{ "slug": "is-pilonidal-cyst-dangerous", "question": "Is a pilonidal cyst dangerous?", "shortTitle": "Pilonidal Cyst: How Dangerous Is It?", "clinicalQuestion": "In people with a pilonidal cyst or sinus (including during pregnancy), what is the risk of serious complications such as abscess formation, systemic infection, or (rarely) malignant transformation if the cyst is left untreated or recurs?", "pico": { "population": "People diagnosed with a pilonidal cyst or sinus, including pregnant women", "intervention": "Presence of a pilonidal cyst/sinus (untreated or watchfully managed)", "comparator": "No pilonidal disease, or pilonidal disease that is surgically treated", "outcomes": [ "Rate of abscess formation or acute infection", "Rate of systemic sepsis or hospitalization", "Recurrence rate after conservative vs surgical management", "Rate of malignant transformation (e.g., squamous cell carcinoma) in chronic pilonidal sinus", "Pregnancy-specific complication rates", "Need for emergency surgical intervention" ] }, "category": "anorectal", "relatedConditions": [ "pilonidal-cyst", "pilonidal-sinus", "perianal-abscess" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "A pilonidal cyst or sinus can sometimes lead to real complications — repeat abscesses, infection, or in rare cases surgery-related skin cancer — but the evidence for how often this happens comes only from observational studies, not controlled trials.", "detail": "Recurrence or re-operation rates after surgery for pilonidal abscess or sinus vary widely across cohort studies, from about 9% needing a repeat procedure within a year in one study of 1,932 patients to 27–34% having recurrence or complications in another, and roughly one third needing another operation within five years after initial drainage of an abscess. Cancer arising from long-standing pilonidal disease is rare — found in 2 of 1,505 patients (0.13%) having surgical removal in the largest series, more often in people over 40 or with cysts present more than three years, and both of those patients were cancer-free two years later. Common bacteria found in infected abscesses include anaerobic organisms and Streptococcus anginosus, but no clear risk factors for recurrence have been identified, and none of these studies focused specifically on pregnancy.", "studyIds": [ "pmid:41454773", "pmid:41239746", "pmid:39544170", "pmid:29870307", "pmid:24239526" ] }, "strength": { "level": "low", "why": "Only observational evidence addresses this question (4 studies).", "override": null }, "direction": { "level": "harm-signal", "why": "15 studies reported harm or tissue damage, including laboratory evidence.", "override": null }, "counts": { "recordsRetrieved": 558, "recordsScreened": 200, "included": 63, "rcts": 1, "systematicReviews": 2, "observational": 21, "participants": 16704, "yearFrom": 2013, "yearTo": 2026, "registeredTrialsWithoutResults": 0 }, "excluded": [], "outcomes": [ { "name": "Rate of abscess formation or acute infection", "status": "possible-harm", "note": "Cohort studies of people with pilonidal disease show abscess and infection are common complications, sometimes needing repeat drainage or surgery.", "studyIds": [ "pmid:41454773", "pmid:41239746", "pmid:29870307", "pmid:24239526" ] }, { "name": "Rate of systemic sepsis or hospitalization", "status": "possible-harm", "note": "Case reports describe rare instances of severe spreading infection — toxic shock, a spinal epidural abscess, and infection perforating into the abdomen — arising from pilonidal disease, though how often this happens is unknown.", "studyIds": [ "pmid:29437816", "pmid:29205143", "pmid:33630288" ] }, { "name": "Recurrence rate after conservative vs surgical management", "status": "insufficient", "note": "Recurrence rates after various surgeries range widely, from about 3% to a third of patients, but no study compared surgery directly against leaving the cyst untreated, so the added risk of not treating isn't measured.", "studyIds": [ "pmid:41239746", "pmid:36268754", "pmid:31511134", "pmid:30064734", "pmid:29870307", "pmid:29699781", "pmid:24239526" ] }, { "name": "Rate of malignant transformation (e.g. squamous cell carcinoma) in chronic pilonidal sinus", "status": "possible-harm", "note": "In the largest study of pilonidal surgery patients, cancer was found in 2 of 1,505 removed chronic cysts (0.13%, about 1 in 750), usually after many years of disease, and both of those patients were cancer-free two years later. Smaller case reports and series describe more aggressive outcomes, including cancers that spread and were fatal, with survival dropping as cancer stage or tumour grade worsens.", "studyIds": [ "pmid:39544170", "pmid:39212563", "pmid:37195200", "pmid:35636935", "pmid:31293248", "pmid:30771803", "pmid:28302173", "pmid:25693725", "pmid:24202229" ] }, { "name": "Pregnancy-specific complication rates", "status": "not-studied", "note": "No study in this review followed pregnant people with a pilonidal cyst or measured outcomes specific to pregnancy.", "studyIds": [] }, { "name": "Need for emergency surgical intervention", "status": "possible-harm", "note": "Acute abscesses sometimes require urgent incision and drainage, and isolated case reports describe emergency surgery for rare complications such as perforation into the abdomen.", "studyIds": [ "pmid:39875233", "pmid:33630288", "pmid:29437816" ] } ], "benefits": [ { "text": "Cancer developing from a pilonidal cyst is rare: in the largest study that checked, only about 1 in 800 removed cysts contained cancer.", "studyIds": [ "pmid:39544170" ] }, { "text": "When an abscess does form, standard drainage or surgical care led to healing in most people across several case series.", "studyIds": [ "pmid:39875233", "pmid:36888964", "pmid:36268754", "pmid:31215233", "pmid:30719564", "pmid:30064734", "pmid:24969346" ] } ], "limitations": [ { "text": "Much of the evidence for serious complications (spreading infection, cancer, death) comes from single case reports describing one patient each, which cannot say how often these events actually happen.", "studyIds": [ "pmid:39212563", "pmid:37195200", "pmid:35636935", "pmid:33630288", "pmid:31293248", "pmid:30771803", "pmid:29437816", "pmid:29205143", "pmid:28302173", "pmid:27391513", "pmid:24202229" ] }, { "text": "The large cohort studies followed people who already had surgery, not people who left the cyst untreated, so they can't show what happens with no treatment at all.", "studyIds": [ "pmid:41239746", "pmid:29870307", "pmid:24239526" ] }, { "text": "Studies define 'serious complication' differently — some count any repeat procedure, others count only major infection — which makes the reported rates hard to compare directly.", "studyIds": [ "pmid:41239746", "pmid:31511134", "pmid:29870307", "pmid:24239526" ] } ], "risks": [ { "text": "An abscess (a pocket of pus) can form at the cyst site, sometimes needing urgent drainage or repeat surgery.", "studyIds": [ "pmid:41454773", "pmid:41239746", "pmid:29870307", "pmid:24239526" ], "severity": "serious" }, { "text": "Rarely, infection from the area has spread to cause severe illness, including toxic-shock-like illness needing intensive care, an abscess tracking toward the spine, and a case of infection perforating into the abdomen.", "studyIds": [ "pmid:29437816", "pmid:29205143", "pmid:33630288" ], "severity": "serious" }, { "text": "Very rarely, a long-standing pilonidal sinus turns into squamous cell carcinoma, a type of skin cancer; when this happens it can spread and be fatal.", "studyIds": [ "pmid:39544170", "pmid:39212563", "pmid:37195200", "pmid:35636935", "pmid:31293248", "pmid:30771803", "pmid:28302173", "pmid:25693725", "pmid:24202229" ], "severity": "serious" }, { "text": "Surgery to remove a pilonidal cyst carries its own risk: in one large study, about 5 in 100 patients had a major complication and 8 in 100 needed repeat surgery within a year.", "studyIds": [ "pmid:29870307" ], "severity": "serious" } ], "whyPeopleTryIt": [ { "text": "The cyst sits in a private area, so embarrassment can delay seeing a doctor about it." }, { "text": "Early on it can look like a small bump or ingrown hair, so it's easy to assume it isn't serious." }, { "text": "Fear of surgery or a visible scar near the tailbone makes people search for reassurance instead of getting it checked." }, { "text": "During pregnancy, people may worry that treatment or imaging could affect the baby, so they delay care and look for answers online instead." } ], "keyStudies": [ "pmid:39544170", "pmid:29870307", "pmid:24239526", "pmid:41239746", "pmid:41454773", "pmid:35636935", "pmid:29437816" ], "studies": [ { "id": "pmid:42759045", "pmid": "42759045", "doi": "10.1097/ASW.0000000000000523", "nctId": null, "pmcid": null, "title": "Hidradenitis Suppurativa: Part of a Tetrad of Follicular Occlusion Disorders", "firstAuthor": "Sie", "multipleAuthors": true, "journal": "Adv Skin Wound Care", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with follicular occlusion disorders, including pilonidal sinus", "intervention": "wound care strategies for follicular occlusion disorders", "comparator": "", "primaryOutcome": "disease characteristics, mechanisms and management of follicular occlusion disorders", "result": "the review describes pilonidal sinus as part of a group of chronic inflammatory conditions causing abscesses, sinus tracts, scarring and psychosocial impact, without a specific outcome measurement for pilonidal cysts", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general narrative review for clinician education, not a study measuring outcomes, so it cannot show whether pilonidal cysts are dangerous.", "directness": "indirect", "limitations": "No original data, no control group, and pilonidal sinus is only one of four conditions discussed with most detail given to hidradenitis suppurativa.", "followUp": "", "plainFinding": "Pilonidal sinus linked to chronic inflammation.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42759045/", "sourceText": "UNLABELLED: Follicular occlusion disorders (FOD) represent a tetrad of chronic, recurrent inflammatory conditions united by a common pathophysiologic mechanism: follicular hyperkeratosis leading to occlusion, rupture, and subsequent abscess or sinus tract formation. First conceptualized as a triad in the 1950s and later expanded to a tetrad in the 1970s, this grouping includes hidradenitis suppurativa (HS), acne conglobata (AC), dissecting cellulitis of the scalp (DCS), and pilonidal sinus (PS). Despite their shared pathogenesis, each condition carries distinct clinical features, epidemiological profiles, and management considerations. This article aims to provide a comprehensive review of FOD, with a primary emphasis on HS (the most prevalent of the disorders). Hidradenitis suppurativa is a debilitating disease affecting ∼1% of the global population, predominantly in females, and the diagnosis is often delayed by 7 or more years. Multiple genes are linked to FOD patients with a positive familial history in 35% to 40%, along with lifestyle factors (smoking, alcohol consumption, and obesity). Key inflammatory mediators, including TNF-α, IL-1β, and IL-17, drive the chronic tissue destruction characteristic of FOD, frequently resulting in scarring, lymphedema, and significant psychosocial impairment. Wound care is critical and often underemphasized in disease management. This article outlines evidence-informed wound care strategies for both nonsurgical and postsurgical presentations, including dressing selection, exudate and odor management, pain and itch control, infection management, and the emerging role of intravenous ertapenem as rescue therapy. An interprofessional approach, integrating dermatology, surgery, wound care nursing, and psychosocial support, is emphasized throughout as essential to improving patient outcomes and quality of life. GENERAL PURPOSE: To increase clinicians' understanding of follicular occlusion disorders including the associated risk factors, clinical manifestations, and evidence-based approaches for management. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will: Assess clinical characteristics of each follicular occlusion disorderEvaluate the basic disease mechanisms for follicular occlusion disordersDescribe principal disease burdens that require wound care attentionIdentify the unique wound care strategies and follicular occlusion disorder challenges JOURNAL/aswca/04.03/00129334-202610000-00004/figure1/v/2026-09-18T181327Z/r/image-jpeg.", "provenance": [ { "field": "population", "quote": "this grouping includes hidradenitis suppurativa (HS), acne conglobata (AC), dissecting cellulitis of the scalp (DCS), and pilonidal sinus (PS)" }, { "field": "intervention", "quote": "This article outlines evidence-informed wound care strategies for both nonsurgical and postsurgical presentations" }, { "field": "primaryOutcome", "quote": "To increase clinicians' understanding of follicular occlusion disorders including the associated risk factors, clinical manifestations, and evidence-based approaches for management." }, { "field": "result", "quote": "follicular hyperkeratosis leading to occlusion, rupture, and subsequent abscess or sinus tract formation" }, { "field": "result", "quote": "frequently resulting in scarring, lymphedema, and significant psychosocial impairment" } ] }, { "id": "pmid:42560577", "pmid": "42560577", "doi": "10.1007/s00383-026-06553-w", "nctId": null, "pmcid": null, "title": "Laser-assisted endoscopic treatment of pilonidal sinus disease in children: a first pediatric series", "firstAuthor": "Türker Çolak", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2026, "design": "case-series", "n": 45, "nField": "reported", "population": "children under 18 years old with pilonidal sinus disease", "intervention": "laser-assisted endoscopic treatment of the pilonidal sinus (LEPSIT)", "comparator": "none reported (no comparison group)", "primaryOutcome": "successful treatment and pain levels after the procedure", "result": "91.1% of patients were cured after one procedure, and all were eventually cured with minimal pain", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study of a small group with no comparison group, so it mainly shows this treatment works well but cannot tell us how dangerous the condition itself is.", "directness": "indirect", "limitations": "Retrospective design, no control/comparator group, single-center experience", "followUp": "32.4 ± 11.3 months", "plainFinding": "High cure rate, minimal pain treatment", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42560577/", "sourceText": "BACKGROUND: This study aims to describe the technical details of laser-assisted endoscopic pilonidal sinus treatment (LEPSIT), a method used for the first time in pediatric pilonidal sinus disease (PSD), and to report early-stage clinical outcomes in a pediatric cohort. METHODS: Clinical data of children under 18 years of age who underwent LEPSIT for PSD between November 2021 and July 2023 were retrospectively analyzed. RESULTS: Of the 45 patients included, 19 (42.2%) were female, and 26 (57.8%) were male; the mean age at surgery was 15.2 ± 3.1 years, and the mean body mass index was 25.1 ± 3.2. Of the 45 patients, 35 presented with an acute pilonidal abscess at initial evaluation and had undergone abscess drainage prior to LEPSIT. Six patients had been previously operated on for pilonidal sinus disease at an external center prior to LEPSIT. Mean procedure duration was 30 ± 7.2 min. The mean visual analog scale (VAS) score at 6 h was 1.8, 24 h was 1,1 and the mean analgesic use was 1 ± 0.3 days. Successful treatment was achieved in 41 patients (91.1%) after a single procedure; 4 patients (8.9%) had recurrence, all of whom achieved cure after a second LEPSIT. Improvement was ultimately achieved in all 45 patients. Mean follow-up was 32.4 ± 11.3 months. CONCLUSION: LEPSIT is an easy-to-administer, minimally painful (mean VAS score: 1.1), and minimally invasive treatment that shortens hospital stay and enables rapid return to daily activities. It is also a safe and well-tolerated option for recurrent PSD.", "provenance": [ { "field": "population", "quote": "Clinical data of children under 18 years of age who underwent LEPSIT for PSD" }, { "field": "intervention", "quote": "laser-assisted endoscopic pilonidal sinus treatment (LEPSIT)" }, { "field": "comparator", "quote": "RESULTS: Of the 45 patients included" }, { "field": "primaryOutcome", "quote": "Successful treatment was achieved in 41 patients (91.1%) after a single procedure" }, { "field": "result", "quote": "Successful treatment was achieved in 41 patients (91.1%) after a single procedure; 4 patients (8.9%) had recurrence, all of whom achieved cure after a second LEPSIT. Improvement was ultimately achieved in all 45 patients." }, { "field": "n", "quote": "Of the 45 patients included, 19 (42.2%) were female, and 26 (57.8%) were male" } ] }, { "id": "pmid:42165106", "pmid": "42165106", "doi": "10.1111/iwj.70942", "nctId": null, "pmcid": "PMC13239841", "title": "Treatment Outcomes of Presacral Pilonidal Sinus Disease Using Crystallised Phenol: A Single-Centre Clinical Series", "firstAuthor": "Acar", "multipleAuthors": true, "journal": "Int Wound J", "year": 2026, "design": "case-series", "n": 40, "nField": "reported", "population": "patients with presacral pilonidal sinus disease treated at a single centre", "intervention": "crystallised phenol treatment (2 or 3 sessions)", "comparator": "two-session versus three-session phenol treatment groups", "primaryOutcome": "number of treatment sessions needed, and rates of treatment-related abscess and recurrence", "result": "Treatment-related abscess developed in 12.5% (5/40) and recurrence during the 3-month follow-up was observed in 12.5% (5/40); all such events occurred in the three-session group", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a small, single-centre case series without a control group and only short-term follow-up, so it cannot show how dangerous the disease itself is.", "directness": "indirect", "limitations": "Single-centre, no untreated comparison group, short follow-up (3 months), and the abstract itself calls for larger studies with longer follow-up.", "followUp": "3 months", "plainFinding": "Some abscess and recurrence after treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42165106/", "sourceText": "OBJECTIVE: To evaluate short-term treatment outcomes and treatment burden in patients with presacral pilonidal sinus disease managed with crystallised phenol in a single-centre clinical series, with particular emphasis on the relationship between pit burden and session requirement. METHODS: Consecutive patients treated with crystallised phenol were analysed (n = 40). Demographic and clinical characteristics, symptom duration, pit count, number of phenol sessions (2 vs. 3), inter-session intervals, and total treatment duration were recorded. All patients completed scheduled clinical reassessment at 5 weeks and 3 months. Treatment-related abscess and recurrence during follow-up were documented. Continuous variables are presented as mean ± standard deviation and median (minimum-maximum). Comparisons between the two-session and three-session groups were performed with the Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables. RESULTS: The cohort was predominantly male (75%), with a mean age of 29.23 ± 9.85 years and a mean body mass index of 25.81 ± 3.85 kg/m2; 62.5% were smokers. Symptom duration was 6.80 ± 7.20 months, and mean pit count was 1.90 ± 0.93. Two sessions were sufficient in 42.5% (17/40), whereas 57.5% (23/40) required three sessions. The interval between the first and second sessions was 11.32 ± 3.30 days, and the interval between the second and third sessions was 11.96 ± 3.23 days in patients who underwent three sessions; overall treatment duration was 18.2 ± 7.58 days. No patient was lost to follow-up. Pit burden was the strongest determinant of requiring a third session: pit count was significantly higher in the three-session group than in the two-session group (2.39 ± 0.89 vs. 1.24 ± 0.44, p < 0.001), and all patients with ≥ 3 pits required three sessions. Smoking status (p = 1.000) and body mass index (BMI) (p = 0.208) were not associated with session requirement. Treatment-related abscess developed in 12.5% (5/40), and recurrence during the 3-month follow-up was observed in 12.5% (5/40); notably, all such events occurred in the three-session group (0/17 vs. 5/23, p = 0.061 for both comparisons). CONCLUSION: In this single-centre series, crystallised phenol provided acceptable short-term outcomes and a relatively short treatment course in presacral pilonidal sinus disease. Pit count emerged as the main determinant of requiring a third session, whereas smoking status and BMI were not associated with session requirement. Larger studies with longer follow-up are needed to clarify predictors of recurrence and to determine whether higher session requirements simply reflect disease complexity or also influence outcome.", "provenance": [ { "field": "n", "quote": "Consecutive patients treated with crystallised phenol were analysed (n = 40)." }, { "field": "population", "quote": "patients with presacral pilonidal sinus disease managed with crystallised phenol in a single-centre clinical series" }, { "field": "intervention", "quote": "crystallised phenol" }, { "field": "comparator", "quote": "Comparisons between the two-session and three-session groups were performed with the Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables." }, { "field": "primaryOutcome", "quote": "relationship between pit burden and session requirement" }, { "field": "result", "quote": "Treatment-related abscess developed in 12.5% (5/40), and recurrence during the 3-month follow-up was observed in 12.5% (5/40); notably, all such events occurred in the three-session group (0/17 vs. 5/23, p = 0.061 for both comparisons)." } ] }, { "id": "pmid:41454773", "pmid": "41454773", "doi": "10.1093/jpids/piaf115", "nctId": null, "pmcid": null, "title": "Patient characteristics and microbiology in pilonidal abscesses in children", "firstAuthor": "Garcia", "multipleAuthors": true, "journal": "J Pediatric Infect Dis Soc", "year": 2026, "design": "retrospective", "n": 154, "nField": "reported", "population": "children who had pilonidal abscesses", "intervention": "none - observational study describing abscess microbiology and characteristics", "comparator": "none", "primaryOutcome": "types of bacteria found in abscesses and risk factors for recurrence", "result": "anaerobic bacteria and Streptococcus anginosus group were the most common organisms found, and no factors linked to recurrence were identified", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a descriptive chart review from one hospital with no comparison group, so it can't show whether treatments work or how dangerous the condition is.", "directness": "direct", "limitations": "single tertiary pediatric center, retrospective design, no control group", "followUp": "", "plainFinding": "Abscesses common; no recurrence risk factors found", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41454773/", "sourceText": "We described the microbiology of 216 pilonidal abscess episodes among 154 children over a 10-year period at a tertiary pediatric center and assessed patient characteristics associated with recurrence. Anaerobes and Streptococcus anginosus group were the most common organisms isolated from surgical cultures. No risk factors for recurrence were identified.", "provenance": [ { "field": "n", "quote": "216 pilonidal abscess episodes among 154 children" }, { "field": "population", "quote": "216 pilonidal abscess episodes among 154 children over a 10-year period at a tertiary pediatric center" }, { "field": "intervention", "quote": "We described the microbiology of 216 pilonidal abscess episodes among 154 children" }, { "field": "comparator", "quote": "We described the microbiology of 216 pilonidal abscess episodes among 154 children over a 10-year period at a tertiary pediatric center and assessed patient characteristics associated with recurrence." }, { "field": "primaryOutcome", "quote": "assessed patient characteristics associated with recurrence" }, { "field": "result", "quote": "Anaerobes and Streptococcus anginosus group were the most common organisms isolated from surgical cultures. No risk factors for recurrence were identified." } ] }, { "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 (a cyst/abscess near the tailbone)", "intervention": "different surgical techniques (drainage, minimally invasive procedures, excision, flap surgery)", "comparator": "non-surgical treatment versus various surgical approaches", "primaryOutcome": "which treatment best reduces recurrence and complications for different disease severities", "result": "the article summarizes which treatment strategy fits which type/severity of pilonidal disease, without giving a single quantitative outcome", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a narrative review based on clinical experience and prior literature, not a controlled study with measured outcomes.", "directness": "indirect", "limitations": "it is a non-systematic review discussing treatment choices rather than a study measuring how dangerous the disease itself is, and reports no patient numbers or outcome data.", "followUp": "", "plainFinding": "Discusses treatment options, not danger.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41397831/", "sourceText": "The treatment of sacrococcygeal pilonidal disease (SPD) remains challenging due to its high recurrence rate and treatment-related complications. An ideal treatment plan for SPD should be simple to perform, reduce recurrence rates, enable patients to quickly return to normal daily activities, and be associated with a low incidence of complications. Various surgical techniques have been employed for the treatment of SPD, but discrepancies and controversies persist in current clinical practice. Non-surgical treatment is suitable for asymptomatic SPD patients. For patients in the acute abscess phase, drainage is the primary therapeutic goal, with avoidance of midline incisions. Minimally invasive procedures may be considered for patients with localized lesions after weighing the recurrence risk, aiming for faster recovery and better cosmetic outcomes. For recurrent SPD or cases with extensive lesions, excision followed by secondary healing or combined with flap techniques is required to pursue a lower recurrence risk. Based on clinical experience and literature review, this article summarizes the treatment strategies for different types of SPD, providing a reference for clinicians in formulating diagnosis and treatment plans.", "provenance": [ { "field": "population", "quote": "sacrococcygeal pilonidal disease (SPD)" }, { "field": "intervention", "quote": "Various surgical techniques have been employed for the treatment of SPD" }, { "field": "comparator", "quote": "Non-surgical treatment is suitable for asymptomatic SPD patients." }, { "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": "this article summarizes the treatment strategies for different types of SPD, providing a reference for clinicians in formulating diagnosis and treatment plans." } ] }, { "id": "pmid:41337870", "pmid": "41337870", "doi": "10.1016/j.bpobgyn.2025.102691", "nctId": null, "pmcid": null, "title": "Connecting polycystic ovary syndrome and pilonidal disease in adolescents: State of the art review", "firstAuthor": "Yung", "multipleAuthors": true, "journal": "Best Pract Res Clin Obstet Gynaecol", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "female teenagers with pilonidal disease or polycystic ovary syndrome", "intervention": "none (this is a review discussing disease association, not a treatment)", "comparator": "", "primaryOutcome": "association between polycystic ovary syndrome and pilonidal disease", "result": "the two conditions share risk factors such as obesity, hyperandrogenism, and metabolic syndrome, and the review recommends a shared management pathway", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is an opinion-based review summarizing an association, not a study that tested dangerousness or treatment outcomes.", "directness": "indirect", "limitations": "no original data, sample size, or outcome measures are reported; it is a narrative/clinical opinion piece.", "followUp": "", "plainFinding": "Linked to PCOS in teen girls.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41337870/", "sourceText": "Pilonidal disease is a dermatologic condition of the natal cleft that affects primarily adolescents. Its severity ranges from asymptomatic to chronically recurring disease. Like pilonidal disease, polycystic ovary syndrome commonly begins to affect women in their adolescence. PCOS is increasing in prevalence, affecting 6-20 % of women, and can significantly compromise quality of life by contributing to acne, weight gain, hirsutism, development of diabetes mellitus, hypertension, mental disorders and infertility. It is therefore increasingly important to be aware of a recently reported association between polycystic ovary syndrome and pilonidal disease within the female adolescent population. The conditions share common risk factors such as obesity, hyperandrogenism, and metabolic syndrome. Early diagnosis of these conditions is important in mitigating morbidity associated with either disease. This clinical opinion suggests a reciprocal pathway for management of female adolescents who may be suffering from either polycystic ovary syndrome or pilonidal disease, with the goal of providing comprehensive management and mitigating morbidity.", "provenance": [ { "field": "population", "quote": "female adolescents who may be suffering from either polycystic ovary syndrome or pilonidal disease" }, { "field": "primaryOutcome", "quote": "a recently reported association between polycystic ovary syndrome and pilonidal disease within the female adolescent population" }, { "field": "result", "quote": "The conditions share common risk factors such as obesity, hyperandrogenism, and metabolic syndrome." }, { "field": "intervention", "quote": "This clinical opinion suggests a reciprocal pathway for management of female adolescents who may be suffering from either polycystic ovary syndrome or pilonidal disease, with the goal of providing comprehensive management and mitigating morbidity." } ] }, { "id": "pmid:41239746", "pmid": "41239746", "doi": "10.1111/codi.70307", "nctId": null, "pmcid": null, "title": "Risk of re-operation after incision and drainage for acute, abscess-forming pilonidal sinus disease: A Danish population-based cohort study", "firstAuthor": "Faurschou", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2025, "design": "registry", "n": 8251, "nField": "reported", "population": "patients diagnosed with acute abscess-forming pilonidal sinus disease", "intervention": "incision and drainage surgery for the abscess", "comparator": "none - single treatment cohort followed over time", "primaryOutcome": "risk of needing another operation for pilonidal disease", "result": "about one third of patients needed a repeat operation within five years, with higher risk in younger patients, females, and those with a family history", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "it is a large nationwide registry study, but it only tracks outcomes after surgery rather than comparing treatments or addressing danger of the disease itself", "directness": "indirect", "limitations": "abstract does not describe how complications or severity of the original abscesses were assessed, and relies on registry data", "followUp": "five-year", "plainFinding": "Most didn't need more surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41239746/", "sourceText": "BACKGROUND: Acute abscess-forming pilonidal sinus disease (PSD) is treated surgically, with lateral incision and drainage (I&D) considered the gold standard; however, the risk of re-operation is unknown. AIM: To evaluate re-operation rates following abscess-forming PSD treatment with lateral I&D, and to identify factors influencing re-operation rates. METHODS: Using data from nationwide Danish databases covering 2010-2021, we identified patients diagnosed with abscess-forming PSD undergoing lateral I&D as the initial treatment for PSD. Patients were followed up until re-operation, death, emigration, or the end of the study period. Stratified by sex, the risk of re-operation was reported as a cumulative incidence function (CIF). To explore risks, we used Cox regression analysis to calculate crude and age-adjusted hazard ratios (aHR). RESULTS: Of 8251 (62% male) patients included, 2455 underwent re-operation for PSD. The overall five-year CIF was 32% for males and 33% for females. In males, the five-year CIF decreased from 47% among 0- to 16-year-olds to 14% among 50+ year-olds. In females, the corresponding numbers were 37% and 13%, respectively. A family history of PSD was found to increase re-operation risk, especially among female patients (aHR: 1.64 (95% confidence interval [95% CI]: 1.39-1.93)). The risk increases following the second and third consecutive I&D procedures to 52% and 69% in males, and to 57% and 64% in females, respectively. CONCLUSION: As roughly two-thirds of patients do not require additional surgery, our findings do not support mandatory follow-up with definitive surgery for all PSD patients undergoing I&D. For certain high-risk subgroups, however, subsequent definitive surgery may be appropriate.", "provenance": [ { "field": "n", "quote": "Of 8251 (62% male) patients included" }, { "field": "population", "quote": "patients diagnosed with abscess-forming PSD undergoing lateral I&D as the initial treatment for PSD" }, { "field": "intervention", "quote": "lateral incision and drainage (I&D) considered the gold standard" }, { "field": "comparator", "quote": "Patients were followed up until re-operation, death, emigration, or the end of the study period." }, { "field": "primaryOutcome", "quote": "To evaluate re-operation rates following abscess-forming PSD treatment with lateral I&D" }, { "field": "result", "quote": "The overall five-year CIF was 32% for males and 33% for females." } ] }, { "id": "pmid:40086161", "pmid": "40086161", "doi": "10.1016/j.jpedsurg.2025.162267", "nctId": null, "pmcid": null, "title": "Gender Differences in Adolescent Pilonidal Disease", "firstAuthor": "Stoeckel", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2025, "design": "retrospective", "n": 1356, "nField": "reported", "population": "adolescents with pilonidal disease, by gender", "intervention": "female gender (comparison of disease characteristics and treatment)", "comparator": "male gender", "primaryOutcome": "disease severity, quality of life impact, and treatment outcomes by gender", "result": "females had earlier disease onset, lower disease severity, but greater quality of life impact than males, despite similar tolerance of treatments", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a retrospective cohort study comparing genders, not evaluating danger or complications of the disease itself, so it offers limited direct evidence on how dangerous pilonidal cysts are.", "directness": "indirect", "limitations": "Retrospective design; focuses on gender differences in disease presentation and quality of life rather than directly assessing disease danger or complication rates.", "followUp": "", "plainFinding": "Disease is uncomfortable, not life-threatening.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40086161/", "sourceText": "BACKGROUND: Pilonidal disease is a common, disruptive condition in adolescents. We studied the effects of pilonidal disease on adolescents by gender. STUDY DESIGN: Prospectively collected data on demographics, mental health comorbidities, disease severity, hirsutism, disease-related quality of life impact, interventions, and outcomes were retrieved from a Pilonidal Care Clinic REDCap database and were analyzed by gender. RESULTS: Of 1356 patients with pilonidal disease, 562 (41 %) were female and 794 male. Average age at disease onset was 14.8 years for females and 16.9 years for males (p-value <0.001). The incidence of mental health comorbidities was similar in females compared to males (17 % vs 16 %; p-value = 0.268) but females had a higher incidence of diagnosed anxiety (15 % vs 10 %; p-value = 0.005). Females were less likely to be hirsute than males (32 % vs 79 %; p-value <0.001), and were more likely to have fine hair in their gluteal crease (51 % vs 5 %; p-value <0.001). Females presented with lower disease severity than males (mild: 68 % vs 47 %, moderate: 22 % vs 33 %, and severe: 3 % vs 10 %; p-value <0.001), and were less likely to have undergone prior operation (3 % vs 8 %; p-value <0.001). However, disease-related quality of life impact was more severe for females than males in 5 of 6 domains examined including: pain (5 vs 3; p-value <0.001), embarrassment (4 vs 3; p-value = 0.021), ability to play sports (2 vs 1; p-value = 0.01), disruption of routine (4 vs 3; p-value = 0.024) and disturbance to school, work, or activities (3 vs 2; p-value = 0.004). More females underwent pit picking on their first clinic visit (33 % vs 27 %; p-value = 0.011) and incision and drainage (6 % vs 3 %; p-value = 0.01), with similar rates of laser follicle ablation (53 % vs 55 %; p-value = 0.45). CONCLUSION: The prevalence of pilonidal disease is much higher in females than previously reported. Pilonidal disease has different impacts on females than males including: earlier onset, higher incidence of anxiety, and greater disease-related impact on quality of life, despite lower disease severity on presentation. Tolerance of clinic treatments is comparable between genders. TYPE OF STUDY: Retrospective, cohort study. LEVEL OF EVIDENCE: III.", "provenance": [ { "field": "n", "quote": "Of 1356 patients with pilonidal disease, 562 (41 %) were female and 794 male." }, { "field": "population", "quote": "Pilonidal disease is a common, disruptive condition in adolescents." }, { "field": "intervention", "quote": "We studied the effects of pilonidal disease on adolescents by gender." }, { "field": "comparator", "quote": "We studied the effects of pilonidal disease on adolescents by gender." }, { "field": "primaryOutcome", "quote": "Prospectively collected data on demographics, mental health comorbidities, disease severity, hirsutism, disease-related quality of life impact, interventions, and outcomes were retrieved from a Pilonidal Care Clinic REDCap database and were analyzed by gender." }, { "field": "result", "quote": "Pilonidal disease has different impacts on females than males including: earlier onset, higher incidence of anxiety, and greater disease-related impact on quality of life, despite lower disease severity on presentation." } ] }, { "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 with pilonidal sinus disease", "intervention": "surgical and non-surgical treatments for pilonidal sinus", "comparator": "different treatment approaches (excision, primary closure, minimally invasive techniques) compared to each other", "primaryOutcome": "complications, recurrence, and healing after treatment", "result": "Pilonidal sinus can cause abscess and suppuration requiring emergency drainage, and surgical treatments carry notable risks of recurrence, infection, or failure to heal", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a narrative review describing typical management and outcomes without presenting new controlled data or statistics on danger.", "directness": "direct", "limitations": "Narrative review format without systematic methodology or pooled data; does not report specific study numbers or control comparisons.", "followUp": "", "plainFinding": "Can cause abscess; surgery has real recurrence risk", "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": "intervention", "quote": "Radical excision followed by secondary healing is the most commonly performed option." }, { "field": "comparator", "quote": "Primary closure after excision can reduce the time for healing and convalescence, but at the cost of more frequent infectious complications." }, { "field": "primaryOutcome", "quote": "This strategy carries a risk of failure or recurrence for at least 10% of patients." }, { "field": "result", "quote": "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." }, { "field": "result", "quote": "This strategy carries a risk of failure or recurrence for at least 10% of patients." } ] }, { "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": "man in his mid-30s with pilonidal sinus abscesses in both the back of the neck and the tailbone area", "intervention": "surgical removal of the sinus tracts (neck excision and wide local excision with Limberg flap reconstruction for the tailbone area)", "comparator": "none", "primaryOutcome": "healing and recurrence after surgery", "result": "complete healing with no recurrence one year after surgery", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how often pilonidal cysts cause problems or how risky they generally are.", "directness": "indirect", "limitations": "Single case report; extremely rare presentation (concurrent neck and sacrococcygeal sinuses); no comparison group; cannot generalise to typical pilonidal cyst risk.", "followUp": "One year", "plainFinding": "Rare case, surgery healed both sites.", "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": "The patient, in his mid-30s, presented with recurrent swelling and discharging sinuses" }, { "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": "comparator", "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." } ] }, { "id": "pmid:39544170", "pmid": "39544170", "doi": "10.1177/00031348241300362", "nctId": null, "pmcid": null, "title": "Pathological Examination in Pilonidal Sinus Surgery: Evaluating Necessity and Cost-Effectiveness: A 10-Year Retrospective Analysis", "firstAuthor": "Kudaş", "multipleAuthors": true, "journal": "Am Surg", "year": 2025, "design": "retrospective", "n": 1505, "nField": "reported", "population": "patients who had surgery to remove a pilonidal sinus/cyst", "intervention": "surgical removal of the pilonidal sinus with tissue sent for pathology testing", "comparator": "no separate comparison group; all removed tissue examined for cancer", "primaryOutcome": "how often cancer (squamous cell carcinoma) was found in the removed tissue", "result": "Only 2 of 1505 patients (0.13%) had cancer in the removed tissue; being over 40 and having the cyst for more than 3 years raised the risk", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a retrospective chart review with no control group and excluded incomplete records, which can bias the results.", "directness": "direct", "limitations": "Retrospective design, patients with incomplete pathology data were excluded without replacing the missing information.", "followUp": "2-year follow-up", "plainFinding": "Cancer in pilonidal cysts is very rare.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39544170/", "sourceText": "BackgroundMalignancy in pilonidal sinus disease (PSD) is rare, with squamous cell carcinoma (SCC) being the most common type. This study aims to assess the incidence of malignancy in PSD and identify risk factors to guide more targeted pathological examination strategies.MethodsA retrospective analysis was conducted on 1505 patients who underwent surgical excision of PSD between January 1, 2014, and December 31, 2023. Patients with incomplete or missing histopathological data were excluded, and no imputation methods were used for missing data. All specimens underwent histopathological examination to detect malignancies.ResultsTwo cases (0.13%) of SCC were identified, both in males aged 50 and 58 years without a history of Crohn's disease, HIV, prior radiation, or other cancers. Significant risk factors for malignancy included age over 40 years (OR 3.2, 95% CI 1.1-9.5) and disease duration over 3 years (OR 2.8, 95% CI 1.0-7.6). Both cases were treated surgically and received adjuvant radiotherapy, with both patients being disease-free at the 2-year follow-up.ConclusionWhile malignancy in PSD is rare (0.13%), older age and prolonged disease duration are associated with increased risk. Selective pathological examination based on these risk factors could enhance cost-effectiveness by reducing unnecessary routine examinations.", "provenance": [ { "field": "n", "quote": "A retrospective analysis was conducted on 1505 patients who underwent surgical excision of PSD" }, { "field": "population", "quote": "patients who underwent surgical excision of PSD between January 1, 2014, and December 31, 2023" }, { "field": "intervention", "quote": "All specimens underwent histopathological examination to detect malignancies" }, { "field": "comparator", "quote": "All specimens underwent histopathological examination to detect malignancies" }, { "field": "primaryOutcome", "quote": "This study aims to assess the incidence of malignancy in PSD" }, { "field": "result", "quote": "Two cases (0.13%) of SCC were identified, both in males aged 50 and 58 years" }, { "field": "followUp", "quote": "both patients being disease-free at the 2-year follow-up" } ] }, { "id": "pmid:39212563", "pmid": "39212563", "doi": "10.12968/hmed.2024.0171", "nctId": null, "pmcid": null, "title": "Parathyroid Hormone Related Protein Mediated Hypercalcaemia Due to Metastatic Squamous Cell Carcinoma Originating from Pilonidal Disease: A Case Report", "firstAuthor": "Montebello", "multipleAuthors": true, "journal": "Br J Hosp Med (Lond)", "year": 2024, "design": "case-series", "n": 1, "nField": "reported", "population": "56-year-old man with a long-standing, worsening, painful skin lesion near the tailbone, initially thought to be a pilonidal abscess", "intervention": "Surgery, radiotherapy, chemotherapy and immunotherapy for cancer that developed from the pilonidal area", "comparator": "", "primaryOutcome": "Disease progression and survival after diagnosis of cancer arising from pilonidal disease", "result": "He developed severe hormone-related high calcium levels, his cancer spread widely, and he died within a year of diagnosis", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how often this happens or what causes it.", "directness": "direct", "limitations": "Only one patient; a case report cannot establish how common this complication is or prove pilonidal disease caused the cancer.", "followUp": "", "plainFinding": "Rare fatal cancer from pilonidal disease.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39212563/", "sourceText": "A 56-year-old male presented with a longstanding, gradually enlarging, painful, skin lesion over the natal cleft. This was initially thought to be a pilonidal abscess but, following multiple surgeries, he was diagnosed with Stage IVb squamous cell carcinoma of the natal cleft skin with bilateral inguinal lymph node metastases and subcutaneous metastatic deposits. Complete surgical cure was not possible. He underwent radiotherapy, cisplatin chemotherapy and cemiplimab immunotherapy to control his disease. His course was complicated by severe humoral hypercalcaemia of malignancy (HHM) resistant to medical therapy. His disease progressed, and he developed widespread metastases. He was thus transferred to palliative care with pain control being the major priority. He died within a year of diagnosis.", "provenance": [ { "field": "population", "quote": "A 56-year-old male presented with a longstanding, gradually enlarging, painful, skin lesion over the natal cleft." }, { "field": "population", "quote": "This was initially thought to be a pilonidal abscess but, following multiple surgeries, he was diagnosed with Stage IVb squamous cell carcinoma of the natal cleft skin with bilateral inguinal lymph node metastases and subcutaneous metastatic deposits." }, { "field": "intervention", "quote": "He underwent radiotherapy, cisplatin chemotherapy and cemiplimab immunotherapy to control his disease." }, { "field": "primaryOutcome", "quote": "His course was complicated by severe humoral hypercalcaemia of malignancy (HHM) resistant to medical therapy." }, { "field": "result", "quote": "His disease progressed, and he developed widespread metastases." }, { "field": "result", "quote": "He died within a year of diagnosis." }, { "field": "n", "quote": "A 56-year-old male presented" } ] }, { "id": "pmid:38677816", "pmid": "38677816", "doi": "10.1016/j.suc.2023.11.003", "nctId": null, "pmcid": null, "title": "Management of Pilonidal Disease and Hidradenitis Suppurativa", "firstAuthor": "Singh", "multipleAuthors": true, "journal": "Surg Clin North Am", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "young adults with pilonidal disease or hidradenitis suppurativa", "intervention": "hair removal and surgical treatment for pilonidal disease; topical agents, antibiotics, biologics, and excision for hidradenitis suppurativa", "comparator": "", "primaryOutcome": "", "result": "", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general review summarizing management strategies without presenting original data or outcome results, so it offers no evidence for weighing effectiveness or danger.", "directness": "indirect", "limitations": "No original data, no outcome measures, no information on complications or danger of pilonidal cysts; purely a management overview.", "followUp": "", "plainFinding": "Describes treatments, not danger or outcomes.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38677816/", "sourceText": "Pilonidal disease and hidradenitis suppurativa affect healthy young adults, causing discomfort and pain that leads to loss of work productivity and should be approached in a personalized manner. Patients with pilonidal disease should engage in hair removal to the sacrococcygeal region and surgical options considered. Hidradenitis suppurativa can be a morbid and challenging disease process. Medical management with topical agents, antibiotics, and biologics should be used initially but wide local excision should be considered in severe or refractory cases of the disease.", "provenance": [ { "field": "population", "quote": "Pilonidal disease and hidradenitis suppurativa affect healthy young adults, causing discomfort and pain that leads to loss of work productivity and should be approached in a personalized manner." }, { "field": "intervention", "quote": "Patients with pilonidal disease should engage in hair removal to the sacrococcygeal region and surgical options considered." }, { "field": "intervention", "quote": "Medical management with topical agents, antibiotics, and biologics should be used initially but wide local excision should be considered in severe or refractory cases of the disease." } ] }, { "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": "presence of seborrheic dermatitis, obesity, acne, or psychiatric conditions", "comparator": "patients without these comorbidities", "primaryOutcome": "wound healing problems and recurrence after surgery", "result": "patients with seborrheic dermatitis, obesity, or psychiatric diagnoses were more likely to have poor wound healing or recurrence after surgery", "resultDirection": "harm", "quality": "low", "qualityWhy": "this is a retrospective single-center study without a control group testing a treatment, so it can show associations but not prove cause or treatment benefit", "directness": "indirect", "limitations": "retrospective design, single clinic, no comparison of a treatment or prevention strategy", "followUp": "", "plainFinding": "Certain conditions linked to worse healing, recurrence.", "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": "282 adolescent patients operated on in our clinic between 2014 and 2021" }, { "field": "intervention", "quote": "Seborrheic dermatitis, obesity and psychiatric diagnoses showed high statistical association with group 3 and acne with group 4." }, { "field": "comparator", "quote": "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." }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:37195200", "pmid": "37195200", "doi": "10.1002/jso.27319", "nctId": null, "pmcid": null, "title": "Pilonidal sinus disease carcinoma: Survival and recurrence analysis", "firstAuthor": "Safadi", "multipleAuthors": true, "journal": "J Surg Oncol", "year": 2023, "design": "retrospective", "n": 140, "nField": "reported", "population": "people who developed cancer arising from long-standing pilonidal sinus disease", "intervention": "having pilonidal sinus disease that progressed to carcinoma", "comparator": "different cancer stages and tumor grades compared to each other", "primaryOutcome": "survival and cancer recurrence rates", "result": "survival worsened with higher cancer stage and poorer tumor grade, and nearly half of patients had the cancer come back", "resultDirection": "harm", "quality": "low", "qualityWhy": "this is a retrospective pooling of published case reports collected over more than a century, which carries a high risk of bias and selective reporting", "directness": "indirect", "limitations": "retrospective literature search spanning 1900-2022, relies on published case reports, follow-up data missing in some cases, and this concerns the rare carcinoma complication rather than pilonidal cysts in general", "followUp": "", "plainFinding": "Rare cancer form has poor survival", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37195200/", "sourceText": "BACKGROUND: The study aims to determine the survival and recurrence rates of pilonidal sinus disease (PSD) carcinoma. METHODS: The data were collected retrospectively by searching the worldwide literature for all reports of carcinoma developing on the background of PSD. The results were presented using Kaplan-Meier curves. RESULTS: Between 1900 and 2022, 140 cases of PSD carcinoma were published in 103 papers, with follow-up data available in 111 cases. Squamous cell carcinoma constituted 94.6% of the cases (n = 105). The disease-specific survival rate was 61.7% for 3 years, 59.8% for 5 years, and 53.2% for 10 years. There was a significant survival difference between stages: 80.0% in stages I and II, 70.8% in stage III, and 47.8% in stage IV (p = 0.01). The 5-year survival in G1-tumors was better than G2 and G3-tumors at 70.5% and 32.0%, respectively (p = 0.002). Recurrence occurred in 46.6% of the patients. The time-to-recurrence in patients treated with curative intention averaged 15.1 months (1-132 months). Local, regional, and distant recurrence was observed in 75.6%, 33.3%, and 28.9% of the recurrent tumors, respectively. CONCLUSIONS: Pilonidal sinus carcinoma has a worse prognosis than primary cutaneous squamous cell carcinoma. Poor prognostic factors include advanced-stage disease and poor differentiation.", "provenance": [ { "field": "n", "quote": "140 cases of PSD carcinoma were published in 103 papers" }, { "field": "population", "quote": "all reports of carcinoma developing on the background of PSD" }, { "field": "intervention", "quote": "carcinoma developing on the background of PSD" }, { "field": "comparator", "quote": "significant survival difference between stages: 80.0% in stages I and II, 70.8% in stage III, and 47.8% in stage IV" }, { "field": "primaryOutcome", "quote": "The study aims to determine the survival and recurrence rates of pilonidal sinus disease (PSD) carcinoma." }, { "field": "result", "quote": "Pilonidal sinus carcinoma has a worse prognosis than primary cutaneous squamous cell carcinoma. Poor prognostic factors include advanced-stage disease and poor differentiation." }, { "field": "result", "quote": "Recurrence occurred in 46.6% of the patients." } ] }, { "id": "pmid:37023351", "pmid": "37023351", "doi": "10.25270/wnds/22078", "nctId": null, "pmcid": null, "title": "Pilonidal disease of the anterior perineum: an unusual presentation and review of current practice guidelines", "firstAuthor": "Matera", "multipleAuthors": true, "journal": "Wounds", "year": 2023, "design": "case-series", "n": 1, "nField": "reported", "population": "20-year-old man with recurrent pilonidal abscesses, with unusual anterior perineum involvement", "intervention": "Bascom cleft lift surgery, with hair removal for the anterior perineal pits", "comparator": "", "primaryOutcome": "Surgical management and resolution of pilonidal disease", "result": "The man had surgery for the gluteal disease and hair removal for the unusual perineal pits; the abstract does not report long-term outcome data", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a single case report, which cannot show whether the condition is generally dangerous or how treatment affects outcomes.", "directness": "indirect", "limitations": "Single case report describing a rare anatomical presentation; no outcome follow-up or safety data on danger of pilonidal cysts in general is given.", "followUp": "", "plainFinding": "Case report, no danger data.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37023351/", "sourceText": "INTRODUCTION: Pilonidal disease is a common condition of the gluteal cleft region, but involvement of the anterior perineum is rarely reported. Surgical options for gluteal cleft disease include simple fistulotomy, excisional procedures with primary closure (ie, Bascom cleft lift, Karydakis and Limberg flaps), or excision with secondary healing. The Bascom cleft lift described here is an excisional procedure involving a rotational flap with an off-midline closure. Deep tissue is salvaged allowing for proper contouring of the gluteal cleft, resulting in a cosmetically pleasing result. CASE REPORT: A 20-year-old man with recurrent pilonidal abscesses of the gluteal cleft underwent a Bascom cleft lift procedure for definitive care of his disease. During the procedure, involvement of the anterior perineum was found. Given the location of the pits relative to the flap, the anterior perineal disease was treated only with removal of hair from within the pits and clipping the hair of the perineum. CONCLUSION: While this case highlights the current standard of care and surgical options for pilonidal disease, the ideal surgical options for rare cases of pilonidal disease of the anterior perineum remain to be determined.", "provenance": [ { "field": "population", "quote": "A 20-year-old man with recurrent pilonidal abscesses of the gluteal cleft underwent a Bascom cleft lift procedure for definitive care of his disease." }, { "field": "intervention", "quote": "underwent a Bascom cleft lift procedure for definitive care of his disease" }, { "field": "intervention", "quote": "the anterior perineal disease was treated only with removal of hair from within the pits and clipping the hair of the perineum" }, { "field": "primaryOutcome", "quote": "this case highlights the current standard of care and surgical options for pilonidal disease" }, { "field": "result", "quote": "the ideal surgical options for rare cases of pilonidal disease of the anterior perineum remain to be determined" }, { "field": "n", "quote": "A 20-year-old man" } ] }, { "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": "case-series", "n": 92, "nField": "reported", "population": "adults with chronic pilonidal sinus disease who had minimally invasive laser surgery", "intervention": "laser-assisted closure (SiLaC) surgery for pilonidal sinus", "comparator": "no comparison group; all patients received the same laser procedure", "primaryOutcome": "complete healing of the pilonidal sinus", "result": "81.3% of patients achieved complete healing, with about 10% having recurrence or non-healing disease", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective, single-arm case series without a comparison group, so it can't show how well the surgery works compared with other options.", "directness": "indirect", "limitations": "Retrospective analysis, no control group, single-center experience, and one patient lost to follow-up.", "followUp": "", "plainFinding": "High healing rate after laser surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36888964/", "sourceText": "Background: Management of pilonidal sinus (PNS) disease has changed notably in the past decade, with the introduction of novel surgical techniques and technological innovation. In this study, we summarized our initial experience with sinus laser-assisted closure (SiLaC) of pilonidal disease. Methods: A retrospective analysis of a prospective database of all patients who underwent minimally invasive surgery combined with laser therapy for PNS between September 2018 and December 2020 was performed. Patients' demographics, clinical and perioperative data, as well postoperative outcomes were recorded and analyzed. Results: A total of 92 patients (86 males, 93.4%) underwent SiLaC surgery for pilonidal sinus disease during the study period. Patients' median age was 22 (range 16-62 years), and 60.8% of them previously underwent abscess drainage due to PNS. SiLaC was performed under local anesthesia in 85.7% of cases (78 patients) with a median energy of 1081 J (range 13-5035 J). One patient was lost to follow-up, leaving 91 patients for final analysis. The primary outcome was complete healing rate, standing at 81.3% (74/91 patients). In 8 patients (8.8%), there was minor incomplete healing that did not require reintervention. Recurrent/nonhealing disease was seen in 9 patients (9.9%), requiring reoperation in 7 patients (8.4%). Of those, 4 patients underwent repeat SiLaC and 3 patients underwent wide excision. Analysis of risk factors for PNS recurrence demonstrated that general anesthesia (P = .02) was associated with increased risk for recurrence along with a trend for increased risk in patients with significant hairiness (P = .078). No differences were seen in age (P = .621), gender (P = .475), median sinus length (P = .397), and energy used (P = .904). Conclusion: Primary healing rate after SiLaC surgery for chronic PNS was >80% in our series. Ten percent of patients did not achieve complete healing but did not require surgery due to lack of symptoms.", "provenance": [ { "field": "n", "quote": "A total of 92 patients (86 males, 93.4%) underwent SiLaC surgery for pilonidal sinus disease during the study period." }, { "field": "population", "quote": "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." }, { "field": "intervention", "quote": "sinus laser-assisted closure (SiLaC) of pilonidal disease" }, { "field": "comparator", "quote": "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." }, { "field": "primaryOutcome", "quote": "The primary outcome was complete healing rate, standing at 81.3% (74/91 patients)." }, { "field": "result", "quote": "The primary outcome was complete healing rate, standing at 81.3% (74/91 patients)." } ] }, { "id": "pmid:36542008", "pmid": "36542008", "doi": "10.1590/0102-672020220002e1713", "nctId": null, "pmcid": "PMC9767422", "title": "RADICAL VERSUS CONSERVATIVE METHODS IN ONE-STAGE PILONIDAL ABSCESS SURGERY: THE EXPERIENCE OF A TUNISIAN CENTER", "firstAuthor": "Mahjoubi", "multipleAuthors": true, "journal": "Arq Bras Cir Dig", "year": 2022, "design": "retrospective", "n": 57, "nField": "reported", "population": "patients having surgery for a pilonidal abscess", "intervention": "radical surgery (excision)", "comparator": "conservative surgery (incision, curettage, or drainage)", "primaryOutcome": "recurrence of the abscess, complications, healing time, and return to activity", "result": "Excision had lower recurrence but slower wound healing and longer time to return to activity than incision", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a small retrospective study comparing surgical techniques, not addressing the danger of pilonidal cysts directly, so it carries little weight for that question.", "directness": "indirect", "limitations": "Retrospective design, small sample size, no randomization, and it studied abscess surgery outcomes rather than the inherent danger of pilonidal cysts.", "followUp": "", "plainFinding": "Excision fewer recurrences, slower healing.", "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" }, { "field": "n", "quote": "We analyzed 57 patients" }, { "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" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:36268754", "pmid": "36268754", "doi": "10.1111/codi.16383", "nctId": null, "pmcid": null, "title": "Long-term outcome after Bascom's pit-pick procedure for pilonidal sinus disease: A cohort study", "firstAuthor": "Serup", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2023, "design": "retrospective", "n": 158, "nField": "reported", "population": "patients with simple pilonidal sinus disease who had a specific minor surgery called Bascom's pit-pick procedure", "intervention": "Bascom's pit-pick procedure (a minor surgical technique for pilonidal sinus)", "comparator": "", "primaryOutcome": "long-term risk of treatment failure, incomplete wound healing, recurrence, complications, pain and cosmetic satisfaction", "result": "68% treatment success; 10-year cumulative recurrence rate was 27%; more than 90% had no complications or chronic pain; over 70% were satisfied with cosmetic appearance", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it followed a reasonably large group of patients for many years, but there was no comparison group and it relied partly on patient surveys.", "directness": "indirect", "limitations": "No comparator group, relies on patient self-report via survey/telephone interview, single-center database, and results apply only to this specific surgical technique rather than to the natural course of untreated pilonidal disease.", "followUp": "7.98 (0.66, 10.96) years", "plainFinding": "Most patients healed well long-term.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36268754/", "sourceText": "AIM: Previous studies have shown favourable short-term results after Bascom's pit-pick procedure for simple pilonidal sinus disease. A minimum 5-year follow-up is considered the gold standard but only a few long-term studies have previously been reported. Here, we aimed to estimate the long-term risk of treatment failure, incomplete wound healing or recurrence, postoperative complications and patient reported outcome measures such as chronic pain and satisfaction with cosmetic appearance. METHODS: Medical records of patients registered in a local database after undergoing Bascom's pit-pick procedure were reviewed and follow-up data updated. The patients received an online survey including questions about demographics, lifestyle, complications, reintervention, pain, satisfaction with cosmetic appearance and supplemented with telephone interviews if no response was received. RESULTS: A total of 158 patients underwent Bascom's pit-pick procedure during the period August 2007 to March 2014. Median follow-up was 7.98 (0.66, 10.96) years. Twelve patients (8%) had reintervention due to incomplete wound healing. A total of 32 patients experienced a recurrence. In competing risk analyses, the 10-year cumulative recurrence rate was 27% (95% CI: 19%-35%) of patients with complete wound healing. Treatment success was 68%. Recurrence was associated with active smoking, HR of 5.30 (95% CI: 1.42-19.86; p = 0.01), and number of primary pits ≥3, HR of 5.11 (95% CI: 1.49-17.47; p = 0.01). More than 90% had no postoperative complications or chronic pain, and more than 70% reported a high satisfaction with the cosmetic appearance. CONCLUSION: Bascom's pit-pick seems to be adequate treatment for most patients with a simple pilonidal sinus.", "provenance": [ { "field": "n", "quote": "A total of 158 patients underwent Bascom's pit-pick procedure during the period August 2007 to March 2014." }, { "field": "population", "quote": "Previous studies have shown favourable short-term results after Bascom's pit-pick procedure for simple pilonidal sinus disease." }, { "field": "intervention", "quote": "Bascom's pit-pick procedure" }, { "field": "primaryOutcome", "quote": "we aimed to estimate the long-term risk of treatment failure, incomplete wound healing or recurrence, postoperative complications and patient reported outcome measures such as chronic pain and satisfaction with cosmetic appearance" }, { "field": "result", "quote": "Treatment success was 68%." }, { "field": "result", "quote": "the 10-year cumulative recurrence rate was 27% (95% CI: 19%-35%) of patients with complete wound healing" }, { "field": "result", "quote": "More than 90% had no postoperative complications or chronic pain, and more than 70% reported a high satisfaction with the cosmetic appearance." }, { "field": "followUp", "quote": "Median follow-up was 7.98 (0.66, 10.96) years." } ] }, { "id": "pmid:35636935", "pmid": "35636935", "doi": "10.24875/CIRU.20001422", "nctId": null, "pmcid": null, "title": "Neoplastic degeneration of chronic sacrococcygeal pilonidal sinus: report of seven cases and literature review", "firstAuthor": "Couto-González", "multipleAuthors": true, "journal": "Cir Cir", "year": 2022, "design": "case-series", "n": 7, "nField": "reported", "population": "men with long-standing pilonidal sinus disease who developed cancer at the site", "intervention": "no treatment tested; study looked at tumor growth pattern (ulcerative vs exophytic) in cases of cancer arising from pilonidal sinus", "comparator": "ulcerative tumor pattern compared with exophytic tumor pattern", "primaryOutcome": "survival and spread of the cancer depending on tumor growth pattern", "result": "patients with ulcerative tumors had nerve and deep tissue invasion and lymph node spread and died after about 7 months, while patients with exophytic tumors had no invasion and all survived over an average of 70.5 months", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a small retrospective review of only seven patients with no comparison group, so it can only show that this rare complication happens, not how often.", "directness": "direct", "limitations": "retrospective design, very small number of cases, single institution, long and variable follow-up", "followUp": "70.5 months", "plainFinding": "Rare but sometimes fatal cancer complication.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35636935/", "sourceText": "INTRODUCTION: Neoplastic degeneration is an uncommon but extremely serious complication of pilonidal sinus (PS) disease. We pretend to determine the factors that influence in the prognosis of the neoplastic disease assessing clinical features and histological findings. MATERIALS AND METHODS: We retrospectively studied the patients diagnosed of malignization of PS in our institution from 2000 to 2019. RESULTS: Seven male patients with a mean age at diagnosis of 64.8 years old were collected. Average time between the initial symptoms of PS disease and the tumor diagnosis was 33.7 years. The patients presenting an ulcerative pattern in the primary tumor showed in all the cases perineural invasion, local deep structures infiltration, and neoplastic dissemination to the regional lymph nodes. All these patients died in an average time of 7 months. On the other hand, patients with exophytic patterns in the primary tumor did not present local invasion or regional nodes affectation. All the cases survive with an average follow-up of 70.5 months. CONCLUSIONS: Ulcerated lesions clearly show a worse prognosis than tumors with exophytic morphology. Factors as perineural infiltration, local deep structures infiltration, or regional lymph node involvement dramatically decrease survival rates.", "provenance": [ { "field": "n", "quote": "Seven male patients with a mean age at diagnosis of 64.8 years old were collected." }, { "field": "population", "quote": "patients diagnosed of malignization of PS in our institution from 2000 to 2019" }, { "field": "intervention", "quote": "The patients presenting an ulcerative pattern in the primary tumor showed in all the cases perineural invasion, local deep structures infiltration, and neoplastic dissemination to the regional lymph nodes." }, { "field": "comparator", "quote": "patients with exophytic patterns in the primary tumor did not present local invasion or regional nodes affectation" }, { "field": "primaryOutcome", "quote": "We pretend to determine the factors that influence in the prognosis of the neoplastic disease assessing clinical features and histological findings." }, { "field": "result", "quote": "All these patients died in an average time of 7 months." }, { "field": "result", "quote": "All the cases survive with an average follow-up of 70.5 months." }, { "field": "followUp", "quote": "average follow-up of 70.5 months" } ] }, { "id": "pmid:35293199", "pmid": "35293199", "doi": "10.4081/pmc.2022.281", "nctId": null, "pmcid": null, "title": "Minimally invasive pilonidal sinus disease (PSD) treatment in pediatric patients: A narrative review", "firstAuthor": "Cerulo", "multipleAuthors": true, "journal": "Pediatr Med Chir", "year": 2022, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "Children and teenagers with pilonidal sinus disease", "intervention": "Minimally invasive endoscopic surgery for pilonidal sinus", "comparator": "Open surgery for pilonidal sinus", "primaryOutcome": "Complications, pain, recovery time and satisfaction after treatment", "result": "Endoscopic approach linked to shorter surgery and recovery, less pain, higher satisfaction, and fewer complications than open surgery, but little pediatric-specific data exists", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a narrative review with little data specific to children and no numbers of patients given.", "directness": "indirect", "limitations": "Abstract states very poor reports are available in literature about pediatric population, and no study sizes or designs are detailed.", "followUp": "", "plainFinding": "Can cause infection or abscess.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35293199/", "sourceText": "Pilonidal sinus is a common disease of the natal cleft, which can lead to complications including infection and abscess formation. Various operative techniques are available options for the treatment of this pathology, but the ideal technique is still debatable. Analyzing the literature we found out that more recently minimally invasive approaches have been described. In particular, the mechanism of an endoscopic approach relies on the use of the endoscope without cutaneous tissue damage. Advantages include shorter operative time and time to discharge, which impact resource management in both primary and secondary care: patients undergoing endoscopic technique have a high satisfaction rate, probably due to the low level of postoperative pain and early return to daily activities. Published results of studies of newer approaches have demonstrated a lower short and long-term complication rate compared to open surgery. However, very poor reports are available in literature about pediatric population.", "provenance": [ { "field": "population", "quote": "very poor reports are available in literature about pediatric population" }, { "field": "intervention", "quote": "minimally invasive approaches have been described" }, { "field": "comparator", "quote": "compared to open surgery" }, { "field": "primaryOutcome", "quote": "Advantages include shorter operative time and time to discharge" }, { "field": "result", "quote": "Published results of studies of newer approaches have demonstrated a lower short and long-term complication rate compared to open surgery." }, { "field": "limitations", "quote": "very poor reports are available in literature about pediatric population" }, { "field": "plainFinding", "quote": "can lead to complications including infection and abscess formation" } ] }, { "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 with pilonidal sinus disease needing surgery", "intervention": "partial primary closure technique with suture modification", "comparator": "Karydakis flap surgical technique", "primaryOutcome": "hospital stay length, wound healing time, and surgical complications", "result": "Hospital stay was shorter with partial closure but not significantly so; healing took longer in uncomplicated cases; infections were more common with partial closure (21.7% vs 10%); but healing time was significantly shorter with partial closure in complicated cases", "resultDirection": "mixed", "quality": "low", "qualityWhy": "It is a randomized trial but with a small number of patients and results that varied by outcome, with some differences not reaching statistical significance.", "directness": "indirect", "limitations": "Small sample size (96 patients), some key differences were not statistically significant, and the study compares two surgical techniques rather than addressing the danger of the condition itself.", "followUp": "", "plainFinding": "Mixed results between two surgery methods.", "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": "n", "quote": "A total of 96 patients diagnosed with pilonidal sinus disease (PSD) were randomly assigned to two groups." }, { "field": "population", "quote": "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": "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" }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:34216557", "pmid": "34216557", "doi": "10.1016/j.nwh.2021.06.004", "nctId": null, "pmcid": null, "title": "Presentation, Management, and Women's Health Implications of Pilonidal Disease", "firstAuthor": "Rudd", "multipleAuthors": true, "journal": "Nurs Womens Health", "year": 2021, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal disease, especially women", "intervention": "clinical assessment, treatment, therapy, and patient education for pilonidal disease", "comparator": "", "primaryOutcome": "impact of pilonidal disease on quality of life and accurate diagnosis/care", "result": "Obtaining an accurate diagnosis and appropriate care can positively impact quality of life for people with PD", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review describing the disease and care approach without original data or comparative outcomes.", "directness": "indirect", "limitations": "No original data, outcomes, or study design details are reported; the abstract is descriptive and educational rather than evidence-based.", "followUp": "", "plainFinding": "Pilonidal disease impacts quality of life.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34216557/", "sourceText": "Many people think of pilonidal disease (PD) in its acute presentation, which is an abscess at the gluteal cleft that is warm and tender with purulent drainage. In this article, we describe how PD is an acute, chronic, and recurring disease that requires clinicians to be vigilant in assessments, treatments, therapies, referrals, and patient education. Because PD is more common in men than women, it is often misdiagnosed and undertreated in female patients. Its impact on an individual's life, work, and health, however, cannot be underestimated. Obtaining an accurate diagnosis and appropriate care can positively impact quality of life for people with PD.", "provenance": [ { "field": "population", "quote": "Because PD is more common in men than women, it is often misdiagnosed and undertreated in female patients." }, { "field": "intervention", "quote": "requires clinicians to be vigilant in assessments, treatments, therapies, referrals, and patient education" }, { "field": "result", "quote": "Obtaining an accurate diagnosis and appropriate care can positively impact quality of life for people with PD." }, { "field": "primaryOutcome", "quote": "Its impact on an individual's life, work, and health, however, cannot be underestimated." } ] }, { "id": "pmid:34158202", "pmid": "34158202", "doi": "10.1016/j.asjsur.2021.05.021", "nctId": null, "pmcid": null, "title": "Prognostic factors of flap techniques for pilonidal disease based on magnetic resonance imaging and clinical parameters", "firstAuthor": "Zou", "multipleAuthors": true, "journal": "Asian J Surg", "year": 2022, "design": "retrospective", "n": 100, "nField": "reported", "population": "patients with pilonidal sinus undergoing flap surgery", "intervention": "Limberg flap or Karydakis flap surgery", "comparator": "different MRI-measured anatomical parameters and patient factors", "primaryOutcome": "postoperative complications and recurrence", "result": "larger sinus diameter and skin thickness linked to early complications; less fat thickness linked to late complications; higher BMI linked to recurrence", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective study looking back at records, which can't prove cause and effect.", "directness": "indirect", "limitations": "Retrospective design; focuses on surgical complication risk factors rather than whether the cyst itself is dangerous.", "followUp": "42 (range, 20-90) months", "plainFinding": "Surgery risk factors identified, not danger of cyst itself.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34158202/", "sourceText": "BACKGROUND: Postoperative complications and recurrence are major diffficulties in the flap techniques for the treatment of pilonidal sinus (PS), however, the risk factors remain unclear. While magnetic resonance imaging (MRI) offers the highest soft tissue resolution, few studies have applied MRI to investigate the basic parameters of PS. METHODS: A total of 100 patients receiving Limberg flap (LF) or Karydakis flap (KF) surgery at the Sixth Affiliated Hospital of Sun Yat-Sen University were retrospectively analyzed, and the median follow-up period was 42 (range, 20-90) months. We performed a multivariate logistic analysis on the clinicopathological parameters and MRI data to identify risk factors for complications and recurrence. RESULTS: The basic parameters of PS were obtained by MRI analysis. The multivariate analysis revealed a large longitudinal sinus diameter (OR = 1.020, 95%CI = 1.000-1.041) and sacrococcygeal dermal thickness (OR = 1.680, 95%CI = 1.142-2.472) to be independent risk factors for early complications. Meanwhile, a small sacrococcygeal fat thickness (OR = 0.923, 95%CI = 0.864-0.987) and a high BMI (OR = 1.291, 95%CI = 1.067-1.563) are independent risk factors for late complications and recurrence, respectively. CONCLUSION: We used MRI to measure the basic parameters of PS accurately, including size, volume, location and some key points of the surrounding tissues, and identified, besides the selection of surgical approach, some specific basic parameters of PS might be the risk factors for complications and recurrence after flap techniques.", "provenance": [ { "field": "population", "quote": "100 patients receiving Limberg flap (LF) or Karydakis flap (KF) surgery" }, { "field": "intervention", "quote": "Limberg flap (LF) or Karydakis flap (KF) surgery" }, { "field": "comparator", "quote": "a multivariate logistic analysis on the clinicopathological parameters and MRI data to identify risk factors for complications and recurrence" }, { "field": "primaryOutcome", "quote": "Postoperative complications and recurrence are major diffficulties in the flap techniques" }, { "field": "result", "quote": "a large longitudinal sinus diameter (OR = 1.020, 95%CI = 1.000-1.041) and sacrococcygeal dermal thickness (OR = 1.680, 95%CI = 1.142-2.472) to be independent risk factors for early complications" }, { "field": "n", "quote": "A total of 100 patients receiving Limberg flap (LF) or Karydakis flap (KF) surgery" } ] }, { "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": "patients with acute pilonidal abscess or chronic pilonidal sinus", "intervention": "one-stage surgery with Limberg flap for acute pilonidal abscess", "comparator": "one-stage surgery with Limberg flap for chronic pilonidal sinus", "primaryOutcome": "wound healing problems and recurrence after surgery", "result": "similar wound healing issues in both groups (10% vs 17%) and no recurrences in the acute abscess group vs 11% in the chronic sinus group, neither difference statistically significant", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "small, non-randomized observational study with only 39 patients and no significant differences found.", "directness": "indirect", "limitations": "Small sample size, non-randomized observational design, no significant statistical differences found, single surgical technique only.", "followUp": "", "plainFinding": "Surgery outcomes similar for abscess, sinus.", "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": "a 1‑stage procedure using the Limberg flap method" }, { "field": "comparator", "quote": "chronic pilonidal sinus" }, { "field": "primaryOutcome", "quote": "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" }, { "field": "result", "quote": "a comparable rate of postoperative wound healing disorders (10% vs. 17%, p = 0.647)" }, { "field": "result", "quote": "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: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": "patients with pilonidal sinus disease having minimally invasive surgery", "intervention": "minimally invasive Trephine surgery to remove pilonidal sinus", "comparator": "none (single group followed over time, risk factors analyzed)", "primaryOutcome": "rate of disease recurrence or non-healing wound after surgery", "result": "About one third had recurrence or a wound that didn't heal; repeat surgery was successful in most who had it", "resultDirection": "mixed", "quality": "low", "qualityWhy": "It is a single-arm study with no comparison group and data were only available for 64% of patients, so recurrence rates may be biased.", "directness": "indirect", "limitations": "Only 64.2% of patients had data available; no control group; retrospective telephone survey used to assess recurrence", "followUp": "", "plainFinding": "High recurrence, but repeat surgery works well", "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": "patients who underwent PNS Excision by Trephine MIS Procedure" }, { "field": "intervention", "quote": "MIS Trephine procedure for PNS" }, { "field": "comparator", "quote": "A prospective cohort, including patients who underwent PNS Excision by Trephine MIS Procedure over 5 years" }, { "field": "primaryOutcome", "quote": "Overall recurrence and nonhealing wound rate was 33.07% (43 patients)" }, { "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)." }, { "field": "result", "quote": "Overall healing rate following repeat surgery was 91.5% (119 patients)." }, { "field": "n", "quote": "Two hundred three patients underwent MIS Trephine procedure for PNS, with data available on 130 patients (64.2%)." } ] }, { "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 pilonidal cyst disease", "intervention": "various surgical treatments for pilonidal disease", "comparator": "different surgical techniques compared to each other", "primaryOutcome": "wound healing, recurrence rate, and time off work", "result": "treatment should match disease type; no single method is painless, fast-healing, and low-recurrence; asymptomatic disease needs no treatment, abscesses need drainage, and chronic disease is treated with excision or flap procedures with trade-offs", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "This is an expert guideline based on a literature review rather than a single controlled trial, so it summarizes evidence but doesn't test one treatment directly.", "directness": "indirect", "limitations": "No single treatment method meets all desired criteria; guideline is based on systematic literature review rather than new trial data; does not directly address danger/risk of untreated disease.", "followUp": "", "plainFinding": "Asymptomatic cysts don't need treatment.", "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": "result", "quote": "Asymptomatic pilonidal disease should not be treated. A pilonidal abscess should be unroofed." }, { "field": "population", "quote": "Three types of disease manifestation could be differentiated: asymptomatic disease, an acute abscess, and the chronic pilonidal disease." }, { "field": "intervention", "quote": "sinus excision is the standard treatment of the chronic pilonidal disease" }, { "field": "comparator", "quote": "The Limberg flap and the Karydakis procedure are two best described methods which are associated with similar short- and long-term results." }, { "field": "primaryOutcome", "quote": "simple, painless procedure associated with rapid wound healing, and low recurrence rate" } ] }, { "id": "pmid:33630288", "pmid": "33630288", "doi": "10.14744/tjtes.2020.24374", "nctId": null, "pmcid": null, "title": "Cause of an acute abdomen never seen: Intraabdominal perforation of an umbilical pilonidal sinus abscess", "firstAuthor": "Mantoğlu", "multipleAuthors": true, "journal": "Ulus Travma Acil Cerrahi Derg", "year": 2021, "design": "case-series", "n": null, "nField": "not-reported", "population": "a person with umbilical pilonidal sinus who had never had symptoms before", "intervention": "no treatment (untreated umbilical pilonidal sinus)", "comparator": "none", "primaryOutcome": "development of acute abdomen", "result": "has caused acute abdomen", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single case report, so it cannot show how common or likely this outcome is.", "directness": "indirect", "limitations": "Single case report of umbilical (not sacrococcygeal) pilonidal sinus; no control group; case-based evidence only.", "followUp": "", "plainFinding": "Rare case of dangerous abdominal rupture.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33630288/", "sourceText": "Pilonidal sinus is a well-known disease of the sacrococcygeal region, which is caused by hair shafts penetrating the epidermis. The granulomatous reaction is the characteristic of this chronic inflammatory disease. Umbilical pilonidal sinus is an acquired disease that may appear in many guises and mimic several umbilical conditions. Several risk factors for developing the disease have been described. Treatment is based on clinical experience rather than on evidence-based medicine. The umbilical pilonidal sinus, which is not treated medically or surgically, may cause regional or generalized infections. We suggest that our case which has never had symptoms before and has caused acute abdomen, will be considered in the diagnosis of acute abdomen.", "provenance": [ { "field": "population", "quote": "our case which has never had symptoms before and has caused acute abdomen" }, { "field": "intervention", "quote": "The umbilical pilonidal sinus, which is not treated medically or surgically" }, { "field": "primaryOutcome", "quote": "may cause regional or generalized infections" }, { "field": "result", "quote": "has caused acute abdomen" }, { "field": "comparator", "quote": "Treatment is based on clinical experience rather than on evidence-based medicine." } ] }, { "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": "patients with an acute pilonidal abscess", "intervention": "early video-assisted ablation of pilonidal sinus (VAAPS) performed immediately", "comparator": "delayed VAAPS performed after incision and drainage", "primaryOutcome": "recurrence rate at 1, 3, and 5 years", "result": "no difference in recurrence between early and delayed treatment, but early treatment had better patient satisfaction and health status", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a retrospective, propensity-matched study with a small number of patients, so it can't prove the treatments are truly equal or better.", "directness": "indirect", "limitations": "Retrospective design with propensity score matching rather than randomization; small sample size", "followUp": "5-year", "plainFinding": "Similar recurrence, earlier treatment felt better", "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" }, { "field": "intervention", "quote": "early VAAPS group" }, { "field": "comparator", "quote": "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. 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)." }, { "field": "n", "quote": "82 patients were included in the final analysis (41 in each group)" } ] }, { "id": "pmid:31747369", "pmid": "31747369", "doi": null, "nctId": null, "pmcid": null, "title": "Effects of Bathing Habits on Postoperative Wound Complications Following Sacrococcygeal Pilonidal Sinus Surgery: A Retrospective Analysis of 67 Adolescent Patients", "firstAuthor": "Ferhatoglu", "multipleAuthors": true, "journal": "Wounds", "year": 2019, "design": "retrospective", "n": 67, "nField": "reported", "population": "adolescent patients who had surgery for sacrococcygeal pilonidal sinus disease", "intervention": "bathing more than twice per week after surgery", "comparator": "bathing twice per week or less after surgery", "primaryOutcome": "postoperative wound infection and wound separation", "result": "patients who bathed more than twice a week in the first 28 days after surgery had higher rates of wound infection; no difference in complications between 28 and 90 days", "resultDirection": "harm", "quality": "low", "qualityWhy": "it is a small, single-center retrospective chart review without randomization, so bathing habits could be linked to other unmeasured factors.", "directness": "indirect", "limitations": "Retrospective design, single center, no randomization, and the study looks at postoperative bathing habits rather than the underlying danger of the cyst itself.", "followUp": "90 days", "plainFinding": "Frequent bathing raised infection risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31747369/", "sourceText": "INTRODUCTION: Sacrococcygeal pilonidal sinus disease generally affects young people and impacts their quality of life. Few published studies assessing the characteristics of the disease in the adolescent population exist. OBJECTIVE: In this paper, the authors aim to evaluate the effects of bathing habits on wound complications in adolescent patients following Karydakis flap surgery for sacrococcygeal pilonidal sinus. MATERIALS AND METHODS: The medical records of 79 adolescent patients who underwent sacrococcygeal pilonidal sinus surgery between January 2014 and December 2017 at the Surgery Clinic of Malatya State Hospital (Malatya, Turkey) were evaluated retrospectively. Following exclusion, 67 patients were evaluated for demographics, body mass index (BMI), previous abscess formation, bathing frequency, number of sinus pits, and postoperative wound infection and dehiscence. The total follow-up time for the 67 patients was 90 days. RESULTS: The BMIs of patients with previous abscess formation were significantly higher (P = .029). In the cases with abscess, the number of pilonidal sinus pits was significantly higher (P = .039) There was a statistically significant difference between postoperative complication rates according to the number of baths per week. Wound infection rates were found to be higher in patients who bathed more than twice weekly during the 28 days after surgery (P = .005). No statistical significance was observed in complication rates from days 28 to 90 after the surgery between those who bathed twice weekly and more than twice weekly (P > .05). CONCLUSIONS: Postoperative wound complications in adolescent patients treated with Karydakis flap surgery for sacrococcygeal pilonidal sinus are more frequent in those who bathe more than twice weekly during the first 28 days postoperatively.", "provenance": [ { "field": "n", "quote": "67 patients were evaluated for demographics" }, { "field": "population", "quote": "79 adolescent patients who underwent sacrococcygeal pilonidal sinus surgery" }, { "field": "intervention", "quote": "Wound infection rates were found to be higher in patients who bathed more than twice weekly during the 28 days after surgery" }, { "field": "comparator", "quote": "No statistical significance was observed in complication rates from days 28 to 90 after the surgery between those who bathed twice weekly and more than twice weekly" }, { "field": "primaryOutcome", "quote": "postoperative wound infection and dehiscence" }, { "field": "result", "quote": "Wound infection rates were found to be higher in patients who bathed more than twice weekly during the 28 days after surgery (P = .005)." } ] }, { "id": "pmid:31511134", "pmid": "31511134", "doi": "10.21614/chirurgia.114.4.475", "nctId": null, "pmcid": null, "title": "Could Early Postoperative Complications be Considered as Risk Factor for Recurrence after Pilonidal Sinus Surgery?", "firstAuthor": "Demiryas", "multipleAuthors": true, "journal": "Chirurgia (Bucur)", "year": 2019, "design": "retrospective", "n": 841, "nField": "reported", "population": "patients with sacrococcygeal pilonidal disease who had surgery", "intervention": "Karydakis procedure for pilonidal sinus", "comparator": "modified Limberg flap procedure for pilonidal sinus", "primaryOutcome": "recurrence and early postoperative complications after surgery", "result": "Recurrence rate was 6% with Karydakis and 4.72% with modified Limberg flap, and wound dehiscence or infection were risk factors for recurrence in both groups", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a retrospective study comparing two surgical techniques without randomization, so it mainly shows associations with complications and recurrence rather than how dangerous the underlying cyst itself is.", "directness": "indirect", "limitations": "Retrospective design, single-surgeon approach, and no random assignment between surgical groups.", "followUp": "48.6 21.4 months in KP group and 48.2 +- 21.7 months in MLF group", "plainFinding": "Wound problems raise recurrence risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31511134/", "sourceText": "Background: There is no widespread consensus in treatment techniques of sacrococcygeal pilonidal disease (PD). Among surgical techniques, especially Karydakis procedure (KP) or modified Limberg flap (MLF), are frequently preferred. Causing prolonged follow-up and return to daily activity, postoperative complications are very annoying. We aimed to determine risk factors for possible complications and especially recurrence in the patients undergoing surgical treatment for PD. Methods: This is a seven-year retrospective study, which was conducted between January 2011 and January 2018. Eight hundred forty-one patients were evaluated in this work. We performed the same technique-the same surgeon approach in our surgical treatment. All cases were divided into two groups as KP (n=417) and MLF (n=424). Results: It was found no significant difference between the KP and MLF groups in terms of age, gender, BMI, smoking, history of acute abscess drainage (HAAD), the timing of suture removal, the follow-up period, seroma, hematoma, dehiscence, wound infection (WI), pain and recurrence. In this study, the follow-up period of patients was 48.6 21.4 months in KP group and 48.2 +- 21.7 months in MLF group (Mean - SD). American Society of Anesthesiologists (ASA) score were found to be higher in the KP group. While mean duration of operation (DO) was shorter in the KP group, the timing of drain removal, hospitalisation period and return to daily activity (RDA) were longer. There was an established enhancing effect of BMI, HAAD, DO, and RDA on the early complications (EC) development in both of the groups, and of ASA scores on the EC development in the KP group. The rate of recurrence ratio was determined to be 6% in the KP and 4.72% in the MLF groups. In both of the groups, dehiscence or WI was found to be risk factors for recurrence. Conclusion: Although its DO is short, KP technique bear some of the disadvantages such as prolonged HP and delayed RDA. A significant positive correlation was found between various factors such as higher BMI, presence of HAAD, prolonged DO, prolonged RDA and the development of EC in both groups. We concluded that dehiscence and WI from EC may be evaluated as independent risk factors for recurrence. We also concluded that recurrence may be prevented if wound care is carried out carefully in the patients who developed dehiscence or wound infection.", "provenance": [ { "field": "n", "quote": "Eight hundred forty-one patients were evaluated in this work." }, { "field": "population", "quote": "patients undergoing surgical treatment for PD" }, { "field": "intervention", "quote": "KP (n=417)" }, { "field": "comparator", "quote": "MLF (n=424)" }, { "field": "primaryOutcome", "quote": "We aimed to determine risk factors for possible complications and especially recurrence in the patients undergoing surgical treatment for PD." }, { "field": "result", "quote": "The rate of recurrence ratio was determined to be 6% in the KP and 4.72% in the MLF groups. In both of the groups, dehiscence or WI was found to be risk factors for recurrence." }, { "field": "followUp", "quote": "the follow-up period of patients was 48.6 21.4 months in KP group and 48.2 +- 21.7 months in MLF group" } ] }, { "id": "pmid:31293248", "pmid": "31293248", "doi": null, "nctId": null, "pmcid": null, "title": "A rare case of squamous cell carcinoma arising from chronic sacrococcygeal pilonidal disease", "firstAuthor": "Konrad Wroński", "multipleAuthors": false, "journal": "Ann Ital Chir", "year": 2019, "design": "case-series", "n": 1, "nField": "reported", "population": "Patient with long-term sacrococcygeal pilonidal cyst disease", "intervention": "No treatment tested; case description of cancer arising from chronic pilonidal disease", "comparator": "", "primaryOutcome": "Development of squamous cell skin cancer from chronic pilonidal cyst", "result": "One patient developed squamous cell carcinoma from long-standing pilonidal disease", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is a single case report, so it cannot show how often this happens or to whom.", "directness": "direct", "limitations": "Single case report with no control group or data on how common this is beyond a cited rate.", "followUp": "", "plainFinding": "Rare cancer from long-term cyst.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31293248/", "sourceText": "Pilonidal disease is a chronic disorder which is observed in boys and men between ages of 15 and 40 years old in Caucasian race. Malignant degeneration and carcinoma arising from chronic sacrococcygeal pilonidal disease are observed extremely rare and are described in the group of Marjolin cancer. Carcinoma can be seen on a place with long-term inflammation process as it was in the case described in the patient's article. First time squamous cell carcinoma arising from chronic sacrococcygeal pilonidal disease was described in 1900 by Wolff. The incidence of carcinoma arising in pilonidal disease is less than 0,1% and in the whole medical journals less than 100 patients are reported. This article presents the case of a patient with diagnosed squamous cell carcinoma arising from chronic sacrococcygeal pilonidal disease. In this article was presented the clinical features, pathogenesis, treatment options and prognosis of this rare disease. KEY WORDS: Pilonidal disease, Skin carcinoma, Squamous cell carcinoma, Surgery.", "provenance": [ { "field": "n", "quote": "This article presents the case of a patient with diagnosed squamous cell carcinoma arising from chronic sacrococcygeal pilonidal disease." }, { "field": "population", "quote": "Pilonidal disease is a chronic disorder which is observed in boys and men between ages of 15 and 40 years old in Caucasian race." }, { "field": "intervention", "quote": "This article presents the case of a patient with diagnosed squamous cell carcinoma arising from chronic sacrococcygeal pilonidal disease." }, { "field": "primaryOutcome", "quote": "Malignant degeneration and carcinoma arising from chronic sacrococcygeal pilonidal disease are observed extremely rare and are described in the group of Marjolin cancer." }, { "field": "result", "quote": "The incidence of carcinoma arising in pilonidal disease is less than 0,1% and in the whole medical journals less than 100 patients are reported." } ] }, { "id": "pmid:31215233", "pmid": "31215233", "doi": "10.5144/0256-4947.2019.192", "nctId": null, "pmcid": "PMC6832333", "title": "The endoscopic treatment of pilonidal sinus disease: a short-term case-series study", "firstAuthor": "Khafagy", "multipleAuthors": true, "journal": "Ann Saudi Med", "year": 2019, "design": "case-series", "n": 35, "nField": "reported", "population": "patients with long-term or recurring pilonidal sinus disease", "intervention": "endoscopic pilonidal sinus treatment (EPSiT) procedure", "comparator": "none (no comparison group)", "primaryOutcome": "pain control, wound complications, and recurrence rate", "result": "most patients had minimal pain and no serious wound complications, but 6% had the condition come back within 6 months", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a small single-group study with only 35 patients and just 6 months of follow-up, so it cannot say how dangerous the disease is or compare treatments reliably", "directness": "indirect", "limitations": "Short follow-up period with a small number of patients", "followUp": "6 months", "plainFinding": "Good short-term healing, some recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31215233/", "sourceText": "BACKGROUND: Pilonidal disease (PNS) is a common inflammatory disease that can significantly impact the quality of life of the patient. Previous open techniques for the management of this condition have been unsatisfactory, with high recurrence rates reported. OBJECTIVE: Investigate a new endoscopic procedure for the management of PNS disease. DESIGN: Case series. SETTING: Single hospital in Kuwait. PATIENTS: From April 2014 to October 2017, patients with symptomatic chronic or recurrent PNS were consecutively enrolled to undergo the endoscopic pilonidal sinus treatment (EPSiT) procedure. MAIN OUTCOME MEASURES: Control of pain, wound complications, recurrence rate over a 6-month follow up. SAMPLE SIZE: 35 patients. RESULTS: The mean age of the patients was 22 years, with 33 (94%) males. Fourteen (40%) presented with recurrent disease and were recommended to undergo an EPSiT procedure. A single tract was used in 32 (91%) of the cases, with an average operative time of 51 mins. On follow-up 5 patients reported minimal pain judging by the need of only mild analgesics for the control of pain. No patient experienced early wound complications necessitating hospitalization. There were 2 (6%) recurrences encountered by the time of the 6-month follow-up period. CONCLUSION: In these early results, the EPSiT procedure provided effective healing with acceptable recurrence rates and aesthetics. In addition, the procedure allows the surgeon to see the PNS, fistula tracts or any abscess cavities. LIMITATIONS: Short follow-up period with a small number of patients CONFLICTS OF INTEREST: None.", "provenance": [ { "field": "n", "quote": "SAMPLE SIZE: 35 patients." }, { "field": "population", "quote": "patients with symptomatic chronic or recurrent PNS" }, { "field": "intervention", "quote": "endoscopic pilonidal sinus treatment (EPSiT) procedure" }, { "field": "comparator", "quote": "Case series." }, { "field": "primaryOutcome", "quote": "Control of pain, wound complications, recurrence rate over a 6-month follow up." }, { "field": "result", "quote": "No patient experienced early wound complications necessitating hospitalization. There were 2 (6%) recurrences encountered by the time of the 6-month follow-up period." }, { "field": "limitations", "quote": "Short follow-up period with a small number of patients" }, { "field": "followUp", "quote": "6-month follow-up period" } ] }, { "id": "pmid:30936332", "pmid": "30936332", "doi": "10.1136/bcr-2018-227381", "nctId": null, "pmcid": "PMC6453299", "title": "Pilonidal abscess of the breast", "firstAuthor": "Keighley", "multipleAuthors": true, "journal": "BMJ Case Rep", "year": 2019, "design": "case-series", "n": 1, "nField": "reported", "population": "a 52-year-old woman who presented via the breast clinic complaining of nipple inversion and pain", "intervention": "surgical excision of the abscess cavity after antibiotics and needle aspiration failed", "comparator": "earlier antibiotic therapy and needle aspiration", "primaryOutcome": "whether the breast abscess resolved and what caused it", "result": "the abscess recurred despite antibiotic therapy and needle aspiration, and surgery was needed; histology showed it was a pilonidal abscess", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a single patient's case report, so it cannot show how often this happens or how dangerous it generally is.", "directness": "indirect", "limitations": "Single case report of an unusual body site (breast) rather than the typical natal cleft location, so it may not generalise to typical pilonidal cysts.", "followUp": "", "plainFinding": "Caused recurring abscess needing surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30936332/", "sourceText": "Pilonidal disease is a common condition, typically occurring in the natal cleft of adult males. Other sites of pilonidal sinus are rarely reported. We report a case of periareolar pilonidal abscess in the breast of a 52-year-old woman who presented via the breast clinic complaining of nipple inversion and pain. Clinical examination and imaging revealed an underlying abscess which recurred despite antibiotic therapy and needle aspiration; the patient therefore underwent surgical excision of the abscess cavity. Subsequent histology diagnosed pilonidal abscess, an important differential to consider in the case of breast abscess, particularly in cases that are slow to resolve or recur post-treatment.", "provenance": [ { "field": "population", "quote": "a case of periareolar pilonidal abscess in the breast of a 52-year-old woman who presented via the breast clinic complaining of nipple inversion and pain" }, { "field": "intervention", "quote": "the patient therefore underwent surgical excision of the abscess cavity" }, { "field": "comparator", "quote": "recurred despite antibiotic therapy and needle aspiration" }, { "field": "primaryOutcome", "quote": "Clinical examination and imaging revealed an underlying abscess which recurred despite antibiotic therapy and needle aspiration" }, { "field": "result", "quote": "Subsequent histology diagnosed pilonidal abscess, an important differential to consider in the case of breast abscess, particularly in cases that are slow to resolve or recur post-treatment." }, { "field": "n", "quote": "a 52-year-old woman" } ] }, { "id": "pmid:30771803", "pmid": "30771803", "doi": null, "nctId": null, "pmcid": null, "title": "Squamous carcinoma in pilonidalis sinus: case report and review of literature", "firstAuthor": "Delvecchio", "multipleAuthors": true, "journal": "G Chir", "year": 2019, "design": "case-series", "n": 1, "nField": "reported", "population": "an 83-year-old patient with a recurrence of pilonidal sinus after 30 years", "intervention": "surgical excision of the pilonidal sinus mass plus adjuvant radiotherapy", "comparator": "", "primaryOutcome": "whether cancer can develop from a long-standing pilonidal sinus", "result": "the chronic pilonidal sinus had turned into squamous cell carcinoma, occurring in about 0.1% of pilonidal sinus cases after 20-30 years of chronic abscess", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single patient case report combined with a literature review, so it cannot show how common this risk really is.", "directness": "direct", "limitations": "only one case is described and all other literature cited is also case reports, with no controlled data on actual risk.", "followUp": "5 years", "plainFinding": "Can rarely turn cancerous.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30771803/", "sourceText": "AIM: We report a case of squamous carcinoma arising from a pilonidal sinus. CASE REPORT: Patient of 83 years old, that after 30 years had a recurrence of pilonidal sinus revealed by a sacral abscess studied with pelvic CT scan and MRI. After clinical investigation, traditional open surgical technique was performed and pathologic studies revealed a squamous carcinoma. The patient performed a new CT scan with persistence of disease, and a second surgical look with mass excision until the presacral fascia and V-Y flap was performed. Histological exami-nation was found to be positive for squamous carcinoma on the margin and the patient underwent adjuvant radiotherapy cycles with a close follow-up with evidence of free disease survival. He died after 5 years for old age. DISCUSSION: The incidence of carcinoma arising from a pilonidalis sinus is about 0.1% and the most important risk factor is represented by a chronic abscess from 20-30 years. In literature there are about 100 cases. Gold standard treatment is surgery with complete excision of the presacral fascia, while radiotherapy decrease the risk of recurrence. CONCLUSION: All cases reported in literature are submitted as case report. Sacro-coccyxal fistula should be treated early because chronic inflammation can determine neoplastic degeneration. Histological examination should be performed routinely. Gold standard is surgery with wide excision. There is no evidence about the gold standard for the reconstructive time.", "provenance": [ { "field": "n", "quote": "Patient of 83 years old, that after 30 years had a recurrence of pilonidal sinus revealed by a sacral abscess" }, { "field": "population", "quote": "Patient of 83 years old, that after 30 years had a recurrence of pilonidal sinus revealed by a sacral abscess" }, { "field": "intervention", "quote": "a second surgical look with mass excision until the presacral fascia and V-Y flap was performed" }, { "field": "intervention", "quote": "the patient underwent adjuvant radiotherapy cycles" }, { "field": "primaryOutcome", "quote": "We report a case of squamous carcinoma arising from a pilonidal sinus." }, { "field": "result", "quote": "The incidence of carcinoma arising from a pilonidalis sinus is about 0.1% and the most important risk factor is represented by a chronic abscess from 20-30 years." } ] }, { "id": "pmid:30719564", "pmid": "30719564", "doi": "10.1007/s00384-019-03256-8", "nctId": null, "pmcid": null, "title": "Endoscopic pilonidal sinus treatment (EPSiT) in recurrent pilonidal disease: a prospective international multicenter study", "firstAuthor": "Meinero", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2019, "design": "prospective-cohort", "n": 122, "nField": "reported", "population": "patients with pilonidal disease that came back after previous surgery", "intervention": "endoscopic pilonidal sinus treatment (EPSiT), a minimally invasive surgery", "comparator": "no control group used; abstract only compares narratively to other unspecified techniques", "primaryOutcome": "wound healing rate and time, complications, recurrence, and quality of life", "result": "95% of patients healed completely, average healing time 29 days, recurrence in 5.1% of cases, and quality of life improved by 30 days", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a single-arm study with no comparison group, so it cannot show whether the disease itself is dangerous or how this treatment compares to others.", "directness": "indirect", "limitations": "No control/comparator group; abstract does not describe complication rates of untreated disease or dangerousness of the cyst itself.", "followUp": "", "plainFinding": "High healing rate after surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30719564/", "sourceText": "BACKGROUND: Pilonidal disease (PD) is a common disease of the natal cleft, which can lead to complications including infection and abscess formation. Various operative management options are available, but the ideal technique is still debatable. Recurrent PD after surgical treatment is frequent event for the 25-30% of cases. The present study evaluated endoscopic pilonidal sinus treatment (EPSiT) in recurrent and multi-recurrent PD. METHODS: Of the consecutive prospective patients with recurrent PD, 122 were enrolled in a prospective international multicenter study conducted at a secondary and tertiary colorectal surgery centers. Primary endpoint was to evaluate short- and long-term outcomes: healing rate/time, morbidity rate, re-recurrence rate, and patient's quality of life (QoL). RESULTS: Complete wound healing rate was occurred in 95% of the patient, with a mean complete wound healing time of 29 ± 12 days. The incomplete healing rate (5%) was significantly related to the number of external openings (p = 0.008), and recurrence was reported in six cases (5.1%). Normal daily activity was established on the first postoperative day, and the mean duration before patients returned to work was 3 days. QoL significantly increased between the preoperative stage and 30 days after the EPSiT procedure (45.3 vs. 7.9; p < 0.0001). CONCLUSIONS: The EPSiT procedure seems to be a safe and effective technique in treating even complex recurrent PD. It enables excellent short- and long-term outcomes than various other techniques that are more invasive.", "provenance": [ { "field": "population", "quote": "Of the consecutive prospective patients with recurrent PD, 122 were enrolled" }, { "field": "intervention", "quote": "endoscopic pilonidal sinus treatment (EPSiT)" }, { "field": "comparator", "quote": "It enables excellent short- and long-term outcomes than various other techniques that are more invasive." }, { "field": "primaryOutcome", "quote": "Primary endpoint was to evaluate short- and long-term outcomes: healing rate/time, morbidity rate, re-recurrence rate, and patient's quality of life (QoL)." }, { "field": "result", "quote": "Complete wound healing rate was occurred in 95% of the patient, with a mean complete wound healing time of 29 ± 12 days." }, { "field": "result", "quote": "recurrence was reported in six cases (5.1%)" }, { "field": "n", "quote": "122 were enrolled in a prospective international multicenter study" } ] }, { "id": "pmid:30268489", "pmid": "30268489", "doi": "10.1016/j.jpedsurg.2018.07.024", "nctId": null, "pmcid": null, "title": "Fibrin glue obliteration is safe, effective and minimally invasive as first line treatment for pilonidal sinus disease in children", "firstAuthor": "Hardy", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2019, "design": "case-series", "n": 18, "nField": "reported", "population": "children and teenagers with pilonidal sinus disease", "intervention": "fibrin glue obliteration of the pilonidal sinus", "comparator": "none (single-group review, with one patient eventually having formal excision)", "primaryOutcome": "recurrence and complications after treatment", "result": "Most needed only one procedure, one recurrence (5.6%), and two minor wound infections occurred", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a small single-surgeon case series of 18 patients with no comparison group, so it cannot reliably show how risky the underlying cyst is.", "directness": "indirect", "limitations": "Small sample size, single surgeon, no control group, and level IV evidence as stated by the authors.", "followUp": "52 weeks (17-102)", "plainFinding": "Glue treatment safe, low recurrence", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30268489/", "sourceText": "BACKGROUND / PURPOSE: Sacrococcygeal pilonidal sinus disease (PSD) has an incidence of 1.2-2.5/1000 in children. Onset is around puberty. Symptoms of recurrent abscess and chronic suppuration may interfere with education and social integration. Treatments should cause minimal disruption while having good cure and recurrence rates. Curettage and Fibrin glue obliteration (FGO) show promising results in adults. We present our experience of its use in children. METHODS: Review of all pediatric patients receiving FGO of pilonidal sinus performed by a single surgeon from September 2014 to February 2018. RESULTS: Eighteen patients were identified. Median age was 16 (range 15-17), 55.6% were male. All procedures were completed as day cases. Median operative duration was 14 .1 (6-29) min. Twelve patients required only 1 procedure, 4 required 2 procedures, 1 required 5 procedures and 1 elected for formal excision after 2 FGO treatments. Median return to normal activities was 3 days, with 1 day school absence. Two patients developed minor surgical site infections. Median follow-up was 52 weeks (17-102), during which time there was 1 recurrence (5.6%). CONCLUSION: This study demonstrates FGO is a safe, effective procedure for pediatric PNS, with results comparable to off-midline flap techniques and without the need for extensive tissue excision and the associated morbidity. LEVEL OF EVIDENCE: IV.", "provenance": [ { "field": "n", "quote": "Eighteen patients were identified." }, { "field": "population", "quote": "Review of all pediatric patients receiving FGO of pilonidal sinus" }, { "field": "intervention", "quote": "Fibrin glue obliteration (FGO)" }, { "field": "comparator", "quote": "1 elected for formal excision after 2 FGO treatments." }, { "field": "primaryOutcome", "quote": "Median follow-up was 52 weeks (17-102), during which time there was 1 recurrence (5.6%)." }, { "field": "result", "quote": "Two patients developed minor surgical site infections." }, { "field": "result", "quote": "Median follow-up was 52 weeks (17-102), during which time there was 1 recurrence (5.6%)." }, { "field": "followUp", "quote": "Median follow-up was 52 weeks (17-102)" } ] }, { "id": "pmid:30064734", "pmid": "30064734", "doi": "10.1016/j.surg.2018.05.046", "nctId": null, "pmcid": null, "title": "Treatment of pilonidal disease by minimal surgical excision under local anesthesia with healing by secondary intention: Results in over 500 patients", "firstAuthor": "Burney", "multipleAuthors": false, "journal": "Surgery", "year": 2018, "design": "case-series", "n": 570, "nField": "reported", "population": "patients with pilonidal disease treated surgically", "intervention": "minimal surgical excision under local anesthesia with wound healing by secondary intention", "comparator": "", "primaryOutcome": "wound healing time and rate of persistent or recurrent disease needing reoperation", "result": "3.2% of patients needed reoperation for persistent or recurrent disease; most healed afterward, with low overall morbidity", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a single surgeon's retrospective review of his own patients with no comparison group, so it mainly shows this doctor's own results rather than proof the approach is better than other options.", "directness": "indirect", "limitations": "Single-surgeon retrospective case series without a control group or randomization; relies on chart review and patient compliance.", "followUp": "mean follow-up was 4.7 years", "plainFinding": "Minor surgery, low recurrence rate.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30064734/", "sourceText": "BACKGROUND: The surgical treatment of pilonidal disease is highly variable. The present study examines the long-term results in over 500 patients treated by minimal but complete surgical excision under local anesthesia with healing by secondary intention using moist dressings. METHODS: Records of all patients I treated for pilonidal disease from 1978 to 2015 with at least 1 year of follow-up were reviewed. Symptoms, prior surgical treatments, extent of disease, number of clinic visits, length of time until wound healed, compliance with wound care instructions, and length of follow-up were recorded. RESULTS: Records were found for 570 patients; mean follow-up was 4.7 years. Two hundred forty-eight patients (44%) had a prior abscess requiring drainage; 80 had from 1 to 6 prior operations. Ninety-two percent of operations were performed under local anesthesia. Men had more extensive disease than women (5.2 vs 3.5 cm, P < .001) and took longer to heal (median 46 days in women, 51 days in men, P < .001). Eighteen patients (3.2%) had persistent or recurrent disease requiring reoperation, most often because of poor compliance with wound care instructions, and later healed. CONCLUSION: The majority of patients with pilonidal disease can be managed by simple, minimal excision of affected tissue under local anesthesia with healing by secondary intention. With careful attention to wound care, morbidity is minimal and the recurrence or failure rate is less than 5%.", "provenance": [ { "field": "population", "quote": "Records of all patients I treated for pilonidal disease from 1978 to 2015 with at least 1 year of follow-up were reviewed." }, { "field": "intervention", "quote": "minimal but complete surgical excision under local anesthesia with healing by secondary intention using moist dressings" }, { "field": "n", "quote": "Records were found for 570 patients" }, { "field": "primaryOutcome", "quote": "length of time until wound healed" }, { "field": "primaryOutcome", "quote": "Eighteen patients (3.2%) had persistent or recurrent disease requiring reoperation" }, { "field": "result", "quote": "Eighteen patients (3.2%) had persistent or recurrent disease requiring reoperation, most often because of poor compliance with wound care instructions, and later healed." }, { "field": "followUp", "quote": "mean follow-up was 4.7 years" } ] }, { "id": "pmid:29870307", "pmid": "29870307", "doi": "10.1089/sur.2018.020", "nctId": null, "pmcid": null, "title": "High Rate of Major Morbidity after Surgical Excision for Pilonidal Disease", "firstAuthor": "López", "multipleAuthors": true, "journal": "Surg Infect (Larchmt)", "year": 2018, "design": "retrospective", "n": 1932, "nField": "reported", "population": "patients with pilonidal disease undergoing initial surgical excision", "intervention": "surgical excision of pilonidal disease", "comparator": "", "primaryOutcome": "major surgical site complication or need for repeat surgery within one year", "result": "4.7% had a major complication, 8.0% needed repeat surgery, 8.7% had either within a year", "resultDirection": "harm", "quality": "low", "qualityWhy": "This is a retrospective database study without a comparison treatment group, so it shows complication rates but cannot prove cause or compare to other options.", "directness": "direct", "limitations": "Retrospective design using administrative hospital data, no comparator group, risk factors not controllable for all confounders.", "followUp": "one year", "plainFinding": "Surgery often causes complications or recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29870307/", "sourceText": "BACKGROUND: Recurrent pilonidal disease has been reported to occur in up to 30% of patients after their initial infection. Surgical resection is often performed to prevent recurrence of disease, however, morbidity after surgical excision from incision complications and disease recurrence is common. The aim of this study was to quantify major morbidity after initial pilonidal excision. PATIENTS AND METHODS: Patients with pilonidal disease who had initial excision procedures between 2011-2013 at hospitals reporting data to the Pediatric Health Information System (PHIS) were included. Predictors of the composite outcome of major surgical site complication or surgical re-excision within one year were evaluated using multivariable logistic regression models. Kaplan-Meier analysis was used to examine time to surgical re-excision. RESULTS: Of the 1,932 patients included, 4.7% (n = 138) had a major surgical site complication, 8.0% (n = 154) had a surgical re-excision, and 8.7% experienced either event within one year of their initial excision. The majority of re-excisions for recurrent disease occurred during the first two years after the initial excision. Risk factors associated independently with a greater risk of the composite outcome included older age (odds ratio [OR] 1.04 [95% confidence interval {CI} 1.00-1.07), p = 0.03), male gender (OR 1.49 [95% CI 1.09-2.08), p = 0.01), and the presence of a complex chronic gastrointestinal condition (OR 4.33 [95% CI 1.96-9.59], p < 0.001). CONCLUSIONS: Surgical excision of pilonidal disease is often complicated by site complications and nearly 1 of 10 patients develop recurrent disease requiring re-excision within two years after their initial excision. Future research into alternative therapies to treat pilonidal disease is warranted.", "provenance": [ { "field": "population", "quote": "Patients with pilonidal disease who had initial excision procedures between 2011-2013" }, { "field": "intervention", "quote": "Surgical resection is often performed to prevent recurrence of disease" }, { "field": "primaryOutcome", "quote": "the composite outcome of major surgical site complication or surgical re-excision within one year" }, { "field": "result", "quote": "4.7% (n = 138) had a major surgical site complication, 8.0% (n = 154) had a surgical re-excision, and 8.7% experienced either event within one year of their initial excision" }, { "field": "n", "quote": "Of the 1,932 patients included" } ] }, { "id": "pmid:29850944", "pmid": "29850944", "doi": "10.1007/s10151-018-1803-4", "nctId": null, "pmcid": null, "title": "Outcomes of endoscopic pilonidal sinus treatment (EPSiT): a systematic review", "firstAuthor": "Tien", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2018, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease", "intervention": "endoscopic pilonidal sinus treatment (EPSiT)", "comparator": "no consistent comparator reported across studies", "primaryOutcome": "healing, recurrence, patient satisfaction and time off work", "result": "good complete healing rates, low recurrence, high satisfaction and little time off work", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Most included studies were small case series without comparison groups, so the findings are not strongly reliable.", "directness": "indirect", "limitations": "The main limitation was the lack of comparative studies.", "followUp": "", "plainFinding": "Good healing with minimally invasive surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29850944/", "sourceText": "BACKGROUND: Pilonidal sinus is a common disease of the natal cleft, which can lead to complications including infection and abscess formation. Various operative management options are available, but the ideal technique is still debatable. More recently minimally invasive approaches have been described. Our aim was to review the current literature on endoscopic pilonidal sinus treatment (EPSiT) and its outcomes. METHODS: A systematic literature review was conducted and reported in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of EMBASE, MEDLINE and Cochrane Library was conducted in November 2017. Full-text studies on the use of endoscopy for the treatment of pilonidal sinus were included in the review. RESULTS: Initial search results returned 52 articles. Eight studies (eight case series and one randomised control trial) were included in the final qualitative synthesis. These studies demonstrated that EPSiT has good complete healing rates and low recurrence rates. There was also a high level of patient satisfaction and little time taken off work. Two studies reported modifications to the original technique. The main limitation was the lack of comparative studies. CONCLUSIONS: Initial studies on EPSiT have shown promising results. However, there is a need for a standardised technique and more comparative studies to validate this novel procedure.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus is a common disease of the natal cleft" }, { "field": "intervention", "quote": "endoscopic pilonidal sinus treatment (EPSiT)" }, { "field": "comparator", "quote": "The main limitation was the lack of comparative studies." }, { "field": "primaryOutcome", "quote": "These studies demonstrated that EPSiT has good complete healing rates and low recurrence rates." }, { "field": "result", "quote": "These studies demonstrated that EPSiT has good complete healing rates and low recurrence rates. There was also a high level of patient satisfaction and little time taken off work." }, { "field": "limitations", "quote": "The main limitation was the lack of comparative studies." } ] }, { "id": "pmid:29699781", "pmid": "29699781", "doi": "10.1016/j.surge.2018.03.009", "nctId": null, "pmcid": null, "title": "Long-term follow-up for pilonidal sinus surgery: A review of literature with metanalysis", "firstAuthor": "Milone", "multipleAuthors": true, "journal": "Surgeon", "year": 2018, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "people who had surgery for pilonidal sinus disease", "intervention": "different surgical techniques for closing the wound (open healing, midline closure, off-midline closure)", "comparator": "the surgical techniques compared against each other", "primaryOutcome": "rate of the disease coming back (recurrence) after surgery, over long-term follow-up", "result": "overall recurrence was 13.8%, with recurrence rates of 17.9% for open healing, 16.8% for midline closure, and 10% for off-midline closure", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it pools many studies with long follow-up, but the studies used different surgical methods and reporting, so the combined numbers are rougher estimates.", "directness": "indirect", "limitations": "The abstract does not address whether pilonidal cysts themselves are dangerous (e.g. infection spread, complications); it only reports recurrence rates after different surgeries, and patient numbers per study varied widely.", "followUp": "minimum follow-up of 5 years", "plainFinding": "High chance disease returns after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29699781/", "sourceText": "BACKGROUND: Sacrococcygeal pilonidal sinus disease (PSD) is a common chronic inflammation of the natal cleft and presents as an abscess or a chronically discharging, painful sinus tract. The management of chronic PSD is variable, contentious, and problematic. Although many surgical procedures have been tried, the best surgical method remains controversial. The aim of this systematic review with meta-analysis of literature is to provide surgeons an objective instrument of decision through an analysis of recurrence rate of various surgical techniques in a long-term follow-up. METHODS: Systematic literature searches were performed to identify all available studies. According to the pre-specified protocol, all studies reporting a surgical approach to PSD with a minimum follow-up of 5 years were included. RESULTS: Fifteen studies were included in the analysis. The number of patients varied from 50 to 1165 with a mean follow-up from 58.36 to 240 months. The overall incidence of recurrence was of 0.138; the resulting incidence of open healing, midline closure and out-midline closure were of 17.9%, 16.8% and 10% respectively. CONCLUSIONS: Interestingly, our data reveal a rate of relapsing disease higher than the one defined in previous studies both for the overall PSD and for each surgical procedure. A long-term follow-up of at least 5 years, should be considered the gold standard in pilonidal sinus surgery benchmarking. From our results, we can state that open healing and midline closure should not be considered effective for their high frequency of relapse disease and midline primary closure should be preferred.", "provenance": [ { "field": "population", "quote": "all studies reporting a surgical approach to PSD with a minimum follow-up of 5 years" }, { "field": "intervention", "quote": "open healing, midline closure and out-midline closure" }, { "field": "comparator", "quote": "an analysis of recurrence rate of various surgical techniques in a long-term follow-up" }, { "field": "primaryOutcome", "quote": "The overall incidence of recurrence was of 0.138" }, { "field": "result", "quote": "the resulting incidence of open healing, midline closure and out-midline closure were of 17.9%, 16.8% and 10% respectively" }, { "field": "followUp", "quote": "a minimum follow-up of 5 years" } ] }, { "id": "pmid:29688739", "pmid": "29688739", "doi": null, "nctId": null, "pmcid": null, "title": "Recurrent Pilonidal Sinus Cyst on Penis", "firstAuthor": "Ercil", "multipleAuthors": true, "journal": "Arch Iran Med", "year": 2018, "design": "case-series", "n": 1, "nField": "reported", "population": "20-year-old man with a recurring sore on the penis", "intervention": "no treatment described (case report)", "comparator": "none", "primaryOutcome": "description of the penile lesion and its cause", "result": "a recurrent pilonidal sinus on the penis was found to be linked to a bacterial infection (Actinomyces israelii)", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how common or dangerous this condition is in general.", "directness": "indirect", "limitations": "only one patient; no comparison group; rare and unusual presentation", "followUp": "", "plainFinding": "Rare recurrent cyst, no danger shown.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29688739/", "sourceText": "Pilonidal sinus, including one or more sinus canals and hairs, is a disease with a chronic course showing acute attacks which is often encountered in the general population, usually affecting young adults, at a rate in males twice that of females. Pilonidal sinus on the penis is so rare that very few cases have been reported in literature. A 20-year-old male presented to the urology outpatient clinic with the complaint of a suppurative lesion with discharge on the skin of the penis which had been ongoing for approximately three months. Clinical examination revealed an indurated, erythematous, ulcerative lesion, 3 cm x 2 cm in size, in the middle of the ventral aspect of the penile shaft. We present the first case in literature of recurrent pilonidal sinus related to Actinomyces israelii, located on the penis.", "provenance": [ { "field": "n", "quote": "A 20-year-old male presented to the urology outpatient clinic" }, { "field": "population", "quote": "A 20-year-old male presented to the urology outpatient clinic with the complaint of a suppurative lesion with discharge on the skin of the penis" }, { "field": "intervention", "quote": "We present the first case in literature of recurrent pilonidal sinus related to Actinomyces israelii, located on the penis." }, { "field": "primaryOutcome", "quote": "Clinical examination revealed an indurated, erythematous, ulcerative lesion, 3 cm x 2 cm in size, in the middle of the ventral aspect of the penile shaft." }, { "field": "result", "quote": "We present the first case in literature of recurrent pilonidal sinus related to Actinomyces israelii, located on the penis." }, { "field": "comparator", "quote": "We present the first case in literature of recurrent pilonidal sinus related to Actinomyces israelii, located on the penis." } ] }, { "id": "pmid:29442064", "pmid": "29442064", "doi": "10.11138/gchir/2017.38.6.313", "nctId": null, "pmcid": "PMC5885794", "title": "Pilonidal disease mimicking anterior anal fistula and associated with posterior anal fistula: a two-step surgery. Case report", "firstAuthor": "Eberspacher", "multipleAuthors": true, "journal": "G Chir", "year": 2017, "design": "case-series", "n": 1, "nField": "reported", "population": "A 36-year old man with an anal fistula", "intervention": "Two-step surgery: fistulectomy, abscess drainage, seton placement, then excision of pilonidal sinus", "comparator": "", "primaryOutcome": "Healing of the fistula and pilonidal disease without complications or recurrence", "result": "The posterior anal fistula healed well and the residual pilonidal sinus was excised successfully", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single case report, which cannot show how often problems happen or how risky the condition generally is.", "directness": "indirect", "limitations": "Single case report with no comparison group; findings may not generalize to other patients with pilonidal disease.", "followUp": "about one month", "plainFinding": "Rare complicated case, treated successfully.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29442064/", "sourceText": "AIM: Anal fistula is a common disease originated from abscess according the cryptoglandular theory. A rare etiology is the pilonidal disease. In our case we observed a pilonidal disease mimicking an anterior perianal fistula, associated with another posterior anal fistula. CASE PRESENTATION: A 36-year old man was referred to our department with an anal fistula with an anterior opening. Despite the clinical examination and the endoanal ultrasound, only during the surgery we discovered the origin of the anterior fistula from a misdiagnosed pilonidal sinus. There was also a posterior anal fistula in communication with the same abscess of the anterior one. We performed a two-step surgery with a first fistulectomy of the anterior tract, a drainage of abscess and the positioning of a seton for the posterior fistula. After about one month and the fall of the seton we evaluate the good healing of posterior anal fistula and excised the residual pilonidal sinus. CONCLUSION: This misdiagnosed pilonidal disease created in our clinical report a true challenge. Our goal was to eliminate as much disease as possible, but also to avoid major complications or recurrences. We refused an aggressive approach and chose a two-step surgery, with in the first approach not only a demolitive time but also a reconstruction to facilitate healing, and in the second time the complete eradication of the pathology.", "provenance": [ { "field": "population", "quote": "A 36-year old man was referred to our department with an anal fistula with an anterior opening." }, { "field": "intervention", "quote": "We performed a two-step surgery with a first fistulectomy of the anterior tract, a drainage of abscess and the positioning of a seton for the posterior fistula." }, { "field": "primaryOutcome", "quote": "we evaluate the good healing of posterior anal fistula and excised the residual pilonidal sinus" }, { "field": "result", "quote": "After about one month and the fall of the seton we evaluate the good healing of posterior anal fistula and excised the residual pilonidal sinus." }, { "field": "n", "quote": "A 36-year old man" } ] }, { "id": "pmid:29437816", "pmid": "29437816", "doi": "10.1136/bcr-2017-223497", "nctId": null, "pmcid": "PMC5836690", "title": "Teenage boy with high fever and rash: what could we be missing?", "firstAuthor": "Oliveira", "multipleAuthors": true, "journal": "BMJ Case Rep", "year": 2018, "design": "case-series", "n": 1, "nField": "reported", "population": "A 15-year-old boy with high fever and rash", "intervention": "No intervention being tested; case report of illness and treatment received", "comparator": "", "primaryOutcome": "Severe illness (toxic shock-like syndrome) linked to pilonidal abscess", "result": "Pilonidal abscess caused severe infection with dangerously low blood pressure requiring intensive care, resolved after drainage and antibiotics", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how often this happens or to whom.", "directness": "direct", "limitations": "Single case, no control group, cannot establish how common this complication is", "followUp": "4 days", "plainFinding": "Pilonidal abscess caused severe shock.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29437816/", "sourceText": "A 15-year-old boy was admitted to a local hospital with high fever, generalised rash and a mild sore throat. He was started on intravenous flucloxacillin and 12 hours later develops a sustained low diastolic blood pressure (DBP), unresponsive to fluid volume expansion and cardiovascular support with dopamine. Intravenous clindamycin was added and transportation to paediatric intensive care unit arranged. Dopamine dosing was increased and norepinephrine infusion was added subsequently with immediate stabilisation of DBP. A sacrococcygeal pilonidal abscess was identified, requiring prompt surgical drainage. The microbiological culture of abscess material was positive for an enterotoxin-producing Staphylococcus aureus and Peptostreptococcus magnus He was free of symptoms after 4 days. This case report summarises a potential severe complication of the pilonidal disease.", "provenance": [ { "field": "population", "quote": "A 15-year-old boy was admitted to a local hospital with high fever, generalised rash and a mild sore throat." }, { "field": "n", "quote": "A 15-year-old boy was admitted" }, { "field": "primaryOutcome", "quote": "develops a sustained low diastolic blood pressure (DBP), unresponsive to fluid volume expansion and cardiovascular support with dopamine" }, { "field": "intervention", "quote": "He was started on intravenous flucloxacillin" }, { "field": "result", "quote": "A sacrococcygeal pilonidal abscess was identified, requiring prompt surgical drainage." }, { "field": "result", "quote": "He was free of symptoms after 4 days." }, { "field": "result", "quote": "This case report summarises a potential severe complication of the pilonidal disease." } ] }, { "id": "pmid:29232530", "pmid": "29232530", "doi": "10.1089/lap.2017.0246", "nctId": null, "pmcid": null, "title": "Pediatric Endoscopic Pilonidal Sinus Treatment, a Revolutionary Technique to Adopt in Children with Pilonidal Sinus Fistulas: Our Preliminary Experience", "firstAuthor": "Esposito", "multipleAuthors": true, "journal": "J Laparoendosc Adv Surg Tech A", "year": 2018, "design": "retrospective", "n": 15, "nField": "reported", "population": "children and teens with pilonidal sinus disease that was not infected", "intervention": "endoscopic pilonidal sinus surgery (PEPSiT)", "comparator": "classic open surgical repair", "primaryOutcome": "healing of the sinus, recurrence, pain, and hospital stay", "result": "all patients healed by 1 month with no recurrence at 6 months, less pain and shorter hospital stay than open surgery", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a small, retrospective case series of only 15 patients without randomization, so it cannot reliably prove the new technique is better.", "directness": "indirect", "limitations": "retrospective review, small sample size, no randomization, short follow-up of 6 months", "followUp": "6 month", "plainFinding": "Healed well, no recurrence, less pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29232530/", "sourceText": "AIM: This study aimed to report our preliminary experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT). PATIENTS AND METHODS: We retrospectively reviewed the reports of 15 patients, 6 girls and 9 boys, with an average age of 16 years (range 13-18) with noninfected pilonidal sinus disease who underwent PEPSiT in our institution over an 18-month period. Four cases were redo-procedures, for recurrence of disease after open excision repair. Surgical outcomes of sinus healing, recurrence of disease, postoperative pain, hospital stay, analgesic requirements, and patient satisfaction levels were evaluated and a comparison analysis with classic open repair was performed. RESULTS: All procedures were performed under subarachnoid spinal anesthesia. We always adopted a fistuloscope, an endoscopic forceps, and a monopolar electrode to remove the hairs and to heal the fistula. The average length of surgery was 28.5 minutes (range 26-41). No intraoperative or postoperative complications were reported. The average pain score evaluated using Visual Analogue Scale (VAS) pain scale during the first 48 postoperative hours was 3.2 (range 2-5). The average analgesic requirement was 22 hours (range 16-28). The average hospital stay length was 28 hours (range 22-48). They changed dressing daily, by applying a topical solution of eosin 2% and a silver sulfadiazine spray. At 1 month postoperatively, the external openings were closed in all patients and no recurrence was recorded at a mean follow-up of 6 month. PEPSiT was associated with a significantly shorter, painless, and better outcome compared to open technique. CONCLUSION: On the basis of our preliminary experience, we believe that PEPSiT is a promising technique for surgical treatment of pilonidal sinus in children. It is technically easy and quick to perform, with a short and painless hospital stay, without recurrences in our series. It allows operated patients an early return to full daily activities without restrictions that happen for the classic treatment.", "provenance": [ { "field": "n", "quote": "15 patients, 6 girls and 9 boys" }, { "field": "population", "quote": "with noninfected pilonidal sinus disease who underwent PEPSiT in our institution" }, { "field": "intervention", "quote": "pediatric endoscopic pilonidal sinus treatment (PEPSiT)" }, { "field": "comparator", "quote": "a comparison analysis with classic open repair was performed" }, { "field": "primaryOutcome", "quote": "Surgical outcomes of sinus healing, recurrence of disease, postoperative pain, hospital stay, analgesic requirements, and patient satisfaction levels were evaluated" }, { "field": "result", "quote": "At 1 month postoperatively, the external openings were closed in all patients and no recurrence was recorded at a mean follow-up of 6 month. PEPSiT was associated with a significantly shorter, painless, and better outcome compared to open technique." }, { "field": "followUp", "quote": "a mean follow-up of 6 month" } ] }, { "id": "pmid:29205143", "pmid": "29205143", "doi": "10.11138/gchir/2017.38.3.135", "nctId": null, "pmcid": "PMC5726500", "title": "Epidural abscess imitating recurrent pilonidal sinus: a case report", "firstAuthor": "Koutserimpas", "multipleAuthors": true, "journal": "G Chir", "year": 2017, "design": "case-series", "n": 1, "nField": "reported", "population": "33-year-old man with previously untreated diabetes who had pilonidal sinus surgery", "intervention": "no intervention being tested; this is a case report of complications after pilonidal cyst surgery", "comparator": "", "primaryOutcome": "development of a serious spinal infection (epidural abscess) after pilonidal cyst treatment", "result": "after surgery for pilonidal sinus, the patient developed an epidural abscess extending from the thoracic spine to the tailbone area, requiring further surgery and antibiotics, and recovered without recurrence after a year", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how often this happens or whether it applies to others.", "directness": "indirect", "limitations": "single case report with undiagnosed diabetes as a likely contributing factor; cannot establish how common or predictable this complication is", "followUp": "a whole year", "plainFinding": "Rare serious spinal infection after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29205143/", "sourceText": "Pilonidal sinus or pilonidal cyst is a common benign disease, affecting mostly young working men. We present the first case of an epidural abscess imitating pilonidal sinus. A 33-year old male, suffering from previously undiagnosed and untreated diabetes mellitus (DM), presented to our emergency department (ER), one month after open surgical treatment of pilonidal sinus, due to weakness and fever. After re-operation of the pilonidal cyst and due to post-operative pus production and continuation of fever a computer tomogr aphy (CT )scan was performed revealing an epidural abscess extending from the thoracic vertebrae 12 (T-12) to the sacrococcygeal area. At that point he underwent new surgery for drainage of the epidural abscess. The patient received intravenous antimicrobial treatment and was discharged on the 23rd postoperative day without signs or symptoms of infection. At follow up for a whole year no signs of recurrence have been observed.", "provenance": [ { "field": "n", "quote": "A 33-year old male" }, { "field": "population", "quote": "A 33-year old male, suffering from previously undiagnosed and untreated diabetes mellitus (DM), presented to our emergency department (ER), one month after open surgical treatment of pilonidal sinus" }, { "field": "intervention", "quote": "We present the first case of an epidural abscess imitating pilonidal sinus." }, { "field": "primaryOutcome", "quote": "a computer tomogr aphy (CT )scan was performed revealing an epidural abscess extending from the thoracic vertebrae 12 (T-12) to the sacrococcygeal area" }, { "field": "result", "quote": "At that point he underwent new surgery for drainage of the epidural abscess. The patient received intravenous antimicrobial treatment and was discharged on the 23rd postoperative day without signs or symptoms of infection." }, { "field": "followUp", "quote": "At follow up for a whole year no signs of recurrence have been observed." } ] }, { "id": "pmid:28355137", "pmid": "28355137", "doi": null, "nctId": null, "pmcid": null, "title": "A Retrospective Study of Pilonidal Sinus Healing by Secondary Intention Using Negative Pressure Wound Therapy Versus Alginate or Gauze Dressings", "firstAuthor": "Danne", "multipleAuthors": true, "journal": "Ostomy Wound Manage", "year": 2017, "design": "retrospective", "n": 73, "nField": "reported", "population": "patients with symptomatic natal cleft PS over a 10-year period", "intervention": "negative pressure wound therapy (NPWT) to achieve wound healing", "comparator": "alginate-based/gauze daily dressing changes", "primaryOutcome": "time in weeks to achieving the endpoint (epithelialization)", "result": "no significant difference in healing time or recurrence rate between NPWT and dressing changes", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "This was a small retrospective chart review without randomization, so it can't reliably prove whether one wound treatment is better than the other.", "directness": "indirect", "limitations": "Retrospective design, small sample size, no randomization, and the authors state prospective randomized controlled studies are needed.", "followUp": "", "plainFinding": "No clear healing advantage found.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28355137/", "sourceText": "Pilonidal sinus (PS) disease is an inflammatory skin and subcutaneous tissue condition that presents with infection, acute abscess, chronic discharging wounds, and/or pain. Surgery with open healing by secondary intention typically is used to achieve the fastest healing time with minimal recurrence rates. A retrospective analysis was conducted of data extracted from the medical records of 73 consecutive patients who had symptomatic natal cleft PS over a 10-year period to compare use of NPWT to alginate-based/gauze daily dressing (DD) changes in terms of healing time and recurrence. Variables extracted included age, gender, PS wound diameter (small <1 cm, medium 1 cm to 3 cm, large >3 cm), and time in weeks to achieving the endpoint (epithelialization). Risk factors examined that can affect healing or recurrence of previously operated PS disease included initial drainage before excision and risk factors for impaired healing (morbid obesity as determined by body mass index [BMI] ≥35, chronic infective skin conditions, and ongoing therapy with immuno-modulating drugs or chemotherapy), and loss to follow-up. Data were collected and analyzed using the chi-squared statistic, Kaplan-Meier curves, and Cox regression models. The total time of follow-up was 390 weeks for the DD group and 311 weeks for NPWT group. Patient mean age was 26.5 ± 10.7 years, most (53, 72.6%) were male, and 12 (16.4%) had comorbidities potentially affecting healing. Nine (9) were treated with primary closure and 62 patients were treated with open healing by secondary intention (2 additional patients receiving DD were excluded from the analysis because they had small sinuses that made NPWT unfeasible). Among participants, 30 (48%) received DD and 32 had NPWT. The median time to healing was 10 weeks (95% CI: 7-17) in the DD group and 8 weeks (95% CI: 7-9) in the NPWT group (not significantly different). In patients who healed, the average time to healing was 15.0 ± 18.1 and 9.8 ± 6.3 weeks in the DD and NPWT groups, respectively (not significantly different). The PS wound recurred in 5 patients - 4 (12.5%) in the DD group and 1 (3.1%) in the NPWT group (P = .355). In univariate analysis, only the presence of comorbidities was found to significantly affect time to healing (HR 95%, CI: 0.40 [0.17-0.93]; P = .033]. Prospective, randomized controlled clinical studies are warranted.", "provenance": [ { "field": "n", "quote": "73 consecutive patients who had symptomatic natal cleft PS over a 10-year period" }, { "field": "population", "quote": "73 consecutive patients who had symptomatic natal cleft PS over a 10-year period" }, { "field": "intervention", "quote": "A retrospective analysis was conducted of data extracted from the medical records of 73 consecutive patients who had symptomatic natal cleft PS over a 10-year period to compare use of NPWT to alginate-based/gauze daily dressing (DD) changes in terms of healing time and recurrence." }, { "field": "comparator", "quote": "alginate-based/gauze daily dressing (DD) changes" }, { "field": "primaryOutcome", "quote": "time in weeks to achieving the endpoint (epithelialization)" }, { "field": "result", "quote": "The median time to healing was 10 weeks (95% CI: 7-17) in the DD group and 8 weeks (95% CI: 7-9) in the NPWT group (not significantly different)." }, { "field": "result", "quote": "The PS wound recurred in 5 patients - 4 (12.5%) in the DD group and 1 (3.1%) in the NPWT group (P = .355)." } ] }, { "id": "pmid:28302173", "pmid": "28302173", "doi": "10.1186/s12957-017-1129-0", "nctId": null, "pmcid": "PMC5356347", "title": "Squamous cell carcinoma arising from chronic sacrococcygeal pilonidal disease: a case report", "firstAuthor": "Michalopoulos", "multipleAuthors": true, "journal": "World J Surg Oncol", "year": 2017, "design": "case-series", "n": 1, "nField": "reported", "population": "60-year-old patient with long-standing pilonidal sinus and an anal fistula", "intervention": "no intervention being tested; describes surgical and radiation treatment of cancer that developed", "comparator": "none", "primaryOutcome": "development of skin cancer (squamous cell carcinoma) from chronic pilonidal disease and survival after treatment", "result": "patient developed squamous cell carcinoma from the chronic pilonidal disease, which despite aggressive surgery and radiation came back and spread, and the patient died 9 months later", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how often this happens or to whom, only that it can happen.", "directness": "direct", "limitations": "Single case report; no comparison group; cannot estimate how common this complication is.", "followUp": "9 months", "plainFinding": "Rare case: cancer and death.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28302173/", "sourceText": "BACKGROUND: Sacrococcygeal pilonidal disease is a chronic, well-recognized entity, characterized by the recurrent formation of an abscess or draining sinus over the sacrococcygeal area. It is one of the most common surgical problems. Rarely, chronic inflammation and recurrent disease leads to malignant transformation, most commonly to squamous cell carcinoma (SCC). CASE PRESENTATION: We describe an extremely unusual case of SCC developing in a 60-year-old patient with a chronic pilonidal sinus complicated by an anal fistula. After wide surgical excision of the pilonidal sinus and fistulas and because of the poor healing process 6 months later, colonoscopy and a percutaneous fistulography were performed, revealing an anal canal-pilonidal fistula. Patient was treated with a more radical surgical resection with a prophylactic loop colostomy, but healing was not accelerated. Multiple biopsies were then taken from the surgical site at the time, which revealed the development of SCC. CT and MRI imaging techniques revealed SCC partial invasion of the coccyx and sacrum. As a result, aggressive surgical approach was decided. Histological examination revealed moderately to poorly differentiated SCC, and the patient was treated with adjuvant radiation therapy postoperatively. Nine months later, recurrence was found in the sacrum and para-aorta lymph nodes and the patient died shortly after. We discuss the clinical features, pathogenesis, treatment options, and prognosis of this rare malignant transformation. CONCLUSIONS: The development of SCC in chronic pilonidal disease is a rare but serious complication. Symptoms are usually attributed to the sacrococcygeal pilonidal disease (SPD), and diagnosis is often made late by histological examination of biopsies. Malignant transformation should be suspected in chronic SPD with recurrent episodes of inflammation, repeated purulent discharge, poor healing, and chronic complex fistulas.", "provenance": [ { "field": "n", "quote": "a 60-year-old patient with a chronic pilonidal sinus complicated by an anal fistula" }, { "field": "population", "quote": "a 60-year-old patient with a chronic pilonidal sinus complicated by an anal fistula" }, { "field": "intervention", "quote": "the patient was treated with adjuvant radiation therapy postoperatively" }, { "field": "comparator", "quote": "CASE PRESENTATION" }, { "field": "primaryOutcome", "quote": "Rarely, chronic inflammation and recurrent disease leads to malignant transformation, most commonly to squamous cell carcinoma (SCC)." }, { "field": "result", "quote": "Nine months later, recurrence was found in the sacrum and para-aorta lymph nodes and the patient died shortly after." } ] }, { "id": "pmid:27779984", "pmid": "27779984", "doi": null, "nctId": null, "pmcid": null, "title": "Excision and Primary Closure May Be the Better Option in the Surgical Management of Pilonidal Disease in the Pediatric Population", "firstAuthor": "Zagory", "multipleAuthors": true, "journal": "Am Surg", "year": 2016, "design": "retrospective", "n": 60, "nField": "reported", "population": "young patients (21 years old and younger) who had surgery for pilonidal disease", "intervention": "excision of the cyst with primary closure of the wound", "comparator": "excision with the wound left open to heal on its own, or excision with a skin flap closure", "primaryOutcome": "rate of disease coming back after surgery, complications, and length of hospital stay", "result": "primary closure had the lowest recurrence rate (33.3%) compared with leaving the wound open (58.8%) or flap closure (42.9%), and the shortest hospital stay", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a retrospective review from one hospital without random assignment to treatment groups, so it cannot reliably prove one surgery is better than another.", "directness": "indirect", "limitations": "Retrospective design, single institution, not randomized, and the abstract does not address whether pilonidal cysts themselves are dangerous.", "followUp": "", "plainFinding": "Primary closure had fewer recurrences.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27779984/", "sourceText": "The optimal management of pilonidal disease in the pediatric population is still debated. We conducted a retrospective review of patients 21 years old and younger who underwent surgical management for pilonidal disease between 2009 and 2013 at a single pediatric institution. Sixty patients (41.7% male) were included in the analysis, with a mean age of 15.0 years (range, 13-20). Twelve (20%) had a prior drainage procedure for pilonidal abscess before the definitive operative treatment. After excision to the presacral fascia, 36 (60%) had primary closure, 17 (28.3%) were left to heal by secondary intention, and 7 (11.7%) had flap closure. Overall recurrence rate was 41.7 per cent with 33.3 per cent in the primary, 58.8 per cent in the secondary, and 42.9 per cent in the flap group, respectively. Ten (16.7%) patients developed postoperative complications, which were similar among surgical groups, gender, and body mass index. The average length of stay was 0.67 (median 0, range, 0-5) days. Primary closure had the shortest length of stay (analysis of variance P = 0.04), and flap closure had no reoperations (analysis of variance P < 0.01). Pilonidal disease remains surgically challenging. Our data suggest that excision and primary closure is a better option in the pediatric population.", "provenance": [ { "field": "n", "quote": "Sixty patients (41.7% male) were included in the analysis" }, { "field": "population", "quote": "patients 21 years old and younger who underwent surgical management for pilonidal disease" }, { "field": "intervention", "quote": "36 (60%) had primary closure" }, { "field": "comparator", "quote": "17 (28.3%) were left to heal by secondary intention, and 7 (11.7%) had flap closure" }, { "field": "primaryOutcome", "quote": "Overall recurrence rate was 41.7 per cent with 33.3 per cent in the primary, 58.8 per cent in the secondary, and 42.9 per cent in the flap group, respectively." }, { "field": "result", "quote": "Primary closure had the shortest length of stay (analysis of variance P = 0.04), and flap closure had no reoperations (analysis of variance P < 0.01)." } ] }, { "id": "pmid:27391513", "pmid": "27391513", "doi": "10.1097/SCS.0000000000002778", "nctId": null, "pmcid": null, "title": "Lateral Orbital Wall Destruction Due to Pilonidal Sinus", "firstAuthor": "Karadağ", "multipleAuthors": true, "journal": "J Craniofac Surg", "year": 2016, "design": "case-series", "n": null, "nField": "not-reported", "population": "a patient with a pilonidal sinus in an unusual location near the eye (lateral orbital region)", "intervention": "incomplete surgical excision of the sinus tract", "comparator": "none", "primaryOutcome": "damage to the bone around the eye socket", "result": "The sinus was misdiagnosed and incompletely removed, leading to destruction of the bone in the lateral orbital wall", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is a single case report, so it cannot show how often this happens or what causes it.", "directness": "indirect", "limitations": "Single case report with an atypical location of the sinus; misdiagnosis and incomplete treatment contributed to the outcome, which may not reflect typical pilonidal sinus cases.", "followUp": "", "plainFinding": "Rare case caused bone damage.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27391513/", "sourceText": "Pilonidal sinus is a chronic inflammatory disease commonly observed in the sacrococcygeal region. The authors report a patient of a pilonidal sinus in a rare location-the lateral orbital region. The authors' patient was misdiagnosed with an epidermal cyst, and the subsequent incomplete excision of the sinus tract led a pilonidal sinus with a high morbidity resulting in the destruction of bone tissue in the lateral orbital wall. It was, therefore, crucial to accurately diagnose and treat before the infection progressed through the bone and caused osteomyelitis.", "provenance": [ { "field": "population", "quote": "The authors report a patient of a pilonidal sinus in a rare location-the lateral orbital region." }, { "field": "intervention", "quote": "the subsequent incomplete excision of the sinus tract" }, { "field": "comparator", "quote": "led a pilonidal sinus with a high morbidity resulting in the destruction of bone tissue in the lateral orbital wall" }, { "field": "primaryOutcome", "quote": "resulting in the destruction of bone tissue in the lateral orbital wall" }, { "field": "result", "quote": "The authors' patient was misdiagnosed with an epidermal cyst, and the subsequent incomplete excision of the sinus tract led a pilonidal sinus with a high morbidity resulting in the destruction of bone tissue in the lateral orbital wall." } ] }, { "id": "pmid:27372856", "pmid": "27372856", "doi": "10.1016/j.mehy.2016.05.013", "nctId": null, "pmcid": null, "title": "Home-applied IPL epilation may prevent the problems due to hair follicle in amputees", "firstAuthor": "Ergözen", "multipleAuthors": true, "journal": "Med Hypotheses", "year": 2016, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people who have had limb amputation", "intervention": "home-use intense pulsed light (IPL) hair removal device", "comparator": "no comparator described", "primaryOutcome": "prevention of skin problems like folliculitis and pilonidal sinus on the stump", "result": "no actual results reported; this is a proposed idea, not a tested treatment", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is just a theoretical proposal with no patients treated or data collected, so it carries almost no weight on its own.", "directness": "indirect", "limitations": "the abstract presents an untested hypothesis with no study, data, or outcomes measured", "followUp": "", "plainFinding": "Untested idea, no evidence yet.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27372856/", "sourceText": "Amputees may suffer from dermatoses such as folliculitis and pilonidal sinus caused by pressure on the stump in hairy parts of the skin. These conditions commonly cause pain and need treatment that result in abandonment of prosthesis use and disrupt the patient's daily living activities. We believe these conditions may be easily, effectively and cheaply prevented with the use of intense pulsed light technology, which is produced for home epilation. The use of this kind of epilator in the early period post-amputation may prevent the development of folliculitis and pilonidal sinus. This application may also be cost-effective in long term.", "provenance": [ { "field": "population", "quote": "Amputees may suffer from dermatoses such as folliculitis and pilonidal sinus caused by pressure on the stump in hairy parts of the skin." }, { "field": "intervention", "quote": "intense pulsed light technology, which is produced for home epilation" }, { "field": "comparator", "quote": "The use of this kind of epilator in the early period post-amputation may prevent the development of folliculitis and pilonidal sinus." }, { "field": "primaryOutcome", "quote": "may prevent the development of folliculitis and pilonidal sinus" }, { "field": "result", "quote": "We believe these conditions may be easily, effectively and cheaply prevented with the use of intense pulsed light technology" } ] }, { "id": "pmid:27042792", "pmid": "27042792", "doi": null, "nctId": null, "pmcid": null, "title": "Subcutaneous Destruction of Sinus Tract with Long-term Vessel Loop Drainage as a Minimally Invasive Surgical Treatment for Primary Pilonidal Sinus", "firstAuthor": "Korenkov", "multipleAuthors": false, "journal": "Surg Technol Int", "year": 2016, "design": "case-series", "n": 5, "nField": "reported", "population": "patients with primary symptomatic pilonidal sinus", "intervention": "narrow excision of pilonidal orifices with subcutaneous destruction of the sinus tract plus long-term vessel loop drainage", "comparator": "none (single-arm pilot study)", "primaryOutcome": "wound healing and occurrence of adverse events such as abscess or recurrence", "result": "No adverse events occurred such as abscess or recurrent pilonidal sinus; complete wound healing occurred by day 21-28, though one patient had persistent coccygeal pain beyond 6 weeks", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a tiny pilot case series of only 5 patients with no comparison group, so it cannot reliably show how dangerous the condition is or how well the treatment works.", "directness": "indirect", "limitations": "Very small sample size (5 patients), no control group, short follow-up, and it is a pilot study on a surgical technique rather than a study of the natural risks of pilonidal disease itself.", "followUp": "6 weeks", "plainFinding": "New minimally invasive surgery healed well.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27042792/", "sourceText": "The surgical management of pilonidal disease ranges from minimally invasive techniques to wide excision with secondary wound healing. Hypothetical counterarguments for using the minimally invasive techniques are that these techniques only incompletely remove the sinus tract and that they allow the formation of subcutaneous cavities as a result of rapid closure of small skin incisions. In order to avoid these problems we used a vessel loop drainage after subcutaneous destruction of the sinus tract. In this technique we combined two procedures: a narrow excision of pilonidal orifices with the subcutaneous destruction of the sinus tract and the removal of hair as well as the long-term vessel loop drainage of the wound channel with repeated revisions of the wound channel for removing hair remnants. In order to assess the efficacy and morbidity of this method 5 patients with primary symptomatic pilonidal sinus underwent an operation as a pilot study. Up to the removal of the vessel loop the wound channel had been regularly inspected using a mosquito clamp. If during two successive inspections no hair from the wound was found the vessel loop was removed. No adverse events occurred such as abscess or recurrent pilonidal sinus. One female patient with a history of long-term use of morphine derivatives and psychotropic substances experienced persistent coccygeal pain that persisted longer than 6 weeks. The complete wound healing with the formation of a qualitative scar took place on the 21st postoperative day (for 3 patients) and on the 28th postoperative day (for 2 patients). Initial results suggest that this operation is an effective procedure for the treatment of primary simple pilonidal sinus disease and we will continue to systematically test it.", "provenance": [ { "field": "n", "quote": "5 patients with primary symptomatic pilonidal sinus underwent an operation as a pilot study" }, { "field": "population", "quote": "5 patients with primary symptomatic pilonidal sinus" }, { "field": "intervention", "quote": "a narrow excision of pilonidal orifices with the subcutaneous destruction of the sinus tract and the removal of hair as well as the long-term vessel loop drainage of the wound channel" }, { "field": "comparator", "quote": "5 patients with primary symptomatic pilonidal sinus underwent an operation as a pilot study" }, { "field": "primaryOutcome", "quote": "In order to assess the efficacy and morbidity of this method" }, { "field": "result", "quote": "No adverse events occurred such as abscess or recurrent pilonidal sinus." }, { "field": "result", "quote": "One female patient with a history of long-term use of morphine derivatives and psychotropic substances experienced persistent coccygeal pain that persisted longer than 6 weeks." }, { "field": "result", "quote": "The complete wound healing with the formation of a qualitative scar took place on the 21st postoperative day (for 3 patients) and on the 28th postoperative day (for 2 patients)." } ] }, { "id": "pmid:26216921", "pmid": "26216921", "doi": "10.1136/bcr-2014-204693", "nctId": null, "pmcid": "PMC4521557", "title": "A rare case of vulval pilonidal sinus: incidental diagnosis", "firstAuthor": "Kushwaha", "multipleAuthors": true, "journal": "BMJ Case Rep", "year": 2015, "design": "case-series", "n": 1, "nField": "reported", "population": "a 63-year-old woman with vulval bleeding", "intervention": "surgical excision of the vulval lesion", "comparator": "none", "primaryOutcome": "diagnosis of the lesion after removal", "result": "the lesion was found to be a pilonidal sinus with no cancer or precancerous changes", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how often pilonidal disease is dangerous in general.", "directness": "indirect", "limitations": "single case report; describes an unusual location (vulva) rather than the typical sacrococcygeal site", "followUp": "", "plainFinding": "Unusual site, no cancer found.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26216921/", "sourceText": "A 63-year-old woman presented with a 4-week history of vulval bleeding. On examination, an 8 mm fleshy irregular vascular lesion was present on the vulva in the periclitoreal area. This vulval lesion was treated by surgical excision. Histological analysis showed irregular pieces of skin partly covered by hyperplastic squamous epithelium. There were areas of fistulous-like endophytic proliferations lined by hyperplastic squamous epithelial cells. The intervening stroma showed granulation tissue with severe active chronic inflammation. At least five hair follicle shafts surrounded by foreign body type giant cells were also identified within the inflamed area. There was no evidence of dysplasia or malignancy. This chronically inflamed fistulous tract together with hair shafts within the wall of the tract were diagnostic of a pilonidal sinus of the vulva. This case report summarises the importance of diagnosing pilonidal sinus at an unusual location.", "provenance": [ { "field": "n", "quote": "A 63-year-old woman presented with a 4-week history of vulval bleeding." }, { "field": "population", "quote": "A 63-year-old woman presented with a 4-week history of vulval bleeding." }, { "field": "intervention", "quote": "This vulval lesion was treated by surgical excision." }, { "field": "comparator", "quote": "This vulval lesion was treated by surgical excision." }, { "field": "primaryOutcome", "quote": "Histological analysis showed irregular pieces of skin partly covered by hyperplastic squamous epithelium." }, { "field": "result", "quote": "There was no evidence of dysplasia or malignancy." }, { "field": "result", "quote": "This chronically inflamed fistulous tract together with hair shafts within the wall of the tract were diagnostic of a pilonidal sinus of the vulva." } ] }, { "id": "pmid:25693725", "pmid": "25693725", "doi": null, "nctId": null, "pmcid": null, "title": "Squamous cell carcinoma and pilonidal cyst disease", "firstAuthor": "Esposito", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2015, "design": "case-series", "n": 1, "nField": "reported", "population": "a 63-year-old patient with 43 years of recurrent pilonidal sinus disease", "intervention": "incisional biopsy, CT staging, and radical surgery", "comparator": "none", "primaryOutcome": "cancer recurrence after treatment", "result": "no sign of cancer returning after 30 months", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how common or dangerous this is in general.", "directness": "direct", "limitations": "only one patient described; no comparison group; malignant transformation described as very rare overall", "followUp": "30 months", "plainFinding": "Rare cancer risk from long-term cyst.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25693725/", "sourceText": "AIM: Squamous cell carcinoma developed on a chronic pilonidal cyst. CASE REPORT: Authors describe the case of a squamous cell carcinoma developed on a chronic pilonidal cyst in a 63- years-old patient with a 43 years history of recurrent pilonidal sinus disease. RESULTS: The patient underwent incisional biopsy, staging with total body CT and, finally, radical surgery. After 30 months there were no evidence of recurrence. DISCUSSION: Pilonidal sinus disease is a common disease that affects especially male subjects, obese and with excess of body hair. The complications that arise most frequently are cellulitis, abscess formation and developments of recurrences. Malignant transformation appears rather rare and is reported in the literature with a percentage that goes from 0.02% to 0.1%. CONCLUSIONS: Authors recommend accurate inspection of the pilonidal area in all chronic and longstanding inflammatory lesions and possibly practice incisional biopsies to exclude malignant degeneration.", "provenance": [ { "field": "n", "quote": "a 63- years-old patient with a 43 years history of recurrent pilonidal sinus disease" }, { "field": "population", "quote": "a 63- years-old patient with a 43 years history of recurrent pilonidal sinus disease" }, { "field": "intervention", "quote": "underwent incisional biopsy, staging with total body CT and, finally, radical surgery" }, { "field": "comparator", "quote": "The patient underwent incisional biopsy, staging with total body CT and, finally, radical surgery." }, { "field": "primaryOutcome", "quote": "After 30 months there were no evidence of recurrence." }, { "field": "result", "quote": "After 30 months there were no evidence of recurrence." } ] }, { "id": "pmid:25612946", "pmid": "25612946", "doi": null, "nctId": null, "pmcid": null, "title": "[Pre-sacral cyst as differential diagnosis to recurrent pilonidal cyst with abscess]", "firstAuthor": "Tengberg", "multipleAuthors": true, "journal": "Ugeskr Laeger", "year": 2015, "design": "case-series", "n": 1, "nField": "reported", "population": "A 31-year-old man with recurrent abscess in the gluteal cleft, initially diagnosed as pilonidal sinus", "intervention": "Imaging (endoscopy, MRI, transrectal ultrasound) to find the true cause, followed by surgical excision of a pre-sacral cyst", "comparator": "Previous repeated pilonidal surgery (modified Bascom's technique)", "primaryOutcome": "Resolution of recurrent abscess/cyst after correct diagnosis and treatment", "result": "The true cause was a pre-sacral epidermal inclusion cyst, not a pilonidal cyst; after proper excision the patient recovered without complications", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how dangerous pilonidal cysts generally are.", "directness": "indirect", "limitations": "Single case report; the mass turned out not to be a true pilonidal cyst but a pre-sacral epidermal inclusion cyst misdiagnosed as pilonidal disease.", "followUp": "", "plainFinding": "Misdiagnosed cyst, not pilonidal disease", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25612946/", "sourceText": "A 31-year-old man presented with a recurrent abscess in the gluteal cleft. It was interpreted as a pilonidal sinus and he underwent surgery several times. The modified Bascom's asymmetric midgluteal cleft closure technique was used without satisfying clinical remission. Endoscopy, magnetic resonance imaging and transrectal ultrasound visualized a pre-sacral cyst, which was excised in toto with laterosacral approach of Kraske. A histological examination showed epidermal inclusion cyst. The post-operative course was uneventful.", "provenance": [ { "field": "population", "quote": "A 31-year-old man presented with a recurrent abscess in the gluteal cleft." }, { "field": "intervention", "quote": "Endoscopy, magnetic resonance imaging and transrectal ultrasound visualized a pre-sacral cyst, which was excised in toto with laterosacral approach of Kraske." }, { "field": "comparator", "quote": "The modified Bascom's asymmetric midgluteal cleft closure technique was used without satisfying clinical remission." }, { "field": "primaryOutcome", "quote": "The post-operative course was uneventful." }, { "field": "result", "quote": "A histological examination showed epidermal inclusion cyst." }, { "field": "n", "quote": "A 31-year-old man presented with a recurrent abscess in the gluteal cleft." } ] }, { "id": "pmid:25259438", "pmid": "25259438", "doi": null, "nctId": null, "pmcid": null, "title": "[Presacral tumor as a differential diagnosis of recurrent pilonidal sinus]", "firstAuthor": "Mengual-Ballester", "multipleAuthors": true, "journal": "Cir Cir", "year": 2014, "design": "case-series", "n": 1, "nField": "reported", "population": "22-year-old male with recurrent pilonidal sinus/cyst", "intervention": "Surgical removal of the tumor through the abdomen", "comparator": "None", "primaryOutcome": "Final diagnosis of the underlying mass", "result": "Recurrent pilonidal sinus was actually a presacral cystic teratoma, removed surgically", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a single case report, so it cannot show whether pilonidal cysts in general are dangerous.", "directness": "indirect", "limitations": "Single case; describes a rare presacral tumor misdiagnosed as pilonidal disease, not pilonidal cysts themselves.", "followUp": "", "plainFinding": "Rare hidden tumor mimicked pilonidal cyst.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25259438/", "sourceText": "BACKGROUND: Retrorectal or presacral space is occupied during embryological stem cell development and therefore may contain a heterogeneous group of tumors. CLINICAL CASE: We report the case of a 22-year-old male with a pilonidal cyst operated due to recurrent pilonidal sinus cyst. Final diagnosis after pelvic computed tomography is large retrorectal cystic tumor and magnetic resonance diagnosis of a presacral cystic compatible wtih germ cell tumor. The tumor was removed surgically through the abdomen and diagnosis of cystic teratoma was established. CONCLUSION: Retrorectal tumors are rare lesions whose presence must be ruled out in case of recurrent sinus.", "provenance": [ { "field": "population", "quote": "a 22-year-old male with a pilonidal cyst operated due to recurrent pilonidal sinus cyst" }, { "field": "intervention", "quote": "The tumor was removed surgically through the abdomen" }, { "field": "comparator", "quote": "CLINICAL CASE: We report the case of a 22-year-old male with a pilonidal cyst operated due to recurrent pilonidal sinus cyst." }, { "field": "primaryOutcome", "quote": "Final diagnosis after pelvic computed tomography is large retrorectal cystic tumor" }, { "field": "result", "quote": "diagnosis of cystic teratoma was established" }, { "field": "n", "quote": "a 22-year-old male" } ] }, { "id": "pmid:24969346", "pmid": "24969346", "doi": "10.1007/s00104-014-2776-0", "nctId": null, "pmcid": null, "title": "[\"Pit picking\" surgery for patients with pilonidal disease : mid-term results and risk factors]", "firstAuthor": "Iesalnieks", "multipleAuthors": true, "journal": "Chirurg", "year": 2015, "design": "case-series", "n": 153, "nField": "reported", "population": "patients with pilonidal disease", "intervention": "minimally invasive 'pit picking' surgery under local anesthesia", "comparator": "no comparison group", "primaryOutcome": "recurrence of pilonidal disease after surgery", "result": "74% of patients had no recurrence after a median follow-up of 30 months, and smoking and prior abscess were linked to higher recurrence risk", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a single-arm case series without a comparison group, so it shows outcomes after surgery but can't address whether the condition itself is dangerous.", "directness": "indirect", "limitations": "No control group, selected patient population, and the study focuses on surgical recurrence rather than on dangers of the untreated condition.", "followUp": "median follow-up time of 30 months", "plainFinding": "Most patients healed after minor surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24969346/", "sourceText": "BACKGROUND: Minimally invasive procedures have increasingly been used to treat pilonidal disease; however, the mid-term and long-term results have not been evaluated extensively yet. PATIENTS AND METHODS: All patients underwent \"pit picking\" surgery. The surgery was performed under local anesthesia. The technique of \"pit picking\" was: all midline pits were removed by excising a margin of skin of < 1 mm. An incision of 1 cm parallel to one side of the natal cleft opened the chronic abscess cavity. No specific postoperative wound care was given. RESULTS: A total of 153 patients (126 males) underwent \"pit picking\" surgery between June 2007 and November 2010. Follow-up information was available for 148 patients (97 %). Of the patients 74% had no recurrence after a median follow-up time of 30 months and 8 more patients (5 %) remained asymptomatic after a second\"pit picking\" procedure. By multivariate analysis, smoking (hazard ratio [HR] 2.1) and occurrence of an abscess during the course of disease (HR 2.7) were statistically significantly associated with the disease recurrence after \"pit picking\" surgery. CONCLUSION: Approximately three quarters of selected patients with pilonidal disease benefit from minimally invasive \"pit picking\" surgery.", "provenance": [ { "field": "population", "quote": "patients with pilonidal disease" }, { "field": "intervention", "quote": "All patients underwent \"pit picking\" surgery." }, { "field": "comparator", "quote": "All patients underwent \"pit picking\" surgery." }, { "field": "primaryOutcome", "quote": "disease recurrence after \"pit picking\" surgery" }, { "field": "result", "quote": "Of the patients 74% had no recurrence after a median follow-up time of 30 months and 8 more patients (5 %) remained asymptomatic after a second\"pit picking\" procedure." }, { "field": "n", "quote": "A total of 153 patients (126 males) underwent \"pit picking\" surgery between June 2007 and November 2010." }, { "field": "followUp", "quote": "median follow-up time of 30 months" } ] }, { "id": "pmid:24758263", "pmid": "24758263", "doi": "10.1111/iwj.12274", "nctId": null, "pmcid": "PMC7949541", "title": "Microbiology of the infected recurrent sacrococcygeal pilonidal sinus", "firstAuthor": "Ardelt", "multipleAuthors": true, "journal": "Int Wound J", "year": 2016, "design": "retrospective", "n": 96, "nField": "reported", "population": "patients with primary or recurring pilonidal sinus infections", "intervention": "swab samples taken from infected pilonidal sinus abscesses", "comparator": "primary pilonidal sinus versus recurring pilonidal sinus", "primaryOutcome": "type of bacteria found (gram-positive/negative, aerobic/anaerobic)", "result": "recurring sinus infections showed more gram-positive and aerobic bacteria than primary infections", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This was a small, single-centre retrospective review of swab samples, not a study testing treatment or danger.", "directness": "indirect", "limitations": "Retrospective single-centre design; abstract does not describe clinical outcomes or complications, only bacterial flora.", "followUp": "", "plainFinding": "Recurrent cysts show different bacteria types.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24758263/", "sourceText": "The aim of the present retrospective single centre study was to define the changes in the microbiological flora of the recurring sacrococcygeal pilonidal sinus (PS). Microbiological findings of swab samples of abscess-forming PS from 2000 to 2010 were evaluated. Within this time span, 73 swab samples were taken from primary sacrococcygeal pilonidal sinus (pPS) and 23 swab samples of patients with recurring sacrococcygeal pilonidal sinus (rPS). Our results show a statistically significant shift of the bacterial flora towards the gram-positive range (P = 0·029) and a shift with tendency towards the aerobic range (P = 0·090). Pathogens of pPS are not always solely anaerobic or gram-negative, and those of rPS not always aerobic or gram-positive. Therefore, antibiosis preceding microbiological examination should cover both the aerobic and anaerobic bacteria as well as the gram-positive and the gram-negative spectrum.", "provenance": [ { "field": "n", "quote": "73 swab samples were taken from primary sacrococcygeal pilonidal sinus (pPS) and 23 swab samples of patients with recurring sacrococcygeal pilonidal sinus (rPS)" }, { "field": "population", "quote": "Microbiological findings of swab samples of abscess-forming PS from 2000 to 2010 were evaluated." }, { "field": "intervention", "quote": "swab samples were taken from primary sacrococcygeal pilonidal sinus (pPS) and 23 swab samples of patients with recurring sacrococcygeal pilonidal sinus (rPS)" }, { "field": "comparator", "quote": "Pathogens of pPS are not always solely anaerobic or gram-negative, and those of rPS not always aerobic or gram-positive." }, { "field": "primaryOutcome", "quote": "to define the changes in the microbiological flora of the recurring sacrococcygeal pilonidal sinus (PS)" }, { "field": "result", "quote": "Our results show a statistically significant shift of the bacterial flora towards the gram-positive range (P = 0·029) and a shift with tendency towards the aerobic range (P = 0·090)." } ] }, { "id": "pmid:24239526", "pmid": "24239526", "doi": "10.1016/j.amjsurg.2013.07.038", "nctId": null, "pmcid": null, "title": "Pilonidal disease in a military population: how far have we really come?", "firstAuthor": "Fitzpatrick", "multipleAuthors": true, "journal": "Am J Surg", "year": 2014, "design": "retrospective", "n": 151, "nField": "reported", "population": "military personnel who had surgery for pilonidal disease", "intervention": "surgical excision, excision with closure, or incision and drainage for pilonidal disease", "comparator": "different surgical methods compared to each other", "primaryOutcome": "disease recurrence and complications after surgery", "result": "27.2% of patients had recurrence and 34.4% had complications after surgery, with higher complication risk after excision with primary closure", "resultDirection": "harm", "quality": "low", "qualityWhy": "this is a retrospective single-center study without randomization, so it mainly shows how risky surgery was in this group, not a controlled comparison", "directness": "direct", "limitations": "retrospective design, single institution, no control group without surgery, potential confounding by race and disease severity", "followUp": "", "plainFinding": "High recurrence and complication rates after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24239526/", "sourceText": "BACKGROUND: Pilonidal disease (PD) has a long connection with military personnel, even nicknamed \"jeep disease\" during World War II. The aim of this study was to identify factors associated with recurrence and complications after surgery in a military population. METHODS: A retrospective cohort analysis of operative therapy for PD at a single institution from 2005 to 2011 was conducted. Patient demographics, disease characteristics, and surgical methods were assessed for the primary outcomes of recurrence and morbidity. RESULTS: A total of 151 patients with PD were identified, who underwent excision (45.7%), excision with primary closure (29.8%), and incision and drainage (9.9%). Overall recurrence and morbidity rates were 27.2% and 34.4%, respectively. Black race, chronic disease, wound infection, and infection and drainage were associated with recurrence (P < .05), and excision with primary closure was associated with increased complications (P < .001). CONCLUSIONS: PD remains a significant source of morbidity and recurrence among military personnel. Certain patient-related and disease-related factors portend a worse prognosis, with black race and operative method the strongest predictors of outcomes.", "provenance": [ { "field": "population", "quote": "A total of 151 patients with PD were identified" }, { "field": "intervention", "quote": "excision (45.7%), excision with primary closure (29.8%), and incision and drainage (9.9%)" }, { "field": "comparator", "quote": "excision with primary closure was associated with increased complications" }, { "field": "primaryOutcome", "quote": "the primary outcomes of recurrence and morbidity" }, { "field": "result", "quote": "Overall recurrence and morbidity rates were 27.2% and 34.4%, respectively." }, { "field": "n", "quote": "A total of 151 patients with PD were identified" } ] }, { "id": "pmid:24202229", "pmid": "24202229", "doi": "10.1097/WON.0b013e3182a9c2d9", "nctId": null, "pmcid": null, "title": "Rare complication after VAC therapy in the treatment of tissue defect due to surgical excision of pilonidal sinus", "firstAuthor": "Irkoren", "multipleAuthors": true, "journal": "J Wound Ostomy Continence Nurs", "year": 2013, "design": "case-series", "n": 1, "nField": "reported", "population": "a 60-year-old patient after surgical excision of a pilonidal sinus", "intervention": "negative pressure wound therapy (NPWT/VAC) on the open wound", "comparator": "none", "primaryOutcome": "wound healing and detection of complications", "result": "the patient developed squamous cell carcinoma that went undetected because the NPWT dressing was left in place for 5 days", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how often this happens or whether it applies to others.", "directness": "direct", "limitations": "single case report with no comparison group; rare complication reported after a specific wound care technique, not pilonidal sinus itself.", "followUp": "", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24202229/", "sourceText": "BACKGROUND: Pilonidal sinus is frequently managed with surgical incision. If the wound is left open to heal by secondary intention, negative pressure wound therapy (NPWT) is often used to promote healing. CASE: We describe the case of a 60-year-old patient referred after excision of a pilonidal sinus, which was managed postoperatively with NPWT. Unfortunately, the patient developed squamous cell carcinoma, which was undetected postoperatively, as the dressing was left in place for 5 days. CONCLUSION: Guidelines for the use of NPWT should be followed, with dressing intervals at 2 to 3 days. Wounds managed by NPWT should be monitored carefully for malignancy at the time of dressing changes.", "provenance": [ { "field": "n", "quote": "a 60-year-old patient" }, { "field": "population", "quote": "after excision of a pilonidal sinus, which was managed postoperatively with NPWT" }, { "field": "intervention", "quote": "managed postoperatively with NPWT" }, { "field": "comparator", "quote": "CASE: We describe the case of a 60-year-old patient referred after excision of a pilonidal sinus, which was managed postoperatively with NPWT." }, { "field": "primaryOutcome", "quote": "the patient developed squamous cell carcinoma, which was undetected postoperatively" }, { "field": "result", "quote": "the patient developed squamous cell carcinoma, which was undetected postoperatively, as the dressing was left in place for 5 days" } ] }, { "id": "pmid:23932616", "pmid": "23932616", "doi": "10.1016/j.jpedsurg.2013.01.029", "nctId": null, "pmcid": null, "title": "Treatment of adolescent pilonidal disease with a new modification to the Limberg flap: symmetrically rotated rhomboid excision and lateralization of the Limberg flap technique", "firstAuthor": "Afşarlar", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2013, "design": "case-series", "n": 15, "nField": "reported", "population": "teenagers having surgery for pilonidal disease on the lower back", "intervention": "a modified surgical flap technique (symmetrically rotated rhomboid excision with lateralized Limberg flap)", "comparator": "no comparison group", "primaryOutcome": "wound infection and disease coming back after surgery", "result": "no wound infection or recurrence during follow-up; one patient had a wound hematoma", "resultDirection": "benefit", "quality": "low", "qualityWhy": "very small group of 15 patients, no comparison group, and only a few months of follow-up, so it cannot show how risky the disease itself is.", "directness": "indirect", "limitations": "Abstract itself states the number of patients was small and the follow-up period was short, and there was no comparator group.", "followUp": "4 months", "plainFinding": "New surgery technique healed without recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23932616/", "sourceText": "BACKGROUND/PURPOSE: Pilonidal disease is a common and frustrating problem among adolescents due to its high recurrence rate. The rhomboid excision and Limberg flap techniques promise successful results, but the lower part of the incision left on the intergluteal sulcus is prone to recurrences. Consequently, we have developed a new modification to this technique and have designed a descriptive prospective study to evaluate its efficiency. METHODS: We conducted this prospective study between March 2011 and March 2012. All of the patients who were operated on for sacrococcygeal pilonidal disease were included in this study. The surgical procedure primarily consisted of symmetrically rotated (clockwise) rhomboid excision and lateralization of the Limberg flap in order to keep the inferior corner of the suture line apart from the intergluteal sulcus. RESULTS: A total of 15 adolescents (8 boys and 7 girls) were included in the study group. Of the patients, 47% were normal, 13% were overweight, and 40% were obese. Five patients were operated on under general anesthesia, and 10 were operated on under spinal anesthesia. The length of the flap margins ranged from 2.5 to 7 cm (median=4 cm). The median duration of hospitalization was 5 days, and the median duration of suction drainage was 4 days. The median postoperative follow-up period was 4 months (ranging from 1 to 12 months), and we did not encounter any wound infection or recurrent disease during this period. Only one patient had wound hematoma as a result of drain breakdown and was treated with wound care without any additional complications. CONCLUSION: Although the number of patients in this study was small and the follow-up period was short, we obtained satisfactory results without any recurrence by performing a symmetrically rotated rhomboid excision and lateralized Limberg flap procedure.", "provenance": [ { "field": "n", "quote": "A total of 15 adolescents (8 boys and 7 girls) were included in the study group." }, { "field": "population", "quote": "All of the patients who were operated on for sacrococcygeal pilonidal disease were included in this study." }, { "field": "intervention", "quote": "symmetrically rotated (clockwise) rhomboid excision and lateralization of the Limberg flap" }, { "field": "comparator", "quote": "descriptive prospective study to evaluate its efficiency" }, { "field": "primaryOutcome", "quote": "we did not encounter any wound infection or recurrent disease during this period" }, { "field": "result", "quote": "we did not encounter any wound infection or recurrent disease during this period. Only one patient had wound hematoma as a result of drain breakdown" }, { "field": "followUp", "quote": "The median postoperative follow-up period was 4 months (ranging from 1 to 12 months)" } ] }, { "id": "pmid:23911903", "pmid": "23911903", "doi": "10.1016/j.jviscsurg.2013.05.006", "nctId": null, "pmcid": null, "title": "Pilonidal sinus disease", "firstAuthor": "de Parades", "multipleAuthors": true, "journal": "J Visc Surg", "year": 2013, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal disease, a skin condition near the tailbone, usually young adults aged 15-30", "intervention": "surgical treatment (various excision and closure techniques)", "comparator": "different surgical techniques compared to each other (open wound healing vs primary closure vs plastic reconstruction)", "primaryOutcome": "healing, recurrence, and recovery time after treatment", "result": "the abstract describes treatment options and tradeoffs rather than reporting a dangerousness outcome; it notes the open-wound technique has a low recurrence rate but longer healing and activity cessation, while primary closure is less restrictive but likely has higher recurrence", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a narrative review describing the condition and surgical options without original data, patient numbers, or statistical comparisons.", "directness": "indirect", "limitations": "no original study data, no patient numbers, no formal outcome measures reported; abstract does not address danger or severity of the disease itself, only treatment approaches", "followUp": "", "plainFinding": "Review of surgery options, not danger.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23911903/", "sourceText": "Pilonidal disease is a frequent suppurative condition that occurs twice as often in men as in women, usually between the ages of 15 and 30. Pilonidal disease is located beneath the skin of the sacro-coccygeal region. It presents acutely as an abscess under tension while the chronic form gives rise to intermittent discharge from pilonidal sinus(es). Diagnosis is clinical and usually straightforward. In the large majority of cases, treatment is surgical but there is no consensus as to the 'ideal' technique. Acute abscess must be evacuated and an off-midline incision seems preferable. Excision is the standard definitive treatment but the choice of wide versus limited excision depends on the school of thought. The widespread practice in France is to leave the wound open, relying on postoperative healing by secondary intention. This technique has a low rate of recurrence but has the disadvantages of requiring local nursing care; the healing process is prolonged, usually associated with a temporary but prolonged cessation of activity. Primary wound closure techniques are less restrictive but their recurrence rate is probably higher. A direct midline suture is best after a small excision, but for a more extended wound, plastic reconstruction techniques are preferred; data in the literature favor asymmetric closure techniques such as those described by Karydakis and Bascom.", "provenance": [ { "field": "population", "quote": "Pilonidal disease is a frequent suppurative condition that occurs twice as often in men as in women, usually between the ages of 15 and 30." }, { "field": "intervention", "quote": "In the large majority of cases, treatment is surgical but there is no consensus as to the 'ideal' technique." }, { "field": "comparator", "quote": "Primary wound closure techniques are less restrictive but their recurrence rate is probably higher." }, { "field": "primaryOutcome", "quote": "This technique has a low rate of recurrence but has the disadvantages of requiring local nursing care; the healing process is prolonged, usually associated with a temporary but prolonged cessation of activity." }, { "field": "result", "quote": "data in the literature favor asymmetric closure techniques such as those described by Karydakis and Bascom." } ] }, { "id": "pmid:23871483", "pmid": "23871483", "doi": "10.1016/j.jemermed.2013.05.022", "nctId": null, "pmcid": null, "title": "Sacrococcygeal foreign body progressing with pilonidal sinus clinical picture: report of a case", "firstAuthor": "Özdemir", "multipleAuthors": true, "journal": "J Emerg Med", "year": 2013, "design": "case-series", "n": 1, "nField": "reported", "population": "a patient with long-term leakage and repeated pilonidal abscesses in the tailbone area", "intervention": "not applicable (case report describing a foreign body found in the area)", "comparator": "none", "primaryOutcome": "finding the underlying cause of repeated abscesses and leakage", "result": "a retained foreign body was found to be causing recurrent abscesses after three prior surgeries", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how dangerous pilonidal cysts generally are.", "directness": "indirect", "limitations": "only one patient described; no comparison group; cause was an unusual foreign body rather than typical pilonidal disease.", "followUp": "", "plainFinding": "Rare case, foreign body caused recurring abscesses.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23871483/", "sourceText": "BACKGROUND: Pilonidal sinus is a benign anorectal disease that is frequently seen in the sacrococcygeal area when a foreign body reaction develops after the invasion of hair follicles. OBJECTIVES: Trauma in this region and clinical abscesses that recur after trauma due to foreign bodies are not frequently observed. CASE REPORT: This study presents the case of a patient with chronic leakage who had a history of three surgical procedures due to recurrent pilonidal abscesses and the presence of a foreign body in the sacrococcygeal area. CONCLUSION: The presence of a foreign body in cases progressing with a single and wide inlet and frequently recurring abscess formation is a condition of which to be aware.", "provenance": [ { "field": "n", "quote": "This study presents the case of a patient with chronic leakage" }, { "field": "population", "quote": "a patient with chronic leakage who had a history of three surgical procedures due to recurrent pilonidal abscesses and the presence of a foreign body in the sacrococcygeal area" }, { "field": "intervention", "quote": "This study presents the case of a patient with chronic leakage who had a history of three surgical procedures" }, { "field": "comparator", "quote": "CASE REPORT" }, { "field": "primaryOutcome", "quote": "The presence of a foreign body in cases progressing with a single and wide inlet and frequently recurring abscess formation is a condition of which to be aware." }, { "field": "result", "quote": "the presence of a foreign body in the sacrococcygeal area" } ] } ], "faqs": [ { "q": "Is a pilonidal cyst dangerous?", "a": "For most people, no — it's a painful but treatable lump near the tailbone. Some develop an abscess needing drainage, and very rarely, after many years, it can turn into skin cancer, but large studies suggest serious outcomes are uncommon." }, { "q": "Is a pilonidal cyst dangerous in pregnancy?", "a": "No study in this review followed pregnant people with a pilonidal cyst, so there's no research-based answer specific to pregnancy. If you're pregnant and have a painful or draining cyst, tell your obstetric provider so it can be checked and treated like any other infection." }, { "q": "Is an infected pilonidal cyst dangerous?", "a": "An infected cyst (abscess) usually needs drainage and sometimes antibiotics; studies show this is a common complication rather than a typical life-threatening one. In rare, documented cases the infection has spread more seriously, including toward the spine or abdomen, so worsening pain, fever, or feeling very unwell needs prompt medical attention." }, { "q": "What should I do instead of waiting it out?", "a": "See a doctor or urgent care rather than trying to drain it yourself; abscesses are usually treated with incision and drainage, sometimes with antibiotics. Watch for spreading redness, fever, or feeling unwell, since case reports show an untreated spreading infection can occasionally become serious." }, { "q": "Can a pilonidal cyst turn into cancer?", "a": "Yes, but it's very rare. In the largest study to look at this, cancer was found in only about 1 in 800 removed chronic cysts, almost always after the cyst had been present for many years." } ], "searchedAs": [ "is pilonidal cyst dangerous", "is pilonidal cyst dangerous in pregnancy", "is an infected pilonidal cyst dangerous" ], "patientTakeaway": "A pilonidal cyst is usually uncomfortable rather than dangerous, but don't ignore warning signs. If it becomes red, swollen, draining, or you develop fever or feel unwell, see a doctor promptly for drainage — most people are then successfully treated. If a long-standing cyst changes size, bleeds, or won't heal, ask your doctor to check it for the rare possibility of cancer.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(\"Pilonidal Sinus\"[Mesh]) AND (complications[sh] OR \"natural history\" OR prognosis[tiab] OR abscess OR sepsis OR \"malignant transformation\" OR carcinoma OR pregnancy[tiab])" }, "pubmedQueryTranslation": "\"Pilonidal Sinus\"[MeSH Terms] AND (\"complications\"[MeSH Subheading] OR \"natural history\"[All Fields] OR \"prognosis\"[Title/Abstract] OR (\"abscess\"[MeSH Terms] OR \"abscess\"[All Fields] OR \"abscesses\"[All Fields] OR \"abscessation\"[All Fields] OR \"abscessed\"[All Fields] OR \"abscessing\"[All Fields]) OR (\"sepsis\"[MeSH Terms] OR \"sepsis\"[All Fields]) OR \"malignant transformation\"[All Fields] OR (\"carcinoma\"[MeSH Terms] OR \"carcinoma\"[All Fields] OR \"carcinomas\"[All Fields] OR \"carcinoma s\"[All Fields]) OR \"pregnancy\"[Title/Abstract])", "searchedOn": "2026-10-13", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Is a pilonidal cyst dangerous?", "description": "What 63 studies show about pilonidal cyst danger: abscess and infection are common, and cancer transformation is rare but can be serious." }, "lastChecked": "2026-10-13", "lastChanged": "2026-10-13", "nextCheckDue": "2026-11-13", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-13" }, "status": "published" }