is a small but randomized trial that tracked healing closely, though its main purpose was comparing dressings, not describing natural healing time", "directness": "direct", "relevanceNote": "", "limitations": "Small sample size (50 patients), and the healing-time data come from a trial primarily designed to compare two dressing types rather than to describe healing time itself.", "followUp": "weekly until wound healing, with a 2-month postoperative survey", "plainFinding": "About 3 weeks to heal if no reopening", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39393119/", "sourceText": "INTRODUCTION: Surgically treated pilonidal sinus disease (PSD) has high rates of postoperative wound complications, with surgical wound dehiscence (SWD) rates up to 44%. Negative pressure wound therapy (NPWT) is proposed to reduce rates of SWD for other high risk surgical wounds. Our aim was to investigate whether NPWT would reduce rates of SWD compared to conventional passive (CP) dressings for PSD excisions with off-midline primary closure. Our secondary outcomes included patient quality of life and time taken return to normal activities. METHOD: We performed a prospective, crossover pediatric/adult randomized controlled trial for patients (12-40 y) with PSD, requiring excision and off-midline primary closure. Participants were randomized to receive a CP (Primapore or Opsite) or NPWT (SNAP) dressing. Follow-up occurred on D3, D7, D10, D14 and then weekly until wound healing. Patients were sent a 2-month postoperative online survey to assess quality of life outcomes. RESULTS: Fifty patients were recruited, 25 to NPWT & 25 to CP. Mean age and body mass index were 22.6 ± 6.7 y and 26.1 ± 4.5 kg/m2, respectively. 36/50 (76%) were male. The overall dehiscence rate was 42% (21/50); 12/25 (48%) for NPWT & 9/25 (36%) for CP, P = 0.6. Five deep (≥5 mm) SWDs occurred in each group, P > 0.9. SWD was associated with increased excision dimensions in the NPWT group only, P = 0.03. Median duration to wound healing was equivalent in nondehisced wounds, (CP 21.0 [14.0-29.5] versus NPWT 21.0 [16.0-24.0] days, P = 0.7). There were no differences in mean time to the following: return to school/work (NPWT 26.1 ± 18.2 versus CP 29.3 ± 14.7 d, P = 0.6), sit normally (NPWT 22.3 ± 16.2 versus CP 20.1 ± 9.4 d, P = 0.7), or return to physical activity (NPWT21.6 ± 17.2 versus CP40.3 ± 2.4 d, P = 0.2). CONCLUSIONS: NPWT did not improve outcomes after excision of PSD with off-midline primary closure. Despite the limited population size, our results do not support its use as a routine preventative measure.", "provenance": [ { "field": "population", "quote": "patients (12-40 y) with PSD, requiring excision and off-midline primary closure" }, { "field": "intervention", "quote": "PSD excisions with off-midline primary closure" }, { "field": "primaryOutcome", "quote": "Median duration to wound healing was equivalent in nondehisced wounds" }, { "field": "result", "quote": "Median duration to wound healing was equivalent in nondehisced wounds, (CP 21.0 [14.0-29.5] versus NPWT 21.0 [16.0-24.0] days, P = 0.7)" }, { "field": "result", "quote": "The overall dehiscence rate was 42% (21/50)" }, { "field": "n", "quote": "Fifty patients were recruited, 25 to NPWT & 25 to CP." } ] }, { "id": "pmid:39313437", "pmid": "39313437", "doi": "10.3760/cma.j.cn441530-20231017-00137", "nctId": null, "pmcid": null, "title": "[Clinical application of parasacral artery perforator flap in the treatment of Pilonidal Sinus Diseases]", "firstAuthor": "Lan", "multipleAuthors": true, "journal": "Zhonghua Wei Chang Wai Ke Za Zhi", "year": 2024, "design": "case-series", "n": 6, "nField": "reported", "population": "people who had surgery for pilonidal sinus disease", "intervention": "parasacral perforator flap reconstruction after removal of infected tissue", "comparator": "", "primaryOutcome": "time to wound healing after surgery", "result": "median time from operation to stitch removal was 14 days, all wounds healed by first intention with no recurrence over 6-16 months follow-up", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "Only six patients from a single center with no comparison group, so the healing time reported may not apply broadly.", "directness": "indirect", "relevanceNote": "", "limitations": "Very small sample (n=6), no control group, specialized flap technique rather than standard excision or open wound care.", "followUp": "6-16 months", "plainFinding": "Healed within about two weeks, no recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39313437/", "sourceText": "Objective: To investigate clinical efficacy of parasacral perforator flap (PPF) on postoperative wound healing in pilonidal sinus diseases (PSDs). Methods: The surgery steps were as follows: (1) To preoperatively detect parasacral perforator arteries with the handhold Doppler probe and mark them; (2) To remove the infected and necrotic tissues of PSDs completely; (3) To design the PPF according to the wound size and the parasacral perforator arteries' localization; (4) To harvest the flap from the gluteus maximus muscle surface and transfer it to the wound without tension. Several data were documented, including surgical duration, flap length, flap width, drainage tube placement duration, hospital stay, duration from operation to stitch removal, postsurgical complications and recurrence. Results: There were six patients with PSDs whose postoperative wound healing was repaired by PPF, admitted in our department from March 2021 to March 2023. Of them, five were male and one was female. Their median age was 24 (range: 18-33) years old. Their median surgical duration was 165 (range: 134-207) minutes, median length of PPF was 8 (range: 7-11) cm, median width of PPF was 3 (range: 3-4) cm, mean duration of drainage tube placement was 8 (range: 4-17) days, mean hospital stay was 13 (range: 6-23) days, mean duration from operation to stitch removal was 14 (range: 14-17) days, median follow-up time was 6-16 months. Incisions of all six cases achieved first-intention healing without early- or late-stage complications. No recurrence occurred during follow-up. All patients involved were satisfied with their clinical efficacy. Conclusion: The utility of PPF in postoperative wound healing of PPDs was effective, safe and reliable.", "provenance": [ { "field": "n", "quote": "There were six patients with PSDs whose postoperative wound healing was repaired by PPF" }, { "field": "population", "quote": "postoperative wound healing in pilonidal sinus diseases (PSDs)" }, { "field": "intervention", "quote": "To harvest the flap from the gluteus maximus muscle surface and transfer it to the wound without tension." }, { "field": "primaryOutcome", "quote": "clinical efficacy of parasacral perforator flap (PPF) on postoperative wound healing in pilonidal sinus diseases" }, { "field": "result", "quote": "mean duration from operation to stitch removal was 14 (range: 14-17) days, median follow-up time was 6-16 months. Incisions of all six cases achieved first-intention healing without early- or late-stage complications. No recurrence occurred during follow-up." } ] }, { "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 aged 0-18 treated for pilonidal sinus disease", "intervention": "crystallized phenol treatment plus platelet-rich plasma injection", "comparator": "crystallized phenol treatment alone", "primaryOutcome": "time to heal the wound", "result": "healing took about 19 days with PRP added versus about 31 days with crystallized phenol alone", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "it was a randomized trial but from a single center with a modest number of patients, which limits how broadly the findings apply.", "directness": "indirect", "relevanceNote": "", "limitations": "single-center study comparing two active treatments rather than observing untreated or standard healing time alone", "followUp": "", "plainFinding": "Healing took about 3 weeks with PRP, 4-5 weeks without", "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": "population", "quote": "Eighty-seven patients aged 0-18 were randomly assigned to two groups" }, { "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" }, { "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)." }, { "field": "n", "quote": "Eighty-seven patients aged 0-18 were randomly assigned to two groups" } ] }, { "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": "People treated for pilonidal sinus disease with radial laser surgery", "intervention": "", "comparator": "", "primaryOutcome": "Recurrence and need for reoperation after laser treatment, over long-term follow-up", "result": "12.2 months median time to recurrence (range 4.2 to 51 months) in patients who had a recurrence; overall recurrence rate 14.5%, with 27.7% needing reoperation over a median follow-up of 5.2 years", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective review of medical records from a single center without a comparison group, so the timing findings may not generalize.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, no control group, and based on medical record review which may miss or misclassify recurrence timing.", "followUp": "a median of 5.2 years, range 1.5 to 7.4 years", "plainFinding": "Recurrences typically appeared around one year", "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": "population", "quote": "83 patients who underwent the radial laser procedure for PSD between January 2017 and September 2019" }, { "field": "n", "quote": "83 patients who underwent the radial laser procedure for PSD" }, { "field": "primaryOutcome", "quote": "Twelve patients had a PSD recurrence after their laser procedure, which gives a recurrence rate of 14.5%" }, { "field": "result", "quote": "These recurrences appeared at a median 12.2 months after the laser procedure, range 4.2 to 51 months." }, { "field": "followUp", "quote": "Our follow-up time was a median of 5.2 years, range 1.5 to 7.4 years." } ] }, { "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 treated for pilonidal sinus disease with a specific laser procedure", "intervention": "laser-assisted closure (SiLaC) surgery for pilonidal sinus", "comparator": "", "primaryOutcome": "recovery (healing) rate and time to return to work after treatment", "result": "85.9% recovery rate; mean time to return to work was 2.4±2.78 days; mean follow-up was 17.0±8.06 months", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "Single-center retrospective series of 64 patients with no comparison group, so healing timelines are not verified against another treatment method.", "directness": "indirect", "relevanceNote": "", "limitations": "No control/comparator group, retrospective design, and the procedure (laser-assisted closure) differs from the standard treatments (incision/drainage, excision, open wound care) the question asks about.", "followUp": "17.0±8.06 months (range: 3 to 36)", "plainFinding": "Most healed; back to work fast", "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": "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": "primaryOutcome", "quote": "the mean time for return to work was 2.4±2.78 days (range: 0 to 14). Our recovery rate was 85.9%." }, { "field": "result", "quote": "Our recovery rate was 85.9%." }, { "field": "result", "quote": "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)." }, { "field": "n", "quote": "The study cohort consisted of 64 patients." }, { "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": "People with pilonidal sinus who had a minimally invasive procedure plus a blood-clot treatment", "intervention": "", "comparator": "", "primaryOutcome": "Whether the wound had completely healed at 3, 6, and 12 months after treatment", "result": "At 3 months 42 of 51 (82.4%) were fully healed, at 6 months 46 of 51 (90.2%) were healed, and at 12 months 42 of 51 (82.4%) remained healed, with 6 patients (11.8%) experiencing recurrence by 12 months", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "It was a small, single-arm, open-label trial of a specific novel product plus procedure, so it does not reflect general healing time after standard pilonidal treatments.", "directness": "indirect", "relevanceNote": "", "limitations": "Single-arm design with no comparator, small sample size (51 patients), and the intervention combined a novel autologous product with a minimally invasive procedure rather than standard treatment.", "followUp": "12 months", "plainFinding": "Most healed by 3 months, some recurrence later", "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 followed by RD2 Ver.02 instillation into the cavity." }, { "field": "primaryOutcome", "quote": "Primary healing was assessed at 3, 6, and 12 months." }, { "field": "result", "quote": "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%)." } ] }, { "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": "People treated for pilonidal sinus disease at three hospitals in the Netherlands", "intervention": "Bascom cleft lift surgery", "comparator": "Excision with secondary wound healing (open wound left to heal on its own)", "primaryOutcome": "Whether the wound healed successfully and how long it took to heal", "result": "Wound healing was successful in 84.4% after Bascom cleft lift versus 32.6% after excision with secondary wound healing, with median healing time of 55 days versus 101 days respectively; complications were more common after Bascom cleft lift (28.9% vs 13.2%)", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective, non-randomized comparison from only three centers with short follow-up and no patient satisfaction data, so selection bias could affect the results.", "directness": "direct", "relevanceNote": "", "limitations": "Retrospective design prone to selection bias and residual confounding; short follow-up period may underestimate true recurrence rates; no patient satisfaction data collected", "followUp": "12 months", "plainFinding": "Cleft lift healed faster than open wound", "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": "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)." }, { "field": "n", "quote": "Of 272 patients, 128 underwent Bascom cleft lift and 144 patients underwent excision and secondary wound healing." } ] }, { "id": "pmid:39045854", "pmid": "39045854", "doi": "10.3310/KFDQ2017", "nctId": null, "pmcid": "PMC11284621", "title": "Treatment options for patients with pilonidal sinus disease: PITSTOP, a mixed-methods evaluation", "firstAuthor": "Brown", "multipleAuthors": true, "journal": "Health Technol Assess", "year": 2024, "design": "prospective-cohort", "n": 667, "nField": "reported", "population": "adults referred for surgery to treat pilonidal disease at NHS hospitals", "intervention": "major surgical procedure for pilonidal disease", "comparator": "minor surgical procedure for pilonidal disease", "primaryOutcome": "time to healing after surgery", "result": "healing took more than 34 days longer after major surgery than after minor surgery", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "it followed many real patients across many hospitals but was not randomised, had missing follow-up data, and used statistical adjustment rather than a controlled comparison", "directness": "direct", "relevanceNote": "", "limitations": "Incomplete recruitment and follow-up data were an issue, particularly given the multiple interventions. Assumptions were made regarding risk adjustment.", "followUp": "", "plainFinding": "Major surgery heals over a month slower.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39045854/", "sourceText": "BACKGROUND: There is no consensus on optimal management of pilonidal disease. Surgical practice is varied, and existing literature is mainly single-centre cohort studies of varied disease severity, interventions and outcome assessments. OBJECTIVES: A prospective cohort study to determine: • disease severity and intervention relationship • most valued outcomes and treatment preference by patients • recommendations for policy and future research. DESIGN: Observational cohort study with nested mixed-methods case study. Discrete choice experiment. Clinician survey. Three-stage Delphi survey for patients and clinicians. Inter-rater reliability of classification system. SETTING: Thirty-one National Health Service trusts. PARTICIPANTS: Patients aged > 16 years referred for elective surgical treatment of pilonidal disease. INTERVENTIONS: Surgery. MAIN OUTCOME MEASURES: Pain postoperative days 1 and 7, time to healing and return to normal activities, complications, recurrence. Outcomes compared between major and minor procedures using regression modelling, propensity score-based approaches and augmented inverse probability weighting to account for measured potential confounding features. RESULTS: Clinician survey: There was significant heterogeneity in surgeon practice preference. Limited training opportunities may impede efforts to improve practice. Cohort study: Over half of patients (60%; N = 667) had a major procedure. For these procedures, pain was greater on day 1 and day 7 (mean difference day 1 pain 1.58 points, 95% confidence interval 1.14 to 2.01 points, n = 536; mean difference day 7 pain 1.53 points, 95% confidence interval 1.12 to 1.95 points, n = 512). There were higher complication rates (adjusted risk difference 17.5%, 95% confidence interval 9.1 to 25.9%, n = 579), lower recurrence (adjusted risk difference -10.1%, 95% confidence interval -18.1 to -2.1%, n = 575), and longer time to healing (>34 days estimated difference) and time to return to normal activities (difference 25.9 days, 95% confidence interval 18.4 to 33.4 days). Mixed-methods analysis: Patient decision-making was influenced by prior experience of disease and anticipated recovery time. The burden involved in wound care and the gap between expected and actual time for recovery were the principal reasons given for decision regret. Discrete choice experiment: The strongest predictors of patient treatment choice were risk of infection/persistence (attribute importance 70%), and shorter recovery time (attribute importance 30%). Patients were willing to trade off these attributes. Those aged over 30 years had a higher risk tolerance (22.35-34.67%) for treatment failure if they could experience rapid recovery. There was no strong evidence that younger patients were willing to accept higher risk of treatment failure in exchange for a faster recovery. Patients were uniform in rejecting excision-and-leave-open because of the protracted nursing care it entailed. Wysocki classification analysis: There was acceptable inter-rater agreement (κ = 0.52, 95% confidence interval 0.42 to 0.61). Consensus exercise: Five research and practice priorities were identified. The top research priority was that a comparative trial should broadly group interventions. The top practice priority was that any interventions should be less disruptive than the disease itself. LIMITATIONS: Incomplete recruitment and follow-up data were an issue, particularly given the multiple interventions. Assumptions were made regarding risk adjustment. CONCLUSIONS AND FUTURE WORK: Results suggest the burden of pilonidal surgery is greater than reported previously. This can be mitigated with better selection of intervention according to disease type and patient desired goals. Results indicate a framework for future higher-quality trials that stratify disease and utilise broad groupings of common interventions with development of a patient-centred core outcome set. TRIAL REGISTRATION: This trial is registered as ISRCTN95551898. FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/17/02) and is published in full in Health Technology Assessment; Vol. 28, No. 33. See the NIHR Funding and Awards website for further award information.", "provenance": [ { "field": "n", "quote": "Over half of patients (60%; N = 667) had a major procedure." }, { "field": "population", "quote": "Patients aged > 16 years referred for elective surgical treatment of pilonidal disease." }, { "field": "intervention", "quote": "Over half of patients (60%; N = 667) had a major procedure." }, { "field": "comparator", "quote": "Outcomes compared between major and minor procedures using regression modelling, propensity score-based approaches and augmented inverse probability weighting to account for measured potential confounding features." }, { "field": "primaryOutcome", "quote": "Pain postoperative days 1 and 7, time to healing and return to normal activities, complications, recurrence." }, { "field": "result", "quote": "longer time to healing (>34 days estimated difference) and time to return to normal activities (difference 25.9 days, 95% confidence interval 18.4 to 33.4 days)." } ] }, { "id": "pmid:38967343", "pmid": "38967343", "doi": "10.12968/jowc.2021.0137", "nctId": null, "pmcid": null, "title": "Effectiveness and safety of an innovative silicone extender in suture reinforcement or dermatotraction: a retrospective study", "firstAuthor": "Yailian", "multipleAuthors": true, "journal": "J Wound Care", "year": 2024, "design": "case-series", "n": 50, "nField": "reported", "population": "Adults who had a silicone tissue extender device used after large wound surgery, including 6 who had pilonidal disease treatment (most of the group, 44 patients, had skin cancer excision instead)", "intervention": "", "comparator": "", "primaryOutcome": "Time until the wound was fully closed/healed", "result": "Overall, across the whole mixed group of 50 patients (only 6 with pilonidal disease), wounds were fully healed within 7 days after the device was removed in 82% of patients; healing time was not reported separately for the pilonidal patients", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "This is a small retrospective case series where only 6 of 50 patients had pilonidal disease, there is no separate healing data for them, and most of the cohort instead had skin cancer wounds.", "directness": "indirect", "relevanceNote": "", "limitations": "The abstract does not break out healing time for the 6 pilonidal patients specifically; results are pooled with 44 patients who had skin cancer excisions, and there is no comparison group.", "followUp": "", "plainFinding": "Pilonidal healing time not reported separately", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38967343/", "sourceText": "OBJECTIVE: Multiple techniques are available for closing skin defects, such as skin grafts, flaps and tissue expansion. The tissue extender MID SEW (MID, France) was developed to achieve dermatotraction or suture reinforcement. The aim of this study was to evaluate the effectiveness and safety of this innovative silicone extender for large surgical wounds. METHOD: A single-centre retrospective and observational study on an unselected consecutive cohort of patients treated with a tissue extender was conducted. Indications, initial and final wound surfaces, and adverse events (AEs) were retrieved from electronic medical records. The main outcome measure was the time to complete wound closure. RESULTS: We identified 50 patients from July 2017 to December 2018. Patients underwent cutaneous tumour-wide excision (n=44), or pilonidal disease surgical treatment (n=6). The average initial wound area was 53.3±42.4cm2. Healing was complete, without secondary dehiscence, within the first seven days after device withdrawal for 41 patients (82%). At least one AE was experienced by eight patients (16%) during the study period: five inflammation; five wound dehiscence; two skin necrosis; and one pain. CONCLUSION: This case series suggests that the tissue extender may be effective and safe in its dermatotraction and suture reinforcement indications in the treatment of large wounds after wide excision of skin cancer or treatment of pilonidal disease. DECLARATION OF INTEREST: This work was supported in part by the Hospices Civils de Lyon, France and in part by the University Claude Bernard Lyon 1, France. OB co-owns the patent on the MID SEW system. The authors have no other conflicts of interest to declare.", "provenance": [ { "field": "n", "quote": "We identified 50 patients from July 2017 to December 2018." }, { "field": "population", "quote": "Patients underwent cutaneous tumour-wide excision (n=44), or pilonidal disease surgical treatment (n=6)." }, { "field": "primaryOutcome", "quote": "The main outcome measure was the time to complete wound closure." }, { "field": "result", "quote": "Healing was complete, without secondary dehiscence, within the first seven days after device withdrawal for 41 patients (82%)." } ] }, { "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 treated for pilonidal sinus disease with a minimally invasive endoscopic procedure", "intervention": "endoscopic pilonidal sinus treatment (EPSiT)", "comparator": "", "primaryOutcome": "how long the wound took to heal, complications, ongoing discharge, and recurrence over 1-7 years", "result": "complete wound healing occurred in 60 of 67 patients (89.6%), with recurrence in 7 patients (10.4%); patients were checked for healing at 1, 3, 6 and 24 weeks after surgery and then yearly for recurrence", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this was a single-center, single-surgeon-team study with no comparison group and a small number of patients, so it can't firmly establish a typical healing timeline.", "directness": "indirect", "relevanceNote": "", "limitations": "no control group, single surgical team, and the abstract does not give a specific average or median healing duration in days or weeks.", "followUp": "1-7 years", "plainFinding": "Most wounds healed; some recurred.", "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": "population", "quote": "comprised all pilonidal sinus cases undergoing minimal invasive endoscopic pilonidal sinus treatment who were treated by a single surgical team" }, { "field": "intervention", "quote": "minimal invasive endoscopic pilonidal sinus treatment" }, { "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%)." }, { "field": "result", "quote": "The patients were observed for wound healing and discharge on follow-up in the out-patient department at 1, 3, 6 and 24 weeks." }, { "field": "n", "quote": "Of the 67 patients, 55(82%) were males and 12(18%) were females." }, { "field": "followUp", "quote": "recurrence at 1-7 years" } ] }, { "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 who had surgery to remove a pilonidal cyst, followed by propeller flap reconstruction", "intervention": "", "comparator": "", "primaryOutcome": "time until wound function improved, and whether the cyst came back", "result": "On average it took 24 days for function to improve after flap surgery; follow-up averaged 4.1 months, and 11.5% had the cyst recur", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a small retrospective chart review of one specific surgical technique (flap reconstruction) at one center, not a general picture of healing after typical pilonidal treatment", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective single-center review, short average follow-up (4.1 months), and specific to flap reconstruction rather than typical excision or open wound care", "followUp": "4.1 ± 5.4 months", "plainFinding": "About 3-4 weeks to functional healing", "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, with two patients receiving a second propeller flap due to recurrence." }, { "field": "primaryOutcome", "quote": "Primary outcomes included flap survival, flap complications, and pilonidal disease recurrence." }, { "field": "result", "quote": "Mean time to functional improvement was 24.0 ± 22.8 days." }, { "field": "result", "quote": "Pilonidal disease recurrence occurred in three patients (11.5%)." }, { "field": "result", "quote": "Mean follow-up was 4.1 ± 5.4 months." } ] }, { "id": "pmid:38849230", "pmid": "38849230", "doi": "10.1016/j.jviscsurg.2024.03.007", "nctId": null, "pmcid": null, "title": "SiLaT: A paradigm shift in the treatment of pilonidal disease?", "firstAuthor": "Draullette", "multipleAuthors": true, "journal": "J Visc Surg", "year": 2024, "design": "retrospective", "n": 111, "nField": "reported", "population": "Adults with primary or recurrent pilonidal sinus treated with sinus laser therapy", "intervention": "", "comparator": "", "primaryOutcome": "Time to healing (closure of skin openings without seepage or abscess)", "result": "78.4% healed, with median time to healing of 20 days (range 15-30 days)", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "Single-center retrospective case series without a comparison group, so healing times may not generalize.", "directness": "direct", "relevanceNote": "", "limitations": "Retrospective design, single center, no control group, and no predictive factors for healing were identified.", "followUp": "339.2 (± 221.4) days", "plainFinding": "Healed in about 20 days.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38849230/", "sourceText": "BACKGROUND: Pilonidal disease (PD) is a common condition for which the global incidence is increasing. Surgery is the currently preferred approach to treatment but there is a growing interest in new minimally invasive techniques, such as sinus laser therapy (SiLaT). AIM: Our primary objective was to assess the efficacy of SiLaT for the treatment of pilonidal disease. The secondary objectives were to evaluate morbidity and patient satisfaction and identify predictive factors of success. METHODS: All adult patients, who underwent SiLaT in our department for a primary or recurrent pilonidal sinus from June 1, 2018, to December 31, 2020, were included in the study. Healing was defined as the closure of cutaneous orifices and the absence of seepage or abscesses. RESULTS: In total, 111 consecutive patients, for whom the male/female sex ratio was 2.1 and the mean age 28.8 (± 9.4) years, were included in this study. Eighteen (16.2%) patients had already undergone prior surgery for PD. The mean follow-up was 339.2 (± 221.4) days. A healing rate of 78.4% was observed, with a median time to healing of 20.0 days (15.0-30.0). The median time to return to usual activities was three days (1-7). The only postoperative complication was bleeding, which occurred for two patients (1.8%). Eighty-two patients (88.2%) reported being \"very satisfied\" with the treatment. Multivariate analysis showed no predictive factors for healing among the studied variables. CONCLUSION: SiLaT is an efficient and safe procedure for the treatment of PD, with a high level of patient satisfaction. It will now be necessary to position it within the therapeutic algorithm.", "provenance": [ { "field": "population", "quote": "All adult patients, who underwent SiLaT in our department for a primary or recurrent pilonidal sinus from June 1, 2018, to December 31, 2020, were included in the study." }, { "field": "n", "quote": "In total, 111 consecutive patients, for whom the male/female sex ratio was 2.1 and the mean age 28.8 (± 9.4) years, were included in this study." }, { "field": "primaryOutcome", "quote": "Healing was defined as the closure of cutaneous orifices and the absence of seepage or abscesses." }, { "field": "result", "quote": "A healing rate of 78.4% was observed, with a median time to healing of 20.0 days (15.0-30.0)." }, { "field": "followUp", "quote": "The mean follow-up was 339.2 (± 221.4) days." } ] }, { "id": "pmid:38776547", "pmid": "38776547", "doi": "10.1089/photob.2024.0028", "nctId": null, "pmcid": null, "title": "Efficacy of Laser Treatment in Pilonidal Disease: A Single-Arm Meta-Analysis", "firstAuthor": "Xie", "multipleAuthors": true, "journal": "Photobiomodul Photomed Laser Surg", "year": 2024, "design": "meta-analysis", "n": 1214, "nField": "reported", "population": "people treated for pilonidal cyst/sinus disease with laser therapy", "intervention": "", "comparator": "", "primaryOutcome": "whether the wound healed after laser treatment, over a period of follow-up", "result": "84.4% of patients had healed by a median follow-up of 12 months (range 7.8-25 months)", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this pools single-arm (no comparison group) studies about one specific treatment, so it doesn't give a general picture of healing time across pilonidal cyst treatments.", "directness": "indirect", "relevanceNote": "", "limitations": "single-arm meta-analysis with no control group; focuses specifically on laser treatment rather than healing time after treatment in general; follow-up times varied widely across included studies (7.8 to 25 months)", "followUp": "12 (range, 7.8-25) months", "plainFinding": "Most healed within about a year.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38776547/", "sourceText": "Objective: This study aimed to collate all published studies on laser therapy for pilonidal disease and demonstrate the safety and effectiveness of minimally invasive techniques. Methods: A comprehensive literature search, with no language limitations, was performed using PubMed, Embase, and Web of Science from inception to April 23, 2023. Two reviewers independently screened the literature according to the inclusion and exclusion criteria and evaluated the bias risk of included studies. Meta-analysis was performed using RevMan software (version 5.4). (PROSPERO Registration ID Number CRD42023420803). Results: The analysis included 1214 patients from 13 studies, who fulfilled the pre-defined inclusion criteria. With a median follow-up of 12 (range, 7.8-25) months, 1000 (84.4%) patients achieved healing after primary laser treatment. The mean complication and recurrence rates were 12.7% and 7.6%, respectively. Conclusions: Laser ablation for pilonidal sinus disease is a new minimally invasive technique with good treatment efficacy, low postoperative recovery, and shorter recovery periods following employment.", "provenance": [ { "field": "n", "quote": "The analysis included 1214 patients from 13 studies" }, { "field": "population", "quote": "patients from 13 studies, who fulfilled the pre-defined inclusion criteria" }, { "field": "primaryOutcome", "quote": "1000 (84.4%) patients achieved healing after primary laser treatment" }, { "field": "result", "quote": "With a median follow-up of 12 (range, 7.8-25) months, 1000 (84.4%) patients achieved healing after primary laser treatment." } ] }, { "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 treated surgically at outpatient surgical centers", "intervention": "Excision and midline closure without skin sutures", "comparator": "Excision and primary closure (with skin sutures)", "primaryOutcome": "Time to return to work, complication rate, and recurrence after surgical treatment", "result": "Time to return to work decreased from 15 to 12 days with midline closure; complication rate was lower (3.7% vs 12.5%); over a five-year mean follow-up, recurrence occurred in 6.2% of the primary closure group versus none in the midline closure group", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "It is a randomized multicenter trial with reasonable follow-up, but it only studied men and compared two surgical techniques rather than tracking natural wound healing time directly.", "directness": "indirect", "relevanceNote": "", "limitations": "Only male patients were included, and the study measured return-to-work time and recurrence rather than actual wound healing duration; excludes recurrent or complicated cases.", "followUp": "five-year mean follow-up", "plainFinding": "Back to work in about 12-15 days", "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": "n", "quote": "Group 1 (n=80; excision and primary closure) or Group 2 (n=80; excision and midline closure without skin sutures)" }, { "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": "the time required to return to work" }, { "field": "result", "quote": "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." }, { "field": "result", "quote": "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)." }, { "field": "followUp", "quote": "During the 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": "patients with pilonidal disease who underwent a laser treatment procedure", "intervention": "minimal energy laser pilonidotomy (MELPi)", "comparator": "", "primaryOutcome": "time to wound healing after treatment", "result": "the median healing time was 15 days, with recurrence in 10% of patients over an average 12-month follow-up", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this is a retrospective, uncontrolled study of a novel laser technique in a modest number of patients, so the healing time reported may not generalize to standard pilonidal treatments.", "directness": "indirect", "relevanceNote": "", "limitations": "retrospective design, no comparison group, single novel technique (MELPi) rather than standard incision, excision or open wound care, multicenter variability", "followUp": "12 months", "plainFinding": "Healed in about 15 days", "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": "population", "quote": "We included 47 consecutive patients who underwent 50 \"minimal energy pilonidotomies (MELPi)\" between 2019 and 2023 in four centers in Brazil." }, { "field": "intervention", "quote": "a new pilonidotomy method using minimal laser energy" }, { "field": "primaryOutcome", "quote": "the median healing time was 15 days" }, { "field": "result", "quote": "The median hospitalization time was 6 h, and the median healing time was 15 days." }, { "field": "result", "quote": "recurrence occurred in 5 (10%)" }, { "field": "n", "quote": "We included 47 consecutive patients who underwent 50 \"minimal energy pilonidotomies (MELPi)\"" } ] }, { "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": "People with long-lasting (chronic) pilonidal sinus disease", "intervention": "Laser obliteration with limited excision of the cyst", "comparator": "Standard wide excision surgery", "primaryOutcome": "Time to complete wound healing, recurrence, and complications", "result": "Wounds healed much faster with laser plus limited excision (about 6.5 weeks) than with wide excision (about 14.5 weeks), with no significant difference in recurrence", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "It was a reasonably sized observational study comparing two treatments but was not randomized, so other differences between groups could have affected healing time.", "directness": "direct", "relevanceNote": "", "limitations": "Not randomized; described as both 'prospective' and 'cross-sectional,' which is unclear methodologically; follow-up duration for recurrence not fully specified.", "followUp": "", "plainFinding": "Healing took about 6.5 to 14.5 weeks.", "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": "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": "The main evaluation criteria were 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": "n", "quote": "A prospective, cross-sectional observational study of 152 patients with chronic pilonidal sinus disease was performed" } ] }, { "id": "pmid:38291247", "pmid": "38291247", "doi": "10.1007/s10103-024-03993-5", "nctId": null, "pmcid": "PMC10827894", "title": "Comparison of laser ablation, simple excision, and flap reconstruction in the treatment of pilonidal sinus disease", "firstAuthor": "Tyrväinen", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2024, "design": "retrospective", "n": 278, "nField": "reported", "population": "patients who had surgery for pilonidal sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "whether wounds healed without problems (eventless healing), residual or recurrent disease, complications, and need for re-operation after different surgical treatments", "result": "The abstract does not state a specific time for wounds to heal. It reports that follow-up ranged from an average of 15.4 ± 7.6 months (laser group) to 87.6 ± 29.3 months (flap group), and that uneventful healing occurred in 67.7% (laser), 66.4% (direct closure), and 56.4% (flap) of patients, with laser patients having more residual disease and direct closure/flap patients having more complications.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective study comparing surgical techniques with very different follow-up durations between groups, and it does not directly measure or report how long it takes a cyst to heal.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, no stated healing-time outcome, large differences in follow-up length between groups, and only indirect measures (uneventful healing rate, complications, recurrence) rather than actual time-to-heal.", "followUp": "15.4 ± 7.6 months to 87.6 ± 29.3 months", "plainFinding": "Healing time not directly reported", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38291247/", "sourceText": "Pilonidal sinus disease (PSD) is a common condition that typically affects young adults. PSD may cause significant morbidity due to its chronic nature and tendency to recur. Laser ablation has recently shown promising results in the treatment of PSD, but comparative studies are sparse. We aimed to compare laser ablation with two conventional treatment options: simple excision with direct closure and excision with flap reconstruction. This retrospective study material included patients who underwent PSD surgery in the plastic surgery department of a single academic teaching hospital. Patients were divided into three groups based on the operation technique: laser group, direct closure group, and flap group. Preoperative and postoperative data were compared between the groups including patient characteristics, residual disease, recurrent disease, complications, and re-operations. Among the 278 patients, 66 underwent laser treatment, 134 excision with direct closure, and 78 excision with flap closure. The follow-up time ranged from 15.4 ± 7.6 months in the laser group to 87.6 ± 29.3 months in the flap group. Eventless healing occurred in 67.7% of the patients in the laser group, 66.4% of the patients in the direct closure group, and 56.4% of the patients in the flap group. There was significantly more residual disease in the laser group whereas significantly more complications were found in the direct closure and flap groups. The advantages of laser treatment include fast postoperative recovery and reduced risk of complications.", "provenance": [ { "field": "population", "quote": "This retrospective study material included patients who underwent PSD surgery in the plastic surgery department of a single academic teaching hospital." }, { "field": "n", "quote": "Among the 278 patients, 66 underwent laser treatment, 134 excision with direct closure, and 78 excision with flap closure." }, { "field": "primaryOutcome", "quote": "Preoperative and postoperative data were compared between the groups including patient characteristics, residual disease, recurrent disease, complications, and re-operations." }, { "field": "result", "quote": "The follow-up time ranged from 15.4 ± 7.6 months in the laser group to 87.6 ± 29.3 months in the flap group." }, { "field": "result", "quote": "Eventless healing occurred in 67.7% of the patients in the laser group, 66.4% of the patients in the direct closure group, and 56.4% of the patients in the flap group." }, { "field": "result", "quote": "There was significantly more residual disease in the laser group whereas significantly more complications were found in the direct closure and flap groups." } ] }, { "id": "pmid:38226663", "pmid": "38226663", "doi": "10.1002/14651858.CD015213.pub2", "nctId": null, "pmcid": "PMC10790338", "title": "Midline and off-midline wound closure methods after surgical treatment for pilonidal sinus", "firstAuthor": "Cai", "multipleAuthors": true, "journal": "Cochrane Database Syst Rev", "year": 2024, "design": "meta-analysis", "n": 3667, "nField": "reported", "population": "adults who had surgery for pilonidal sinus, comparing wound closed in the midline versus to the side of the midline", "intervention": "off-midline wound closure methods after pilonidal sinus surgery", "comparator": "midline wound closure methods (conventional and tension-free) after pilonidal sinus surgery", "primaryOutcome": "time until the surgical wound healed", "result": "Off-midline closure healed about 5 days faster than conventional midline closure (MD -5.23 days), and in one trial off-midline closure healed in a median of 14 days versus 51 days for tension-free midline closure; healing time was similar between Karydakis and Limberg flap techniques (MD 0.36 days).", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "The review pooled many randomized trials, but most of the specific healing-time comparisons were rated low or very low certainty because of few studies, small numbers, and inconsistent results.", "directness": "direct", "relevanceNote": "", "limitations": "Findings are predominantly based on young adult studies; many comparisons relied on few trials with low or very low certainty evidence, and the authors call for larger, better-designed trials.", "followUp": "", "plainFinding": "Healing time varies by surgical closure method.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38226663/", "sourceText": "BACKGROUND: Pilonidal sinus disease is a common and debilitating condition. Surgical treatment remains the mainstay for managing chronic disease, with options including midline and off-midline wound closure methods. However, the optimal approach remains uncertain. Recent developments in tension-free midline techniques require further exploration. OBJECTIVES: To assess the effects of midline and off-midline wound closure methods for pilonidal sinus, and to determine the optimal off-midline flap procedures. SEARCH METHODS: In June 2022, we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL Plus EBSCO, and clinical trials registries. We also scanned the reference lists of included studies, as well as reviews, meta-analyses, and health technology reports. We applied no language, publication date, or study setting restrictions. SELECTION CRITERIA: We included parallel RCTs involving participants undergoing midline closure without flap techniques and off-midline closure for pilonidal sinus treatment. We excluded quasi-experimental studies and studies that enroled participants presenting with an abscess. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methodology. The critical outcomes included wound healing (time to wound healing, proportion of wounds healed), recurrence rate, wound infection, wound dehiscence, time to return to work, and quality of life. We assessed biases in these outcomes utilising the Cochrane risk of bias 2 tool and appraised evidence certainty via the GRADE approach. MAIN RESULTS: We included 33 studies with 3667 analysed participants. The median or average age of the participants across the included studies ranged from 21.0 to 34.2 years, with a predominant male representation. Geographically, the trials were primarily conducted in the Middle East. We identified nine intervention comparisons. In this abstract, we focus on and present the summarised findings for the three primary comparisons. Off-midline closure versus conventional midline closure Off-midline closure probably reduces the time to wound healing (mean difference (MD) -5.23 days, 95% confidence interval (CI) -7.55 to -2.92 days; 3 studies, 300 participants; moderate-certainty evidence). However, there may be little to no difference between the two methods in the proportion of wounds healed (100% versus 88.5%, risk ratio (RR) 1.13, 95% CI 0.92 to 1.39; 2 studies, 207 participants; very low-certainty evidence). Off-midline closure probably results in lower rates of recurrence (1.5% versus 6.8%, RR 0.22, 95% CI 0.11 to 0.45; 13 studies, 1492 participants; moderate-certainty evidence) and wound infection (3.8% versus 11.7%, RR 0.32, 95% CI 0.22 to 0.49; 13 studies, 1568 participants; moderate-certainty evidence), and may lower rates of wound dehiscence (3.9% versus 8.9%, RR 0.44, 95% CI 0.27 to 0.71; 11 studies, 1389 participants; low-certainty evidence). Furthermore, off-midline closure may result in a reduced time to return to work (MD -3.72 days, 95% CI -6.11 to -1.33 days; 6 studies, 820 participants; low-certainty evidence). There were no data available for quality of life. Off-midline closure versus tension-free midline closure Off-midline closure may reduce the time to wound healing (median 14 days in off-midline closure versus 51 days in tension-free midline closure; 1 study, 116 participants; low-certainty evidence) and increase wound healing rates at three months (94.7% versus 76.4%, RR 1.24, 95% CI 1.06 to 1.46; 1 study, 115 participants; low-certainty evidence), but may result in little to no difference in rates of recurrence (5.4% versus 7.8%, RR 0.69, 95% CI 0.30 to 1.61; 6 studies, 551 participants; very low-certainty evidence), wound infection (2.8% versus 6.4%, RR 0.44, 95% CI 0.16 to 1.17; 6 studies, 559 participants; very low-certainty evidence), and wound dehiscence (2.5% versus 3.0%, RR 0.82, 95% CI 0.17 to 3.84; 3 studies, 250 participants; very low-certainty evidence) compared to tension-free midline closure. Furthermore, off-midline closure may result in longer time to return to work compared to tension-free midline closure (MD 3.00 days, 95% CI 1.52 to 4.48 days; 1 study, 60 participants; low-certainty evidence). There were no data available for quality of life. Karydakis flap versus Limberg flap Karydakis flap probably results in little to no difference in time to wound healing compared to Limberg flap (MD 0.36 days, 95% CI -1.49 to 2.22; 6 studies, 526 participants; moderate-certainty evidence). Compared to Limberg flap, Karydakis flap may result in little to no difference in the proportion of wounds healed (80.0% versus 66.7%, RR 1.20, 95% CI 0.77 to 1.86; 1 study, 30 participants; low-certainty evidence), recurrence rate (5.1% versus 4.5%, RR 1.14, 95% CI 0.61 to 2.14; 9 studies, 890 participants; low-certainty evidence), wound infection (7.9% versus 5.1%, RR 1.55, 95% CI 0.90 to 2.68; 8 studies, 869 participants; low-certainty evidence), wound dehiscence (7.4% versus 6.2%, RR 1.20, 95% CI 0.41 to 3.50; 7 studies, 776 participants; low-certainty evidence), and time to return to work (MD -0.23 days, 95% CI -5.53 to 5.08 days; 6 studies, 541 participants; low-certainty evidence). There were no data available for quality of life. AUTHORS' CONCLUSIONS: This Cochrane review examines the midline and off-midline wound closure options for pilonidal sinus, predominantly based on young adult studies. Off-midline flap procedures demonstrate there may be benefits over conventional midline closure for pilonidal sinus, with various off-midline flap techniques. When off-midline flap closures were compared to tension-free midline closure, low-certainty evidence indicated there may be improved wound healing and increased time to return to work for off-midline closure, whilst very low-certainty evidence indicated there may be no evidence of a difference in other outcomes. There may be no evidence of an advantage found amongst the off-midline techniques evaluated. The choice of either procedure is likely to be based on a clinician's preference, experience, patient characteristics, and the patients' preferences. To more accurately determine the benefits and potential harms of these closure techniques, further large-scale and meticulously-designed trials are essential. Specifically, there is a pressing need for more studies addressing the paediatric population, in addition to adult studies.", "provenance": [ { "field": "n", "quote": "We included 33 studies with 3667 analysed participants." }, { "field": "population", "quote": "We included parallel RCTs involving participants undergoing midline closure without flap techniques and off-midline closure for pilonidal sinus treatment." }, { "field": "intervention", "quote": "Off-midline closure probably reduces the time to wound healing (mean difference (MD) -5.23 days, 95% confidence interval (CI) -7.55 to -2.92 days; 3 studies, 300 participants; moderate-certainty evidence)." }, { "field": "comparator", "quote": "Off-midline closure versus conventional midline closure" }, { "field": "primaryOutcome", "quote": "The critical outcomes included wound healing (time to wound healing, proportion of wounds healed), recurrence rate, wound infection, wound dehiscence, time to return to work, and quality of life." }, { "field": "result", "quote": "Off-midline closure may reduce the time to wound healing (median 14 days in off-midline closure versus 51 days in tension-free midline closure; 1 study, 116 participants; low-certainty evidence)" }, { "field": "result", "quote": "Karydakis flap probably results in little to no difference in time to wound healing compared to Limberg flap (MD 0.36 days, 95% CI -1.49 to 2.22; 6 studies, 526 participants; moderate-certainty evidence)." }, { "field": "limitations", "quote": "This Cochrane review examines the midline and off-midline wound closure options for pilonidal sinus, predominantly based on young adult studies." }, { "field": "limitations", "quote": "To more accurately determine the benefits and potential harms of these closure techniques, further large-scale and meticulously-designed trials are essential." } ] }, { "id": "pmid:38131372", "pmid": "38131372", "doi": null, "nctId": null, "pmcid": null, "title": "Clinical outcomes of crystallized phenol as a first treatment option in patients with recurrent pilonidal sinus", "firstAuthor": "Esmer", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2023, "design": "retrospective", "n": 107, "nField": "reported", "population": "People with recurrent pilonidal sinus disease treated with phenol", "intervention": "", "comparator": "", "primaryOutcome": "Whether phenol treatment succeeded or failed, and time to return to work, walk without pain, or sit without pain", "result": "No statistically significant difference between successful and unsuccessful treatment groups in time to recurrence, follow-up time, time to return to work, or time to walk/sit without pain, but actual durations were not given", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective single-center study focused on predictors of treatment failure, not a systematic measurement of healing time, and it reports comparisons between groups rather than actual healing durations.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, no control group, and no explicit healing-time data provided despite mentioning time-related variables.", "followUp": "", "plainFinding": "No specific healing time reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38131372/", "sourceText": "AİM: This study aimed to observe the clinical outcomes of phenol treatment in patients with recurrent pilonidal sinus disease. MATERİAL AND METHODS: This study retrospectively collected data from 107 patients with recurrent the pilonidal disease who received phenol treatment in a single institute. Patients were divided into two groups as successful treatment (ST) and unsuccessful treatment (UST) after phenol application. A comparison was held between groups to define factors associated with failure treatment. RESULTS: There were 89 patients in ST and 18 patients in UST group. The treatment success rate after phenol treatment was 83.2%. We observed no difference between ST and UST in terms of age, gender, family history, surgical technique at the first operation, time to recurrence, procedure time, follow-up time, time to return to work, walk without pain or sit on the toilet without pain (p>0.05). However, smoking rate, presence of comorbidity, and mean BMI were statistically significantly higher in the UST group compared to the ST group (p<0.05). In addition, being obese (OR: 2.45, 95% CI: 1.07 - 5.60), having a comorbid disease (OR: 3.11, 95% CI: 1.29 - 7.47), and smoking (OR: 1.97, 95% CI: 0.85 - 4.53) were significantly associated with treatment failure. CONCLUSİON: Phenol treatment is an effective and simple procedure that could be easily applied even in rural hospitals in an outpatient fashion. Therefore, it should be considered for patients suffering from recurrence without the need for an aggressive surgical excision. KEY WORDS: Crystallized phenol, Pilonidal sinus, Recurrence.", "provenance": [ { "field": "population", "quote": "107 patients with recurrent the pilonidal disease who received phenol treatment in a single institute" }, { "field": "n", "quote": "This study retrospectively collected data from 107 patients" }, { "field": "primaryOutcome", "quote": "Patients were divided into two groups as successful treatment (ST) and unsuccessful treatment (UST) after phenol application." }, { "field": "result", "quote": "We observed no difference between ST and UST in terms of age, gender, family history, surgical technique at the first operation, time to recurrence, procedure time, follow-up time, time to return to work, walk without pain or sit on the toilet without pain (p>0.05)." } ] }, { "id": "pmid:38097850", "pmid": "38097850", "doi": "10.1007/s00104-023-02014-5", "nctId": null, "pmcid": "PMC11649773", "title": "Sinus pilonidalis-elastic ligature as an optimal outpatient treatment", "firstAuthor": "Danihel", "multipleAuthors": true, "journal": "Chirurgie (Heidelb)", "year": 2024, "design": "case-series", "n": 50, "nField": "reported", "population": "People treated with elastic ligature for pilonidal sinus (acute abscess, recurrent abscess, or chronic fistula)", "intervention": "Elastic ligature treatment for pilonidal sinus", "comparator": "", "primaryOutcome": "Time to complete healing of the pilonidal defect", "result": "47 of 50 patients had complete recovery, with an average total treatment time of 1 month for complete healing; 3 patients had recurrence over a 30-month follow-up", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "It is a small single-arm case series without a comparison group, so healing times may not generalize to other treatments.", "directness": "indirect", "relevanceNote": "", "limitations": "No control group; single specific technique (elastic ligature) rather than standard drainage or excision; median observation time used rather than fixed follow-up for all patients.", "followUp": "30 months (median observation time)", "plainFinding": "Healed in about 1 month.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38097850/", "sourceText": "BACKGROUND: The incidence of pilonidal sinus shows a steadily rising tendency, especially in the patient age group of up to 40 years. Treatment of this condition is often protracted involving lengthy sick leave and an increased risk of recurrence. The optimal treatment of pilonidal sinus remains open to debate, but it should focus on decreasing the length of hospitalization, promoting a rapid return to daily life, maintaining low pain levels, and keeping costs at a minimum. MATERIALS AND METHODS: In our study conducted between 2017 and 2021, we focused on treatment of pilonidal sinus. We performed 50 elastic ligature procedures with a median observation time of 30 months. The patients were divided into three groups according to the characteristics of pilonidal sinus: (1) acute primary abscess; (2) acute recurrent abscess; and (3) chronic fistula. RESULTS: Out of a total of 50 patients with a subsequent 30-month follow-up, we observed complete recovery in 47 patients and recurrence in three patients. Return to work was possible immediately after the operation, with an average total treatment time of 1 month for complete healing of the defect. CONCLUSION: The current results suggest that the technique of elastic ligature is a desirable solution for pilonidal sinus, because of the initial low costs, no need for hospitalization, and good patient tolerance.", "provenance": [ { "field": "population", "quote": "The patients were divided into three groups according to the characteristics of pilonidal sinus: (1) acute primary abscess; (2) acute recurrent abscess; and (3) chronic fistula." }, { "field": "intervention", "quote": "We performed 50 elastic ligature procedures with a median observation time of 30 months." }, { "field": "primaryOutcome", "quote": "average total treatment time of 1 month for complete healing of the defect" }, { "field": "result", "quote": "we observed complete recovery in 47 patients and recurrence in three patients. Return to work was possible immediately after the operation, with an average total treatment time of 1 month for complete healing of the defect." }, { "field": "n", "quote": "We performed 50 elastic ligature procedures" }, { "field": "followUp", "quote": "median observation time of 30 months" } ] }, { "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": "People treated for pilonidal sinus disease with either surgical flap reconstruction or phenol injection", "intervention": "", "comparator": "", "primaryOutcome": "Time to return to work, hospital stay, and recurrence after treatment for pilonidal sinus disease", "result": "Return to work took about 2.8 days after phenol treatment versus about 15.4 days after Karidakis flap surgery; recurrence occurred in 4.22% of flap patients, and phenol failed in 5.4% of patients after multiple sessions; patients were followed for about 13-14 months on average.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective comparison of two different treatments without randomization, so differences in recovery time could reflect patient selection rather than true healing speed.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, no randomization between treatment groups, and the study compares two specific treatments rather than describing the general time course of healing.", "followUp": "13.44 (11-16) months in the KFR group and 13.67 (11-16) months in the phenol group", "plainFinding": "Recovery and return to work varied by treatment.", "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": "216 patients treated for pilonidal sinus disease with the researched methods between June 2016 and July 2019 were included in the study" }, { "field": "result", "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." }, { "field": "result", "quote": "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." }, { "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." } ] }, { "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": "People treated for pilonidal sinus disease with minimally invasive methods", "intervention": "", "comparator": "", "primaryOutcome": "Time to complete wound healing after treatment", "result": "Wound closure took about 32 days after EPSIT versus 37 days after PEBAI; complete wound healing and recurrence rate were similar between groups, with follow-up averaging 24 months", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective comparison between two surgical methods, not a study of untreated natural healing, so it gives only indirect evidence about typical healing time.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design comparing two specific minimally invasive techniques; not a general study of pilonidal cyst healing time across treatment types.", "followUp": "24 (12 to 34) months", "plainFinding": "Wounds closed in about 1 month", "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": "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": "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)]" }, { "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." }, { "field": "n", "quote": "One hundred 4 patients who underwent EPSIT and 184 patients who underwent PEBAI were included in the study." }, { "field": "followUp", "quote": "The median follow-up was 24 (12 to 34) months." } ] }, { "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": "people treated for pilonidal sinus with laser or laser plus phenol at a hospital surgery clinic", "intervention": "laser treatment alone", "comparator": "laser treatment combined with phenol", "primaryOutcome": "complete healing and recurrence of the pilonidal sinus", "result": "Most patients in both groups achieved complete healing (91.7% laser-only, 95.5% laser-phenol), with recurrence noted after the fourth month in a small number of patients (13.6% laser-only, 4.8% laser-phenol); differences were not statistically significant", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a small retrospective study without statistical significance and no clear total sample size reported, so it carries limited weight.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, small and inconsistently reported group sizes, differences described as not statistically significant.", "followUp": "fourth month", "plainFinding": "Most healed by 4 months", "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 who were treated in the general surgery clinic of the Balikesir University Hospital between October 2019 and February 2022" }, { "field": "intervention", "quote": "laser treatment group" }, { "field": "comparator", "quote": "laser-phenol treatment group" }, { "field": "primaryOutcome", "quote": "complete healing" }, { "field": "result", "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. Notably, 22 (91.7%) patients in the laser treatment group and 21 (95.5%) patients in the laser-phenol treatment group had complete healing." } ] }, { "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 treated for pilonidal sinus disease with non-excisional techniques", "intervention": "", "comparator": "", "primaryOutcome": "How long the wound takes to heal and recurrence after non-excisional treatment", "result": "Healing rates ranged from 67 to 100%, wound healing time was between three and forty-seven days, and return to daily activities varied from one to nine days, but recurrence rates were high (0 to 29%)", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "It pools many studies with a large total number of patients, but the included studies likely vary a lot in design and quality, and the review does not grade individual study quality.", "directness": "direct", "relevanceNote": "", "limitations": "The review combines many different non-excisional techniques and studies with varying follow-up times, which may affect how comparable the healing and recurrence figures are.", "followUp": "", "plainFinding": "Heals in days to weeks, often recurs", "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": "Non-excisional techniques for pilonidal sinus disease (PSD) have gained popularity over the last years." }, { "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%." }, { "field": "result", "quote": "the wound healing time was between three and forty-seven days" }, { "field": "result", "quote": "The return to daily activities varied from one to nine days." }, { "field": "result", "quote": "Recurrence rates after additional laser, phenol and endoscopic techniques varied from 0 to 29%." } ] }, { "id": "pmid:37722760", "pmid": "37722760", "doi": "10.1111/iwj.14404", "nctId": null, "pmcid": "PMC10788639", "title": "New factors affecting wound healing and recurrence after pilonidal sinus surgery in adolescents; seborrheic dermatitis and psychiatric co-occurring conditions", "firstAuthor": "Kaba", "multipleAuthors": false, "journal": "Int Wound J", "year": 2024, "design": "retrospective", "n": 282, "nField": "reported", "population": "Adolescents who had surgery for pilonidal sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "Pattern of wound healing after surgery (uneventful, prolonged care, non-closure with recurrence, or recurrence after healing) and factors associated with each", "result": "53.5% healed without problems, 22.6% had prolonged wound care, 17.7% never closed and recurred, and 6% recurred after healing; seborrheic dermatitis, obesity and psychiatric diagnoses were linked to the groups with worse healing", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective chart review without a comparison group or controlled follow-up, so it can describe patterns but not prove causes.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, single clinic, no standardized follow-up time reported, and factors are associative not causal.", "followUp": "", "plainFinding": "About half heal fine, rest vary", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37722760/", "sourceText": "Postoperative wound healing problems and recurrence remain common for pilonidal sinus disease (PSD). Our study aimed to examine the effect of comorbidities in addition to the classic known factors that may affect wound complications and recurrence after PSD surgery. We retrospectively analysed 282 adolescent patients operated on in our clinic between 2014 and 2021. We gathered the postoperative wound healing patterns of the patients under four groups. With a mean age of 15.49 ± 1.45, 59.9% (n = 169) were male, 40.1% (n = 113) were female and 23.8% (n = 67) had recurrence. When examined according to the wound healing groups, 53.5% (n = 151) had an uneventful wound, 22.6% (n = 64) had prolonged wound care, 17.7% (n = 50) of the postoperative wounds did not close and had a recurrence and 6% (n = 17) had recurrence after the wound was healed. The number of sinuses, abscess presentation and the incidence of comorbid disease in group 1 were found to be statistically significantly lower than all other groups. Seborrheic dermatitis, obesity and psychiatric diagnoses showed high statistical association with group 3 and acne with group 4. In patients with seborrheic dermatitis or psychiatric diagnosis, a significant correlation was found between wound healing according to the type of surgery (p < 0.05). The wound healing patterns of these patients after total excision and primary closure surgeries were included in Group 3 with a statistically significant high rate. As two new factors, the significance of the presence of seborrheic dermatitis and psychiatric comorbidities should be evaluated in these patients whose wounds remain open postoperatively and do not respond to primary wound care and eventually relapse. Further histologic and pathologic investigations are needed for seborrheic dermatitis and PSD relation. Awareness of these diseases may change the decision of the type of surgery, and their treatment within the same time may support wound healing and ultimately reduce recurrence.", "provenance": [ { "field": "n", "quote": "We retrospectively analysed 282 adolescent patients operated on in our clinic between 2014 and 2021." }, { "field": "population", "quote": "adolescent patients operated on in our clinic between 2014 and 2021" }, { "field": "primaryOutcome", "quote": "We gathered the postoperative wound healing patterns of the patients under four groups." }, { "field": "result", "quote": "53.5% (n = 151) had an uneventful wound, 22.6% (n = 64) had prolonged wound care, 17.7% (n = 50) of the postoperative wounds did not close and had a recurrence and 6% (n = 17) had recurrence after the wound was healed." } ] }, { "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": "prospective-cohort", "n": 96, "nField": "reported", "population": "young adults treated for pilonidal sinus disease", "intervention": "simplified modified Limberg flap surgery combined with vacuum-assisted wound closure", "comparator": "", "primaryOutcome": "time to drain removal, hospital stay, and return to normal activity after surgery", "result": "average time to remove the wound drain was about 6.4 days, average hospital stay was 19.4 days, and patients returned to daily activities after an average of 26.3 days; no recurrences occurred", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "This is a retracted publication with only one treatment group and no comparison, so its reported healing times cannot be trusted.", "directness": "direct", "relevanceNote": "", "limitations": "The paper has been retracted, it followed only one group of patients with no comparator, and came from a single hospital.", "followUp": "", "plainFinding": "Back to activity in about 26 days", "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": "Pilonidal sinus disease (PSD), a chronic inflammatory disease, affects the sacrococcygeal soft tissue, especially in young adults." }, { "field": "intervention", "quote": "simplified modified Limberg flap reconstruction with vacuum-assisted closure" }, { "field": "primaryOutcome", "quote": "extubation time, hospital stay, time to return to normal life or work, wound infection, wound dehiscence and recurrence rate were recorded" }, { "field": "result", "quote": "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." }, { "field": "result", "quote": "The mean time to the resumption of daily activities was 26.3 days." } ] }, { "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": "People with extensive, complex or recurrent pilonidal disease who had cleft closure (Bascom cleft lift) surgery", "intervention": "", "comparator": "", "primaryOutcome": "How long wounds took to fully heal after surgery, and whether disease came back", "result": "Just over 60% healed initially, rising to 88.5% healed by 12 weeks and 91.8% by 16 weeks; most of the rest healed over following weeks, with only 3% needing further surgery; 5.3% had disease return at a median of 12 months after healing", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "A large single-surgeon case series over many years gives useful real-world healing timelines, but without a comparison group or randomisation it cannot rule out other explanations for the results.", "directness": "indirect", "relevanceNote": "", "limitations": "Single surgeon series across two centres over 26 years, no control group, and some patients lacked documented follow-up (656 of 714).", "followUp": "12 months", "plainFinding": "Most heal within 12-16 weeks", "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": "population", "quote": "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" }, { "field": "n", "quote": "Some 714 patients had a cleft closure of whom 656 had documented follow-up." }, { "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. 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." } ] }, { "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 (under 18) who had endoscopic surgery for pilonidal sinus", "intervention": "", "comparator": "", "primaryOutcome": "time to healing and treatment success after endoscopic pilonidal sinus treatment", "result": "weighted mean time to healing was 4.1 weeks, with treatment successful in 90.9% of patients; recurrence occurred in 9.1% after a weighted mean of 4.6 months", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this is a pooled review of mostly uncontrolled case series using a specific endoscopic technique in children, so it may not reflect healing times for other treatments or age groups.", "directness": "indirect", "relevanceNote": "", "limitations": "studies included were on a specific endoscopic technique (PEPSiT) in pediatric patients only, with no comparison to conventional excision or open wound healing in the same review.", "followUp": "13.5 months", "plainFinding": "Healed in about 4 weeks", "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": "primaryOutcome", "quote": "pertaining to demographics, technique, and outcomes" }, { "field": "result", "quote": "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." }, { "field": "followUp", "quote": "follow-up duration of 13.5 months were included" } ] }, { "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 treated for pilonidal sinus disease with either phenol injection or surgical excision", "intervention": "phenol treatment", "comparator": "surgical excision", "primaryOutcome": "time until the wound completely healed after treatment", "result": "Postoperative complete healing time was significantly shorter than surgical healing time (weighted mean difference -17.11, 95% CI [-32.18,-2.03])", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "It pools data from 14 studies, but nine were non-randomized, which can bias the healing-time estimates.", "directness": "indirect", "relevanceNote": "", "limitations": "Included both randomized and non-randomized studies, and exact healing-time duration (e.g., in days or weeks) is not stated, only the relative difference between treatments.", "followUp": "", "plainFinding": "Phenol treatment heals faster than surgery", "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": "n", "quote": "Fourteen publications were included, including five RCTs and nine non-RCTs." }, { "field": "population", "quote": "comparing phenol treatment and surgical treatment of pilonidal sinus" }, { "field": "intervention", "quote": "phenol treatment" }, { "field": "comparator", "quote": "surgical excision treatment" }, { "field": "primaryOutcome", "quote": "Postoperative complete healing time" }, { "field": "result", "quote": "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 treated surgically with laser", "intervention": "", "comparator": "", "primaryOutcome": "Time to complete recovery (healing) after treatment and time to return to daily activities", "result": "Mean time to return to daily life was 4.5 (median 2) days; mean complete recovery time was 27.4 days; 87.8% of patients completely recovered", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective single-center study of one specific laser technique without a control group for healing time, so the findings may not reflect typical healing after standard treatments.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, no control group, outcomes reported only for diode laser treatment rather than standard incision/drainage or excision methods", "followUp": "a minimum of 1 year", "plainFinding": "Healed in about 27 days on average", "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": "population", "quote": "A total of 106 patients with PSD who underwent laser treatment between November 2017 and September 2021 were included in this study." }, { "field": "n", "quote": "A total of 106 patients with PSD who underwent laser treatment" }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "Eighty-six (87.8%) patients completely recovered and the mean complete recovery time was 27.4 ± 15.9 days." }, { "field": "followUp", "quote": "Follow-up period was determined as a minimum of 1 year." } ] }, { "id": "pmid:37351640", "pmid": "37351640", "doi": "10.1007/s00384-023-04475-w", "nctId": null, "pmcid": null, "title": "Bilaterally parallel elliptic flap versus Karydakis flap in primary pilonidal sinus disease: a randomized controlled trial", "firstAuthor": "Turan", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2023, "design": "rct", "n": 102, "nField": "reported", "population": "Adults having surgery for pilonidal sinus disease", "intervention": "Bilateral parallel elliptical flap surgery", "comparator": "Karydakis flap surgery", "primaryOutcome": "Time until patients could return to work or school after surgery", "result": "Patients returned to work or school in about 21 days after the bilateral parallel elliptical flap versus about 27 days after the Karydakis flap; wound complications occurred in 18% vs 26%, and recurrence in 4% vs 5.6%, with no significant difference in hospital stay (about 1.4 days for both).", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "It was a randomized trial but relatively small and compared two surgical techniques rather than tracking general healing time, and it was registered only after the study was already underway.", "directness": "indirect", "relevanceNote": "", "limitations": "Small sample size, single center, and the trial was retrospectively registered after completion.", "followUp": "", "plainFinding": "Back to activity in 3-4 weeks", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37351640/", "sourceText": "PURPOSE: Pilonidal sinus disease is a disease that especially affects the young population and causes loss of workforce. Although many treatment methods have been defined, there is still no \"gold standard\" treatment method. Our objective was to evaluate the postoperative results of bilateral parallel elliptical flap and Karydakis flap in the surgical treatment of pilonidal sinus. METHODS: This study was conducted at the Colorectal Surgery Department of Ankara Numune Training and Research Hospital. It designed a prospective randomized controlled study. Patients that underwent surgery due to pilonidal sinus were included in the study. The patients were randomly divided into two groups. Surgery was performed with the bilateral parallel elliptical flap (BPEF) technique in one group and the Karydakis flap (KF) technique in the other group. Postoperative pain, length of hospital stay, wound complications, time taken to return to work/school, and recurrence incidence were evaluated. RESULTS: A total of 102 patients were included in the study, 49 in the BPEF group and 53 in the KF group. The length of hospital stay was similar in the BPEF and KF groups (1.41 ± 0.81 and 1.45 ± 0.84, respectively; p > 0.05). There was less postoperative pain in the BPEF group (2.47 ± 1.02 vs 3.57 ± 1.10, p < 0.05). Wound complications were observed in nine patients in the BPEF group (18.2%) and 14 patients in the KF group (26.2%). The time to return to work/school was shorter in the BPEF group (21.06 ± 6.37 vs 27.04 ± 7.45; p < 0.05). Recurrence developed in two (4%) patients in the BPEF group and three (5.6%) patients in the KF group (p > 0.05). CONCLUSIONS: The patients who underwent surgery with the bilateral parallel elliptical flap technique had less pain and a shorter time to return to work/school after the operation. The postoperative complication and recurrence rates were similar in both groups. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT05851690. (5/11/2023) (retrospectively registered).", "provenance": [ { "field": "population", "quote": "Patients that underwent surgery due to pilonidal sinus were included in the study." }, { "field": "intervention", "quote": "Surgery was performed with the bilateral parallel elliptical flap (BPEF) technique in one group" }, { "field": "comparator", "quote": "and the Karydakis flap (KF) technique in the other group." }, { "field": "primaryOutcome", "quote": "Postoperative pain, length of hospital stay, wound complications, time taken to return to work/school, and recurrence incidence were evaluated." }, { "field": "result", "quote": "The time to return to work/school was shorter in the BPEF group (21.06 ± 6.37 vs 27.04 ± 7.45; p < 0.05)." }, { "field": "result", "quote": "Wound complications were observed in nine patients in the BPEF group (18.2%) and 14 patients in the KF group (26.2%)." }, { "field": "result", "quote": "Recurrence developed in two (4%) patients in the BPEF group and three (5.6%) patients in the KF group (p > 0.05)." }, { "field": "n", "quote": "A total of 102 patients were included in the study, 49 in the BPEF group and 53 in the KF group." } ] }, { "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 undergoing surgical treatment", "intervention": "", "comparator": "", "primaryOutcome": "Healing time and recurrence after surgical treatment of pilonidal disease", "result": "Lay-open excision with healing by secondary intention has low recurrence but involves long healing time and sick-leave; newer minimally invasive endoscopic and laser techniques aim for quicker healing with failure rates under 10% at 1 year and low complications, but this needs confirmation with longer follow-up", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "This is a narrative discussion of multiple surgical approaches without a defined cohort, systematic methodology, or quantified healing-time data, so it cannot reliably answer how long healing takes.", "directness": "indirect", "relevanceNote": "", "limitations": "these interesting results need to be confirmed by better quality studies with longer follow-up", "followUp": "1 year", "plainFinding": "Healing time varies by procedure, not clearly stated", "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": "primaryOutcome", "quote": "This procedure has low recurrence rates, but involves daily nursing care, long healing time and long period of sick-leave." }, { "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": "result", "quote": "This procedure has low recurrence rates, but involves daily nursing care, long healing time and long period of sick-leave." }, { "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 with pilonidal sinus disease treated with a non-surgical injection method", "intervention": "Salih's preparation (a non-operative sclerosing/antimicrobial injection treatment)", "comparator": "", "primaryOutcome": "recurrence of the pilonidal sinus at 6 weeks after treatment", "result": "The study tracked recurrence, not time to healing; the presence of an abscess was the strongest factor linked to recurrence, and patients were grouped into three classes predicting recurrence risk", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "Large single-group cohort with no comparison group and only a short 6-week follow-up, so it can't show how long healing actually takes or compare to other treatments.", "directness": "indirect", "relevanceNote": "", "limitations": "No control/comparator group; follow-up limited to 6 weeks; focuses on recurrence classification rather than healing duration.", "followUp": "6 weeks", "plainFinding": "No healing-time data; tracked recurrence risk only", "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": "consecutive patients that had pilonidal sinus" }, { "field": "intervention", "quote": "All the patients were managed using Salih's preparation." }, { "field": "primaryOutcome", "quote": "The patients were seen at the clinic 6 weeks after the intervention to record data of recurrence." }, { "field": "n", "quote": "only 3529 patients were included in this study" }, { "field": "result", "quote": "The most significant factor related to the recurrence was the presence of an abscess." }, { "field": "result", "quote": "the patients were divided into three classes" } ] }, { "id": "pmid:37256592", "pmid": "37256592", "doi": "10.1001/jamasurg.2023.0373", "nctId": null, "pmcid": null, "title": "Management of Pilonidal Disease: A Review", "firstAuthor": "Gil", "multipleAuthors": true, "journal": "JAMA Surg", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "People with pilonidal disease undergoing treatment", "intervention": "", "comparator": "", "primaryOutcome": "How well different pilonidal treatments work and how long disease/recovery lasts", "result": "The abstract does not report a specific healing duration; it states that evidence on treatment outcomes is limited by inconsistent disease severity reporting and variable outcome definitions across studies", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a narrative review summarizing treatment options and explicitly states the underlying studies are limited in quality and inconsistent, so it cannot answer how long healing takes.", "directness": "indirect", "relevanceNote": "", "limitations": "The abstract itself states current evidence is limited by study quality, inconsistent characterization of disease severity, and variable definitions/reporting of outcomes across studies.", "followUp": "", "plainFinding": "No healing-time data reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37256592/", "sourceText": "IMPORTANCE: The management of pilonidal disease continues to be a challenge due to high rates of recurrence and treatment-associated morbidity. OBSERVATIONS: There is a heterogeneous repertoire of treatment modalities used in the management of pilonidal disease and wide practice variation among clinicians. Available treatment options vary considerably in their level of invasiveness, associated morbidity and disability, risks of complications, and effectiveness at preventing disease recurrence. Conservative nonoperative management strategies, including persistent improved hygiene, depilation, and lifestyle modification, focus on disease prevention and minimization of disease activity. Epilation techniques using both laser and intense pulse light therapy are also used as primary and adjunct treatment modalities. Other nonoperative treatment modalities include phenol and fibrin injection to promote closure of pilonidal sinuses. The traditional operative management strategy for pilonidal disease involves excision of affected tissue paired with a variety of closure types including primary midline closure, primary off-midline closure techniques (ie, Karydakis flap, Limberg flap, Bascom cleft lift), and healing by secondary intention. There has been a recent shift toward more minimally invasive operative approaches including sinusectomy (ie, trephination or Gips procedure) and endoscopic approaches. Overall, the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies. CONCLUSIONS AND RELEVANCE: Pilonidal disease is associated with significant physical and psychosocial morbidity. Optimal treatments will minimize disease and treatment-associated morbidity. There is a need for standardization of definitions used to characterize pilonidal disease and its outcomes to develop evidence-based treatment algorithms.", "provenance": [ { "field": "population", "quote": "the management of pilonidal disease" }, { "field": "result", "quote": "Overall, the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies." }, { "field": "primaryOutcome", "quote": "effectiveness at preventing disease recurrence" } ] }, { "id": "pmid:37204472", "pmid": "37204472", "doi": "10.1007/s10103-023-03788-0", "nctId": null, "pmcid": null, "title": "Laser ablation: a unique and beneficial therapeutic option for pilonidal sinus? And the potential for further innovation-a review", "firstAuthor": "Ganduboina", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "People treated for pilonidal sinus with laser ablation techniques", "intervention": "Laser ablation procedures (SiLaC, SiLaT, PiLaT, LEPSiT) using diode or Nd:YAG lasers", "comparator": "Conventional surgical methods for pilonidal sinus", "primaryOutcome": "Healing rate, recurrence, and post-operative complications", "result": "Laser ablation showed the highest healing rate with Nd:YAG laser and SiLaT technique, low recurrence, and lower morbidity than conventional surgery, but no specific healing duration in weeks or months was given", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a narrative review of mixed laser techniques without a clear systematic methodology or reported healing timeframes, and it focuses on comparing treatments rather than describing the natural time course of healing.", "directness": "indirect", "relevanceNote": "", "limitations": "The abstract does not specify how long it takes for the wound or sinus to heal, only relative comparisons between laser and conventional methods; no systematic quality assessment or pooled statistics are described.", "followUp": "", "plainFinding": "No specific healing time reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37204472/", "sourceText": "Laser has revolutionized the medical field, broadening the diagnostic and therapeutic spectrum, with diode (630-980 nm) and Nd:YAG (1064 nm) lasers being the common choices in ablation procedures. Laser ablation in pilonidal sinus disease is a new minimally invasive technique with good treatment efficacy, low post-op morbidity, and shorter recovery periods following employment. This review study aimed to provide information on the use of lasers in pilonidal sinus disease and their effectiveness compared to other conventional methods. The articles considered were obtained by performing a literature search in PubMed, Cochrane, and Google Scholar, and 44 articles were included in this study. Techniques like sinus laser-assisted closure (SiLaC), sinus laser therapy (SiLaT), pilonidal sinus laser treatment (PiLaT), and laser-assisted endoscopic pilonidal sinus treatment (LEPSiT) were included and reviewed. Diode laser was most commonly used, with local anesthesia preferred over spinal or general anesthesia. The highest healing rate was observed with Nd:YAG laser and the SiLaT technique. Recurrence was low, particularly in patients who underwent multiple procedures. On reviewing the published literature, laser ablation procedures showed lower morbidity and post-op complications. Patient satisfaction was higher, and the overall cost was found to be lower with minimally invasive techniques. Long-term prospective studies comparing lasers with other surgical techniques would help us ascertain the future treatment modality of pilonidal sinus disease.", "provenance": [ { "field": "population", "quote": "Laser ablation in pilonidal sinus disease is a new minimally invasive technique with good treatment efficacy, low post-op morbidity, and shorter recovery periods following employment." }, { "field": "intervention", "quote": "Techniques like sinus laser-assisted closure (SiLaC), sinus laser therapy (SiLaT), pilonidal sinus laser treatment (PiLaT), and laser-assisted endoscopic pilonidal sinus treatment (LEPSiT) were included and reviewed." }, { "field": "comparator", "quote": "their effectiveness compared to other conventional methods" }, { "field": "primaryOutcome", "quote": "The highest healing rate was observed with Nd:YAG laser and the SiLaT technique." }, { "field": "result", "quote": "Recurrence was low, particularly in patients who underwent multiple procedures. On reviewing the published literature, laser ablation procedures showed lower morbidity and post-op complications." } ] }, { "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 (ages 10-18) who had pilonidal sinus disease treated with a minimally invasive endoscopic procedure", "intervention": "", "comparator": "", "primaryOutcome": "Time to full healing of the wound after treatment", "result": "Median time to full healing was 23.4 days (range 19-50 days); overall success rate was 95.2%", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective review of medical records from one treatment type without a comparison group, so healing time may not generalize to other treatments.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, no comparison group, specific to one surgical technique (PEPSiT) in a pediatric population, so healing time may differ from other treatment approaches or adult patients.", "followUp": "", "plainFinding": "Healed in about 23 days.", "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": "A total of 294 patients (182 boys), with median age of 14 years (range 10-18), receiving PEPSiT in the study period, were enrolled." }, { "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 (either mini-invasive pit-picking or a flap procedure)", "intervention": "mini-invasive pit-picking surgery (PPS)", "comparator": "asymmetrical excision with local flap (AELF)", "primaryOutcome": "whether the wound had healed, and whether the disease came back, after pilonidal sinus surgery", "result": "At the first follow-up visit after surgery, about three-quarters of patients in both groups had healed (75.0% with pit-picking vs 76.8% with flap surgery). Sick leave was shorter after pit-picking (median 14 days) than after flap surgery (median 21 days). Over long-term follow-up (median 9.3 years), the sinus came back much more often after pit-picking (50.9%) than after flap surgery (10.3%).", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective review of medical records comparing two surgical techniques, without randomization, so differences between groups could reflect patient selection rather than the treatments themselves.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, patients were not randomly assigned to surgery type, and the abstract does not report an exact average healing time, only the proportion healed at one follow-up visit.", "followUp": "median 9.3 years (range 5.4-10.6)", "plainFinding": "Most healed early; many recurred later.", "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": "population", "quote": "We retrospectively studied the medical records of 146 patients who underwent primary PSD surgery between November 2010 and October 2015." }, { "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": "intervention", "quote": "mini-invasive pit-picking surgery (PSS) (n = 55)" }, { "field": "comparator", "quote": "asymmetrical excision with local flap (AELF) (n = 58)" }, { "field": "primaryOutcome", "quote": "at the first postoperative follow-up visit, both surgery methods healed similarly (75.0% vs 76.8%, p = 0.83)" }, { "field": "result", "quote": "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)." }, { "field": "followUp", "quote": "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": "people who had surgery to remove a pilonidal sinus near the tailbone", "intervention": "", "comparator": "", "primaryOutcome": "wound healing and recurrence of the sinus after surgery", "result": "all wounds healed right away with no infection or wound breakdown, and no sinus came back during follow-up", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this is a very small case series of only 9 patients with no comparison group, so it cannot reliably show typical healing time", "directness": "indirect", "relevanceNote": "", "limitations": "very small sample, no control group, specific surgical flap technique rather than general pilonidal treatment, no exact healing duration in days/weeks given", "followUp": "3-36 months", "plainFinding": "Healed quickly, 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" }, { "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": "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" }, { "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 treated for pilonidal sinus disease", "intervention": "Endoscopic (minimally invasive) treatment", "comparator": "Excision and primary closure", "primaryOutcome": "Wound healing time, hospital stay, recurrence and complications after treatment", "result": "Endoscopic treatment was better tolerated and had fewer complications and less recurrence than excision with primary closure, but the review says healing time has not yet been shown to be statistically better and will only be proven with more studies", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "It is a systematic review of a small, mixed set of pediatric studies with no pooled statistics on healing time itself, so the evidence on healing duration is weak.", "directness": "indirect", "relevanceNote": "", "limitations": "Only 20 of 38 identified studies were included after excluding adult or irrelevant studies, and the abstract does not give actual healing time figures, only a comparison between techniques.", "followUp": "", "plainFinding": "Healing time comparison inconclusive so far", "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 changed dramatically in the last few years" }, { "field": "intervention", "quote": "endoscopic techniques for PSD" }, { "field": "comparator", "quote": "excision and primary closure (EPC)" }, { "field": "primaryOutcome", "quote": "important endpoints such as wound healing time and length of hospital stay will be proved to be superior" }, { "field": "result", "quote": "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." }, { "field": "n", "quote": "We pooled 38 studies, 18 of these were excluded" } ] }, { "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": "young adults (mostly male) treated surgically for pilonidal sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "time to recovery after surgery, including drain duration, hospital stay, and return to work", "result": "mean duration of drain in situ was 4±1.34 days, length of hospital stay was 2.83±1.68 days, and mean days for return to work was 14.5±5.7; complication rate was 9.52% with no flap necrosis or recurrence", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "Small single-center study with no comparison group, so healing times may not generalize.", "directness": "direct", "relevanceNote": "", "limitations": "Small sample size (42 patients), single hospital, no control group, and follow-up duration beyond return-to-work not specified.", "followUp": "", "plainFinding": "Back to work in about 2 weeks", "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": "forty-two patients" }, { "field": "population", "quote": "42 patients were operated ranging from 16-31 years with mean of 22.86 years, male to female ratio was 7.5:1" }, { "field": "primaryOutcome", "quote": "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" }, { "field": "result", "quote": "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." } ] }, { "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": 92, "nField": "reported", "population": "People with chronic pilonidal sinus disease who had minimally invasive laser surgery (SiLaC)", "intervention": "Laser-assisted closure (SiLaC) surgery for pilonidal sinus", "comparator": "", "primaryOutcome": "Complete healing rate after surgery", "result": "81.3% of patients healed completely, 8.8% had minor incomplete healing not needing further treatment, and 9.9% had recurrence or non-healing requiring reoperation in most cases", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective single-center series without a comparison group and no explicit follow-up time stated, so it can't reliably show how long healing takes.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective analysis, single center, no control group, and no explicit time-to-healing or follow-up duration reported", "followUp": "", "plainFinding": "Most healed completely 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": "population", "quote": "all patients who underwent minimally invasive surgery combined with laser therapy for PNS between September 2018 and December 2020" }, { "field": "intervention", "quote": "sinus laser-assisted closure (SiLaC) of pilonidal disease" }, { "field": "n", "quote": "A total of 92 patients (86 males, 93.4%) underwent SiLaC surgery for pilonidal sinus disease during the study period." }, { "field": "primaryOutcome", "quote": "The primary outcome was complete healing rate, standing at 81.3% (74/91 patients)." }, { "field": "result", "quote": "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%)." } ] }, { "id": "pmid:36877001", "pmid": "36877001", "doi": "10.1097/DCR.0000000000002745", "nctId": null, "pmcid": null, "title": "Laser Ablation of Pilonidal Sinus Disease: A Pilot Study", "firstAuthor": "Williams", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2023, "design": "case-series", "n": 25, "nField": "reported", "population": "adults and children treated for pilonidal sinus disease with laser ablation", "intervention": "laser ablation of the pilonidal sinus tract", "comparator": "", "primaryOutcome": "whether the wound was healed at follow-up", "result": "82% of patients were healed at 6 months", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This was a small pilot study with no comparison group and only 25 patients, so it cannot reliably show typical healing time.", "directness": "direct", "relevanceNote": "", "limitations": "Pilot/feasibility study with small sample size, no control group, and follow-up time varied between patients.", "followUp": "6 months", "plainFinding": "82% healed by 6 months.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36877001/", "sourceText": "BACKGROUND: Pilonidal disease is classically treated with wide local excision, although a number of minimally invasive approaches are currently under investigation. We aimed to determine the safety and feasibility of laser ablation of pilonidal sinus disease. IMPACT OF INNOVATION: Laser ablation provides a minimally invasive means of obliterating pilonidal sinus tracts without a need for excessive tract dilation. Laser ablation can be performed more than once on the same patient if necessary. TECHNOLOGY MATERIALS AND METHODS: This technique uses the NeoV V1470 Diode Laser (neoLaser Ltd, Caesarea, Israel) with a 2-mm probe. We performed laser ablation in adults and pediatric patients. PRELIMINARY RESULTS: We performed 27 laser ablation procedures in 25 patients, with a median operative time of 30 minutes. Eighty percent of patients reported either no pain or mild pain at the 2-week postoperative visit. The median time to return to work or school was 3 days. Eighty-eight percent of patients reported being satisfied or very satisfied with the procedure at their most recent follow-up (median, 6 mo). Eighty-two percent of patients were healed at 6 months. CONCLUSIONS AND FUTURE DIRECTIONS: Laser ablation of pilonidal disease is safe and feasible. Patients experienced short recovery time and reported low levels of pain and high levels of satisfaction.", "provenance": [ { "field": "population", "quote": "We performed laser ablation in adults and pediatric patients." }, { "field": "n", "quote": "We performed 27 laser ablation procedures in 25 patients" }, { "field": "intervention", "quote": "Laser ablation provides a minimally invasive means of obliterating pilonidal sinus tracts" }, { "field": "primaryOutcome", "quote": "Eighty-two percent of patients were healed at 6 months." }, { "field": "result", "quote": "Eighty-two percent of patients were healed at 6 months." }, { "field": "followUp", "quote": "most recent follow-up (median, 6 mo)" } ] }, { "id": "pmid:36856904", "pmid": "36856904", "doi": "10.1007/s10103-023-03741-1", "nctId": null, "pmcid": "PMC9977879", "title": "An effective and considerable treatment of pilonidal sinus disease by laser ablation", "firstAuthor": "Li", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2023, "design": "retrospective", "n": 48, "nField": "reported", "population": "Adults who had surgery for pilonidal sinus disease", "intervention": "Laser ablation using a 1470-nm diode laser fiber", "comparator": "", "primaryOutcome": "Time for the wound to fully heal", "result": "All patients healed completely, with an average healing time of about 28 days", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "Small single-center retrospective study of one specific laser technique with no comparison group and only one month of routine follow-up.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, small sample, single center, no control group, short follow-up period for assessing recurrence.", "followUp": "every 1 week for 1 month", "plainFinding": "Healed in about a month.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36856904/", "sourceText": "The treatment of sacrococcygeal pilonidal disease (SPD) is still challenging. Although many non-surgical and surgical methods exist, no consensus has been reached on the best treatment. This study aimed to evaluate the efficacy of laser ablation using 1470-nm radial diode laser fiber in treating SPD. We retrospectively studied the data of our 48 patients who operated on this technique between March 2019 and July 2022. All patients were treated with laser ablation using 1470-nm radial diode laser fiber. The healing rate and recurrence rate, demographic and surgical data, postoperative pain, complications (wound infection, wound bleeding), the time of returning to regular work and life, and the time of wound healing were recorded. Postoperative pain was measured based on the visual analog scale (VAS) score. Postoperative follow-up was performed in the outpatient clinic every 1 week for 1 month. Among the 48 patients, 41 males and 7 females, with a mean age of 27.7 years (range 14-42), the healing rate was 100%, and the average healing time was 28.3 ± 5.5 days. Mean operative time was 15.5 ± 3.3 min. The recurrence rate was 2.1%. One patient relapsed 3 months after the operation. The patient underwent laser ablation again, and the sinus tract was closed. The median visual analog scale (VAS) score on the day of operation was 0(0,2). The median VAS score on the first, third, seventh, and fourteenth day after operation was 0(0,2), 0(0,1), 0(0,1), and 0(0,0), respectively. There was no wound infection or bleeding after the operation. The mean time to normal work/life was 7.1 ± 3.2 days. Almost all the patients felt very satisfied with the operation. Laser ablation using 1470-nm radial diode laser fiber is effective in SPD treatment. It is associated with minor wounds and mild postoperative pain. It is a simple, safe, and minimally invasive technique and its clinical application for acute and chronic SPD in the absence of abscess is promising.", "provenance": [ { "field": "population", "quote": "we retrospectively studied the data of our 48 patients who operated on this technique between March 2019 and July 2022" }, { "field": "intervention", "quote": "All patients were treated with laser ablation using 1470-nm radial diode laser fiber." }, { "field": "primaryOutcome", "quote": "the time of wound healing were recorded" }, { "field": "result", "quote": "the healing rate was 100%, and the average healing time was 28.3 ± 5.5 days" }, { "field": "n", "quote": "Among the 48 patients, 41 males and 7 females, with a mean age of 27.7 years (range 14-42)" }, { "field": "followUp", "quote": "Postoperative follow-up was performed in the outpatient clinic every 1 week for 1 month." } ] }, { "id": "pmid:36802113", "pmid": "36802113", "doi": "10.1111/iwj.14105", "nctId": null, "pmcid": "PMC10333017", "title": "The application of the Limberg flap repair technique in the surgical treatment of pilonidal sinus disease", "firstAuthor": "Song", "multipleAuthors": true, "journal": "Int Wound J", "year": 2023, "design": "retrospective", "n": 37, "nField": "reported", "population": "patients with pilonidal sinus disease who had Limberg flap surgery", "intervention": "", "comparator": "", "primaryOutcome": "time for the surgical wound to heal", "result": "average wound healing time was about 15.4 days, with most patients healing in one stage", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this is a small retrospective single-treatment study without a comparison group, so it can only describe healing time after this specific surgery, not how pilonidal cysts heal in general", "directness": "indirect", "relevanceNote": "", "limitations": "retrospective design, small sample size, no untreated or differently-treated comparison group, specific to one surgical technique (Limberg flap)", "followUp": "", "plainFinding": "Healed in about 15 days after flap surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36802113/", "sourceText": "Pilonidal sinus disease (PNSD) challenged surgeons for decades. Limberg flap repair (LFR) is a common treatment for PNSD. The purpose of this study was to observe the effect and risk factors of LFR in PNSD. A retrospective study was conducted on the PNSD patients who visited two medical centers and four departments in the People's Liberation Army General Hospital and were taking LFR treatment between 2016 and 2022. The risk factors, the effect of the operation, and complications were observed. The effects of known risk factors on the surgical results were compared. There were 37 PNSD patients: male/female ratio of 35:2, average age: 25.1 ± 7.9 years. Average BMI: 25.2 ± 4.0 kg/m2 , average wound healing time: 15.4 ± 3.4 days. 30 patients (81.0%) healed in stage one and 7 (16.3%) had postoperative complications. Only 1 patient (2.7%) had a recurrence while others were healed after dressing-changing. There was no significant difference in age, BMI, preoperative debridement history, preoperative sinus classification, Wound area, Negative pressure drainage tube, prone time (<3d) and treatment effect. Squat defecate and premature defecation were associated with treatment effect, and they were independent predictors of treatment effect in the multivariate analysis. LFR has a stable therapeutic outcome. Compared with other skin flaps, the therapeutic effect of this flap is not significantly different, but the design is simple and is not affected by the known risk factors before operation. However, it is necessary to avoid the influence of two independent risk factors, squatting defecation and premature defecation, on the therapeutic effect.", "provenance": [ { "field": "population", "quote": "PNSD patients who visited two medical centers and four departments in the People's Liberation Army General Hospital and were taking LFR treatment between 2016 and 2022" }, { "field": "n", "quote": "There were 37 PNSD patients" }, { "field": "primaryOutcome", "quote": "average wound healing time: 15.4 ± 3.4 days" }, { "field": "result", "quote": "average wound healing time: 15.4 ± 3.4 days. 30 patients (81.0%) healed in stage one and 7 (16.3%) had postoperative complications." } ] }, { "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": "a 13-year-old girl with a pilonidal sinus caused by a foreign body", "intervention": "", "comparator": "", "primaryOutcome": "time to healing after treatment with crystalloid phenol", "result": "the patient was completely healed by three weeks after treatment", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "this is a single case report, so it cannot tell us how long healing usually takes for people with pilonidal disease.", "directness": "indirect", "relevanceNote": "", "limitations": "single case with an unusual cause (a foreign body), not typical pilonidal disease, and treated with a specific chemical method not representative of standard care", "followUp": "three weeks", "plainFinding": "Healed within three weeks", "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": "a 13-year-old female student" }, { "field": "population", "quote": "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" }, { "field": "primaryOutcome", "quote": "on regular follow-up she was completely fine by the end of the third week" }, { "field": "result", "quote": "The patient was treated with crystalloid phenol and on regular follow-up she was completely fine by the end of the third week." } ] }, { "id": "pmid:36763170", "pmid": "36763170", "doi": "10.1007/s00384-023-04324-w", "nctId": null, "pmcid": null, "title": "Does minimally invasive laser-assisted treatment of pilonidal sinus disease live up to its expectations: a multi-center study with 226 patients", "firstAuthor": "De Decker", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2023, "design": "retrospective", "n": 226, "nField": "reported", "population": "People treated with laser-assisted therapy for pilonidal sinus disease at three hospitals", "intervention": "Laser-assisted treatment of pilonidal sinus", "comparator": "", "primaryOutcome": "Overall wound healing after one or more laser procedures", "result": "78.8% healed after one laser procedure, rising to 85.4% after one or more procedures, with a mean follow-up of 129 days (range 7-1120); 12.8% needed a secondary surgery", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "Retrospective, multicenter case series without a comparison group and a very wide follow-up range, so healing timing is uncertain.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, no control group, wide range of follow-up times (7 to 1120 days), and findings specific to one treatment technique (laser)", "followUp": "129 days [7-1120]", "plainFinding": "Most healed within about 4 months.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36763170/", "sourceText": "PURPOSE: The minimally invasive character, the possibility to perform under local anesthesia, and the ease to repeat have led to increasing popularity of laser-assisted treatment of pilonidal sinus disease. Hereby, potentially avoiding prolonged need for medical care at home, incapacity to work, and high expenses for patients and society. This retrospective, multi-center study is aimed at evaluating the feasibility of laser-assisted treatment for pilonidal sinus disease. METHODS: The patient population is comprised of all patients undergoing laser-assisted treatment of pilonidal sinus disease at three Belgian hospitals between January 2017 and December 2021. Data were retrospectively collected. The primary endpoint was overall wound healing after one or more laser assisted procedures. RESULTS: A total of 226 patients were included with a mean follow-up time of 129 days [7-1120]. The healing rate after one laser procedure was 78.8%. Some of these patients were healed by a second or third procedure adding up to an overall healing rate of 85.4% after one or more laser procedures. Wound infections were the main postoperative complication (8.0%) of which 5 patients required drainage (2.2%). For 29 patients (12.8%), laser-assisted treatment was insufficient, leading to a secondary operation (drainage, excision, or flap). CONCLUSION: This study shows that laser-assisted treatment is feasible for pilonidal sinus disease. The minimally invasive character of this technique might make up for a higher non-healing rate compared to other techniques like flap repair. However, care must be taken that healing rate might be related to the presentation of the sinus and expectations should be lowered as presumed high healing rates are not always achieved.", "provenance": [ { "field": "population", "quote": "The patient population is comprised of all patients undergoing laser-assisted treatment of pilonidal sinus disease at three Belgian hospitals between January 2017 and December 2021." }, { "field": "intervention", "quote": "laser-assisted treatment of pilonidal sinus disease" }, { "field": "primaryOutcome", "quote": "The primary endpoint was overall wound healing after one or more laser assisted procedures." }, { "field": "result", "quote": "The healing rate after one laser procedure was 78.8%. Some of these patients were healed by a second or third procedure adding up to an overall healing rate of 85.4% after one or more laser procedures." }, { "field": "n", "quote": "A total of 226 patients were included with a mean follow-up time of 129 days [7-1120]." }, { "field": "followUp", "quote": "mean follow-up time of 129 days [7-1120]" } ] }, { "id": "pmid:36598614", "pmid": "36598614", "doi": "10.1007/s10151-022-02740-8", "nctId": null, "pmcid": null, "title": "The value of honey dressings in pilonidal cyst healing: a prospective randomized single-center trial", "firstAuthor": "Abet", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2023, "design": "rct", "n": 100, "nField": "reported", "population": "adults with a wound that had not healed by 6 weeks after surgical excision of a pilonidal cyst, needing ongoing wound packing", "intervention": "alginate wick dressing plus honey", "comparator": "alginate wick dressing alone", "primaryOutcome": "time for the wound to fully heal", "result": "mean healing time was 61 days with honey added versus 78 days with alginate dressing alone, a difference that was not statistically significant", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "it is a randomized trial but only looked at a selected subgroup of pilonidal wounds that had already failed to heal by 6 weeks, and the main comparison was not statistically significant", "directness": "indirect", "relevanceNote": "", "limitations": "study focuses on comparing two dressing types in persistent, slow-healing wounds rather than describing healing time for pilonidal cysts in general; difference between groups did not reach significance", "followUp": "", "plainFinding": "Took roughly 2 to 3 months to heal", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36598614/", "sourceText": "BACKGROUND: Honey is described as a wound healing agent. Many virtues have been attributed to it, in particular, antibacterial properties. The aim of our study was to evaluate its value in healing of wounds after wide excision on pilonidal cyst healing. METHODS: A prospective randomized trial was conducted from March 2016 to February 2022 which included patients with a persistent non healed wound which required packing 6 weeks after pilonidal cyst excision. Patients were randomly allocated to simple alginate wick dressings or the same design plus honey. RESULTS: Fifty patients were included in each arm. There were 57 men and 43 women. The median age was 22 years (range 19-28 years). The mean healing time was 61 (± 44) days in the wick + honey group compared to 78 (± 55) days in the simple alginate wick group (p = 0.094). There was no significant difference between the two groups in terms of time off work and time without physical activity The VQ-Dermato quality of life score was equivalent in both groups. CONCLUSIONS: Tolerability for honey dressings is good and is equivalent to that of alginate dressings in cavity wound care. This trial did not reach a significant difference in its primary endpoint but it shows the value of honey in this indication, although its use requires further study. TRIAL REGISTRATION NUMBER: CLINICAL TRIALS: NCT02485860 and EUDRACT: 2015-A00452-47 (10/03/2015).", "provenance": [ { "field": "population", "quote": "patients with a persistent non healed wound which required packing 6 weeks after pilonidal cyst excision" }, { "field": "intervention", "quote": "the same design plus honey" }, { "field": "comparator", "quote": "simple alginate wick dressings" }, { "field": "primaryOutcome", "quote": "The mean healing time was 61 (± 44) days in the wick + honey group compared to 78 (± 55) days in the simple alginate wick group" }, { "field": "result", "quote": "The mean healing time was 61 (± 44) days in the wick + honey group compared to 78 (± 55) days in the simple alginate wick group (p = 0.094)." }, { "field": "n", "quote": "Fifty patients were included in each arm." } ] }, { "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": "adults who had surgery for a pilonidal abscess", "intervention": "radical excision surgery for pilonidal abscess", "comparator": "conservative incision/drainage surgery for pilonidal abscess", "primaryOutcome": "time for the surgical wound to heal and recurrence of the cyst", "result": "the wound healed faster after conservative incision surgery than after radical excision, but excision had a lower rate of recurrence (19% vs 54%); no exact healing times in days or weeks were given", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this is a small retrospective single-center study without randomization, so the comparison of healing speed could be biased by differences between who got each operation.", "directness": "direct", "relevanceNote": "", "limitations": "retrospective record review and patient interviews, small sample of 57 patients, no exact healing duration reported, single center.", "followUp": "", "plainFinding": "Faster wound healing with conservative surgery", "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": "population", "quote": "patients operated on for pilonidal abscess, with a satisfactory postoperative follow-up" }, { "field": "intervention", "quote": "The type of operation was excision in 46 (81%) cases" }, { "field": "comparator", "quote": "incision in 11 (19%) cases associated with curettage in three cases and drainage in 1 case" }, { "field": "primaryOutcome", "quote": "We looked for the occurrence of postoperative recurrence in the medical records or by interviewing reachable patients." }, { "field": "result", "quote": "Conservative surgery was significantly associated with faster healing of the surgical wound (p<0.001)." }, { "field": "result", "quote": "The recurrence rate was 19% in radical surgery and 54% in conservative surgery." }, { "field": "n", "quote": "We analyzed 57 patients: 33 males and 24 females." } ] }, { "id": "pmid:36524520", "pmid": "36524520", "doi": "10.26355/eurrev_202212_30576", "nctId": null, "pmcid": null, "title": "Comparison of different interval times of Limberg flap reconstruction after pilonidal sinus abscess", "firstAuthor": "Halaclar", "multipleAuthors": true, "journal": "Eur Rev Med Pharmacol Sci", "year": 2022, "design": "retrospective", "n": 132, "nField": "reported", "population": "People who had Limberg flap surgery after drainage of a pilonidal abscess", "intervention": "Limberg flap reconstruction performed less than 4 weeks after abscess drainage", "comparator": "Limberg flap reconstruction performed more than 4 weeks after abscess drainage", "primaryOutcome": "Time to return to work, complications, and recurrence after surgery", "result": "No difference in pain, complications, or recurrence between the two timing groups, but patients who had surgery earlier (<4 weeks) took longer to return to work", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective study comparing surgical timing, not a direct measure of how long a pilonidal cyst takes to heal naturally or after drainage alone.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, unequal group sizes (100 vs 32), single private hospital, and no data on actual wound healing time.", "followUp": "", "plainFinding": "No difference in complications by surgery timing", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36524520/", "sourceText": "OBJECTIVE: Pilonidal disease (PD) is a chronic inflammatory condition located in the natal cleft originating from the subcutaneous hair characterized by sinuses and painful cysts. PD has a wide symptom perspective, presenting different clinical findings and affecting the patient's quality of life in case of frequent recurrences. There is no definite consensus on when definitive treatment should be given after drainage of pilonidal abscess. In this study, it was aimed to evaluate the effect of the timing chosen for Limberg flap reconstruction after drainage of pilonidal abscess on the postoperative process and complications. PATIENTS AND METHODS: This retrospective study includes patients with Limberg flap reconstruction performed after pilonidal abscess drainage between January 1, 2015 and January 1, 2019 at a private hospital in Adana, Turkey. The patients to whom Limberg flap reconstruction was offered were divided into two groups, according to interval times from the abscess drainage as <4 weeks (Group 1, 100 patients) and >4 weeks (Group 2, 32 patients). RESULTS: Both groups, having a homogeneous distribution in terms of age, gender, and comorbidity, were compared in terms of return to work, complications, and recurrence. There was no statistical difference between the groups in terms of postoperative pain, individual complications, and recurrence (p=0.999). However, the time to return to work was longer in Group 1 (p=0.012). CONCLUSIONS: Results suggest that there is no need to wait for a long time for elective surgery after drainage of pilonidal abscess, and that it can be safely performed when the interval time is less than 4 weeks.", "provenance": [ { "field": "population", "quote": "patients with Limberg flap reconstruction performed after pilonidal abscess drainage between January 1, 2015 and January 1, 2019 at a private hospital in Adana, Turkey" }, { "field": "intervention", "quote": "interval times from the abscess drainage as <4 weeks (Group 1, 100 patients)" }, { "field": "comparator", "quote": ">4 weeks (Group 2, 32 patients)" }, { "field": "primaryOutcome", "quote": "compared in terms of return to work, complications, and recurrence" }, { "field": "result", "quote": "There was no statistical difference between the groups in terms of postoperative pain, individual complications, and recurrence (p=0.999). However, the time to return to work was longer in Group 1 (p=0.012)." }, { "field": "n", "quote": "<4 weeks (Group 1, 100 patients) and >4 weeks (Group 2, 32 patients)" } ] }, { "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", "intervention": "", "comparator": "", "primaryOutcome": "wound healing time and 10-year recurrence after cleft-lift surgery", "result": "Most wounds healed completely within about a month, with low long-term recurrence", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "Large single-centre cohort with long follow-up and prospective data, but no comparison group and single-surgeon/centre setting limits generalisability.", "directness": "direct", "relevanceNote": "", "limitations": "Single-centre study without a comparator group; relies partly on survey data and electronic records.", "followUp": "median 8.5 (1.0-10.7) years", "plainFinding": "Healed in about a month", "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": "population", "quote": "Two hundred patients with complex pilonidal sinus disease were included." }, { "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)." }, { "field": "n", "quote": "Two hundred patients with complex pilonidal sinus disease were included." }, { "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 who had surgery or endoscopic treatment for pilonidal sinus", "intervention": "endoscopic treatment for pilonidal sinus", "comparator": "conventional surgical excision with primary closure", "primaryOutcome": "time to complete wound healing", "result": "healing time was similar between endoscopic treatment and conventional excision with primary closure, but no actual duration in days or weeks was given", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this is a meta-analysis of only six studies with very high statistical inconsistency (I2=99% for pain), and it does not report actual healing-time figures, only that the two treatments were 'similar'.", "directness": "indirect", "relevanceNote": "", "limitations": "small number of included trials, high heterogeneity, and no numeric healing-time data provided for either group", "followUp": "", "plainFinding": "No healing duration reported", "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": "population", "quote": "comparing the outcomes of endoscopic treatment versus conventional treatment for pilonidal sinus disease" }, { "field": "intervention", "quote": "endoscopic management" }, { "field": "comparator", "quote": "excision followed by the primary closure technique" }, { "field": "primaryOutcome", "quote": "total healing time" }, { "field": "result", "quote": "Compared to the excision followed by the primary closure technique, the operation time, time to complete wound healing, and satisfaction were similar." } ] }, { "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": "", "comparator": "", "primaryOutcome": "Healing time and quality of life after treatment", "result": "Healing time was 40 to 75 days with open surgery versus 20 to 41 days with endoscopic treatment (PEPSIT)", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective review comparing two surgery types, not a controlled study of natural healing time, so it only loosely answers how long healing takes in general.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, comparison of two different surgical techniques rather than a general account of healing time, no control group without surgery.", "followUp": "", "plainFinding": "Healing took 20 to 75 days depending on surgery type.", "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)" }, { "field": "primaryOutcome", "quote": "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" } ] }, { "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": "people who had a pit-pick surgery for simple pilonidal sinus disease", "intervention": "Bascom's pit-pick procedure", "comparator": "", "primaryOutcome": "wound healing, recurrence, and complications over long-term follow-up", "result": "8% needed another procedure due to incomplete wound healing, and by 10 years about 27% of those who initially healed had the cyst come back, giving an overall treatment success of 68%", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "it followed a fairly large group of patients for many years using both records and surveys, but it was a single-center study without a comparison group and relied partly on patient-reported follow-up.", "directness": "direct", "relevanceNote": "", "limitations": "Single-center cohort, relies on patient surveys/telephone interviews for some outcomes, no comparator group, and some loss to follow-up possible with online/telephone methods.", "followUp": "7.98 (0.66, 10.96) years", "plainFinding": "Most healed, but recurrence rose over 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": "population", "quote": "patients registered in a local database after undergoing Bascom's pit-pick procedure" }, { "field": "intervention", "quote": "Bascom's pit-pick procedure" }, { "field": "n", "quote": "A total of 158 patients underwent Bascom's pit-pick procedure during the period August 2007 to March 2014." }, { "field": "primaryOutcome", "quote": "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": "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%." }, { "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 treated with endoscopic (video-assisted) surgery for pilonidal sinus disease", "intervention": "endoscopic sinusectomy procedures for pilonidal disease", "comparator": "", "primaryOutcome": "how surgical technique was reported and standardized (IDEAL framework stage), with recurrence and complications as secondary outcomes", "result": "Follow-up across studies ranged from 1 to 60 months; postoperative complications occurred in 0%-6% of cases and recurrence rates varied from 0% to 22%, but the abstract does not state how long wounds or sinuses took to heal", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "The included studies had moderate-to-critical risk of bias and poor reporting of technique details, so the findings carry little weight for answering how long healing takes.", "directness": "indirect", "relevanceNote": "", "limitations": "Poor reporting of technique details and outcome domains across studies; risk of bias moderate to critical in comparative series; this review focuses on technique variation and reporting quality rather than specifically on healing duration.", "followUp": "1 to 60 months", "plainFinding": "Healing time not clearly reported.", "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": "A total of 38 articles were included reporting a very similar technique under eight different acronyms." }, { "field": "intervention", "quote": "video-assisted surgery" }, { "field": "primaryOutcome", "quote": "The primary outcome measure was the IDEAL framework stage of innovation." }, { "field": "result", "quote": "Mean follow-up ranged from 1 to 60 months." }, { "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." }, { "field": "result", "quote": "The recurrence rate varied from 0% to 22%." }, { "field": "followUp", "quote": "Mean follow-up ranged from 1 to 60 months." } ] }, { "id": "pmid:36155543", "pmid": "36155543", "doi": null, "nctId": null, "pmcid": null, "title": "Effect of treatment of pilonidal sinus with phenol on patients' clinical condition and quality of life", "firstAuthor": "Tazeoglu", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2022, "design": "retrospective", "n": 145, "nField": "reported", "population": "patients who had surgery for pilonidal sinus (treated with either phenol application or surgical excision)", "intervention": "phenol application treatment", "comparator": "surgical excision treatment", "primaryOutcome": "time to return to work, pain-free walking and sitting, daily pain scores, and quality of life after treatment", "result": "Return to work, painless walking and sitting on the toilet, and mean daily pain scores were significantly shorter/lower in the phenol group than the excision group, but no exact number of days or weeks is given for either group.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a non-randomised comparison of two treatments at one clinic with no exact healing times reported, so it gives only indirect and imprecise information about how long a treated pilonidal sinus takes to heal.", "directness": "indirect", "relevanceNote": "", "limitations": "No randomisation described, single-centre data, and no explicit duration (days/weeks) to wound healing or final resolution is reported — only relative comparisons between two treatment groups.", "followUp": "4 weeks", "plainFinding": "Faster recovery with phenol than excision.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36155543/", "sourceText": "BACKGROUND: Pilonidal sinus is a common disease. Curative treatment is surgical excision. However, minimally invasive surgery is preferred day by day. Our study aimed to compare the effects of phenol and excision on postoperative results and quality of life in the treatment of pilonidal sinus. METHODS: The patients who underwent surgery with the diagnosis of the pilonidal sinus in our clinic between June 2019 and June 2021 were examined. Demographic data, anthropometric measurements, clinical information, treatment, and postoperative data of the patients were recorded. Daily pain follow-up with daily visceral pain scale (VPS) was performed in the first ten days postoperatively, and a short form 36 (SF-36) questionnaire was used in the first and fourth weeks. The patients were grouped as phenol and excision groups and compared. RESULTS: The study included 145 patients. Phenol was applied to 83 (57.2%) patients, and excision was applied to 62 (42.8%) patients. There was no statistically significant difference between the groups regarding age, gender, BMI, number of pilonidal sinuses, and family history (p>0.05). Return to work, painless walking and sitting on the toilet, and mean daily VPS values in the phenol group were significantly shorter than the excision group (p<0.05). All subscale values in the postoperative first week SF-36 results were significantly higher than in the excision group (p<0.001) in the phenol group. CONCLUSION: Phenol is effective in the treatment of pilonidal sinus. Despite excision, treatment with phenol affects the patient's quality of life less in the early postoperative period. KEY WORDS: Minimally invasive surgery , Pilonidal sinus, Phenol, Quality of life.", "provenance": [ { "field": "population", "quote": "The patients who underwent surgery with the diagnosis of the pilonidal sinus in our clinic between June 2019 and June 2021 were examined." }, { "field": "intervention", "quote": "Phenol was applied to 83 (57.2%) patients" }, { "field": "comparator", "quote": "excision was applied to 62 (42.8%) patients" }, { "field": "primaryOutcome", "quote": "Return to work, painless walking and sitting on the toilet, and mean daily VPS values in the phenol group were significantly shorter than the excision group (p<0.05)." }, { "field": "result", "quote": "Return to work, painless walking and sitting on the toilet, and mean daily VPS values in the phenol group were significantly shorter than the excision group (p<0.05)." }, { "field": "n", "quote": "The study included 145 patients." } ] }, { "id": "pmid:36151862", "pmid": "36151862", "doi": null, "nctId": null, "pmcid": null, "title": "Pilonidal sinus disease. A single center retrospective series analysis", "firstAuthor": "Palmieri", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2023, "design": "retrospective", "n": null, "nField": "not-reported", "population": "People with chronic pilonidal disease who were treated surgically", "intervention": "Gips technique (a minimally invasive punch/trephine procedure) for pilonidal sinus disease", "comparator": "", "primaryOutcome": "Recovery time and return to work or school after treatment", "result": "The abstract only states that minimally invasive procedures are associated with fewer dressings, faster recovery, and quicker return to work or school, but it does not give any specific healing time, number of days/weeks, or quantitative outcome data.", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "The abstract is mostly background text from a retrospective single-center series with no patient numbers, no measured healing times, and no follow-up duration reported, so it offers almost no usable evidence.", "directness": "indirect", "relevanceNote": "", "limitations": "No sample size, no quantitative healing or recovery times, and no follow-up period are reported in the abstract.", "followUp": "", "plainFinding": "No specific healing time reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36151862/", "sourceText": "The surgical approach to chronic pilonidal disease has been significantly changed by minimally invasive and targeted procedures, with the aim to minimize costs and favoring less dressings, faster recovery, and prompt return to work or to school activity. Less invasive procedures are gaining wide acceptance as first approach. We present a single-center experience with the Gips technique, also called Israeli technique or trephine technique, and a brief review of the literature, focusing on minimally invasive procedures. KEY WORDS: Pilonidal Disease, Punch, Minimally Invasive Surgery, Trephines.", "provenance": [ { "field": "population", "quote": "The surgical approach to chronic pilonidal disease has been significantly changed by minimally invasive and targeted procedures" }, { "field": "intervention", "quote": "the Gips technique, also called Israeli technique or trephine technique" }, { "field": "primaryOutcome", "quote": "favoring less dressings, faster recovery, and prompt return to work or to school activity" }, { "field": "result", "quote": "favoring less dressings, faster recovery, and prompt return to work or to school activity" } ] }, { "id": "pmid:36064868", "pmid": "36064868", "doi": "10.1007/s00268-022-06711-w", "nctId": null, "pmcid": null, "title": "Platelet-Rich Plasma (PRP) for Sacrococcygeal Pilonidal Disease: An Updated Systematic Review and Meta-Analysis", "firstAuthor": "Brewer", "multipleAuthors": true, "journal": "World J Surg", "year": 2022, "design": "meta-analysis", "n": 930, "nField": "reported", "population": "Patients who had surgery (open or minimally-invasive) for a pilonidal cyst/sinus", "intervention": "Platelet-rich plasma (PRP) applied to the wound after surgery", "comparator": "Standard wound care without PRP", "primaryOutcome": "Time for the surgical wound to heal", "result": "Across the open-surgery studies, wounds treated with PRP healed on average 14 days faster than those without PRP, but there was very high variability between studies, so no single healing time could be established.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "The pooled studies showed very high statistical variation between them (I2 = 98%), and the authors say more consistent, high-quality trials are still needed.", "directness": "indirect", "relevanceNote": "", "limitations": "Considerable heterogeneity among PRP manufacture and administration techniques; minimally-invasive studies could not be pooled due to methodological heterogeneity.", "followUp": "", "plainFinding": "Faster healing with PRP, time unclear overall.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36064868/", "sourceText": "BACKGROUND: Pilonidal disease can be a debilitating condition which carries a significant physical and economic burden. This systematic review and updated meta-analysis presents the evidence for the use of platelet-rich plasma (PRP) for wound healing following open and minimally-invasive sacrococcygeal pilonidal surgery. METHODS: A literature search was performed during December 2021 for studies relating to platelet-rich plasma and pilonidal wound healing following surgery. RESULTS: Nine studies remained after applying the exclusion criteria, incorporating a total of 621 (open surgery group) and 309 (minimally-invasive group) patients, respectively. Pooled analysis of the six open surgery group studies demonstrated a significant reduction in wound healing time (mean difference [MD] = - 13.98 days, 95% CI - 18.41 to - 9.55, p < 0.001, I2 = 98%). Three open surgery group studies compared post-operative time off work, while three recorded mean pain duration; pooled analysis also revealed a significant reduction in both outcomes, respectively (MD = - 8.7 days, 95% CI - 9.4 to - 8.0, p < 0.001, I2 = 57%; MD = - 9.5 days, 95% CI - 15.6 to - 3.3, p = 0.002, I2 = 98%). Methodological heterogeneity among the minimally-invasive studies precluded formal meta-analysis; however, two studies demonstrated a modest improvement in wound healing when treated with PRP. CONCLUSIONS: This systematic review and updated meta-analysis provide further evidence supporting the use of PRP for wound healing in sacrococcygeal pilonidal disease. PRP application was demonstrated to significantly reduce healing time, postoperative pain and time off work in the open surgery group. Nevertheless, there is still considerable heterogeneity among PRP manufacture and administration techniques, and further high-powered RCTs with consistent methodology are required to substantiate these findings.", "provenance": [ { "field": "n", "quote": "incorporating a total of 621 (open surgery group) and 309 (minimally-invasive group) patients, respectively" }, { "field": "population", "quote": "following open and minimally-invasive sacrococcygeal pilonidal surgery" }, { "field": "intervention", "quote": "the use of platelet-rich plasma (PRP) for wound healing" }, { "field": "comparator", "quote": "Pooled analysis of the six open surgery group studies demonstrated a significant reduction in wound healing time" }, { "field": "primaryOutcome", "quote": "a significant reduction in wound healing time (mean difference [MD] = - 13.98 days, 95% CI - 18.41 to - 9.55, p < 0.001, I2 = 98%)" }, { "field": "result", "quote": "PRP application was demonstrated to significantly reduce healing time, postoperative pain and time off work in the open surgery group." } ] }, { "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 non-healing pilonidal sinus wounds after surgery or anal-near primary/recurrent pilonidal sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "time until the wound completely healed", "result": "median time to complete healing was 159 days, with 83.3% of patients achieving complete healing", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this was a small pilot study of only 30 patients with no comparison group, looking at a specific novel fat-injection treatment rather than typical pilonidal healing", "directness": "indirect", "relevanceNote": "", "limitations": "small single-arm pilot study without a control group, focused on complicated/non-healing or anal-near cases treated with a novel fat-injection procedure rather than standard treatment", "followUp": "12 weeks", "plainFinding": "Healing took 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": "primaryOutcome", "quote": "The primary endpoint was time to healing." }, { "field": "result", "quote": "The median time to complete healing was 159 (189) days." }, { "field": "result", "quote": "Complete healing was achieved in 25 patients [83.3%; 95% CI (69.9-96.7)]." }, { "field": "followUp", "quote": "Patients were examined 2 and 12 weeks after surgery." } ] }, { "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": "people with umbilical pilonidal sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "factors linked to recurrence after treatment (conservative treatment, surgery, or silver nitrate)", "result": "The abstract does not report how long it takes for the sinus/wound to heal; it reports that smoking was linked to recurrence and that the three treatments did not differ in recurrence rate.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a small retrospective review of a rare umbilical location, not the more common sacrococcygeal pilonidal cyst, and it does not measure or report healing time at all.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, small sample, and the population is umbilical pilonidal sinus rather than the typical sacrococcygeal site; no healing duration is reported.", "followUp": "", "plainFinding": "No healing-time 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": "population", "quote": "82 patients (19 women, 63 men) with a history of umbilical PSD between 2012 and 2020" }, { "field": "primaryOutcome", "quote": "to determine predisposing factors and treatment modalities" }, { "field": "result", "quote": "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)." }, { "field": "n", "quote": "the authors evaluated 82 patients (19 women, 63 men) with a history of umbilical PSD" } ] }, { "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 surgery (EPSiT) for pilonidal sinus", "intervention": "", "comparator": "", "primaryOutcome": "recurrence of the pilonidal sinus after surgery", "result": "8% of patients had the cyst come back within a year (around 6 months later on average), and 15% had it come back by about 4 years of follow-up (around 19 months later on average)", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this is a single-center, retrospective review without a comparison group, so it mainly tracks recurrence rather than healing time itself.", "directness": "indirect", "relevanceNote": "", "limitations": "retrospective design, single center, not all patients had long-term follow-up, and it reports recurrence rather than wound healing time directly.", "followUp": "36-61 months", "plainFinding": "Cyst can recur 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": "population", "quote": "Patients under 18 years of age at first surgery were included." }, { "field": "n", "quote": "A total of 99 patients underwent 115 EPSiT procedures in a 5-year period." }, { "field": "primaryOutcome", "quote": "Details regarding demographic data, surgical procedure, and recurrences were recorded." }, { "field": "result", "quote": "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." }, { "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." } ] }, { "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 teens treated for pilonidal sinus disease with minimally invasive surgery", "intervention": "Sinusectomy (SE)", "comparator": "Pit-picking plus laser ablation (PPL)", "primaryOutcome": "Time for the wound to heal after treatment", "result": "Median healing time was 20 days with sinusectomy versus 30 days with pit-picking plus laser ablation, a significant difference", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective review comparing two techniques without randomization, so differences in patient selection could affect healing time estimates.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, comparison limited to two specific minimally invasive techniques rather than overall natural healing course, and no untreated or traditionally-treated comparison group.", "followUp": "", "plainFinding": "Healed in about 20 to 30 days.", "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": "n", "quote": "One-hundred and six patients were included" }, { "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": "intervention", "quote": "sinusectomy (SE)" }, { "field": "comparator", "quote": "pit-picking plus laser ablation (PPL)" }, { "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)." } ] }, { "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": "meta-analysis", "n": 932, "nField": "reported", "population": "Adults who had surgery for pilonidal sinus disease and were left with an open wound to heal", "intervention": "", "comparator": "", "primaryOutcome": "Time for the surgical wound to heal completely", "result": "Across 11 trials, reported median healing times ranged roughly from about 54 to 85 days depending on the dressing or topical agent used, but the evidence for any specific healing time was low to very low certainty and no study reported healing at 6 or 12 months", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "All included trials had a high risk of bias in at least one area and most results came from single small studies, so the certainty of any healing-time estimate is low to very low.", "directness": "indirect", "relevanceNote": "", "limitations": "No studies provided data on proportion of wounds healed at 6 or 12 months, all studies were at high risk of bias except one, and results on time to healing were inconsistent between studies.", "followUp": "", "plainFinding": "Healing takes weeks to months, timing uncertain.", "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": "We included studies with participants who had undergone any type of sacrococcygeal pilonidal sinus disease surgery and were left with an open wound." }, { "field": "primaryOutcome", "quote": "It is unclear whether TNPWT reduces time to wound healing compared with conventional open wound healing" }, { "field": "result", "quote": "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)." }, { "field": "result", "quote": "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)." }, { "field": "qualityWhy", "quote": "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." } ] }, { "id": "pmid:35580246", "pmid": "35580246", "doi": "10.1177/00031348221075731", "nctId": null, "pmcid": null, "title": "Bilateral Gluteal Fasciocutaneous Advancement Flaps With and Without Tie-Over Sutures in Treatment of Chronic Pilonidal Disease: A Prospective Case Series", "firstAuthor": "Nasseri", "multipleAuthors": true, "journal": "Am Surg", "year": 2023, "design": "case-series", "n": 51, "nField": "reported", "population": "Patients with chronic pilonidal disease who had surgical excision and flap reconstruction", "intervention": "", "comparator": "", "primaryOutcome": "Recurrence and wound dehiscence after flap surgery", "result": "At a mean follow-up of 38.7 months, there were no recurrences but 19 (37.3%) patients had wound dehiscence", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a single-arm case series without a comparison group, so it cannot show how healing time compares to other approaches or to no treatment.", "directness": "indirect", "relevanceNote": "", "limitations": "No control group; single surgical technique; does not report actual time-to-healing, only dehiscence and recurrence at follow-up.", "followUp": "38.7 months", "plainFinding": "No recurrence, but wounds reopened in over a third.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35580246/", "sourceText": "PURPOSE: Flap procedures following pilonidal excision have high recurrence and dehiscence rates. We present a cosmetic, outpatient technique to reconstruction via bilateral gluteal fasciocutaneous advancement flaps with and without tie-over sutures. METHODS: This is a prospective case series of 51 patients (40 males and 11 females). Following elliptical excision of pilonidal disease, gluteal fasciocutaneous advancement flaps were elevated circumferentially using blunt, discontinuous dissection, and a multilayered closure was performed. The resulting scar was midline. Thirty-five patients (68.6%) also had two full-thickness, compressing sutures tied over rolled up gauze. RESULTS: Patients had a mean age of 28.2 and body mass index of 26.8. Eight (15.9%) were smokers and 11 (21.6%) were obese. At a mean follow-up of 38.7 months, there were no recurrences and 19 (37.3%) patients had wound dehiscence. There was no significant difference in dehiscence between patients with and without tie-over sutures (31.4% vs 50%, P = 0.20). There was no significant difference in dehiscence between smokers and non-smokers, (62.5% vs 41.9%, P = 0.47), or between obese and non-obese patients (36.4% vs 46.3%, P = 0.51). Obese patients with tie-over sutures had significantly less dehiscence compared to obese patients without tie-over sutures (14% vs 75%, P = 0.03). CONCLUSION: Bilateral gluteal fasciocutaneous advancement flap with consideration of tie-over sutures is an outpatient treatment for chronic pilonidal disease with resultant midline scar and with no recurrence in our series.", "provenance": [ { "field": "population", "quote": "Following elliptical excision of pilonidal disease, gluteal fasciocutaneous advancement flaps were elevated circumferentially" }, { "field": "primaryOutcome", "quote": "there were no recurrences and 19 (37.3%) patients had wound dehiscence" }, { "field": "result", "quote": "At a mean follow-up of 38.7 months, there were no recurrences and 19 (37.3%) patients had wound dehiscence." }, { "field": "n", "quote": "This is a prospective case series of 51 patients (40 males and 11 females)." } ] }, { "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": "patients treated for pilonidal sinus disease (mean age 15.5 years)", "intervention": "crystallized phenol application", "comparator": "surgical excision (Karydakis flap method)", "primaryOutcome": "time to recovery and return to daily activities (school) after treatment", "result": "Return to school averaged 2.8 days after phenol treatment versus 12.3 days after surgery; healing failed in 5.7% of phenol patients after three sessions, and 6.3% of surgery patients had recurrence requiring re-operation", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective comparison of two treatment groups without randomization, so differences in healing time could be due to how patients were selected rather than the treatments themselves.", "directness": "indirect", "relevanceNote": "", "limitations": "Not randomized; comparative study design with no mention of blinding or controlling for disease severity between groups.", "followUp": "", "plainFinding": "Faster return to activity 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": "population", "quote": "Patients who were treated for pilonidal Sinus and treated with surgical repair (karydakis flap method) and crystallized phenol method were included in the study." }, { "field": "intervention", "quote": "crystallized phenol application" }, { "field": "comparator", "quote": "Karydakis Flap method" }, { "field": "primaryOutcome", "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." }, { "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. 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." }, { "field": "n", "quote": "Of the patients, 111 (34.7%) were treated with surgical repair, and 208 (65.3%) with the crystallized phenol method." } ] }, { "id": "pmid:35485755", "pmid": "35485755", "doi": "10.54847/cp.2022.02.15", "nctId": null, "pmcid": null, "title": "En bloc resection vs. Gips procedure in pilonidal sinus surgery", "firstAuthor": "Diéguez", "multipleAuthors": true, "journal": "Cir Pediatr", "year": 2022, "design": "retrospective", "n": 60, "nField": "reported", "population": "Children under 16 having surgery for a pilonidal sinus for the first time", "intervention": "Gips procedure (less invasive surgical technique)", "comparator": "En bloc resection (traditional wider surgical excision)", "primaryOutcome": "Time until the wound healed after surgery", "result": "Median time to healing was about 6.1 months after en bloc resection versus about 3.3 months after the Gips procedure, a statistically significant difference", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a small, retrospective study comparing two surgical groups of unequal size without randomization, so the healing-time estimates may be biased.", "directness": "direct", "relevanceNote": "", "limitations": "Retrospective design, small and unevenly sized groups (46 vs 14), single institution, no randomization or blinding.", "followUp": "Median follow-up time to healing was 6.13 ± 0.98 months vs. 3.31 ± 1.26 months", "plainFinding": "Healing took about 3 to 6 months.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35485755/", "sourceText": "INTRODUCTION: Pilonidal sinus (PS) is an infectious/inflammatory condition of the sacrococcygeal region, with frequent relapses. There is no clear consensus as to which management technique is best. The most widely used technique is en bloc resection (EBR), but less invasive methods (Gips procedure) are now being developed. OBJECTIVE: To compare complications and progression of pediatric patients undergoing PS surgery in our institution using two different surgical techniques. MATERIAL AND METHODS: A retrospective study of patients under 16 years of age undergoing PS surgery (EBR/Gips procedure) for the first time from 2014 to 2020 was carried out. Demographic variables, complications in the first month (exudate, wound infection, dehiscence, and bleeding), and result at the end of follow-up were collected. Qualitative variables were expressed as absolute frequency and percentage, whereas quantitative variables were expressed as mean and standard deviation. RESULTS: 60 patients underwent surgery. EBR was used in the first group, and the Gips procedure was used in the second group (76.67%, n = 46 vs. 23.33%, n = 14). Both were comparable in terms of sex (32.61% vs. 35.71% male), age (14.04 vs. 13.79 years old), and BMI (26.63 vs. 26.20 kg/m2) at surgery. 6 patients underwent re-intervention (10.87% vs. 7.14%; p = 0.684). Median follow-up time to healing was 6.13 ± 0.98 months vs. 3.31 ± 1.26 months (p < 0.024). The Gips procedure caused no dehiscence, whereas dehiscence rate in EBR was 65.22%. CONCLUSION: The Gips procedure is a minimally invasive alternative to EBR. It avoids dehiscence, and time to healing is shorter. Therefore, it should be regarded as the first-line treatment in PS patients.", "provenance": [ { "field": "n", "quote": "60 patients underwent surgery." }, { "field": "population", "quote": "patients under 16 years of age undergoing PS surgery (EBR/Gips procedure) for the first time from 2014 to 2020" }, { "field": "intervention", "quote": "the Gips procedure was used in the second group" }, { "field": "comparator", "quote": "EBR was used in the first group" }, { "field": "primaryOutcome", "quote": "complications in the first month (exudate, wound infection, dehiscence, and bleeding), and result at the end of follow-up were collected" }, { "field": "result", "quote": "Median follow-up time to healing was 6.13 ± 0.98 months vs. 3.31 ± 1.26 months (p < 0.024)." } ] }, { "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": "retrospective", "n": 35, "nField": "reported", "population": "People who had pilonidal sinus disease treated with a laser-based procedure (PiLAC)", "intervention": "Pilonidal sinus Laser-Assisted Closure (PiLAC)", "comparator": "", "primaryOutcome": "Whether the pilonidal sinus had healed or recurred at long-term follow-up", "result": "Of 28 patients with long-term follow-up (mean 407 days), 25 (89.3%) had healed with no recurrence", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a small single-centre case series without a control group, combining retrospective notes review with telephone follow-up, so recall and selection bias are likely.", "directness": "indirect", "relevanceNote": "", "limitations": "Small sample (35 patients, only 28 with long-term follow-up), no comparator group, follow-up partly by telephone, single-centre design", "followUp": "mean 407 days (range 67-887 days)", "plainFinding": "Most healed within about a year", "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": "population", "quote": "All patients undergoing PiLAC as a day-case between April 2016 and July 2019 were included." }, { "field": "intervention", "quote": "We routinely treat primary and recurrent pilonidal sinus disease with Pilonidal sinus Laser-Assisted Closure (PiLAC)." }, { "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": "n", "quote": "A total of 35 patients underwent PiLAC, median age 28 (18-53 years), 28 males:7 females." }, { "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": "People with pilonidal sinus disease treated with an endoscopic procedure (some had prior pilonidal surgery)", "intervention": "", "comparator": "", "primaryOutcome": "Whether and how quickly the wound healed after treatment", "result": "72.2% healed completely at a median of 6 weeks with no further treatment needed; 13.5% healed but then had recurrence; 14.3% never healed. Among those who had recurrence or failed to heal, repeat treatment led to healing in most within a median of 7 weeks.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This was a retrospective, single-centre study with no comparison group and 11 patients lost to follow-up, so the findings are less reliable than a controlled study.", "directness": "direct", "relevanceNote": "", "limitations": "Retrospective, non-randomized, single-centre design with 11 patients lost to follow-up; no control group.", "followUp": "mean 56.2 months", "plainFinding": "Most healed by about 6 weeks", "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": "population", "quote": "137 patients with PSD underwent EPSiT. Seventy-two had undergone previous surgery for PSD." }, { "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": "result", "quote": "20/35 underwent repeat EPSiT with healing occurring in 18/20 patients at a median of 7 weeks" }, { "field": "n", "quote": "137 patients with PSD underwent EPSiT" }, { "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": "retrospective", "n": 848, "nField": "reported", "population": "people treated for pilonidal cyst/sinus disease with biopsy punch excision surgery", "intervention": "", "comparator": "", "primaryOutcome": "time to full recovery and recurrence of the cyst after treatment", "result": "full recovery took on average about 21 days, with return to work/school after about 4 days; recurrence rates increased over time, being 8.1% at 1 year, 13.0% at 2 years, and 16.4% at 5 years", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this is a single-centre retrospective case series without a comparison group, and follow-up was incomplete for a meaningful portion of patients over time.", "directness": "direct", "relevanceNote": "", "limitations": "retrospective design, no control group, follow-up completeness dropped to 70% by 5 years, and results depended heavily on surgeon experience", "followUp": "60 months", "plainFinding": "Healed in about 3 weeks", "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": "population", "quote": "848 patients with pilonidal disease (PD) treated by biopsy punch excision (BPE)" }, { "field": "primaryOutcome", "quote": "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." }, { "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": "n", "quote": "848 patients with pilonidal disease (PD)" } ] }, { "id": "pmid:35289848", "pmid": "35289848", "doi": "10.1093/bjsopen/zrac007", "nctId": null, "pmcid": "PMC8932511", "title": "Excision and suture in the midline versus Karydakis flap surgery for pilonidal sinus: randomized clinical trial", "firstAuthor": "Hemmingsson", "multipleAuthors": true, "journal": "BJS Open", "year": 2022, "design": "rct", "n": 116, "nField": "reported", "population": "adults with long-term pilonidal sinus disease who had surgery", "intervention": "", "comparator": "", "primaryOutcome": "time until the wound was completely healed, and recurrence rate", "result": "median time to complete wound healing was 49 days after excision and midline suture versus 14 days after Karydakis flap surgery, with no difference in recurrence after a median of 11 years' follow-up", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "it was a randomized trial but was stopped early for slow recruitment, included only 116 analysed patients, and had no blinding of patients or surgeons, which can affect how healing was judged.", "directness": "direct", "relevanceNote": "", "limitations": "study terminated early at interim analysis due to slow recruitment; not blinded; fewer patients than the planned sample size of 400", "followUp": "6-13 years", "plainFinding": "Healing took 2 weeks to 7 weeks, depending on surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35289848/", "sourceText": "BACKGROUND: There are several surgical options for the management of pilonidal disease, including midline and off midline closure, but prospective studies are rare. The study hypothesis was that Karydakis flap surgery would result in shorter wound healing and fewer recurrences than excision of pilonidal sinus and suture in the midline. METHODS: A randomized clinical trial was conducted in two hospitals in Sweden between 2006 and 2015 to compare excision and suture in the midline with Karydakis flap surgery. Adult patients with a chronic pilonidal sinus disease were randomized 1:1 at the outpatient clinic without blinding. Power calculation based on recurrence of 2 per cent for Karydakis flap and 10 per cent for excision and primary closure in the midline required 400 patients with 90 per cent statistical power at 5 per cent significance assuming 10 per cent loss during follow-up. Participants were followed up until complete wound healing; late follow-up after 6-13 years was performed by telephone by two blinded assessors. The two co-primary outcomes were time to complete wound healing and recurrence rate. RESULTS: The study was terminated early at a planned interim analysis due slow recruitment and a significant difference in primary outcome. In total, 125 patients were randomized, of whom 116 were available for the present analysis. Median wound healing time was 49 days (95 per cent confidence interval (c.i.) 32 to 66) for excision with suture in the midline and 14 days (95 per cent c.i. 12 to 20) for Karydakis flap surgery (P < 0.001). There were five recurrences in each group, after a median follow-up of 11 years (P = 0.753). CONCLUSION: Karydakis flap surgery for pilonidal sinus disease led to a shorter wound healing time than excision and suture in the midline but no difference in recurrence rates.Registration number: NCT00412659 (http://www.clinicaltrials.gov).", "provenance": [ { "field": "population", "quote": "Adult patients with a chronic pilonidal sinus disease" }, { "field": "n", "quote": "In total, 125 patients were randomized, of whom 116 were available for the present analysis." }, { "field": "primaryOutcome", "quote": "The two co-primary outcomes were time to complete wound healing and recurrence rate." }, { "field": "result", "quote": "Median wound healing time was 49 days (95 per cent confidence interval (c.i.) 32 to 66) for excision with suture in the midline and 14 days (95 per cent c.i. 12 to 20) for Karydakis flap surgery (P < 0.001). There were five recurrences in each group, after a median follow-up of 11 years (P = 0.753)." }, { "field": "followUp", "quote": "late follow-up after 6-13 years was performed by telephone by two blinded assessors" } ] }, { "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": "People who had a minimally invasive trephine procedure for pilonidal sinus, median age 20 years", "intervention": "trephine procedure for pilonidal sinus", "comparator": "", "primaryOutcome": "time to return to work/school and recurrence rate of pilonidal sinus after treatment", "result": "Median time to return to work or school was 10 days; at a median follow-up of 29 months, 45.1% of patients had recurrence of the sinus", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "It is a retrospective single-center study with incomplete follow-up (113 of 169 patients) and relies partly on telephone recall, which weakens confidence in the exact healing time.", "directness": "direct", "relevanceNote": "", "limitations": "Retrospective design, loss to follow-up (56 of 169 patients not included), and reliance on patient recall via telephone interview for long-term outcomes.", "followUp": "29 months", "plainFinding": "Back to normal in 10 days, but often recurs later.", "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": "Follow-up included 113 patients, median age 20 years." }, { "field": "intervention", "quote": "Patients who underwent trephine procedure between 2011 and 2015 were included." }, { "field": "primaryOutcome", "quote": "The median time to return to work or school was 10 days." }, { "field": "result", "quote": "At a median follow-up of 29 months (IQR 19-40), recurrence rate was 45.1% (51/113)" } ] }, { "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": "people who had surgery to remove a pilonidal cyst", "intervention": "alginate dressings with silver and cellulose on the wound", "comparator": "simple gauze dressings", "primaryOutcome": "how long the wound took to heal", "result": "wound healing duration was comparable between the two dressing groups, with no specific healing time given in days or weeks", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "it is a small randomised trial that only compares two dressing types and does not report an actual healing duration for patients, and the authors themselves call the sample size suboptimal", "directness": "indirect", "relevanceNote": "", "limitations": "Due to suboptimal sample size and several study limitations, further RCTs are required to confirm our findings.", "followUp": "", "plainFinding": "No specific healing time reported", "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:35025023", "pmid": "35025023", "doi": "10.1007/s10151-021-02568-8", "nctId": null, "pmcid": null, "title": "Endoscopic pilonidal sinus treatment vs. laser-assisted endoscopic pilonidal sinus treatment: short-term results from a retrospective case-matched study", "firstAuthor": "Gulcu", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2022, "design": "retrospective", "n": 96, "nField": "reported", "population": "adults with pilonidal sinus disease who had endoscopic surgical treatment", "intervention": "laser-assisted endoscopic pilonidal sinus treatment (LEPSIT)", "comparator": "standard endoscopic pilonidal sinus treatment (EPSIT)", "primaryOutcome": "complete wound healing", "result": "Both groups had similarly high wound healing rates, but the laser-assisted method had significantly faster wound closure and shorter time to return to work; follow-up was a median of 9 months.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This was a small, retrospective, case-matched study from a single hospital with short follow-up, so the findings may not hold up in larger or longer studies.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, small sample size, single-center, short follow-up (3-15 months).", "followUp": "9 months", "plainFinding": "Faster wound closure with laser method", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35025023/", "sourceText": "BACKGROUND: The aim of this study was to investigate whether the addition of laser to the endoscopic pilonidal sinus treatment (EPSIT), laser-assisted EPSIT (LEPSIT) has an effect on the method and clinical results in the treatment of pilonidal sinus disease (PSD). METHODS: Between September 2019 and September 2020, patients who underwent LEPSIT and EPSIT procedures for PSD at Bursa Medicana Hospital, Turkey, were matched for age, pit location and number, body mass index (BMI), and sex. The primary endpoint was complete wound healing and the secondary endpoints were quality of life, cosmetic results, and cost. RESULTS: Twenty-four LEPSIT patients were matched to 72 EPSIT patients. Eighty-one (84.4%) of the included patients were male, and the median age was 26 years (range 16-52 years). The median follow-up time was 9 months (range 3-15 months).Wound healing rates (LEPSIT; 95.8% vs. EPSIT; 93%; p = 0.99) were similar in both groups. In patients who underwent LEPSIT, the operative time (p = 0.00086) was significantly shorter, time taken to return to work (p = 0.03572) and wound closure (p < 0.00001) were significantly less. However, the time taken to return to daily activities and the percentage of wound complications were similar in both groups. The pain scores on postoperative -days 1 7, and 14 were significantly higher after EPSIT (p = 0.0083, p = 0.00054, and p = 0.0479, respectively). The postoperative analgesic requirement was significantly higher after EPSIT (p = 0.01492). The total hospital cost was significantly less in patients who underwent EPSIT (p < 0.00001). Significantly better cosmetic improvement was observed in LEPSIT procedure (p = 0.00694). First month quality of life (evaluated with the Short Form 36 Health Survey Questionnaire) was similar except for bodily pain (better after LEPSIT). CONCLUSIONS: The success rates of LEPSIT and EPSIT are similar. LEPSIT results in better wound healing and patient comfort, and a shorter time to return to work.", "provenance": [ { "field": "n", "quote": "Twenty-four LEPSIT patients were matched to 72 EPSIT patients." }, { "field": "population", "quote": "patients who underwent LEPSIT and EPSIT procedures for PSD at Bursa Medicana Hospital, Turkey" }, { "field": "intervention", "quote": "laser-assisted EPSIT (LEPSIT)" }, { "field": "comparator", "quote": "the endoscopic pilonidal sinus treatment (EPSIT)" }, { "field": "primaryOutcome", "quote": "The primary endpoint was complete wound healing" }, { "field": "result", "quote": "Wound healing rates (LEPSIT; 95.8% vs. EPSIT; 93%; p = 0.99) were similar in both groups." }, { "field": "result", "quote": "time taken to return to work (p = 0.03572) and wound closure (p < 0.00001) were significantly less" }, { "field": "followUp", "quote": "The median follow-up time was 9 months (range 3-15 months)." } ] }, { "id": "pmid:34993686", "pmid": "34993686", "doi": "10.1007/s10151-021-02550-4", "nctId": null, "pmcid": null, "title": "Sinus laser-assisted closure (SiLaC®) for pilonidal disease: results of a multicentre cohort study", "firstAuthor": "Sluckin", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2022, "design": "prospective-cohort", "n": 311, "nField": "reported", "population": "people treated for pilonidal disease with the SiLaC laser procedure", "intervention": "SiLaC (sinus laser-assisted closure) treatment for pilonidal disease", "comparator": "", "primaryOutcome": "time until the wound fully closed (healed)", "result": "Mean time until wound closure was 6 weeks, with a range of 1 to 24 weeks", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "It was a cohort study without a comparison group and partly retrospective data collection, so healing times could be biased or incompletely captured.", "directness": "indirect", "relevanceNote": "", "limitations": "No control group, partial retrospective data collection, and follow-up time varied widely between patients (1-52 months).", "followUp": "median follow-up of 10 months (range 1-52 months)", "plainFinding": "Healed in about 6 weeks", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34993686/", "sourceText": "BACKGROUND: An emerging and promising minimally invasive treatment for pilonidal disease (PD) is sinus laser-assisted closure (SiLaC®). Previous studies have shown encouraging results concerning safety, patient satisfaction, wound healing and acceptable recurrence rates. This study investigated outcomes for a large cohort of PD patients treated with SiLaC®. METHODS: A multicentre cohort study with a prospective design and partial retrospective data collection for patients with PD treated with SiLaC® in three hospitals in the Netherlands (Albert Schweitzer Hospital, Flevoziekenhuis and Medical Centre Zuiderzee) from January 1st 2017 to March 1st 2020. The primary outcome was recurrence. Secondary outcomes were incidence of complete wound closure, time until wound closure, postoperative complications, ability to perform daily activities and reported patient satisfaction. RESULTS: A total of 311 patients were included with a median follow-up of 10 months (range 1-52 months). The recurrence rate after one SiLaC® treatment was 26% with 7% experiencing incomplete wound closure, resulting in an initial success rate of 66% after one SiLaC® procedure. This increased to 92% and 98% after two and three SiLaC® procedures, respectively. Mean time until wound closure was 6 weeks (range 1-24 weeks). Seven patients (2%) were still unsuccessfully treated after three SiLaC® treatments and required additional and extensive surgery. Mean time to perform regular daily activities including working was 6 days (range 0-42 days) and the vast majority of patients (84%) did not require painkillers or only paracetamol. Twelve patients (4%) developed a postoperative wound infection. The mean satisfaction score was 9 (range 5-10). CONCLUSIONS: SiLaC® is a promising minimally invasive treatment for PD with high patient satisfaction and an acceptable success rate. These results suggest that SiLaC® could be used as a safe and effective primary treatment for PD.", "provenance": [ { "field": "population", "quote": "patients with PD treated with SiLaC" }, { "field": "intervention", "quote": "sinus laser-assisted closure (SiLaC®)" }, { "field": "n", "quote": "A total of 311 patients were included" }, { "field": "primaryOutcome", "quote": "time until wound closure" }, { "field": "result", "quote": "Mean time until wound closure was 6 weeks (range 1-24 weeks)." }, { "field": "followUp", "quote": "median follow-up of 10 months (range 1-52 months)" } ] }, { "id": "pmid:34855026", "pmid": "34855026", "doi": "10.1007/s10151-021-02552-2", "nctId": null, "pmcid": null, "title": "Extensive suppuration and being overweight are factors associated with the failure of laser treatment for pilonidal disease: lessons from the first French retrospective cohort", "firstAuthor": "Spindler", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2022, "design": "retrospective", "n": 29, "nField": "reported", "population": "adults treated with laser therapy for pilonidal cyst/sinus disease", "intervention": "sinus laser therapy (SiLaT) for pilonidal disease", "comparator": "", "primaryOutcome": "time to healing (closure of skin openings, no discharge/abscess) after treatment", "result": "Mean time to healing was 25 days (±8.1 days); overall 69% of patients were considered cured, with 24.1% recurrence and 6.9% primary treatment failure over a mean follow-up of 370.3 days.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a small, single-center retrospective study of only 29 patients with no comparison group, so its healing-time estimate may not generalize.", "directness": "indirect", "relevanceNote": "", "limitations": "Small sample size, single center, no control group, and the treatment studied (laser therapy) is a specific technique not one of the standard treatments (drainage, excision, open wound care) the question focuses on.", "followUp": "370.3 days", "plainFinding": "Healed in about 25 days after laser treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34855026/", "sourceText": "BACKGROUND: The aim of our study was to assess the efficacy of sinus laser therapy (SiLaT) for the treatment of pilonidal disease. METHODS: All adult patients treated with SiLaT in our department between June 1, 2018, and August 23, 2019, were included in the study. Success was defined as the closure of cutaneous orifices and the absence of discharge or abscesses. RESULTS: We included 29 consecutive patients (22 males) with a median age of 32.5 ± 10.5 years. Eight patients had already undergone prior surgery for pilonidal disease. The procedure was performed under spinal (55%) or general (45%) anesthesia. The mean follow-up was 370.3 days (± 165.8 days). We observed 2 primary failures (6.9%) and 7 recurrences (24.1%). Ultimately, 20 patients were considered to have been cured (69%). The mean time to healing was 25 days (± 8.1 days). No serious complications were reported. Usual activities were resumed within a mean of 4.9 days (± 7.2), and 86% of patients reported being \"very satisfied\" with the treatment. The body mass index was lower for patients who were cured (24.0 ± 3.6) than for those who experienced treatment failure (27.6 ± 3.4; p = 0.018). The cured patients were less likely to have one or more secondary openings (35.0 versus 88.9%, p = 0.014). CONCLUSIONS: Almost 70% of our patients were cured by SiLaT. Complications were rare and mild. The technique appeared to be less effective for overweight patients and those with one or more secondary openings associated with pilonidal pits.", "provenance": [ { "field": "n", "quote": "We included 29 consecutive patients (22 males)" }, { "field": "population", "quote": "All adult patients treated with SiLaT in our department between June 1, 2018, and August 23, 2019, were included in the study." }, { "field": "intervention", "quote": "sinus laser therapy (SiLaT) for the treatment of pilonidal disease" }, { "field": "primaryOutcome", "quote": "Success was defined as the closure of cutaneous orifices and the absence of discharge or abscesses." }, { "field": "result", "quote": "The mean time to healing was 25 days (± 8.1 days)." }, { "field": "result", "quote": "We observed 2 primary failures (6.9%) and 7 recurrences (24.1%). Ultimately, 20 patients were considered to have been cured (69%)." }, { "field": "followUp", "quote": "The mean follow-up was 370.3 days (± 165.8 days)." } ] }, { "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": "Adults who had surgery for pilonidal disease (cyst/sinus near tailbone)", "intervention": "", "comparator": "", "primaryOutcome": "Time to complete wound healing after surgery", "result": "Complete healing took about 35.3 days on average after unroofing curettage versus about 23.2 days after modified Limberg flap surgery", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective study comparing two surgical techniques, not a controlled study of natural healing time, so the numbers may be affected by unmeasured differences between groups.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design; compares two surgical techniques rather than describing healing time generally; healing time depends heavily on which surgery was done.", "followUp": "60-month median follow-up for recurrence; healing time measured post-surgery", "plainFinding": "Healing took about 3-5 weeks.", "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": "The data of 278 patients who underwent surgery for the treatment of pilonidal disease were analyzed." }, { "field": "population", "quote": "Sacrococcygeal pilonidal disease (estimated incidence, 25/100,000) is a chronic inflammatory condition that commonly affects young adults." }, { "field": "primaryOutcome", "quote": "Secondary outcomes included adverse events, limitation of daily activities, and healing time." }, { "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)." } ] }, { "id": "pmid:34786914", "pmid": "34786914", "doi": "10.17116/hirurgia202111134", "nctId": null, "pmcid": null, "title": "[Limberg Flap reconstruction for pilonidal sinus]", "firstAuthor": "Danilov", "multipleAuthors": true, "journal": "Khirurgiia (Mosk)", "year": 2021, "design": "retrospective", "n": 117, "nField": "reported", "population": "adults who had surgery for pilonidal sinus", "intervention": "Limberg flap reconstruction surgery", "comparator": "conventional suturing of the sinus", "primaryOutcome": "wound healing time, complications, and recurrence after surgery", "result": "Hospital stay was longer with Limberg flap (8.2 vs 5.4 days) and sutures were removed later (13 vs 8 days), but wound infection (3.2% vs 14.5%) and recurrence (1 vs 6 patients) were lower with the flap technique", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a small comparison of two surgical techniques without clear mention of randomization, so results may be biased by how patients were assigned to each group.", "directness": "indirect", "relevanceNote": "", "limitations": "No mention of randomization, blinding, or length of follow-up for recurrence; single-center data analyzed after the fact.", "followUp": "", "plainFinding": "Longer healing but fewer complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34786914/", "sourceText": "OBJECTIVE: To compare the effectiveness of two surgical techniques in patients with pilonidal sinus. MATERIAL AND METHODS: There were 117 patients with pilonidal sinus divided into 2 groups depending on surgical approach: main group - Limberg Flap reconstruction (n=62), control group - conventional suturing of sinus (n=55). Patient data were analyzed using SPSS software. RESULTS: Mean length of hospital-stay in the main group was 8.2 days, in the control group - 5.4 days. Pain syndrome was more significant after 1 postoperative day in the main group. Three days later, severity of pain was similar in both groups. In the main group, sutures were removed after 13 days, in the control group - after 8 days. Incidence of postoperative wound infection was 3.2% in the main group and 14.5% in the control group. Long-term postoperative recurrence occurred in 1 patient of the main group and 6 patients of the control group. CONCLUSION: Limberg flap reconstruction is followed by fewer postoperative complications and recurrences. However, period of rehabilitation and wound healing is longer compared to traditional technique.", "provenance": [ { "field": "population", "quote": "There were 117 patients with pilonidal sinus divided into 2 groups depending on surgical approach" }, { "field": "intervention", "quote": "main group - Limberg Flap reconstruction (n=62)" }, { "field": "comparator", "quote": "control group - conventional suturing of sinus (n=55)" }, { "field": "primaryOutcome", "quote": "To compare the effectiveness of two surgical techniques in patients with pilonidal sinus." }, { "field": "result", "quote": "Mean length of hospital-stay in the main group was 8.2 days, in the control group - 5.4 days." }, { "field": "result", "quote": "In the main group, sutures were removed after 13 days, in the control group - after 8 days." }, { "field": "result", "quote": "Incidence of postoperative wound infection was 3.2% in the main group and 14.5% in the control group." }, { "field": "result", "quote": "Long-term postoperative recurrence occurred in 1 patient of the main group and 6 patients of the control group." }, { "field": "n", "quote": "There were 117 patients with pilonidal sinus" } ] }, { "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 treated for pilonidal sinus with PEPSiT surgery", "intervention": "", "comparator": "", "primaryOutcome": "time for the wound to heal after surgery", "result": "average wound healing time was 5.9 weeks, return to everyday activity after 1.37 days, hospital stay averaged 1.74 days", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "small, uncontrolled single-center case series without comparison group, so healing time may not generalize.", "directness": "direct", "relevanceNote": "", "limitations": "small sample, no control group, excluded patients who did not attend follow-up, single surgical technique only", "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": "n", "quote": "31 PEPSiT operations were recorded on 28 patients" }, { "field": "primaryOutcome", "quote": "wound healing time and return to everyday activity were assessed" }, { "field": "result", "quote": "mean wound healing time was 5.9 weeks" }, { "field": "result", "quote": "Return to everyday activity was an average 1.37 days" }, { "field": "result", "quote": "mean length of stay was 1.74 days" } ] }, { "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 with long-term (chronic) pilonidal sinus disease having surgical treatment", "intervention": "", "comparator": "", "primaryOutcome": "time for the wound to heal after surgery", "result": "Wound-healing time and cavity size were compared at postoperative days 0, 2, 3, 4 and 21; the group treated with curettage plus platelet-rich plasma had shorter healing times and smaller remaining cavity than the other groups, while the open-surgery-plus-PRP group had faster recovery per unit of cavity volume than the others.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a small single-trial comparison of different surgical techniques, and it reports relative differences in healing speed between groups rather than giving an overall typical healing duration, so it only partly answers how long healing normally takes.", "directness": "indirect", "relevanceNote": "", "limitations": "No total participant number given; healing time is reported only as relative comparisons between treatment groups rather than as an overall duration; follow-up timing for recurrence is not specified.", "followUp": "postoperative days 0, 2, 3, 4, and 21", "plainFinding": "Healing speed varies by surgical method used.", "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": "primaryOutcome", "quote": "duration of wound healing after open excision and secondary closure" }, { "field": "result", "quote": "The cavity volume and wound-healing time were compared among the groups on postoperative days 0, 2, 3, 4, and 21." }, { "field": "result", "quote": "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." }, { "field": "result", "quote": "In contrast, the recovery time per unit of cavity volume was significantly faster in group B than in the other groups." }, { "field": "followUp", "quote": "on postoperative days 0, 2, 3, 4, and 21" } ] }, { "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 treated for pilonidal sinus disease with minimally invasive curettage-based procedures", "intervention": "curettage plus platelet-rich plasma gel", "comparator": "curettage plus phenol application", "primaryOutcome": "time to achieve healing of the pilonidal wound", "result": "Median healing time was 6 days (range 4-14) with platelet-rich plasma versus 10 days (range 5-42) with phenol, a statistically significant difference", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "It was a randomized trial with clear healing-time data, but it was a single outpatient-clinic study without blinding of patients or investigators.", "directness": "indirect", "relevanceNote": "This study compares two different treatments (platelet-rich plasma gel versus phenol application) to determine which heals faster, rather than answering how long a pilonidal cyst takes to heal after treatment in general; it tests whether one treatment is superior to another, not the natural healing timeline itself.", "limitations": "Neither the patients nor the investigators were blinded, despite the randomized prospective design.", "followUp": "43.1 months", "plainFinding": "Healed in about 6 to 10 days.", "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 and were enrolled if they met the inclusion criteria and gave informed consent." }, { "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; the secondary outcome was recurrence rate." }, { "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": "followUp", "quote": "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)." } ] }, { "id": "pmid:34606699", "pmid": "34606699", "doi": null, "nctId": null, "pmcid": null, "title": "Advantages of endoscopic pilonidal sinus treatment", "firstAuthor": "Pérez-Bertólez", "multipleAuthors": true, "journal": "Cir Pediatr", "year": 2021, "design": "prospective-cohort", "n": 49, "nField": "reported", "population": "children who had surgery for pilonidal sinus", "intervention": "", "comparator": "", "primaryOutcome": "time to full healing and return to normal activities after surgery", "result": "Full healing was 11 weeks faster with the endoscopic technique (PEPSiT) than with excision and healing by secondary intention (EHSI), and return to normal life was 78 days faster than EHSI and 39 days faster than excision with primary closure (EPC); exact absolute healing times for each group were not given", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this was a small single-center study where the surgical technique was chosen by the surgeon rather than randomly assigned, so the groups may not be comparable.", "directness": "indirect", "relevanceNote": "", "limitations": "Quasi-experimental design with surgeon-dependent (non-randomized) choice of technique, single institution, small group sizes, and no absolute healing time reported—only relative comparisons between techniques.", "followUp": "", "plainFinding": "Healing time differs a lot by surgery type", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34606699/", "sourceText": "INTRODUCTION: Classic treatment of pilonidal sinus is associated with a high rate of complications and a long and painful postoperative period requiring daily wound care, with a decrease in patients' quality of life. The objective of our study was to evaluate the effectiveness and advantages of the endoscopic technique vs. 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 in 2019. Excision and healing by secondary intention (EHSI), excision and primary closure (EPC), and Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT) were compared. The surgical technique chosen was surgeon-dependent. RESULTS: 49 patients were studied - 14 undergoing PEPSiT, 23 undergoing EHSI, and 12 undergoing EPC. Full healing process was faster in PEPSiT than in EHSI (11 weeks earlier; 95% CI: 6.2-15.9; p < 0.001). Pain on the Visual Analogue Scale (VAS) and need for analgesics were less in the PEPSiT group (p = 0.001). Mean time to return to normal life was shorter with PEPSiT - 78 days earlier than EHSI (95% CI: 42.2-114.9; p < 0.001) and 39 days earlier than EPC (95% CI: -2.5-81.4; p = 0.06). No complications were recorded with PEPSiT, whereas complication rate with EHSI was 69.6%, and complication rate with EPC was 58.3% (p = 0.001). CONCLUSIONS: Endoscopic pilonidal sinus treatment is effective, with a short and painless postoperative period, and easy wound care. It allows for an early return to normal life without restrictions.", "provenance": [ { "field": "n", "quote": "49 patients were studied" }, { "field": "population", "quote": "pediatric patients undergoing pilonidal sinus surgery" }, { "field": "primaryOutcome", "quote": "Full healing process was faster in PEPSiT than in EHSI" }, { "field": "result", "quote": "Full healing process was faster in PEPSiT than in EHSI (11 weeks earlier; 95% CI: 6.2-15.9; p < 0.001)." }, { "field": "result", "quote": "Mean time to return to normal life was shorter with PEPSiT - 78 days earlier than EHSI (95% CI: 42.2-114.9; p < 0.001) and 39 days earlier than EPC (95% CI: -2.5-81.4; p = 0.06)." } ] }, { "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": "people with sacrococcygeal pilonidal disease who had marsupialization surgery", "intervention": "propolis applied to the wound after marsupialization surgery", "comparator": "standard care without propolis after marsupialization surgery", "primaryOutcome": "time to complete wound healing", "result": "Wound healing was faster in the propolis group from the first week, especially between days 14 and 28, and the complete recovery score was significantly lower than in controls", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "Very small trial with only 33 patients split between two groups and no exact healing-time numbers reported, so the findings are not very reliable.", "directness": "indirect", "relevanceNote": "", "limitations": "Small sample size of 33 patients split into two groups; no specific day-count for complete healing is given, only relative comparisons between groups.", "followUp": "", "plainFinding": "Propolis sped up wound healing after surgery", "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 were analyzed prospectively" }, { "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": "People who had surgery to remove a pilonidal sinus/cyst", "intervention": "Complete surgical excision followed by negative pressure wound therapy", "comparator": "", "primaryOutcome": "Time for the wound to heal and recurrence of the cyst", "result": "All wounds healed, with the median time to healing being 28 days; 1.6% had the cyst come back", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This was a retrospective, single-center case series without a comparison group, so healing times may not generalize.", "directness": "direct", "relevanceNote": "", "limitations": "Retrospective design, single technique/center, no comparator group to other treatments or to no treatment.", "followUp": "", "plainFinding": "Healed in about 4 weeks.", "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": "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." } ] }, { "id": "pmid:34417712", "pmid": "34417712", "doi": "10.1007/s13304-021-01153-w", "nctId": null, "pmcid": null, "title": "Comparison of the Keystone flap and the Limberg flap technique in the surgical treatment of pilonidal sinus disease", "firstAuthor": "Calisir", "multipleAuthors": true, "journal": "Updates Surg", "year": 2021, "design": "retrospective", "n": 124, "nField": "reported", "population": "patients who had surgery for pilonidal sinus disease", "intervention": "Keystone flap surgical technique", "comparator": "Limberg flap surgical technique", "primaryOutcome": "time to wound healing after surgery (plus operation time, return to work, complications, recurrence)", "result": "Healing time was significantly shorter after the Keystone flap than after the Limberg flap, though exact healing durations in days or weeks are not given; recurrence rates did not differ.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective, non-randomized comparison of two surgical techniques, so it mainly tells us which operation healed faster relative to the other, not the general time course of pilonidal cyst healing.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, no randomization, no absolute healing-time figures reported, and it compares two specific surgical techniques rather than describing general healing time after treatment.", "followUp": "", "plainFinding": "Keystone flap healed faster than Limberg flap.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34417712/", "sourceText": "Pilonidal sinus (PS) disease is a chronic inflammatory disease of the sacrococcygeal region. Although various methods have been described for surgical treatment, there is no consensus on the best surgical technique. The aim of this study was to present the results of a new advancement flap technique named the \"Keystone flap (KSF)\" and compared with the Limberg flap (LF) technique in pilonidal sinus surgery. A retrospective review was made of 124 consecutive patients surgically treated for PS disease with KSF and LF procedures. Baseline characteristics, operation time, volume of excised specimen, duration of hospitalization, duration of drainage, duration of healing, time to return to work, local complications and recurrence were evaluated and compared between the two procedures. Operation time, healing time, and time to return to work were significantly shorter in the KSF group. Partial wound dehiscense and prolonged wound healing were more common in the LF group. An additional intervention in the operating room was required by 21.1% of the LF group and was a significantly lower rate in the KSF group at 7.5%. There was no significant difference between the groups in terms of recurrence. The KSF procedure seems promising for treating pilonidal sinus disease, with the advantages of shorter operation, healing, and return to work times. It also provides lower partial wound dehiscence and necrosis rates.", "provenance": [ { "field": "n", "quote": "A retrospective review was made of 124 consecutive patients surgically treated for PS disease with KSF and LF procedures." }, { "field": "population", "quote": "124 consecutive patients surgically treated for PS disease with KSF and LF procedures" }, { "field": "intervention", "quote": "Keystone flap (KSF)" }, { "field": "comparator", "quote": "Limberg flap (LF) technique" }, { "field": "primaryOutcome", "quote": "Operation time, healing time, and time to return to work were significantly shorter in the KSF group." }, { "field": "result", "quote": "Operation time, healing time, and time to return to work were significantly shorter in the KSF group." } ] }, { "id": "pmid:34310558", "pmid": "34310558", "doi": "10.1097/SLE.0000000000000974", "nctId": null, "pmcid": null, "title": "Endoscopic Pilonidal Sinus Treatment: Rapid Recovery, Satisfactory Success, and High Quality of Life", "firstAuthor": "Gulcu", "multipleAuthors": true, "journal": "Surg Laparosc Endosc Percutan Tech", "year": 2021, "design": "retrospective", "n": 86, "nField": "reported", "population": "People treated for pilonidal sinus disease with a minimally invasive endoscopic procedure (EPSIT)", "intervention": "", "comparator": "", "primaryOutcome": "Complete wound healing after treatment", "result": "94.2% of patients had complete wound healing, 4.6% had incomplete healing, and 1.2% had recurrence; patients returned to daily activities after a median of 1 day and to work after a median of 3 days, over a median follow-up of 12 months", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective analysis of a single treatment group with no comparison group, so it mainly describes recovery after one specific minimally invasive technique rather than pilonidal healing in general.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective analysis of prospectively collected data, single technique (EPSIT) only, no comparator group, and exact time to complete wound healing (in days/weeks) is not explicitly reported.", "followUp": "12 (3 to 23) months", "plainFinding": "Most healed, quick return to activity", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34310558/", "sourceText": "PURPOSE: In the treatment of pilonidal sinus disease (PD), endoscopic pilonidal sinus treatment (EPSIT), a skin-sparing minimally invasive technique, has attracted attention as an effective treatment. The aim of this study to evaluate the treatment success, cosmetic outcomes, and the quality of life in the patients who underwent an EPSIT for PD. MATERIALS AND METHODS: The prospectively maintained data of 86 patients who underwent EPSIT for PD were retrospectively analyzed. The primary end-point of this study was complete wound healing, while the secondary end-points were the quality of life and cosmetic outcomes. RESULTS: Seventy-two (83.7%) patients were male, and the median age was 28 (16 to 52). The median operative time was 32 (24 to 44) minutes, the median time to return to daily activities was 1 (1 to 4) day, and the median time to return to work was 3 (1 to 11) days. Fifty-two patients (60.4%) required no analgesics. No wound complication was observed. The median follow-up period was 12 (3 to 23) months. The complete wound healing rate was 94.2%, incomplete wound healing rate was 4.6% and the recurrence rate was 1.2%. Treatment failure was observed in 5 of the 6 patients with >3 pits located in the midline. The first-year median Wound evaluation scale score was 0 (0 to 4). The quality of life [physical function, physical role difficulty, pain, general health perception, energy/vitality, social functioning, emotional role, and mental health (P<0.0001)] significantly increased from preoperative levels a month after the EPSIT procedure. CONCLUSION: EPSIT, a minimally invasive treatment modality for the treatment of sacrococcygeal PD, is an effective treatment that does not hamper the daily life of the patients, presents high success rates, and has satisfactory cosmetic outcomes.", "provenance": [ { "field": "population", "quote": "patients who underwent EPSIT for PD" }, { "field": "primaryOutcome", "quote": "The primary end-point of this study was complete wound healing" }, { "field": "result", "quote": "The complete wound healing rate was 94.2%, incomplete wound healing rate was 4.6% and the recurrence rate was 1.2%" }, { "field": "result", "quote": "the median time to return to daily activities was 1 (1 to 4) day, and the median time to return to work was 3 (1 to 11) days" }, { "field": "n", "quote": "The prospectively maintained data of 86 patients who underwent EPSIT for PD were retrospectively analyzed." }, { "field": "followUp", "quote": "The median follow-up period was 12 (3 to 23) months." } ] }, { "id": "pmid:34303591", "pmid": "34303591", "doi": "10.1016/j.asjsur.2021.06.029", "nctId": null, "pmcid": null, "title": "Partial primary closure in sacrococcygeal pilonidal sinus: Modified with suture technique", "firstAuthor": "Yildiz", "multipleAuthors": false, "journal": "Asian J Surg", "year": 2022, "design": "rct", "n": 96, "nField": "reported", "population": "people having surgery for pilonidal sinus disease", "intervention": "partial primary closure technique (with suture modification)", "comparator": "Karydakis flap technique", "primaryOutcome": "wound healing time and complications after surgery", "result": "Healing time was longer with partial primary closure in uncomplicated cases but significantly shorter in complicated cases compared to the Karydakis technique", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a small randomized trial of two surgical techniques with no blinding mentioned, so it gives only rough, technique-specific healing time estimates rather than a general picture of how long pilonidal wounds take to heal.", "directness": "indirect", "relevanceNote": "", "limitations": "Small sample of 96 patients split between two active surgical techniques, no blinding reported, and healing time is reported only in relation to complication status rather than as an overall timeline.", "followUp": "", "plainFinding": "Healing time varies by surgery type and complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34303591/", "sourceText": "AIM AND BACKGROUND: The primary purpose of pilonidal sinus treatment is to minimize complications, accelerate wound healing, and minimize recurrence. However, invasive and minimally invasive methods are being developed to reduce these problems. Early and late postoperative complications remain significant problems in pilonidal surgery. This study aimed to contribute to this issue in surgery by comparing the results of the Karydakis flap (KF) technique and those of the partial primary closure (PPC) technique, to which we applied suture modification. METHODS: A total of 96 patients diagnosed with pilonidal sinus disease (PSD) were randomly assigned to two groups. Apply the partial primary closure in 46 patients and the Karydakis technique in 50. RESULTS: In comparison to the Karydakis technique, the partial primary closure (PPC) group's hospitalization stay was shorter, although the difference was not significant. Healing time was also longer in uncomplicated cases (p = 0.200 and 0.064, respectively). Abscesses and hematomas were not observed with partial primary closure, but the total complication rate was similar to that of the Karydakis technique. Surgical site infections were often seen in the PPC group (21.7% vs. 10%). In contrast, healing time for complicated cases was found to be significantly shorter in the PPC technique (p < 0.05). CONCLUSION: Postoperative abscess, hematoma, and seroma are the most common causes of total wound dehiscence, and delay in wound healing in off-midline techniques. We recommend the PPC technique with suture modification as an alternative to off-midline techniques in clean and chronically infected cases, other than cellulitis, abscess, and purulent discharge cases. However, we primarily recommend off-midline techniques in clean or asymptomatic cases.", "provenance": [ { "field": "population", "quote": "A total of 96 patients diagnosed with pilonidal sinus disease (PSD) were randomly assigned to two groups." }, { "field": "intervention", "quote": "Apply the partial primary closure in 46 patients" }, { "field": "comparator", "quote": "the Karydakis technique in 50" }, { "field": "primaryOutcome", "quote": "Healing time was also longer in uncomplicated cases" }, { "field": "result", "quote": "Healing time was also longer in uncomplicated cases (p = 0.200 and 0.064, respectively)." }, { "field": "result", "quote": "healing time for complicated cases was found to be significantly shorter in the PPC technique (p < 0.05)." }, { "field": "n", "quote": "A total of 96 patients diagnosed with pilonidal sinus disease (PSD) were randomly assigned to two groups." } ] }, { "id": "pmid:34291332", "pmid": "34291332", "doi": "10.1007/s10103-021-03379-x", "nctId": null, "pmcid": null, "title": "Laser treatment of pilonidal disease: a systematic review", "firstAuthor": "Romic", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2022, "design": "systematic-review", "n": 971, "nField": "reported", "population": "People with chronic pilonidal disease treated with laser procedures", "intervention": "", "comparator": "", "primaryOutcome": "Whether the wound healed (primary healing) and time to healing/follow-up", "result": "Among 971 patients across 10 studies, 94.4% achieved primary healing, with a median follow-up of 12 months (range 7-25 months) and a weighted mean recurrence rate of 3.8%", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a systematic review pooling small, non-randomized studies limited to laser treatment of mild chronic pilonidal disease, so healing times may not reflect all pilonidal cyst treatments.", "directness": "indirect", "relevanceNote": "", "limitations": "The abstract notes results were limited to mild chronic PD, techniques varied, and standardized outcome reporting was lacking; no randomized controlled trials were included.", "followUp": "12 (range 7-25) months", "plainFinding": "Most healed within about a year.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34291332/", "sourceText": "Pilonidal disease (PD) is a common condition, and there is still an ongoing debate on ideal management that should be minimally invasive, safe, and efficient. The use of radially emitting laser in the treatment of chronic PD is a novel minimally invasive technique, and initial studies with a small number of patients showed promising results. This study aimed to assess the efficacy and safety of chronic PD treatment with a laser using a systematic review of the published literature. A systematic review was conducted after PubMed, Scopus, Embase, Web of Science, and the Cochrane database search for studies reporting laser treatment of chronic PD. Also, our unpublished prospective single-center study was included in this review. Ten of 87 studies were eligible for the review, including 971 patients. The median age of the patients was 26 (range 13-68), and the median operative time was 26 (range 6-65) min. With a median follow-up of 12 (range 7-25) months, 917 (94.4%) patients achieved primary healing with a weighted mean recurrence rate of 3.8%. The weighted mean complication rate was 10% (95% CI 5.7-14.3%, I2 = 82.28, p < 0.001), and all were minor. The published literature demonstrates that laser treatment is a promising procedure in the management of chronic PD. Furthermore, the review showed that standardized operative techniques and perioperative steps were used. The results were limited to the mild chronic PD. Classification of PD severity and standardized outcome reporting is required to define indications and contraindications for laser PD treatment. Randomized controlled trials are needed to determine the long-term effectiveness and superiority of laser treatment over other methods.", "provenance": [ { "field": "population", "quote": "studies reporting laser treatment of chronic PD" }, { "field": "n", "quote": "including 971 patients" }, { "field": "primaryOutcome", "quote": "917 (94.4%) patients achieved primary healing with a weighted mean recurrence rate of 3.8%" }, { "field": "result", "quote": "With a median follow-up of 12 (range 7-25) months, 917 (94.4%) patients achieved primary healing with a weighted mean recurrence rate of 3.8%" }, { "field": "followUp", "quote": "median follow-up of 12 (range 7-25) months" } ] }, { "id": "pmid:34271267", "pmid": "34271267", "doi": "10.1016/j.jss.2021.06.010", "nctId": null, "pmcid": null, "title": "Room for Improvement: The Trephination Procedure for Pediatric Patients with Pilonidal Disease", "firstAuthor": "Metzger", "multipleAuthors": true, "journal": "J Surg Res", "year": 2021, "design": "retrospective", "n": 19, "nField": "reported", "population": "children and teenagers treated for pilonidal disease with the trephination procedure", "intervention": "trephination procedure for pilonidal disease", "comparator": "", "primaryOutcome": "time to wound healing, disease recurrence, and need for a second surgery", "result": "Only about a quarter of patients were fully healed at 30 days, and just over 40% were healed by 6 months; 16.1% had the disease come back by 6 months and about 15% needed another operation", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This was a small, single-center retrospective study of only 19 patients, which limits how much the findings can be trusted.", "directness": "direct", "relevanceNote": "", "limitations": "Small sample size, single institution, retrospective design, short follow-up window.", "followUp": "6-months", "plainFinding": "Slow healing, many not fully healed by 6 months", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34271267/", "sourceText": "BACKGROUND: Pilonidal disease is common amongst adolescent males and females and often leads to recurrent symptoms and life-altering morbidity. The traditional surgical approach includes wide excision of the involved area and carries a high rate of postoperative morbidity. A minimally invasive surgical approach using trephines was described by Gips in 2008 and has since been widely adopted by many surgeons. The aim of this study was to explore outcomes of the trephination procedure for pediatric and adolescent patients by evaluating postoperative wound healing and disease recurrence. MATERIALS AND METHODS: A retrospective cohort study for patients that underwent the trephination procedure as part of standard of care for the treatment of pilonidal disease from November 1, 2019-November 1, 2020 was performed. Patient demographics, presenting characteristics, and previous treatment history were identified. Outcome measures included healing time, recurrent disease, and need for reoperation. RESULTS: A total of 19 patients underwent the trephination procedure at a mean age of 16.4 years of age. An average of 3.8 pits were excised and there were no reported intraoperative complications. Following trephination, 26.3% of patients were healed at 30-day's, with just over 40% showing complete healing by 6-months. The recurrence rate was 16.1% at 6-months and approximately 15% of patients required a second surgery. CONCLUSION: Early results for trephination at our institution show a high rate of healing complications and frequent reoperation. Future research is needed to establish the role of the trephination procedure in the context of defining the best practices for treating this challenging disease.", "provenance": [ { "field": "population", "quote": "patients that underwent the trephination procedure as part of standard of care for the treatment of pilonidal disease" }, { "field": "intervention", "quote": "A minimally invasive surgical approach using trephines was described by Gips in 2008" }, { "field": "primaryOutcome", "quote": "Outcome measures included healing time, recurrent disease, and need for reoperation." }, { "field": "result", "quote": "Following trephination, 26.3% of patients were healed at 30-day's, with just over 40% showing complete healing by 6-months. The recurrence rate was 16.1% at 6-months and approximately 15% of patients required a second surgery." }, { "field": "n", "quote": "A total of 19 patients underwent the trephination procedure" } ] }, { "id": "pmid:34256587", "pmid": "34256587", "doi": "10.12968/jowc.2021.30.Sup7.S28", "nctId": null, "pmcid": null, "title": "Surgical reconstruction of pilonidal sinus disease with concomitant extracellular matrix graft placement: a case series", "firstAuthor": "Chaffin", "multipleAuthors": true, "journal": "J Wound Care", "year": 2021, "design": "case-series", "n": 6, "nField": "reported", "population": "People with recurrent pilonidal sinus disease after failed prior surgery", "intervention": "Surgical flap reconstruction with extracellular matrix graft implantation", "comparator": "", "primaryOutcome": "Time to complete wound healing", "result": "Five of six patients fully healed by 3 weeks, the sixth by 4 weeks, and all remained healed at 12 weeks", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "Tiny uncontrolled case series of only six patients with no comparison group, so healing times may not generalize.", "directness": "indirect", "relevanceNote": "", "limitations": "Very small sample size, retrospective design, no comparator group, and patients had complex recurrent disease with prior failed surgery, limiting generalisability to typical pilonidal cases.", "followUp": "12 weeks", "plainFinding": "Healed within 3 to 4 weeks", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34256587/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a chronic inflammatory disease affecting the soft tissue of the sacrococcygeal region and remains a challenging disease for clinicians to treat. The optimal treatment for PSD remains controversial and recent reports describe several different surgical approaches offering different benefits. Approximately 40% of initial incision and drainage cases require subsequent surgery. Due to high recurrence rates and postoperative complications, a more complex revision surgery involving a flap reconstruction may be required. We hypothesised that the combination of an extracellular matrix (ECM) graft with tissue flap reconstruction may decrease the postoperative complications and recurrence rates for PSD. METHOD: We report a retrospective case series using a surgical flap reconstruction with concomitant implantation of an ovine forestomach ECM graft under a fasciocutaneous flap with an off-midline closure for recurrent PSD, where previously surgical intervention had failed due to wound dehiscence and/or recurrent disease. RESULTS: The case series included six patients. After three weeks, all patients except one were fully healed, and the sixth was fully healed by week 4; all wounds remained fully healed at 12 weeks. All patients achieved good cosmesis and were able to return to normal function without any residual symptoms. CONCLUSION: This pilot case series explored augmenting a flap reconstruction for complex PSD with advanced ECM graft materials, demonstrating that it may improve outcomes and minimise typical complications seen in flap closure, such as inflammation, infection, haematoma/seroma and hypoperfusion. Although the study had a limited number of participants, long-term outcomes were promising and suggest that further studies are warranted.", "provenance": [ { "field": "population", "quote": "recurrent PSD, where previously surgical intervention had failed due to wound dehiscence and/or recurrent disease" }, { "field": "intervention", "quote": "surgical flap reconstruction with concomitant implantation of an ovine forestomach ECM graft under a fasciocutaneous flap with an off-midline closure" }, { "field": "primaryOutcome", "quote": "After three weeks, all patients except one were fully healed, and the sixth was fully healed by week 4" }, { "field": "result", "quote": "After three weeks, all patients except one were fully healed, and the sixth was fully healed by week 4; all wounds remained fully healed at 12 weeks." }, { "field": "n", "quote": "The case series included six patients." } ] }, { "id": "pmid:34254748", "pmid": "34254748", "doi": null, "nctId": null, "pmcid": null, "title": "Pilonidal sinus in adolescence: is there an ideal surgical approach?", "firstAuthor": "Roldón Golet", "multipleAuthors": true, "journal": "Cir Pediatr", "year": 2021, "design": "retrospective", "n": 61, "nField": "reported", "population": "Teenagers aged 11-18 who had surgery for pilonidal sinus", "intervention": "Excision with primary closure (Karydakis technique)", "comparator": "En bloc resection with wound left open to heal on its own", "primaryOutcome": "Time to full recovery after surgery", "result": "Recovery took about 38 days with the Karydakis technique versus about 108 days with en bloc resection and open healing", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This was a retrospective study comparing two different surgeon groups without randomization, so other factors could explain the difference in healing time.", "directness": "direct", "relevanceNote": "", "limitations": "Retrospective, multi-center design with different surgical teams (pediatric vs general surgeons) performing each technique, which could introduce bias.", "followUp": "", "plainFinding": "Healing took about 38 to 108 days depending on surgery type.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34254748/", "sourceText": "OBJECTIVE: The objective of this work was to compare excision with primary closure according to Karydakis technique (KT) with en bloc resection with secondary healing (EB) in the treatment of pilonidal sinus in adolescents. MATERIAL AND METHODS: An observational, retrospective, multi-center study was carried out in adolescent patients (11-18 years old) diagnosed with pilonidal sinus and undergoing surgery from 2011 to 2017. Patients were divided into 2 groups: KT (pediatric surgeons) and EB (general surgeons). RESULTS: Our sample consisted of 61 patients (KT: 26 patients; EB: 35 patients). Mean total recovery time (days) was significantly shorter in the KT group (37.77 KT vs. 107.76 EB, p< 0.001). In terms of postoperative complications, no differences were noted regarding overall complication rate (53.8% KT vs. 40% EB). However, differences were found in postoperative bleeding (0% KT vs. 25.7% EB, p=0.005), seroma occurrence (23.1% KT vs. 0% EB, p=0.003), and surgical wound dehiscence (42.3% KT vs. 8.6% EB, p=0.002). Recurrence rate was lower in the Karydakis group than in the en bloc resection group (4% vs. 28.6%, p=0.015). CONCLUSIONS: Both surgical techniques (KT and EB) are acceptable and safe, but in our study, Karydakis technique demonstrated to be more effective than en bloc resection with secondary closure, since it allowed for shorter recovery times and lower recurrence rates. Therefore, Karydakis surgical technique can be an excellent alternative in the treatment of pilonidal sinus in the adolescent population.", "provenance": [ { "field": "population", "quote": "adolescent patients (11-18 years old) diagnosed with pilonidal sinus and undergoing surgery from 2011 to 2017" }, { "field": "intervention", "quote": "excision with primary closure according to Karydakis technique (KT)" }, { "field": "comparator", "quote": "en bloc resection with secondary healing (EB)" }, { "field": "primaryOutcome", "quote": "Mean total recovery time (days)" }, { "field": "result", "quote": "Mean total recovery time (days) was significantly shorter in the KT group (37.77 KT vs. 107.76 EB, p< 0.001)." }, { "field": "n", "quote": "Our sample consisted of 61 patients (KT: 26 patients; EB: 35 patients)." } ] }, { "id": "pmid:34213001", "pmid": "34213001", "doi": "10.14744/tjtes.2020.74677", "nctId": null, "pmcid": null, "title": "Endoscopic pilonidal sinus treatment (EPSiT) in the pediatric age group: Short-term results", "firstAuthor": "Gökbuget", "multipleAuthors": true, "journal": "Ulus Travma Acil Cerrahi Derg", "year": 2021, "design": "retrospective", "n": 29, "nField": "reported", "population": "Children and teens treated for pilonidal sinus with the EPSiT procedure", "intervention": "", "comparator": "", "primaryOutcome": "Time for the wound to fully heal after surgery", "result": "Average total wound healing time was about 18.7 days (range 7-60 days); most healed early (~14 days) but some healed late (~60 days)", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "Small retrospective single-group study with no comparison group, so healing times may not generalize.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, small sample size, no comparator group, short follow-up period, and recurrences requiring repeat procedures.", "followUp": "8.3±3.34 months", "plainFinding": "Healed in about 2-9 weeks", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34213001/", "sourceText": "BACKGROUND: This study aims to evaluate the short term outcomes of the Endoscopic pilonidal sinus treatment (EPSiT) in the pediatric age group. METHODS: In this study, between June 2018 and July 2019, pediatric patients with pilonidal sinus (PS) who were treated with the EPSiT method were reviewed retrospectively. RESULTS: Of the twenty-nine patients (20 males, nine females), the average age was 15.5±2.8 years, and the average body mass index (BMI) was 25.8±4.2. Eight patients (28%) presented with a history of recurrence following the previous surgery. The average number of fistulas present in cases was 1.17 (1-2). The localization of the fistula was midline in twenty-four and lateral in five of the patients. The average time of the EPSiT procedure was 57±13.9 minutes, and the average time of hospital stay was 11.4±7.2 hours. The pain score average was 0.86 (range of 0-3) and the duration of analgesic use was 37 hr (12-72 hr). The mean post-operative time of total wound healing was 18.71 days (7-60 days) for primary presenting cases. Early wound healing was seen in twenty-five patients (average of 14 days), while late wound healing was observed in four patients (average of 60 days). The mean time of follow-up was 8.3±3.34 months. The average time of return to full daily activity was 2.1 days (0-30 days), while it was the same day for sixteen (53%) patients. In post-operative follow-up, early (bleeding: 1) and late (formation of granulation tissue: 1, recurrence: 8) complications were seen in nine patients. Of the eight patients (27.5%) whose recurrence was detected, seven were primary and one was secondary presenting patients. The average time of presentation for recurrence was 5.8 mo (1-10 mo). Re-EPSiT was applied in two of the eight patients with recurrence and is planned for five, while one of the patients lost to follow-up. CONCLUSION: EPSiT is an easily applicable, pain-free minimal invasive procedure with a short period of hospital stay and a fast return to routine daily activity. It provides comfortable and repeatable intervention in cases with recurrences after the EPSiT procedure and other methods for PS treatment.", "provenance": [ { "field": "n", "quote": "Of the twenty-nine patients (20 males, nine females)" }, { "field": "population", "quote": "pediatric patients with pilonidal sinus (PS) who were treated with the EPSiT method" }, { "field": "primaryOutcome", "quote": "The mean post-operative time of total wound healing was 18.71 days (7-60 days) for primary presenting cases." }, { "field": "result", "quote": "Early wound healing was seen in twenty-five patients (average of 14 days), while late wound healing was observed in four patients (average of 60 days)." }, { "field": "followUp", "quote": "The mean time of follow-up was 8.3±3.34 months." } ] }, { "id": "pmid:34132822", "pmid": "34132822", "doi": "10.1007/s00104-021-01439-0", "nctId": null, "pmcid": "PMC8821484", "title": "[Results of the Limberg flap procedure in acute and chronic pilonidal abscesses]", "firstAuthor": "Driouch", "multipleAuthors": true, "journal": "Chirurg", "year": 2022, "design": "prospective-cohort", "n": 39, "nField": "reported", "population": "adults treated surgically for either an acute pilonidal abscess or a chronic pilonidal sinus", "intervention": "Limberg flap surgery (a one-stage flap reconstruction) for pilonidal disease", "comparator": "", "primaryOutcome": "rate of wound-healing problems and cyst recurrence after surgery", "result": "Wound healing problems occurred in 10% of the acute-abscess group versus 17% of the chronic-sinus group (not a significant difference), and there was no recurrence in the acute group compared with 11% recurrence in the chronic group; the abstract does not state how long it took for wounds to heal.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a small observational study of only 39 patients comparing two patient groups rather than measuring healing time directly, so it gives limited information for this question.", "directness": "indirect", "relevanceNote": "", "limitations": "Small sample size, non-randomized observational design, and the study measured complication and recurrence rates rather than time to healing.", "followUp": "", "plainFinding": "No healing time reported", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34132822/", "sourceText": "BACKGROUND: A number of different treatment algorithms are recommended for the treatment of an acute pilonidal abscess and a chronic pilonidal sinus. While a 1-stage surgical procedure using excision or plastic reconstruction according to Limberg or Karydakis is suggested for chronic pilonidal sinus, a 2‑stage procedure is recommended for an acute pilonidal abscess. The aim of this study was to compare the results of the 1‑stage surgery with plastic reconstruction according to Limberg for acute pilonidal abscess and chronic pilonidal sinus in terms of recurrence, disorders of wound healing, inpatient length of stay and patient satisfaction. METHODS: From 2009 to 2014 a total of 39 patients were included in this prospective observational study: 21 patients with acute pilonidal abscess and 18 patients with chronic pilonidal sinus. All patients were surgically treated with a 1‑stage procedure using the Limberg flap method. The groups were compared in terms of postoperative complication rates and frequency of recurrence. RESULTS: Both groups were basically comparable with respect to demographic characteristics and risk factor profiles. Analysis of the postoperative results showed a comparable rate of postoperative wound healing disorders (10% vs. 17%, p = 0.647). In the group with acute pilonidal abscesses there was no recurrence during the observational period, while in the chronic pilonidal sinus group there were 2 (11%) recurrences (p = 0.206). CONCLUSION: The results of the Limberg flap procedure regarding acute pilonidal abscesses were comparable to those of chronic pilonidal sinus. The results of this study show a trend to a lower risk of recurrence. The use of the Limberg flaps therefore also seems to be an adequate treatment option in an acute infection situation.", "provenance": [ { "field": "n", "quote": "a total of 39 patients were included in this prospective observational study" }, { "field": "population", "quote": "21 patients with acute pilonidal abscess and 18 patients with chronic pilonidal sinus" }, { "field": "intervention", "quote": "All patients were surgically treated with a 1‑stage procedure using the Limberg flap method" }, { "field": "primaryOutcome", "quote": "The groups were compared in terms of postoperative complication rates and frequency of recurrence" }, { "field": "result", "quote": "Analysis of the postoperative results showed a comparable rate of postoperative wound healing disorders (10% vs. 17%, p = 0.647)" }, { "field": "result", "quote": "In the group with acute pilonidal abscesses there was no recurrence during the observational period, while in the chronic pilonidal sinus group there were 2 (11%) recurrences (p = 0.206)" } ] }, { "id": "pmid:34110535", "pmid": "34110535", "doi": "10.1007/s10151-021-02477-w", "nctId": null, "pmcid": null, "title": "A minimally invasive approach to pilonidal disease with endoscopic pilonidal sinus treatment (EPSiT): a single-center case series with long-term results", "firstAuthor": "Foti", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2021, "design": "retrospective", "n": 42, "nField": "reported", "population": "adults treated for primary or recurrent pilonidal cyst/sinus with a minimally invasive procedure (EPSiT)", "intervention": "", "comparator": "", "primaryOutcome": "whether the wound healed, recurred, or persisted after treatment, and how long healing took", "result": "76.1% of procedures resulted in healing after a single treatment, rising to 83.3% after a second procedure; the abstract reports wound healing time was measured as a secondary outcome but does not give the actual duration in days or weeks, only that median follow-up was 62 months and 13.0% had persistence and 10.9% had recurrence", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a single-center retrospective case series without a comparison group, so it can describe what happened to these patients but can't be generalized with confidence.", "directness": "direct", "relevanceNote": "", "limitations": "Retrospective, single surgical team, no control group, and the specific wound healing time (though listed as a measured outcome) is not numerically reported in the abstract.", "followUp": "median 62 (IQR 43) months", "plainFinding": "Most healed after one procedure; exact healing time not given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34110535/", "sourceText": "BACKGROUND: Minimally invasive techniques for treating pilonidal disease are safe and effective alternatives to conventional surgery, with improved recovery time, cosmetic results, and pain control. The aim of this study was to evaluate the 5-year surgical outcomes of a single-center case series treated with endoscopic pilonidal sinus treatment (EPSiT). METHODS: We conducted a retrospective single-center analysis of all patients treated with EPSiT, by a single surgical team, from March 2015 to December 2019, for primary or recurrent pilonidal disease. The primary outcomes were recurrence, persistence and treatment failure. The secondary outcomes were postoperative pain, painkiller use, time off work, satisfaction, complications, wound healing time, time to persistence or recurrence. RESULTS: Forty-two patients underwent 46 EPSiT procedures [34 males, 8 females, median age 25 (IQR 13.75) years] for primary (47.8%) or recurrent pilonidal disease (52.2%). All patients completed the follow-up [median 62 (IQR 43) months]. The single procedure healing rate was 76.1%. The healing rate for the first procedures plus the second EPSiT procedure (performed in 4 cases) was 83.3%. Among the 46 EPSiT procedures, we recorded six cases of persistence (13.0%) and five cases of recurrence (10.9%) The median operative time was 32.5 (IQR 18.75) minutes, the median pain score (visual analog scale) in week 1 was 2 (IQR 2), and the median time off work was 4 (IQR 2) days. Four patients (8.7%) experienced complications: serosanguineous (n = 2) or seropurulent discharge (n = 2). The satisfaction rate was 95.7%. CONCLUSIONS: In our experience, EPSiT is safe, well accepted. and associated with a low level of postoperative pain, short hospitalization, short time off work, as well as optimal cosmetic results. Its failure rate is similar to that of excisional surgery.", "provenance": [ { "field": "population", "quote": "patients treated with EPSiT, by a single surgical team, from March 2015 to December 2019, for primary or recurrent pilonidal disease" }, { "field": "n", "quote": "Forty-two patients underwent 46 EPSiT procedures" }, { "field": "primaryOutcome", "quote": "The primary outcomes were recurrence, persistence and treatment failure." }, { "field": "result", "quote": "The single procedure healing rate was 76.1%. The healing rate for the first procedures plus the second EPSiT procedure (performed in 4 cases) was 83.3%. Among the 46 EPSiT procedures, we recorded six cases of persistence (13.0%) and five cases of recurrence (10.9%)" }, { "field": "followUp", "quote": "All patients completed the follow-up [median 62 (IQR 43) months]." } ] }, { "id": "pmid:34042233", "pmid": "34042233", "doi": "10.1111/codi.15755", "nctId": null, "pmcid": null, "title": "Sinus laser therapy versus sinus lay open in the management of sacrococcygeal pilonidal disease", "firstAuthor": "Abdelnaby", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2021, "design": "retrospective", "n": 139, "nField": "reported", "population": "Adults with sacrococcygeal pilonidal disease who had surgical treatment (sinus laser therapy or lay open)", "intervention": "Sinus laser therapy (SiLaT)", "comparator": "Sinus lay open surgery", "primaryOutcome": "Complete healing of the wound by 12 months after surgery, and time taken to heal", "result": "SiLaT led to quicker healing with less delayed wound healing, but lay open had better overall success with no recurrences recorded, while 6 patients had recurrence after SiLaT", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective review comparing two surgical techniques, not a controlled study specifically measuring natural healing duration, so the findings on timing are indirect and subject to bias.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, patients were not randomized between treatments, and exact healing times in days or weeks are not given.", "followUp": "12 months postoperatively", "plainFinding": "Laser surgery heals faster, open surgery more reliable", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34042233/", "sourceText": "AIM: There is no standard method for the management of sacrococcygeal pilonidal disease (SPND); however, surgery remains the gold standard treatment. Wide surgical excision of the sinus is the traditional surgical treatment of SPND, yet it is associated with extended healing time and delayed recovery. This study aimed to compare the outcomes of sinus laser therapy (SiLaT) and sinus lay open in the management of SPND. METHODS: Patients with SPND who were treated with SiLaT or lay open were retrospectively reviewed. The main outcome measures were the success of surgery in terms of complete healing at 12 months postoperatively, time to complete healing, complications, operation time and quality of life (QoL). RESULTS: A total of 139 patients with a mean age of 25 years were included to the study. Sixty-two patients underwent SiLaT and 77 underwent lay open. Six patients experienced recurrence after SiLaT while there was no recorded recurrence after the lay open technique (P = 0.007). Sinus lay open had a shorter operation time than SiLaT (P < 0.0001). On the other hand, SiLaT was followed by a shorter healing time, lower incidence of delayed wound healing, better cosmetic outcome, and higher QoL scores compared to the lay open group. The complication rates were comparable between the two groups. CONCLUSION: Sinus lay open was associated with better success than SiLaT. On the other hand, SiLaT was associated with quicker healing, better cosmesis, better QoL and longer operation time. The complication rate of the two procedures was comparable.", "provenance": [ { "field": "population", "quote": "Patients with SPND who were treated with SiLaT or lay open were retrospectively reviewed." }, { "field": "intervention", "quote": "sinus laser therapy (SiLaT)" }, { "field": "comparator", "quote": "sinus lay open" }, { "field": "primaryOutcome", "quote": "The main outcome measures were the success of surgery in terms of complete healing at 12 months postoperatively, time to complete healing, complications, operation time and quality of life (QoL)." }, { "field": "result", "quote": "SiLaT was followed by a shorter healing time, lower incidence of delayed wound healing, better cosmetic outcome, and higher QoL scores compared to the lay open group." }, { "field": "result", "quote": "Six patients experienced recurrence after SiLaT while there was no recorded recurrence after the lay open technique (P = 0.007)." }, { "field": "n", "quote": "A total of 139 patients with a mean age of 25 years were included to the study." } ] }, { "id": "pmid:34031284", "pmid": "34031284", "doi": null, "nctId": null, "pmcid": null, "title": "A comparison of crystal phenol treatment, midline primary closure and Limberg flap reconstruction methods in female patients with primary pilonidal sinus disease", "firstAuthor": "Kanlioz", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2021, "design": "retrospective", "n": null, "nField": "not-reported", "population": "women may also be affected", "intervention": "", "comparator": "", "primaryOutcome": "recurrence and complication rates of the method, recovery time, patients' preference and surgeon's skill", "result": "no statistically significant difference has been noted between primary versus secondary (Karydakis flap or Limberg flap) closure", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "The provided text is only introductory/background material with no reported methods, sample size, or measured outcomes, so it carries very little weight.", "directness": "indirect", "relevanceNote": "", "limitations": "This excerpt appears to contain only the background/introduction of the abstract; no actual results, patient numbers, or follow-up duration are reported.", "followUp": "", "plainFinding": "No healing time data given", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34031284/", "sourceText": "Pilonidal sinus disease (PSD) is a chronic problem often occurs in healthy hirsute men, however, women may also be affected. A range of conservative techniques to surgical flaps have been used to treat this condition. Currently, midline primary closure (MPC) is considered the standard of therapy; however, no statistically significant difference has been noted between primary versus secondary (Karydakis flap or Limberg flap) closure. Recently, flap reconstruction methods have been applied and superiority of these methods have been shown. Treatment methods should be employed to the individual, taking into account recurrence and complication rates of the method, recovery time, patients' preference and surgeon's skill. KEY WORDS: Crystal Phenol Treatment, Female Patient, Pilonidal Sinus, Limberg Flap Reconstruction, Primary Midline Closure.", "provenance": [ { "field": "population", "quote": "women may also be affected" }, { "field": "primaryOutcome", "quote": "recurrence and complication rates of the method, recovery time, patients' preference and surgeon's skill" }, { "field": "result", "quote": "no statistically significant difference has been noted between primary versus secondary (Karydakis flap or Limberg flap) closure" } ] }, { "id": "pmid:34021885", "pmid": "34021885", "doi": "10.1007/s13304-021-01094-4", "nctId": null, "pmcid": "PMC8606398", "title": "Pediatric endoscopic pilonidal sinus treatment (PEPSiT): what we learned after a 3-year experience in the pediatric population", "firstAuthor": "Esposito", "multipleAuthors": true, "journal": "Updates Surg", "year": 2021, "design": "retrospective", "n": 152, "nField": "reported", "population": "children and teenagers (under 18) with pilonidal sinus disease, some first-time and some recurrent", "intervention": "endoscopic pilonidal sinus treatment (PEPSiT), a minimally invasive surgical technique, with laser therapy before and after surgery", "comparator": "", "primaryOutcome": "how long the wound took to fully heal after surgery", "result": "Complete healing within 8 weeks occurred in 145 of 152 patients (95.4%), with a median healing time of 24.6 days (range 16-31 days)", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "it is a fairly large multi-centre review of outcomes after one specific surgical technique, but it is retrospective with no comparison group, so the healing times may not generalise to other treatments.", "directness": "direct", "relevanceNote": "", "limitations": "Retrospective design, no comparator group, and findings apply specifically to this endoscopic surgical technique rather than pilonidal disease treatment in general.", "followUp": "12.8 months (range 1-36)", "plainFinding": "Healed in about 3-4 weeks after surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34021885/", "sourceText": "This paper aimed to report a multi-institutional 3-year experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT) and describe tips and tricks of the technique. We retrospectively reviewed all patients < 18 years, with primary or recurrent pilonidal sinus disease (PSD), undergoing PEPSiT in the period 2017-2020. All patients received pre-operative laser therapy, PEPSiT and post-operative dressing and laser therapy. Success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. A total of 152 patients (98 boys) were included. Median patient's age was 17.1 years. Fifteen/152 patients (9.8%) presented a recurrent PSD. All patients resumed full daily activities 1 day after surgery. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10). Patient satisfaction was excellent (median score 4.8). The median follow-up was 12.8 months (range 1-36). Complete healing in 8 weeks was achieved in 145/152 (95.4%) and the median healing time was 24.6 days (range 16-31). We reported post-operatively immediate Clavien grade 2 complications (3 oedema, 2 burns) in 5/152 (3.3%) and delayed Clavien grade 2 complications (3 granulomas, 8 wound infections) in 11/152 (7.2%). Disease recurrence occurred in 7/152 (4.6%), who were re-operated using PEPSiT. PEPSiT should be considered the standard of care for surgical treatment of PSD in children and teenagers. PEPSiT is technically easy, with short and painless post-operative course and low recurrence rate (4.6%). Standardized treatment protocol, correct patient enrollment and information, and intensive follow-up are key points for the success of the procedure.", "provenance": [ { "field": "population", "quote": "patients < 18 years, with primary or recurrent pilonidal sinus disease (PSD), undergoing PEPSiT" }, { "field": "intervention", "quote": "All patients received pre-operative laser therapy, PEPSiT and post-operative dressing and laser therapy" }, { "field": "primaryOutcome", "quote": "healing rate/time" }, { "field": "result", "quote": "Complete healing in 8 weeks was achieved in 145/152 (95.4%) and the median healing time was 24.6 days (range 16-31)" }, { "field": "n", "quote": "A total of 152 patients (98 boys) were included" }, { "field": "followUp", "quote": "The median follow-up was 12.8 months (range 1-36)" } ] }, { "id": "pmid:33988547", "pmid": "33988547", "doi": "10.1097/DSS.0000000000003080", "nctId": null, "pmcid": null, "title": "A Retrospective Study of the Safety and Efficacy of a Radial Diode Laser Probe in the Management of Pilonidal Sinus Disease", "firstAuthor": "Bonito", "multipleAuthors": true, "journal": "Dermatol Surg", "year": 2021, "design": "retrospective", "n": 25, "nField": "reported", "population": "adults with mild pilonidal sinus disease", "intervention": "radial 1,470-nm diode laser treatment of the sinus", "comparator": "none (single-arm case series)", "primaryOutcome": "recovery time and return to daily activities after treatment", "result": "Mean time to return to daily activities was 5.8 days, with an 84% success rate, a 9.5% recurrence rate after a mean follow-up of 8.3 months, and 16% developing minor postoperative bleeding.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a small, retrospective, single-group study with telephone follow-up and no comparison group, so the recovery times may not be reliable or generalizable.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, small sample size, no control group, follow-up based partly on telephone questioning, limited to mild disease.", "followUp": "8.3 months", "plainFinding": "About 6 days to resume normal activities", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33988547/", "sourceText": "BACKGROUND: Recently, the interest in minimally invasive techniques in the management of the pilonidal sinus has been rising. The main goal is to avoid the prolonged recovery period associated with traditional surgeries. OBJECTIVE: To evaluate the safety and efficacy of a radial diode laser probe in the destruction of the pilonidal sinus. METHODS: Twenty-seven patients with pilonidal sinus were treated with a radial 1,470-nm diode laser between July 2018 and August 2020 and were examined retrospectively. Charts were reviewed and patients were questioned by telephone about their postlaser recovery period. RESULTS: Twenty-five patients were included. The overall success rate was 84%. Recurrence rate was 9.5%, after a mean follow-up of 8.3 months. The mean duration of analgesia intake was 2.5 days, and the mean period required to return to daily activities was 5.8 days. Sixteen percent of the patients developed a small postoperative hemorrhage as a complication. CONCLUSION: This study demonstrated that radial diode laser is safe, effective, and associated with a low recurrence rate in the treatment of mild pilonidal sinus disease. Dermatologists can perform it easily in the outpatient clinic, with minimal postoperative pain and a fast return to the patients' daily activities.", "provenance": [ { "field": "n", "quote": "Twenty-five patients were included." }, { "field": "population", "quote": "Twenty-seven patients with pilonidal sinus were treated with a radial 1,470-nm diode laser" }, { "field": "intervention", "quote": "radial 1,470-nm diode laser" }, { "field": "comparator", "quote": "Twenty-five patients were included." }, { "field": "primaryOutcome", "quote": "the mean period required to return to daily activities was 5.8 days" }, { "field": "result", "quote": "The overall success rate was 84%. Recurrence rate was 9.5%, after a mean follow-up of 8.3 months. The mean duration of analgesia intake was 2.5 days, and the mean period required to return to daily activities was 5.8 days." } ] }, { "id": "pmid:33966964", "pmid": "33966964", "doi": "10.1016/j.asjsur.2021.04.026", "nctId": null, "pmcid": null, "title": "Sinus laser closure (SiLaC) versus Limberg flap in management of pilonidal disease: A short-term non-randomized comparative prospective study", "firstAuthor": "Algazar", "multipleAuthors": true, "journal": "Asian J Surg", "year": 2022, "design": "prospective-cohort", "n": 71, "nField": "reported", "population": "adults with pilonidal cyst/sinus disease undergoing surgery", "intervention": "Sinus Laser Closure (SiLaC) treatment for pilonidal disease", "comparator": "Limberg flap surgery for pilonidal disease", "primaryOutcome": "healing rate and recurrence after surgery", "result": "Primary healing occurred in 23 of 24 SiLaC patients (95.8%) and recurrence occurred in two patients in each group after initial healing; the abstract does not give a specific time period to full healing", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "small, non-randomized comparison with short-term follow-up and no stated healing-time outcome, so it gives little solid information about how long healing actually takes", "directness": "indirect", "relevanceNote": "", "limitations": "Non-randomized comparison, short-term follow-up, no specific healing duration reported, and it studies two surgical techniques rather than the natural course of healing.", "followUp": "", "plainFinding": "Healing rates similar; no healing time given", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33966964/", "sourceText": "INTRODUCTION: Fistula Laser Closure (FiLAC) is a method that was originally applied in the treatment of perianal fistulas. Because of promising results, diode lasers were later on used to treat pilonidal sinus disease in a method called sinus Laser Closure (SiLaC). The aim of this study is to compare between SiLaC and Limberg flap in management of pilonidal disease. METHODS: A prospective, nonrandomized comparative study. A short-term follow-up of 71 patients with pilonidal disease was analyzed (24 operated on using the SiLaC technique and 47 using the Limberg technique). With a primary outcome is healing rate and recurrence and a secondary outcome is other measures i.e. complications, hospital stay and postoperative pain. RESULTS: The median operative time in the SiLaC group was 26.45 ± 5.41 min (20-35 min) and in the Limberg group 58.63 ± 7.42 min (50-75 min). In the SiLaC group, the primary healing was achieved in 23 out of 24 patients (95.8%) with a total complication rate of 20.83%. There were two cases of recurrence after initial healing in each group. CONCLUSION: Sinus laser Closure (SiLaC) is comparable to Limberg flap technique in the terms of healing rate and recurrence with better outcome regarding operative time, hospital stay and post-operative pain.", "provenance": [ { "field": "population", "quote": "71 patients with pilonidal disease" }, { "field": "intervention", "quote": "SiLaC technique" }, { "field": "comparator", "quote": "Limberg technique" }, { "field": "primaryOutcome", "quote": "primary outcome is healing rate and recurrence" }, { "field": "result", "quote": "the primary healing was achieved in 23 out of 24 patients (95.8%) with a total complication rate of 20.83%. There were two cases of recurrence after initial healing in each group." }, { "field": "n", "quote": "A short-term follow-up of 71 patients with pilonidal disease was analyzed" } ] }, { "id": "pmid:33960849", "pmid": "33960849", "doi": "10.1089/lap.2021.0097", "nctId": null, "pmcid": null, "title": "Surgical Outcomes of Minimally Invasive Trephine Surgery for Pilonidal Sinus Disease and Risk Factors for Recurrence", "firstAuthor": "Khalilieh", "multipleAuthors": true, "journal": "J Laparoendosc Adv Surg Tech A", "year": 2022, "design": "prospective-cohort", "n": 130, "nField": "reported", "population": "People who had minimally invasive trephine surgery for pilonidal sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "Time to disease recurrence or non-healing wound after surgery", "result": "About a third of patients had recurrence or non-healing wounds, occurring on average 13.3 months after surgery (range 2-47 months); repeat surgery healed 91.5% successfully", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "It followed a reasonably sized group prospectively, but over a third of the original patients had no outcome data, which weakens confidence.", "directness": "direct", "relevanceNote": "", "limitations": "Only 64.2% of patients had available follow-up data, and the study was from a single center.", "followUp": "13.3 months (range 2-47 months)", "plainFinding": "Recurrence often takes over a year", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33960849/", "sourceText": "Background: Minimally invasive surgical (MIS) techniques for pilonidal sinus disease (PNS) have gained popularity in recent years, due to faster recovery and lower complication rate compared with conventional methods. Our aim was to assess recurrence rate following MIS Trephine procedure for PNS and to identify possible risk factors for recurrence. Materials and Methods: A prospective cohort, including patients who underwent PNS Excision by Trephine MIS Procedure over 5 years in a large tertiary medical center was established. Patient data were collected from medical charts and patient telephone survey to asses recurrence rate. Results: Two hundred three patients underwent MIS Trephine procedure for PNS, with data available on 130 patients (64.2%). Overall recurrence and nonhealing wound rate was 33.07% (43 patients), with disease recurrence occurring in mean time of 13.3 months (range 2-47 months). Thirty-six patients underwent repeat MIS Trephine surgery with recurrence occurring in 6 patients (4.6%). Overall healing rate following repeat surgery was 91.5% (119 patients). Univariate analysis of preoperative and clinical factors, including body mass index (P = .77), smoking status (P = .53), number of sinus tracts (P = .78), previous abscess drainage (P = .45), and diameter size of the trephine blade (P = .72) demonstrated no correlation to disease recurrence following surgery. Multivariate Cox regression analysis showed similar results, with only young age (<30 years) associated with disease recurrence (P = .01). Conclusion: Recurrence following minimally invasive trephine excision for PNS is fairly high, but repeat surgery in recurring patients has a high rate of a successful outcome.", "provenance": [ { "field": "population", "quote": "Two hundred three patients underwent MIS Trephine procedure for PNS, with data available on 130 patients (64.2%)." }, { "field": "n", "quote": "with data available on 130 patients (64.2%)" }, { "field": "primaryOutcome", "quote": "Overall recurrence and nonhealing wound rate was 33.07% (43 patients), with disease recurrence occurring in mean time of 13.3 months (range 2-47 months)." }, { "field": "result", "quote": "Overall recurrence and nonhealing wound rate was 33.07% (43 patients), with disease recurrence occurring in mean time of 13.3 months (range 2-47 months). Thirty-six patients underwent repeat MIS Trephine surgery with recurrence occurring in 6 patients (4.6%). Overall healing rate following repeat surgery was 91.5% (119 patients)." } ] }, { "id": "pmid:33950407", "pmid": "33950407", "doi": "10.1007/s00423-020-02060-1", "nctId": null, "pmcid": "PMC8097120", "title": "German National Guideline on the management of pilonidal disease: update 2020", "firstAuthor": "Iesalnieks", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2021, "design": "guideline", "n": null, "nField": "not-reported", "population": "People with chronic pilonidal disease treated surgically", "intervention": "", "comparator": "", "primaryOutcome": "Wound healing, recurrence, and time off work after treatment", "result": "Wide excision with open treatment leads to prolonged secondary healing and time off work, with considerable recurrence; minimally invasive procedures have higher recurrence rates; no specific healing duration is given", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a guideline summarizing literature without reporting specific healing-time data or study numbers.", "directness": "direct", "relevanceNote": "", "limitations": "The abstract does not give specific healing durations in days or weeks, only relative comparisons between treatment types.", "followUp": "", "plainFinding": "Healing is slow after open excision.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33950407/", "sourceText": "BACKGROUND: The present German National Guideline is an updated version of previous Guideline published in 2014. It aims to compare various treatment methods and to assist physicians with evidence-based recommendations. METHODS: Systemic literature review. RESULTS: Three types of disease manifestation could be differentiated: asymptomatic disease, an acute abscess, and the chronic pilonidal disease. At present, there is no treatment method fulfilling all desired criteria: simple, painless procedure associated with rapid wound healing, and low recurrence rate. Thus, treatment modality should be tailored to disease manifestation and extent. CONCLUSION: Asymptomatic pilonidal disease should not be treated. A pilonidal abscess should be unroofed. After resolution of the acute inflammation, the disease should be treated definitely. As for today, sinus excision is the standard treatment of the chronic pilonidal disease. Wide excision and open treatment of chronic disease is a safe procedure which, however, leads to prolonged secondary healing and time off-work, as well as to considerable recurrence rate. The extent of excision should be as limited as possible. Excision and midline wound closure is associated with impaired outcomes. Today, it has become obsolete. Minimally invasive procedures (e.g., pit picking surgery) represent a treatment option for chronic pilonidal disease. However, the recurrence rate is higher compared to excision procedures. Nevertheless, they may be used for small primary disease. Off-midline procedures should be used for disease not suitable for minimally invasive treatments. The Limberg flap and the Karydakis procedure are two best described methods which are associated with similar short- and long-term results.", "provenance": [ { "field": "population", "quote": "the chronic pilonidal disease" }, { "field": "primaryOutcome", "quote": "simple, painless procedure associated with rapid wound healing, and low recurrence rate" }, { "field": "result", "quote": "Wide excision and open treatment of chronic disease is a safe procedure which, however, leads to prolonged secondary healing and time off-work, as well as to considerable recurrence rate." }, { "field": "result", "quote": "Minimally invasive procedures (e.g., pit picking surgery) represent a treatment option for chronic pilonidal disease. However, the recurrence rate is higher compared to excision procedures." } ] }, { "id": "pmid:33865363", "pmid": "33865363", "doi": "10.1186/s12893-021-01204-4", "nctId": null, "pmcid": "PMC8052720", "title": "Sacro-coxxygial hygiene, a key factor in the outcome of pilonidal sinus surgical treatment?", "firstAuthor": "Dupuis", "multipleAuthors": true, "journal": "BMC Surg", "year": 2021, "design": "retrospective", "n": 292, "nField": "reported", "population": "Patients who had surgery (sinusectomy) for pilonidal sinus", "intervention": "", "comparator": "", "primaryOutcome": "How long the wound took to heal after surgery", "result": "The abstract reports that healing time was similar across groups with different hygiene levels, but does not give an actual duration for healing.", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective, non-randomized study that compares hygiene groups rather than measuring healing time directly, and it never reports an actual number of days or weeks to healing.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, no randomization, healing time is only compared between hygiene groups rather than reported as an absolute duration, and follow-up length differed significantly between groups.", "followUp": "", "plainFinding": "Similar healing regardless of hygiene, no exact time given", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33865363/", "sourceText": "BACKGROUND: Surgical wound infection contributes to prolonged recovery time after pilonidal sinus excision. As a standard procedure after surgery, we recommend our patients to perform water irrigations in the intergluteal cleft 4 to 6 times a day during the post-operative period. Our hypothesis is that this should reduce healing time and complication rates. The aim of this study was to measure the importance of sacro coccygeal hygiene in the management of pilonidal sinus disease. METHODS: We retrospectively collected data after surgical management of pilonidal sinus (sinusectomy procedures) in our division over a 10-year period. Patients were divided into three groups according to their local hygiene during postoperative follow-up and scored one (G1: good hygiene) to three (G3: poor hygiene). Primary outcome was complication rates. Secondary endpoints were, healing time, follow-up, time off work, and recurrence rate. RESULTS: In G1 (N = 112), complication rate was 3.6%. In G2 (N = 109), it was 5.5%, whereas in G3 (N = 71), it reached 7.03%. However, there were no statistically significant differences between hygiene groups regarding complication rates in both univariate and multivariable analysis. Regarding secondary outcomes, there were significant differences between hygiene groups concerning median follow-up (p = 0.0001) and median time off work (p = 0.0127). CONCLUSION: Good hygiene of wound is essential for optimal, rapid healing without complications. The importance of this report is to show that thanks to our hygiene follow-up strategy with frequent perineal irrigations and regular follow-up checks, patients with at a first glance \"unclean local conditions\", reached similar complications, median healing time and recurrences rates to patients with medium and good wound hygiene level.", "provenance": [ { "field": "n", "quote": "G1 (N = 112)" }, { "field": "n", "quote": "G2 (N = 109)" }, { "field": "n", "quote": "G3 (N = 71)" }, { "field": "population", "quote": "after surgical management of pilonidal sinus (sinusectomy procedures) in our division over a 10-year period" }, { "field": "primaryOutcome", "quote": "Secondary endpoints were, healing time, follow-up, time off work, and recurrence rate." }, { "field": "result", "quote": "reached similar complications, median healing time and recurrences rates to patients with medium and good wound hygiene level" } ] }, { "id": "pmid:33839888", "pmid": "33839888", "doi": "10.1007/s00384-021-03922-w", "nctId": null, "pmcid": null, "title": "Karydakis procedure versus Limberg flap for treatment of pilonidal sinus: an updated meta-analysis of randomized controlled trials", "firstAuthor": "Emile", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2021, "design": "meta-analysis", "n": 1943, "nField": "reported", "population": "People who had surgery (Karydakis procedure or Limberg flap) for pilonidal sinus disease", "intervention": "Karydakis procedure (a type of surgical closure for pilonidal sinus)", "comparator": "Limberg flap (a different surgical closure technique for pilonidal sinus)", "primaryOutcome": "Time for the wound to heal after surgery, compared between the two surgical techniques", "result": "Time to healing was similar between the Karydakis procedure and Limberg flap; the abstract does not give an actual number of days or weeks for healing", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "It pools 15 randomized trials with nearly 2000 patients, but it only compares two surgical techniques against each other and does not report an actual healing duration, so it cannot answer how long healing generally takes.", "directness": "indirect", "relevanceNote": "", "limitations": "The abstract only reports whether healing time was similar or different between two specific surgeries, not an actual duration, and does not describe natural healing without surgery or after simple drainage.", "followUp": "", "plainFinding": "No difference in healing time between the two surgeries", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33839888/", "sourceText": "BACKGROUND: The Karydakis procedure (KP) and Limberg flap (LF) are two commonly performed operations for pilonidal sinus disease (PND). The present meta-analysis aimed to review the outcome of randomized trials that compared KP and LF. METHODS: Electronic databases were searched in a systematic manner for randomized trials comparing KP and LF through July 2020. This meta-analysis was reported in line with the PRISMA statement. The main outcome measures were failure of healing of PND, complications, time to healing, time to return to work, and cosmetic satisfaction. RESULTS: Fifteen randomized controlled trials (1943 patients) were included. KP had a significantly shorter operation time than LF with a weighted mean difference (WMD) of -0.788 (95%CI: -11.55 to -4.21, p < 0.0001). Pain scores, hospital stay, and time to healing were similar. There was no significant difference in overall complications (OR= 1.61, 95%CI: 0.9-2.85, p = 0.11) and failure of healing (OR= 1.22, 95%CI: 0.76-1.95, p = 0.41). KP had higher odds of wound infection (OR= 1.87, 95%CI: 1.15-3.04, p = 0.011) and seroma formation (OR= 2.33, 95%CI: 1.39-3.9, p = 0.001). KP was followed by a shorter time to return to work (WMD= -0.182; 95%CI: -3.58 to -0.066, p = 0.04) and a higher satisfaction score than LF (WMD= 2.81, 95%CI: 0.65-3.77, p = 0.01). CONCLUSIONS: KP and LF were followed by similar rates of complications and failure of healing of PND and comparable stay, pain scores, and time to wound healing. KP was associated with higher rates of seroma and wound infection, shorter time to return to work, and higher cosmetic satisfaction than LF.", "provenance": [ { "field": "n", "quote": "Fifteen randomized controlled trials (1943 patients) were included." }, { "field": "population", "quote": "randomized trials that compared KP and LF" }, { "field": "intervention", "quote": "The Karydakis procedure (KP)" }, { "field": "comparator", "quote": "Limberg flap (LF) are two commonly performed operations for pilonidal sinus disease" }, { "field": "primaryOutcome", "quote": "The main outcome measures were failure of healing of PND, complications, time to healing, time to return to work, and cosmetic satisfaction." }, { "field": "result", "quote": "Pain scores, hospital stay, and time to healing were similar." } ] }, { "id": "pmid:33830126", "pmid": "33830126", "doi": null, "nctId": null, "pmcid": null, "title": "Limberg Flap in Pilonidal Sinus: Experience in Shaheed Suhrawardy Medical College Hospital", "firstAuthor": "Saha", "multipleAuthors": true, "journal": "Mymensingh Med J", "year": 2021, "design": "case-series", "n": 19, "nField": "reported", "population": "Adults treated surgically for sacrococcygeal pilonidal sinus disease", "intervention": "Limberg (rhomboid) flap surgery for pilonidal sinus", "comparator": "", "primaryOutcome": "Postoperative recovery including hospital stay length and complications", "result": "All patients had good postoperative outcome with minimal discomfort and were discharged in 3-4 days; 3 patients had complications", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "Small, uncontrolled case series from a single center with no comparison group or detailed healing timeline.", "directness": "indirect", "relevanceNote": "", "limitations": "Small sample size, no control group, no detailed wound healing time reported, short description of outcomes.", "followUp": "", "plainFinding": "Quick recovery, discharged in days", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33830126/", "sourceText": "Pilonidal sinus disease is a common anorectal condition usually seen in young adult patients. Various methods have been described over the years and there is ongoing debate regarding the ideal method. This study was conducted to evaluate the advantages, results of rhomboid excision and Limberg flap reconstruction in the management of sacrococcygeal pilonidal sinus disease. This cross-sectional study was conducted in Surgery Unit-I of Department of Surgery, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh a tertiary care centre from July 2016 to November 2017. It includes 19 patients who were treated for sacrococcygeal pilonidal sinus disease by Limberg (Rhomboid) flap. All patients that underwent the procedure had good postoperative outcome with minimal postoperative discomfort and were discharged in 3-4 days. There were 3 cases with complications. Limberg flap coverage is very effective for pilonidal disease with low complication rates, reduced hospital stay, low recurrence rates, earlier healing and shorter time off-work. This technique can be easily mastered and used as an indispensable tool for treating sacrococcygeal pilonidal sinus disease.", "provenance": [ { "field": "population", "quote": "It includes 19 patients who were treated for sacrococcygeal pilonidal sinus disease by Limberg (Rhomboid) flap." }, { "field": "intervention", "quote": "rhomboid excision and Limberg flap reconstruction in the management of sacrococcygeal pilonidal sinus disease" }, { "field": "primaryOutcome", "quote": "All patients that underwent the procedure had good postoperative outcome with minimal postoperative discomfort and were discharged in 3-4 days." }, { "field": "result", "quote": "All patients that underwent the procedure had good postoperative outcome with minimal postoperative discomfort and were discharged in 3-4 days. There were 3 cases with complications." }, { "field": "n", "quote": "It includes 19 patients who were treated for sacrococcygeal pilonidal sinus disease by Limberg (Rhomboid) flap." } ] }, { "id": "pmid:33755853", "pmid": "33755853", "doi": "10.1007/s10151-021-02431-w", "nctId": null, "pmcid": null, "title": "Negative pressure-assisted endoscopic pilonidal sinus treatment", "firstAuthor": "Giordano", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2021, "design": "prospective-cohort", "n": 13, "nField": "reported", "population": "men who had surgery for pilonidal sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "how well and how quickly the wound healed after surgery", "result": "11 of 13 patients fully healed; 2 had only partial healing of the tract (one needed repeat surgery), assessed over a mean follow-up of 14 months; the abstract does not give an exact time to healing", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "This is a tiny, single-arm case series of 13 patients with no comparison group, so it gives weak evidence about typical healing time.", "directness": "indirect", "relevanceNote": "This study tests whether negative pressure wound therapy improves healing after endoscopic pilonidal surgery, not the natural healing timeline of pilonidal cysts after standard treatment.", "limitations": "Very small sample size, single technique (NPA EPSiT), no control group, and no explicit reporting of days or weeks to heal.", "followUp": "mean follow-up was 14 months (range 4-28 months)", "plainFinding": "Most healed; exact time unclear", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33755853/", "sourceText": "BACKGROUND: Endoscopic pilonidal sinus treatment (EPSiT) is a novel minimally invasive option for the treatment of pilonidal sinus disease (PSD). To optimise the postoperative wound management after EPSiT, an ultraportable negative pressure wound therapy (NPWT) device was used. The aim of this study was to assess the clinical outcomes of negative pressure-assisted (NPA) EPSiT. METHODS: All patients with PSD treated by EPSIT from November 2017 to October 2019 were managed postoperatively with a commercially available NPTW dressing applied to the wound. All patients were prospectively entered into a dedicated database. Primary outcome measures were healing rate and return to normal activities. Secondary outcomes were postoperative complications and patient satisfaction. RESULTS: Thirteen male patients underwent NPA EPSiT (mean age 27.8 years, range 16-52 years). Two patients had previous surgery for PSD. The mean follow-up was 14 months (range 4-28 months). In two patients, only partial healing of the tract was achieved. One of these required a further successful NPA EPSiT, while the other one refused any other treatment because of the lack of symptoms. Eight patients were very satisfied and 5 were satisfied with this treatment. CONCLUSIONS: NPA EPSiT is a simple method for improving postoperative wound management, facilitating a quicker recovery and possibly improving overall patient satisfaction.", "provenance": [ { "field": "n", "quote": "Thirteen male patients underwent NPA EPSiT" }, { "field": "population", "quote": "All patients with PSD treated by EPSIT from November 2017 to October 2019" }, { "field": "primaryOutcome", "quote": "Primary outcome measures were healing rate and return to normal activities." }, { "field": "result", "quote": "In two patients, only partial healing of the tract was achieved. One of these required a further successful NPA EPSiT, while the other one refused any other treatment because of the lack of symptoms." }, { "field": "followUp", "quote": "The mean follow-up was 14 months (range 4-28 months)." } ] }, { "id": "pmid:33729169", "pmid": "33729169", "doi": "10.5604/01.3001.0014.4674", "nctId": null, "pmcid": null, "title": "Complications And Recurrence After The Karydakis Flap Surgery", "firstAuthor": "Çakır", "multipleAuthors": true, "journal": "Pol Przegl Chir", "year": 2020, "design": "retrospective", "n": 112, "nField": "reported", "population": "patients who underwent Karydakis surgery for pilonidal sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "complications and recurrence after surgery", "result": "wound dehiscence by 10.2%, infection by 3.6%, and bleeding (hematome) by 7.1%; four patients developed recurrence during follow up; postoperative hospital stay averaged 2.1 days", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "It is a retrospective single-group review of one surgical technique with no comparison group and it reports complication and recurrence rates rather than directly measuring how long the wound takes to heal.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, no control group, outcomes reported are complications/recurrence rather than a direct healing-time measure, and it covers only one specific surgical technique (Karydakis flap).", "followUp": "28 months", "plainFinding": "Short hospital stay, some recurrence later", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33729169/", "sourceText": "INTRODUCTION: Pilonidal sinus is a disease affecting young age group. Numerous surgical methods have been described in the treatment of pilonidal sinus disease. Currently, there is no treatment method providing a rapid recovery with low recurrence risk. AIM: In this study, we aimed to evaluate the results of our patients who underwent Karydakis surgery. MATERIAL AND METHODS: Results of 112 patients operated between 2012 and 2019 were retrospectively evaluated. Only the patients who underwent Karydakis surgery were included in the study. RESULTS: Of all patients, 20 were female and 92 were male. The mean age was 21 years in the female and 20.8 years in the male patients. The mean BMI was 29.6 Kg/m2. Thye patients were followed up for mean 28 months. Postoperative length of stay in hospital was 2.1 days. The complications included wound dehiscence by 10.2%, infection by 3.6%, and bleeding (hematome) by 7.1%. Four patients developed recurrence during follow up. CONCLUSION: Karydakis surgery is a preferable surgical technique with low rates of complications and recurrence.", "provenance": [ { "field": "population", "quote": "patients who underwent Karydakis surgery" }, { "field": "n", "quote": "Results of 112 patients operated between 2012 and 2019 were retrospectively evaluated." }, { "field": "primaryOutcome", "quote": "evaluate the results of our patients who underwent Karydakis surgery" }, { "field": "result", "quote": "The complications included wound dehiscence by 10.2%, infection by 3.6%, and bleeding (hematome) by 7.1%. Four patients developed recurrence during follow up." }, { "field": "result", "quote": "Postoperative length of stay in hospital was 2.1 days." }, { "field": "followUp", "quote": "Thye patients were followed up for mean 28 months." } ] }, { "id": "pmid:33645880", "pmid": "33645880", "doi": "10.1111/codi.15606", "nctId": null, "pmcid": null, "title": "Patient decision-making and regret in pilonidal sinus surgery: a mixed-methods study", "firstAuthor": "Strong", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2021, "design": "prospective-cohort", "n": 20, "nField": "reported", "population": "people who had surgery for pilonidal sinus disease", "intervention": "", "comparator": "", "primaryOutcome": "decision regret and shared decision-making about surgery choice, not healing time itself", "result": "The abstract reports on regret and decision-making, not on how long wounds actually took to heal; it only notes a gap between what patients expected and what actually happened", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "Small qualitative/mixed-methods study of 20 patients focused on decision regret, not designed to measure or report healing duration.", "directness": "indirect", "relevanceNote": "", "limitations": "Only 20 patients, focus is on psychological/decision outcomes rather than wound healing time; no actual healing durations are given.", "followUp": "6 months", "plainFinding": "Healing time not reported here.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33645880/", "sourceText": "AIM: Little is known about optimal management strategies for pilonidal sinus disease (PSD). We conducted a mixed-methods study to understand why patients make, and sometimes regret, treatment decisions. METHOD: We conducted longitudinal semi-structured interviews at the time of surgery and 6 months later with 20 patients from 13 UK hospitals. Framework analysis was performed, and themes were mapped to (1) the coping in deliberation framework and (2) an acceptability framework. Results were triangulated with those from structured survey instruments evaluating shared decision-making (SDM, best = 9) at baseline and decision regret (DR, most regret = 100) at 6 months. RESULTS: Nine of 20 patients were not offered a choice of treatment, but this was not necessarily seen as negative (SDM median 4; range 2-4). Factors that influenced decision-making included previous experience and anticipated recovery time. Median (range) DR was 5 (0-50). Those with the highest DR (scores 40-50) were, paradoxically, also amongst the highest scores on SDM (scores 4). Burden of wound care and the disparity between anticipated and actual recovery time were the main reasons for decision regret. CONCLUSION: To minimize regret about surgical decisions, people with PSD need better information about the burden of wound care and the risks of recurrence associated with different surgical approaches.", "provenance": [ { "field": "population", "quote": "20 patients from 13 UK hospitals" }, { "field": "primaryOutcome", "quote": "Results were triangulated with those from structured survey instruments evaluating shared decision-making (SDM, best = 9) at baseline and decision regret (DR, most regret = 100) at 6 months." }, { "field": "result", "quote": "Burden of wound care and the disparity between anticipated and actual recovery time were the main reasons for decision regret." }, { "field": "n", "quote": "longitudinal semi-structured interviews at the time of surgery and 6 months later with 20 patients" } ] }, { "id": "pmid:33589359", "pmid": "33589359", "doi": "10.1016/j.anplas.2021.01.003", "nctId": null, "pmcid": null, "title": "[Perforating flap for covering sacro-coccygeal cysts: About 8 cases]", "firstAuthor": "Hollard-Kissel", "multipleAuthors": true, "journal": "Ann Chir Plast Esthet", "year": 2021, "design": "case-series", "n": 8, "nField": "reported", "population": "people with recurrent pilonidal (sacro-coccygeal) cysts who had already had multiple prior surgeries", "intervention": "a local perforator skin flap used to cover the wound after removing the recurrent cyst", "comparator": "", "primaryOutcome": "whether the wound healed and whether the cyst came back", "result": "all patients healed completely with no recurrence at 2 years, though two had minor complications (a hematoma and a donor-site wound separation)", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "this is a very small series of only 8 patients with no comparison group, so it cannot reliably show typical healing time for pilonidal cysts in general.", "directness": "indirect", "relevanceNote": "", "limitations": "Very small sample size, no control group, patients were a selected group with recurrent disease after multiple prior operations, so findings may not reflect typical pilonidal cyst healing.", "followUp": "2years", "plainFinding": "Healed completely by 2 years.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33589359/", "sourceText": "INTRODUCTION: Multiple surgical revisions (exeresis and directed healing) of recurrent pilonidal cysts are sources of unstable scars. Chronic ulcerations often appear with or without authentic recidivism. A local fasciocutaneous perforating flap based on the parasacral arteries would bring healthy tissue and avoid the disadvantages of conventional techniques (musculo-cutaneous or random). MATERIALS AND METHODS: A series of 8 cases of transposition flap covering based on parasacral perforators, in multi-operated patients. The perforators are identified by Doppler probe before the gesture, then the flap is traced obliquely according to the size of the loss of substance. The gesture is short, not morbid and accessible to all by a technique that excludes fine dissection of the pedicle. The duration of hospitalization is 2days. RESULTS: Despite two minor and resolving complications (a hematoma and a disunion of the donor sit) the healing was complete and without recurrence in all patients at 2years, with 100% satisfaction. CONCLUSION: This reliable and reproducible simple flap becomes the reference technique in our department for the sequelae of recurrent sacro-coccygeal cyst.", "provenance": [ { "field": "population", "quote": "A series of 8 cases of transposition flap covering based on parasacral perforators, in multi-operated patients." }, { "field": "intervention", "quote": "A local fasciocutaneous perforating flap based on the parasacral arteries" }, { "field": "primaryOutcome", "quote": "the healing was complete and without recurrence in all patients at 2years" }, { "field": "result", "quote": "Despite two minor and resolving complications (a hematoma and a disunion of the donor sit) the healing was complete and without recurrence in all patients at 2years, with 100% satisfaction." }, { "field": "n", "quote": "A series of 8 cases of transposition flap covering based on parasacral perforators, in multi-operated patients." } ] }, { "id": "pmid:33455871", "pmid": "33455871", "doi": "10.1016/j.bjps.2020.12.074", "nctId": null, "pmcid": null, "title": "The internal pudendal artery turnover (IPAT) flap: A new, simple and reliable technique for perineal reconstruction", "firstAuthor": "Nassar", "multipleAuthors": true, "journal": "J Plast Reconstr Aesthet Surg", "year": 2021, "design": "retrospective", "n": 38, "nField": "reported", "population": "patients with perineal defects (including severe pilonidal disease, after abdomino-perineal excision or pelvic exenteration) who had flap reconstruction", "intervention": "", "comparator": "", "primaryOutcome": "whether the reconstructed perineal wound/flap was fully healed", "result": "at three months, 37 of 38 flaps were fully healed, with no flap failures", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this is a small retrospective single-surgeon case series that mixes pilonidal disease with other, more complex perineal surgeries, so it does not isolate healing time for pilonidal disease alone.", "directness": "indirect", "relevanceNote": "", "limitations": "retrospective design, mixed population (pilonidal disease, abdomino-perineal excision, pelvic exenteration) with results not broken down by cause, single surgeon series", "followUp": "three months", "plainFinding": "Most flaps healed by three months", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33455871/", "sourceText": "Perineal defects can be a reconstructive challenge following abdomino-perineal excision of the rectum, pelvic exenteration or the excision of severe pilonidal disease. These defects often involve large perineal cavities and pelvic dead space with often poorly mobile soft tissues due to neoadjuvant chemoradiation. Because of the inherent challenges of wound healing in the perineal region, well vascularised and robust reconstruction is mandated. In this paper, we describe a novel perforator-based turnover flap for perineal reconstruction - the internal pudendal artery turnover flap (IPAT flap). The flap requires no visualisation or dissection of perforating vessels, has a reliable vasculature, is quick and straightforward to perform and allows for the effective reconstruction of deep three-dimensional defects following perineal excisions. This is a retrospective study. A cohort of 38 consecutive patients who underwent various reconstructions with the IPAT flap under a single surgeon were included between 2012 and 2019. At three months, 37 flaps were fully healed. There were no flap failures or partial flap losses. Complications were seen in 10 of 38 patients with nine of these being minor and one that requires a return to the theatre for washout secondary to a urinary leak. The Internal Pudendal Artery Turn Over Flap allows us to reconstruct three-dimensional defects following perineal surgery, achieving more significant mobilisation of the flap to fill deep dead space without the added complexity and additional operative time associated with perforator dissection. The IPAT flap can be used in several common perineal reconstructive challenges expeditiously - often at the end of lengthy oncological resections - with minimal donor site morbidity, and in our experience, yields reliable outcomes.", "provenance": [ { "field": "population", "quote": "A cohort of 38 consecutive patients who underwent various reconstructions with the IPAT flap under a single surgeon were included between 2012 and 2019." }, { "field": "population", "quote": "Perineal defects can be a reconstructive challenge following abdomino-perineal excision of the rectum, pelvic exenteration or the excision of severe pilonidal disease." }, { "field": "primaryOutcome", "quote": "At three months, 37 flaps were fully healed." }, { "field": "result", "quote": "At three months, 37 flaps were fully healed. There were no flap failures or partial flap losses." }, { "field": "n", "quote": "A cohort of 38 consecutive patients who underwent various reconstructions with the IPAT flap under a single surgeon were included between 2012 and 2019." } ] }, { "id": "pmid:33378636", "pmid": "33378636", "doi": "10.21614/chirurgia.115.6.775", "nctId": null, "pmcid": null, "title": "Use of Silver Nitrate Application as Mini-Invasive Treatment of Pilonidal Sinus Disease", "firstAuthor": "Kanat", "multipleAuthors": true, "journal": "Chirurgia (Bucur)", "year": 2020, "design": "retrospective", "n": 45, "nField": "reported", "population": "People treated with silver nitrate for pilonidal sinus disease (sacrococcygeal area)", "intervention": "Silver nitrate application with debridement", "comparator": "", "primaryOutcome": "Cure/recurrence rate and complication rate after treatment", "result": "Recurrence occurred in 8.9% of patients; complications (abscess, redness, tissue death) occurred in 22.2%, with higher recurrence in those who developed abscesses", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "Retrospective chart review with no comparison group, modest sample size, and missing data in some patients, so it can't reliably show how long healing actually takes.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design, 11 patients excluded for incomplete records, no control group, and no specific healing-time data reported, only recurrence/complication rates.", "followUp": "", "plainFinding": "Low recurrence after silver nitrate treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33378636/", "sourceText": "OBJECTIVES: To investigate the cure rate and adverse effects of silver nitrate application for treatment of pilonidal sinus disease (PSD). Methods: Number of sinus pit orifices, and complications with silver nitrate application and debridement for sacrococcygeal PSD between January 2015 and July 2018 were analyzed in this retrospective study. Data were obtained from surgical, discharge, and outpatient follow-up records. Among 56 patients who were treated with silver nitrate stick, 11 patients with incomplete hospital records were excluded from the study. Demographic data including age, gender, length of follow-up, number of silver nitrate applications, number of involved sinuses and recurrence and complication rates were recorded. Results were expressed as frequencies, means, and range of values. The Mann Whitney U and chi square tests were used to evaluate significance. Results: Mean age was 24.3 +- 5.18 (range, 14 - 36) years, and recurrence occurred in 4 (8.9%) patients. Complications developed in 10 (22.2%) patients and included abscess, erythema, and necrosis in 5 (11.1%), 2 (4.4%), and 3 (6.6%) patients, respectively. The recurrence rate was significantly higher in patients who developed abscesses during the follow-up period (p = 0.001) than those who did not. There was no statistically significant correlation between the recurrence rate and number of sinuses or the number of silver nitrate applications. CONCLUSION: Low morbidity and high healing rates achieved with silver nitrate provide support for this application as a feasible and effective conservative outpatient treatment for PSD in certain patients.", "provenance": [ { "field": "n", "quote": "Among 56 patients who were treated with silver nitrate stick" }, { "field": "n", "quote": "11 patients with incomplete hospital records were excluded from the study" }, { "field": "population", "quote": "sacrococcygeal PSD" }, { "field": "intervention", "quote": "silver nitrate application and debridement for sacrococcygeal PSD" }, { "field": "primaryOutcome", "quote": "Number of sinus pit orifices, and complications with silver nitrate application and debridement" }, { "field": "result", "quote": "recurrence occurred in 4 (8.9%) patients" }, { "field": "result", "quote": "Complications developed in 10 (22.2%) patients and included abscess, erythema, and necrosis in 5 (11.1%), 2 (4.4%), and 3 (6.6%) patients, respectively" } ] }, { "id": "pmid:33336345", "pmid": "33336345", "doi": "10.1055/a-1301-2051", "nctId": null, "pmcid": null, "title": "[Wound Healing Disorders after Excision and Open Treatment for Pilonidal Sinus]", "firstAuthor": "Petersen", "multipleAuthors": true, "journal": "Zentralbl Chir", "year": 2021, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people treated with surgical excision and open wound care for pilonidal sinus/cyst", "intervention": "", "comparator": "", "primaryOutcome": "how long the open wound takes to heal after excision", "result": "wounds healed on average within about two months, nearly all by three months, but 2-5% had significantly delayed healing persisting beyond three to four months", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this is a narrative review summarizing prior published data without a defined single study population or systematic methodology described.", "directness": "direct", "relevanceNote": "", "limitations": "review article without systematic search methodology described; relies on pooled data from varied studies including a military cohort.", "followUp": "up to three to four months", "plainFinding": "Heals in about two months usually.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33336345/", "sourceText": "INTRODUCTION: Pilonidalis sinus disease is a mostly chronic selective infection of the hairy skin in the area of skin wrinkles, mainly in the area of the natal cleft. Open treatment is still the most common recommended therapy. Nevertheless, there may be healing disorders within the framework of open wound treatment, which can significantly complicate the course. METHODS: The following is an overview of wound healing disorders after excision of pilonidalis sinus. Healing time and frequency are determined on the basis of current data and the causes of the healing disorder are evaluated. In addition, possible treatment options are presented and treatment recommendations are made. RESULTS: The evaluation of published data on wound healing period showed that the wound usually heals after a mean of two months. The results of the German forces cohort study show by way of example that almost all wounds have healed in the period up to three months. However, a small percentage of non-healing wounds remain. The frequency of significantly delayed wound healing is given in the literature as 2 - 5%. The influencing factors for wound healing after sinus pilonidalis excision are not only the size and symmetry of the excision wound but also other details of open wound treatment. In addition to intensification of the previous open wound treatment, the new excision and refreshment of the wound are mentioned as treatment options in the event of a lack of wound healing. Furthermore, changes in strategy for plastic-reconstructive procedures or other surface treatment are also recommended. CONCLUSION: The excision wound of pilonidalis sinus should be healed after three to four months at the latest, after which the wound can be regarded as a wound with significantly delayed healing or as a wound healing disorder. Around this time, the findings should be re-evaluated and, if necessary, a change in the treatment concept should be made.", "provenance": [ { "field": "population", "quote": "wound healing disorders after excision of pilonidalis sinus" }, { "field": "primaryOutcome", "quote": "Healing time and frequency are determined on the basis of current data" }, { "field": "result", "quote": "the wound usually heals after a mean of two months" }, { "field": "result", "quote": "almost all wounds have healed in the period up to three months" }, { "field": "result", "quote": "The frequency of significantly delayed wound healing is given in the literature as 2 - 5%" }, { "field": "result", "quote": "The excision wound of pilonidalis sinus should be healed after three to four months at the latest" } ] }, { "id": "pmid:33301262", "pmid": "33301262", "doi": "10.17116/hirurgia202012199", "nctId": null, "pmcid": null, "title": "[Surgical treatment of pilonidal disease]", "firstAuthor": "Nechai", "multipleAuthors": true, "journal": "Khirurgiia (Mosk)", "year": 2020, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "People who had surgery for pilonidal cyst/sinus", "intervention": "", "comparator": "", "primaryOutcome": "How well and how long the surgical wound takes to heal", "result": "The review states that 'closed' surgical methods lead to good wound healing and cosmetic results, and that long-term results depend on which technique was used and how long patients were followed, but no specific healing time is given", "resultDirection": "not-applicable", "quality": "very-low", "qualityWhy": "This is a narrative review comparing surgical techniques without reporting actual patient numbers or measured healing durations, so it carries little weight for answering how long healing takes.", "directness": "indirect", "relevanceNote": "", "limitations": "No quantitative data, sample size, or defined follow-up period are reported; conclusions are general statements rather than measured outcomes.", "followUp": "", "plainFinding": "Closed surgery heals well, no exact timeframe given", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33301262/", "sourceText": "This review is devoted to comparison of the most common methods of surgical treatment of pilonidal disease. It was found that «closed» methods of surgical treatment of pilonidal disease are effective and accompanied by favorable wound healing and good cosmetic effect. Long-term outcomes of «closed» techniques significantly depend on the choice of surgical treatment and follow-up period.", "provenance": [ { "field": "population", "quote": "comparison of the most common methods of surgical treatment of pilonidal disease" }, { "field": "primaryOutcome", "quote": "favorable wound healing and good cosmetic effect" }, { "field": "result", "quote": "«closed» methods of surgical treatment of pilonidal disease are effective and accompanied by favorable wound healing and good cosmetic effect. Long-term outcomes of «closed» techniques significantly depend on the choice of surgical treatment and follow-up period." } ] }, { "id": "pmid:33162406", "pmid": "33162406", "doi": null, "nctId": null, "pmcid": null, "title": "Recurrent sacrococcygeal pilonidal disease: the efficacy of minimal subcutaneous excision of the sinus and unroofing of pseudocystic cavity", "firstAuthor": "Geraci", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2020, "design": "prospective-cohort", "n": 48, "nField": "reported", "population": "People with recurrent pilonidal cyst/sinus who had already had prior surgery for it", "intervention": "", "comparator": "", "primaryOutcome": "Time for the wound to heal after minimal excision surgery, and whether disease came back", "result": "Average healing time was about 23 days; 85% of patients remained healed without recurrence at 7 years follow-up", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "Small single-group study without a comparison group, so healing times may not generalize to other treatments or settings.", "directness": "direct", "relevanceNote": "", "limitations": "No control group; single surgical technique; small sample of 48 patients from one center.", "followUp": "7 years", "plainFinding": "Healed in about 3 weeks on average", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33162406/", "sourceText": "UNLABELLED: Patients undergoing surgery for recurrent pilonidal disease are at high risk of developing re-recurrence. The present prospective analysis was performed to evaluate the outcome for recurrent pilonidal disease treatment with a technique that provides a minimal subcutaneous excision of fistula and of the skin above the cyst, with secondary healing of wounds. METHODS: 48 consecutive patients with previous surgical excision and recurrent pilonidal disease underwent surgery from January 2009 to December 2016, under local anaesthesia. The age of the patients (42 males and 6 females) at the time of our observation was 28.5 ± 10.2 years, the BMI of 26.3 ± 6.8. The average number of interventions prior to our was 2.02 ± 1.14. RESULTS: The mean operative time was 18.2 ± 5.5 minutes. All patients were discharged 2 to 4 hours after surgery, with an average healing time of 22.8 ± 15.3 days. We recorded, in the follow-up period, only 4 relapses (8.32%), all retreated with the same surgical procedure and brought to complete healing. The results of the cosmetic questionnaire, which assessed patient satisfaction and contentment, showed that 96% of patients were completely satisfied and all patients recommended surgery to others. Kaplan-Meier analysis showed that in 7 years of follow-up, 85% of patients healed without recurrence. CONCLUSIONS: Our simple procedure appears to be safe and easily reproducible, allowing a high surgical success in the treatment of recurrent pilonidal disease. KEY EORDS: Excision, Healing, Recurrent sacrococcygeal pilonidal disease.", "provenance": [ { "field": "population", "quote": "48 consecutive patients with previous surgical excision and recurrent pilonidal disease underwent surgery" }, { "field": "n", "quote": "48 consecutive patients with previous surgical excision and recurrent pilonidal disease underwent surgery" }, { "field": "primaryOutcome", "quote": "average healing time of 22.8 ± 15.3 days" }, { "field": "result", "quote": "an average healing time of 22.8 ± 15.3 days" }, { "field": "result", "quote": "Kaplan-Meier analysis showed that in 7 years of follow-up, 85% of patients healed without recurrence" } ] }, { "id": "pmid:33032439", "pmid": "33032439", "doi": "10.33699/PIS.2020.99.8.350-355", "nctId": null, "pmcid": null, "title": "Pilonidal sinus disease: Karydakis flap procedure in our patients", "firstAuthor": "Bubenová", "multipleAuthors": true, "journal": "Rozhl Chir", "year": 2020, "design": "prospective-cohort", "n": 27, "nField": "reported", "population": "People treated with the Karydakis flap procedure for primary or recurrent pilonidal sinus disease", "intervention": "Karydakis flap surgery for pilonidal disease", "comparator": "", "primaryOutcome": "Wound healing, complications, and recurrence after surgery", "result": "At follow-up, all 27 patients had a fully healed, lateralized wound with no sign of new disease; the healing process was free of serious complications in 25 of 27, with seroma managed by puncture in the others", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This was a small, single-center study with no comparison group and only short-term follow-up, so the healing timeline it reports may not generalize.", "directness": "indirect", "relevanceNote": "", "limitations": "Small sample (27 patients), no untreated or comparator group, and the abstract does not give an exact time-to-heal figure, only outcomes at scheduled follow-up visits.", "followUp": "12 months", "plainFinding": "Wound fully healed, no recurrence by a year", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33032439/", "sourceText": "INTRODUCTION: Despite the available guidelines, opinions of many surgeons are quite ambiguous when it comes to the therapy of pilonidal sinus disease. The treatment can be a frustrating problem both for the surgeon and the patient because it is associated with wound complications and high recurrence rate. The objective of this study was to analyze the results of patients with pilonidal sinus disease undergoing the Karydakis flap procedure. METHODS: A total of 27 patients treated for primary and recurrent pilonidal disease using the Karydakis flap procedure at our department between October 23, 2018 and November 22, 2019 were analyzed prospectively. We evaluated postoperative wound healing, complications and recurrence of the disease in a short-term follow-up period. Disease recurrence was defined as prolonged healing or as a new disease requiring repeated surgery. RESULTS: In December 2019 all 27 patients came for a follow-up visit. The result was a fully lateralized wound without any signs of a new disease in all patients. In May 2020 a follow-up visit by phone was performed. The median follow-up was 12 months. The healing process was free of any serious complications in 25 patients. Seroma formation cases were managed by puncture in the outpatient setting. CONCLUSION: According to the available evidence and guidelines, off-midline procedures - the Karydakis flap, Bascom cleft lift, and Limberg flap procedures - are associated with lower recurrence rates and better wound healing. An important goal is to achieve complete wound lateralization and to change the configuration of the gluteal cleft by reshaping it, which results in a nicely flattened gluteal crease.", "provenance": [ { "field": "population", "quote": "A total of 27 patients treated for primary and recurrent pilonidal disease using the Karydakis flap procedure" }, { "field": "intervention", "quote": "Karydakis flap procedure" }, { "field": "primaryOutcome", "quote": "We evaluated postoperative wound healing, complications and recurrence of the disease in a short-term follow-up period." }, { "field": "result", "quote": "The result was a fully lateralized wound without any signs of a new disease in all patients." }, { "field": "result", "quote": "The healing process was free of any serious complications in 25 patients. Seroma formation cases were managed by puncture in the outpatient setting." }, { "field": "n", "quote": "A total of 27 patients" }, { "field": "followUp", "quote": "The median follow-up was 12 months." } ] }, { "id": "pmid:33011845", "pmid": "33011845", "doi": "10.1007/s00384-020-03767-9", "nctId": null, "pmcid": null, "title": "Early versus delayed endoscopic treatment of acute pilonidal abscess: a propensity score-matched analysis", "firstAuthor": "Manigrasso", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2021, "design": "retrospective", "n": 82, "nField": "reported", "population": "People treated for an acute pilonidal abscess with an endoscopic procedure (VAAPS), either right away or after a delay", "intervention": "Early endoscopic treatment (VAAPS) done immediately for acute pilonidal abscess", "comparator": "Delayed endoscopic treatment (VAAPS) done after initial incision and drainage", "primaryOutcome": "Rate of the abscess coming back (recurrence) at 1, 3, and 5 years", "result": "The abstract reports 'time to wound healing' was tracked as a secondary outcome, but gives no specific healing-time figures; it states recurrence was the same between early and delayed treatment, while patient satisfaction and health status were better with early treatment", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "This is a retrospective, propensity-matched comparison of two treatment timings rather than a study designed to measure how long a pilonidal cyst takes to heal, and it does not report actual healing-time numbers.", "directness": "indirect", "relevanceNote": "", "limitations": "Retrospective design with propensity-score matching rather than randomisation, and the abstract does not give actual duration-to-healing data despite listing it as a secondary outcome.", "followUp": "1-year, 3-year, and 5-year follow-up", "plainFinding": "Healing time not actually reported", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33011845/", "sourceText": "BACKGROUND: According to the Italian Society of Colorectal Surgery guidelines, the most effective approach to the pilonidal abscess is adequate surgical drainage, concerning incision and drainage of the pilonidal cavity. Few recent studies have demonstrated that endoscopic approach could be a valid treatment option even in the case of acute pilonidal abscess. The aim of our study is to assess if video-assisted ablation of pilonidal sinus (VAAPS) could be an alternative to treat an acute pilonidal abscess and to evaluate if an immediate endoscopic approach to the pilonidal abscess is preferable to a delayed procedure after incision and drainage. METHODS: All consecutive patients with an acute pilonidal abscess since 1 January 2014 to 31 December 2018 were enrolled in our propensity score-matched analysis and divided into two groups: the early VAAPS group and the delayed VAAPS group. Primary outcomes were recurrence rate at 1-year, 3-year, and 5-year follow-up. Secondary outcomes were time off, time to wound healing, incomplete wound healing, perioperative infection, patients' satisfaction 1 month after the complete wound healing, and their health status before surgery and 6 months after complete wound healing. RESULTS: After the propensity score matching, 82 patients were included in the final analysis (41 in each group). No differences were found in terms of recurrence in the two groups. Early endoscopic approach was associated with a better patients' satisfaction (8.17 ± 1.2 vs 6.06 ± 1.48, p = 0.001) and a better postoperative health status (86.27 ± 6.54 vs 77.32 ± 5.85, p = 0.001). CONCLUSIONS: Our results encouraged to perform an immediate endoscopic approach to an acute pilonidal abscess.", "provenance": [ { "field": "population", "quote": "All consecutive patients with an acute pilonidal abscess since 1 January 2014 to 31 December 2018 were enrolled" }, { "field": "intervention", "quote": "the early VAAPS group" }, { "field": "comparator", "quote": "the delayed VAAPS group" }, { "field": "primaryOutcome", "quote": "Primary outcomes were recurrence rate at 1-year, 3-year, and 5-year follow-up." }, { "field": "result", "quote": "No differences were found in terms of recurrence in the two groups." }, { "field": "n", "quote": "82 patients were included in the final analysis (41 in each group)" }, { "field": "followUp", "quote": "recurrence rate at 1-year, 3-year, and 5-year follow-up" } ] }, { "id": "pmid:32962673", "pmid": "32962673", "doi": "10.1186/s12893-020-00865-x", "nctId": null, "pmcid": "PMC7510145", "title": "Assessment of the effect of platelet rich plasma on the healing of operated sacrococcygeal pilonidal sinus by lay-open technique: a randomized clinical trial", "firstAuthor": "Gohar", "multipleAuthors": true, "journal": "BMC Surg", "year": 2020, "design": "rct", "n": 100, "nField": "reported", "population": "patients with pilonidal sinus disease treated by lay-open surgical excision", "intervention": "platelet-rich plasma injection into the wound after surgery", "comparator": "regular wound dressing after surgery", "primaryOutcome": "time for the surgical wound to fully heal", "result": "average complete healing time was 45 days with PRP versus 57 days with regular dressing", "resultDirection": "not-applicable", "quality": "moderate", "qualityWhy": "it was a randomized trial with 100 patients but single-center and details on blinding and dropout are not given", "directness": "indirect", "relevanceNote": "", "limitations": "single center study, no mention of blinding of outcome assessors, and this tests PRP as an add-on rather than the natural healing course itself", "followUp": "until complete wound healing (up to about 57 days)", "plainFinding": "open pilonidal wounds took 45 to 57 days to fully heal", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32962673/", "sourceText": "BACKGROUND: Sacrococcygeal pilonidal sinus disease (PSD) is an infection of the skin and subcutaneous tissue at the upper part of the natal cleft of the buttocks. Excision and healing by granulation \"lay-open\" method is still more preferable than other methods of midline closure or using flaps but the healing time is lengthy. The present study was performed to assess the healing promotion effect of platelet-rich plasma (PRP) on the pilonidal sinus wounds treated by the lay-open method. METHODS: One hundred patients suffering from PSD were randomly divided into two groups, they were treated by the lay-open method, at General surgery department, Kafr El-Sheik University hospital, Egypt, during the period from December 2018 to December 2019. Group (A) was adopted the regular dressing postoperatively, while group (B) was treated with PRP injection into the wound at 4 and 12 postoperative days. RESULTS: Accelerated rate of wound healing was detected in group (B) in day 10, with a significant difference detected in days 15, 20, 25 and 30 postoperative, with a mean time of complete healing 45 ± 2.6 days in group B, while it was 57 ± 2.4 days in group A with a p-value of 0.001 which indicates considerable effect in the treated group. CONCLUSIONS: PRP injection is an effective new technique in accelerating the healing of pilonidal wound after surgery, with a significant decrease in post-operative pain, complications and an early return to work. TRIAL REGISTRATION: retrospectively registered. TRIAL REGISTRATION NUMBER: 12/35/1016 issued on December 2018 from the Institution Review Board at Kafr El Sheikh University. ClinicalTrials.gov identifier: NCT04430413.", "provenance": [ { "field": "population", "quote": "One hundred patients suffering from PSD were randomly divided into two groups, they were treated by the lay-open method" }, { "field": "intervention", "quote": "group (B) was treated with PRP injection into the wound at 4 and 12 postoperative days" }, { "field": "comparator", "quote": "Group (A) was adopted the regular dressing postoperatively" }, { "field": "primaryOutcome", "quote": "Accelerated rate of wound healing was detected in group (B)" }, { "field": "result", "quote": "mean time of complete healing 45 ± 2.6 days in group B, while it was 57 ± 2.4 days in group A with a p-value of 0.001" }, { "field": "n", "quote": "One hundred patients suffering from PSD were randomly divided into two groups" } ] }, { "id": "pmid:32885705", "pmid": "32885705", "doi": "10.1080/09546634.2020.1818676", "nctId": null, "pmcid": null, "title": "Long-term outcomes of crystallized phenol application for the treatment of pilonidal sinus disease", "firstAuthor": "Dogru", "multipleAuthors": true, "journal": "J Dermatolog Treat", "year": 2022, "design": "retrospective", "n": 1026, "nField": "reported", "population": "patients with primary pilonidal sinus treated at an outpatient clinic", "intervention": "crystallized phenol treatment (CPT)", "comparator": "", "primaryOutcome": "healing time and recurrence after treatment", "result": "the mean recovery time was 8.9 weeks, with a success rate of 84.3% and a mean of 2.1 applications needed", "resultDirection": "not-applicable", "quality": "low", "qualityWhy": "this is a retrospective single-center case series without a comparison group, so healing time may be affected by unmeasured factors.", "directness": "indirect", "relevanceNote": "", "limitations": "No control group; single treatment type (chemical cauterization) rather than the standard surgical or open-wound management described in the question; retrospective design.", "followUp": "", "plainFinding": "Healed in about 9 weeks", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32885705/", "sourceText": "OBJECTIVE: This study aimed to better demonstrate the long-term outcomes and effectiveness of crystallized phenol treatment (CPT) by presenting our 20 years experience. METHODS: One thousand and twenty-six patients who have primer pilonidal sinus were enrolled. The operation was applied outpatient clinic under local anesthesia. Recurrence rate, application number, healing time, and factors affecting them were analyzed. RESULTS: The success rate was 84.3%. The mean number of CPT applications was 2.1 and the mean recovery time was 8.9 weeks. The rate of recurrence was higher in patients with a long disease duration prior to initiating treatment (p = .04). The rate of recurrence was higher in patients with a higher number of opening and CPT application, those with longer application time, and those with a positive family history (respectively p = .01, p = .002, p = .008). CONCLUSIONS: Long-term outcomes are also very successful in the treatment of pilonidal disease with CPT. We believe that CPT should be the first choice in the treatment of pilonidal disease because it is inexpensive, can be applied as an outpatient treatment, is a noninvasive procedure, has results comparable to surgical procedures, and does not cause loss of work and strength.", "provenance": [ { "field": "n", "quote": "One thousand and twenty-six patients who have primer pilonidal sinus were enrolled." }, { "field": "population", "quote": "One thousand and twenty-six patients who have primer pilonidal sinus were enrolled." }, { "field": "intervention", "quote": "crystallized phenol treatment (CPT)" }, { "field": "primaryOutcome", "quote": "Recurrence rate, application number, healing time, and factors affecting them were analyzed." }, { "field": "result", "quote": "The success rate was 84.3%. The mean number of CPT applications was 2.1 and the mean recovery time was 8.9 weeks." } ] } ], "faqs": [ { "q": "How long is recovery from pilonidal cyst removal?", "a": "It depends on the technique. Minimally invasive or laser procedures typically let people return to work within days to about two weeks, while bigger flap or excision surgery can take longer, and full wound closure can lag behind return-to-activity by weeks." }, { "q": "How long does it take for a pilonidal cyst open wound to heal?", "a": "When the wound is left open to heal on its own (secondary intention) after excision, studies report average healing times of roughly 8 to 15 weeks, with nearly all wounds closed by around three months but some taking longer." }, { "q": "How long does it take for a pilonidal cyst to heal after it's drained?", "a": "Only one small study in this review directly compared drainage with excision, and it did not report an exact number of days — it found drainage healed faster than excision but came with a much higher chance of the cyst returning (54% vs 19%)." }, { "q": "How long does a pilonidal cyst take to heal on its own, without any treatment?", "a": "This has not been studied. Every study we found followed people after some treatment — surgery, laser, drainage, or a chemical like phenol. There is no published evidence on what happens if a pilonidal cyst is left completely untreated." }, { "q": "Does it matter if the wound is stitched closed or left open?", "a": "Yes — studies consistently find open wounds (left to heal by secondary intention) take much longer to close than wounds that are stitched or reconstructed with a flap, sometimes twice as long or more, though open wounds may have different recurrence trade-offs." } ], "searchedAs": [ "how long does a pilonidal cyst take to heal", "how long is recovery from pilonidal cyst removal", "how long does it take for pilonidal cyst open wound to heal", "how long does a pilonidal cyst take to heal after it is drained", "how long for pilonidal cyst to heal after draining", "how long does a pilonidal cyst take to heal on its own", "how long does it take for a pilonidal cyst wound to heal" ], "patientTakeaway": "If you've had a small, minimally invasive procedure, expect the wound to likely close within about 2 to 4 weeks, with return to normal activity often sooner than that. If the wound was left open to heal on its own after excision, expect it to take longer — commonly 6 to 14 weeks or more. No study has followed what happens if a pilonidal cyst is simply left untreated, so if you have one, see a clinician rather than waiting it out on your own.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(\"Pilonidal Sinus\"[Mesh]) AND (\"Wound Healing\"[Mesh] OR \"Time Factors\"[Mesh] OR \"Recovery of Function\"[Mesh] OR healing[tiab] OR recovery[tiab] OR \"return to work\"[tiab])" }, "pubmedQueryTranslation": "\"Pilonidal Sinus\"[MeSH Terms] AND (\"Wound Healing\"[MeSH Terms] OR \"Time Factors\"[MeSH Terms] OR \"Recovery of Function\"[MeSH Terms] OR \"healing\"[Title/Abstract] OR \"recovery\"[Title/Abstract] OR \"return to work\"[Title/Abstract])", "searchedOn": "2026-11-10", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Studies mainly about Untreated pilonidal cyst natural course without any intervention", "Studies mainly about Hidradenitis suppurativa", "Studies mainly about Perianal or perirectal abscess unrelated to pilonidal disease", "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 Take to Heal?", "description": "Published research (175 studies) shows healing takes 2-4 weeks after minimally invasive pilonidal surgery, 6-14 weeks for open wounds." }, "lastChecked": "2026-11-10", "lastChanged": "2026-11-10", "nextCheckDue": "2026-12-10", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-2", "ranOn": "2026-11-10", "gradeRules": "ev-2", "review": { "verdict": "pass", "rounds": 1, "sentBack": [], "notes": [ "round 1: pass — The page honestly answers the duration question with treatment-specific ranges that are well supported by a large, appropriately scoped evidence base, clearly separates the untreated-course question as unstudied rather than conflating it, and includes appropriate caveats and safety guidance — it is ready to publish as is." ] } }, "status": "published" }