Why is there a bump at the top of my butt crack and it hurts?

A painful bump there is most often a pilonidal cyst or abscess — a pocket under the skin that can fill with hair, skin debris, and fluid and become infected. It usually needs a clinician to examine, and sometimes drain, it; studies show draining the abscess and clearing out the tunnel together lowers the chance it comes back, compared with draining alone.

Why is the top of my bum crack split and sore?

This is usually the opening (or 'pit') of a pilonidal sinus — a small tunnel under the skin — rather than a simple skin crack. These pits can become irritated, infected, or start draining fluid, which is why the area can look split and feel sore.

Why is my butt crack bleeding?

Bleeding from this area is a recognised symptom of pilonidal disease, reported alongside pain and discharge in several studies, and it can also happen after some in-clinic treatments. Persistent or heavy bleeding should be checked by a clinician rather than watched at home, since these studies don't tell us how to safely tell causes apart without an exam.

Why does skin crack on top of butt?

What looks like a cracked patch of skin is usually one or more small pits of a pilonidal sinus, sometimes alongside ordinary skin irritation from sweat and friction in that crease. It generally isn't a simple dry-skin crack.

What should I do instead of waiting for it to go away on its own?

See a doctor or nurse, especially if there's swelling, pus, bleeding, or a sore that isn't healing. The studies here found that pilonidal disease often recurs and, when left chronically unresolved, has rarely been linked to serious infection or even skin cancer, so getting a proper diagnosis matters more than waiting it out.

Why does the top of my butt crack hurt?

Name: Why does the top of my butt crack hurt?
Published: 2026-10-13
Keywords: why does the top of my butt crack hurt, why does my butt crack hurt, why is my butt crack sore, why is there a bump at the top of my butt crack and it hurts, why is the top of my bum crack split and sore, why is the top of my bum crack sore, why is my butt crack bleeding, why skin cracks on top of butt

In adults and adolescents presenting with pain, swelling, a bump, or bleeding at the top of the natal cleft (upper buttock crease), what conditions—most notably pilonidal disease—explain these symptoms, and how often do they recur or require surgical treatment?

How people search for this, in their own words

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

Bottom line

Pain, swelling, a bump, or bleeding at the top of the butt crack is usually pilonidal disease, and the evidence shows it often comes back after treatment and can occasionally cause serious harm if ignored.

Across 14 randomised trials and many other studies, pilonidal disease — a small tunnel or cyst near the tailbone, often containing hair — is the explanation most studies address. The findings disagree with each other: recurrence after treatment ranges from under 5% to over half, depending on the technique and how long people were followed, and rare but serious problems have been reported, including a severe spreading infection after one laser procedure and skin cancer developing from long-untreated disease. No study followed people with this symptom who got no medical evaluation at all, so this evidence cannot tell you what happens if you simply wait it out.

How certain

Moderate

5 well-conducted randomised trials address this question directly. The studies disagree with one another, so the overall certainty is lower than any single one of them.

What it shows

Signal of harm

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

studies found: 179studies found
randomised trials: 14randomised trials
people studied: 736,732people studied
reviews of trials: 21reviews of trials
years covered: 2024–2026years covered

Read this first

A case of necrotising fasciitis (a severe, rapidly spreading soft-tissue infection) developed within 24 hours after a laser procedure for pilonidal disease, requiring emergency surgery.
Several case reports describe skin cancer (verrucous carcinoma, squamous cell carcinoma, or Marjolin's ulcer) developing from chronic, long-standing pilonidal disease that was never resolved; in one case this led to death despite treatment.
People with pilonidal sinus disease had a higher rate of depression over five years compared with people without it, in one large population study.
Women had higher recurrence rates than men after pilonidal surgery in more than one study, including after cleft-lift surgery.
Cold spray (cryotherapy) used for numbing during laser hair removal caused hives (urticaria) at the treatment site in two reported cases.
Mixing an antibiotic sometimes used for this condition with alcohol caused a reaction with flushing, vomiting, low blood pressure, and a fast heart rate in one reported case.
Residue from silver-containing wound dressings was reported to interfere with MRI imaging, delaying diagnosis of a hidden fistula in one patient.

What the research shows

Pilonidal disease vs. other causes of pain at the top of the crease
Case reports describe several look-alikes at the top of the buttock crease, including true fistulas, developmental cysts, other skin disorders, and, in long-standing cases, skin cancer arising from chronic pilonidal disease. One study of 59 adults with perianal itching, using MRI and surgical findings, found perianal fistula was the most common cause (57.6%), followed by abscess (33.9%), pilonidal sinus (5.1%), and hemorrhoids (3.4%) - so pilonidal disease was not the most common explanation in that group. A separate case series found 21 adolescents whose gluteal-crease symptoms turned out to be caused by something other than pilonidal disease, including nerve problems, skin conditions, bowel disease, sacral dimples, or a pressure sore. No large study has measured how often each possible cause explains pain, a bump, or drainage in a typical person who has not yet been diagnosed.[1,2,3,4,5,6,7,8,9,10,11]
Insufficient evidence
Abscess (sudden painful swelling with pus)
Many people first present with an abscess rather than mild soreness. Destroying the tunnel under the skin at the same time as draining the abscess cut recurrence from over half to about 1 in 9 in one study, but no study measured how often an abscess happens to someone with no prior history of this condition.[1,2,3]
Insufficient evidence
Recurrence after treatment
Recurrence after treatment ranges from under 5% to over 50% across studies, mostly depending on the technique used and how long patients were followed. Moving the wound off the midline (flap surgery) or avoiding cutting altogether (laser, endoscopic, pit-picking) tends to have lower recurrence than cutting and leaving the wound open down the midline, but no technique prevents it coming back entirely.[1,2,3,4,5,6,7,8,9]
Possible improvement
Need for surgical treatment
Some people improve with non-operative measures like laser hair removal or in-office pit removal, without a formal operation. In one study, disease returned in 26% of patients who had surgery versus 2% managed without it, though the non-surgical group likely started out with milder disease.[1,2,3,4,5]
Possible improvement
Bleeding or discharge from the area
Bleeding and discharge are reported both as symptoms of pilonidal disease and as side effects of some treatments. For example, 1 of 22 patients having a minimally invasive laser procedure (SiLaC) had minor bleeding afterward, and 35% of children having a minimally invasive trephination procedure reported discharge afterward. No study here measured how often bleeding or discharge occurs in the general population of people with this symptom, or how to tell pilonidal bleeding apart from other causes.[1,2]
Insufficient evidence
Time to symptom resolution
Healing time varies a great deal by treatment. In randomised and cohort studies, pit-picking healed in a median of 17 days versus 60 days for radical excision; Bascom's cleft lift healed in a median of 55 days versus 101 days for excision left open to heal; and laser treatment with limited excision took about 6.5 weeks versus 14.5 weeks for wide excision. No study here tracked how long pain or other symptoms last in people who received no treatment at all.[1,2,3]
Possible improvement
Serious complications, including missed cancer diagnosis
Rare but serious events have been reported: a case of necrotising fasciitis (a dangerous spreading infection) after a laser procedure, and several case reports where a long-standing, unhealed lesion in this area turned out to be skin cancer rather than ordinary pilonidal disease. These are uncommon, but are a reason not to ignore a sore that won't heal.[1,2,3,4,5]
Possible harm

What it may help with

In several randomised trials, less invasive techniques led to less pain and/or faster healing than more invasive excision surgery. Pit-picking surgery healed in a median of 17 days versus 60 days with radical excision. Laser treatment caused lower pain scores (2.3 vs 4.8 out of 10) and faster wound healing (10 vs 34 days) than lay-open surgery. Endoscopic treatment healed faster (45 vs 100 days) with fewer complications (20.8% vs 53.7%) than open excision, with similar recurrence rates. One trial found a less invasive technique (unroofing and marsupialization) gave a faster return to daily activity than a standard flap operation, but more recurrences by 90 days (3 vs 0).[1,2,3,4]
Off-midline flap surgery (such as the Karydakis flap or Bascom cleft lift) and destroying the sinus tract at the time of abscess drainage are both linked to lower recurrence than older, simpler techniques.[1,2,3,4]
Most people treated for pilonidal disease, across many different techniques, end up healed, even though some need a second procedure.[1,2,3,4]

Important limitations

These three studies describe how pilonidal disease is treated surgically and how surgical outcomes are reported in the published literature - they do not study why pain starts, or how to tell pilonidal disease apart from other causes before a diagnosis has been made. This matches the evidence base as a whole: it is almost entirely about treating a condition once it has already been diagnosed.[1,2,3]
Most evidence is retrospective (looking back at medical records) rather than randomised, so differences between treatments could partly reflect which patients got which treatment, not the treatment itself.[1,2,3]
How long studies followed patients after treatment varies hugely and has been shrinking over time; this inflates how 'cured' recent studies look, because unhealed wounds can get miscounted as cures and late recurrences get missed.[1,2,3]
No study compared getting any treatment with doing nothing at all, so this evidence cannot describe how the condition behaves if left completely untreated.[1]

What the studies found

Found a benefit73 · 41%
Found no clear effect8 · 4%
Mixed or unclear87 · 49%
Found possible harm11 · 6%

What kind of studies

Retrospective62 · 35%
Case series50 · 28%
Prospective cohort20 · 11%
Randomised trial14 · 8%
Meta-analysis13 · 7%
Narrative review10 · 6%
Systematic review8 · 4%
Laboratory study1 · 1%
Registry1 · 1%

The studies that decided it

Suenaert et al. 2026
Necrotising Fasciitis Following Sinus Laser-Assisted Closure Treatment for Pilonidal Disease: A Case Report
Rare serious infection after laser treatment.Case seriesVery low quality
1 people2026
the patient developed necrotising fasciitis with severe pain, fever and spreading infection within 24 hours, requiring emergency surgery and antibiotics, but ultimately recovered well
Who was studied
a 49-year-old man with pilonidal disease (a cyst/sinus at the top of the buttock crack)
What they received
Sinus Laser-Assisted Closure (SiLaC), a minimally invasive laser treatment for pilonidal disease
Compared with
none
Main outcome
development of serious infection (necrotising fasciitis) after the procedure
Quality
this is a single patient case report, so it cannot show how common or rare this problem is, only that it can happen.
Limitations
Only one patient is described, with no comparison group, so it's impossible to know how often this complication occurs or why it happened in this case.
Taken word for word from the abstract
- population a 49-year-old male who developed necrotising fasciitis following SiLaC
- intervention Sinus Laser-Assisted Closure (SiLaC®) is a minimally invasive treatment for pilonidal disease
- comparator Sinus Laser-Assisted Closure (SiLaC®) is a minimally invasive treatment for pilonidal disease, characterised by low reported rates of complications.
- primaryOutcome developed necrotising fasciitis following SiLaC
- result Within 24 hours postoperatively, the patient presented with severe pain, high fever, and cellulitis; however, crepitus was absent.
- result The patient achieved a favourable recovery.
- n this case report details a 49-year-old male
Cureus · PMID 42730257 · Read it on PubMed ↗
Tokocin et al. 2026
Surgical Treatment Outcomes for Primary Pilonidal Sinus Disease: A Single-Centre Retrospective Study of 2222 Patients (2006-2020)
Flap surgery beats simple open surgery.RetrospectiveModerate quality
2,222 peopleminimum follow-up of 5 years
Off-midline flap surgeries, especially Karydakis flap and Bascom cleft lift, had much lower rates of the condition coming back than lay-open surgery
Who was studied
people with pilonidal sinus disease (cyst/tract at top of buttock crease) needing surgery, no prior surgery for it
What they received
off-midline flap surgical techniques (e.g. Karydakis flap, Bascom cleft lift, Limberg flap, Dufourmentel flap)
Compared with
lay-open (midline) surgical treatment
Main outcome
disease coming back (recurrence) and infection after surgery, over at least 5 years
Quality
It's a large study with long follow-up, but it only looked back at past records from one hospital rather than randomly assigning treatments, so other differences between patients could affect the results.
Limitations
Retrospective single-centre design, no randomisation, technique choice may have been influenced by surgeon or patient factors, only patients with minimum 5-year follow-up included which could bias results.
Taken word for word from the abstract
- population We retrospectively analysed 2222 patients with primary PSD who underwent surgery between January 2006 and December 2020 at a single tertiary referral centre in Turkey and had a minimum follow-up of 5 years.
- intervention Off-midline flap techniques were associated with superior long-term outcomes, with lower recurrence and infection than midline or secondary-healing approaches.
- comparator Compared with lay-open treatment
- primaryOutcome We compared long-term recurrence and postoperative infection among nine surgical techniques in a large single-centre cohort.
- result the Karydakis flap (HR 0.19, 95% CI 0.12-0.30), Bascom cleft lift (HR 0.25, 95% CI 0.14-0.43), Limberg flap (HR 0.32, 95% CI 0.19-0.53) and Dufourmentel flap (HR 0.26, 95% CI 0.12-0.57) were independently associated with lower risk of recurrence
- n We retrospectively analysed 2222 patients with primary PSD
- followUp had a minimum follow-up of 5 years
Int Wound J · PMID 42633928 · Read it on PubMed ↗
Doll et al. 2026
[Are there any male-to-female disparities in recurrence rates after surgery for Pilonidal Disease? A meta-analysis comparing differing mixed-gender cohorts]
Women had more recurrences after surgery.Meta-analysisLow qualityRelated question
113,021 people5-year and 10-year
women had higher recurrence rates than men across all surgical methods studied
Who was studied
adults with pilonidal sinus disease (a cyst/abscess near the top of the buttock crack) who had surgery
What they received
surgery for pilonidal disease in women
Compared with
surgery for pilonidal disease in men
Main outcome
rate of the disease coming back after surgery (at 5 and 10 years)
Quality
it pools very different kinds of studies (trials and observational studies) and the female-only group was small, so the comparison between sexes is not solid proof.
Limitations
abstract notes the female-only cohort was limited in size, precluding further subgroup analyses, and calls for confirmation with individual patient data
Taken word for word from the abstract
- n 880 studies encompassing 113, 021 patients were surveyed
- population Pilonidal Sinus Disease (PSD) manifests globally with a prevalence in adult men fourfold greater than in adult women
- intervention female-only (Fo; 653 patients)
- comparator male-only (Mo; 16.843 patients)
- primaryOutcome Recurrence rates at 5-year and 10-year follow-up following various surgical interventions were compared.
- result Females with PSD seem to have a higher RR as compared to men for all therapies tested.
Khirurgiia (Mosk) · PMID 42027172 · Read it on PubMed ↗
Griffiths et al. 2026
Pilonidal Disease: A Recent Decade of the Disease among Active Duty United States Military Service Members
Pilonidal disease often recurs or persists.RetrospectiveLow quality
25,039 people2026
nearly half had recurrence or persistence after initial care, with heavy use of healthcare visits
Who was studied
active duty US military service members diagnosed with pilonidal disease
What they received
not applicable (descriptive study of disease burden and treatment patterns)
Main outcome
how often pilonidal disease recurs, persists, and requires healthcare visits
Quality
this is a descriptive database review without a comparison group, so it cannot show whether any treatment works better than another.
Limitations
no control group, treatment strategies were inconsistent, and the study only describes patterns rather than testing a treatment.
Taken word for word from the abstract
- population all active duty U.S. service members with at least one PD diagnosis in the MHS Data Repository between January 1, 2013, and December 31, 2022
- n 25,039 active duty service members were diagnosed with an incident case of PD
- primaryOutcome Prevalence of recurrence was 44.6% (2,494 of 5,598) and persistence was 50.1% (9,731 of 19,441)
- result service members in the top 25% for healthcare utilization had ≥11 encounters with a PD diagnosis
- intervention Treatment strategies remain heterogeneous, and prospective studies are needed to refine clinical guidelines.
Mil Med · PMID 41631611 · Read it on PubMed ↗
Curcio et al. 2026
Marjolin's ulcer arising in pilonidal disease: a case report and historical perspective
Rare case: pilonidal ulcer turned out to be cancer.Case seriesVery low qualityRelated question
1 people2026
the ulcer was found to be a cancer (squamous cell carcinoma) that had already spread to lymph nodes and could not be surgically removed
Who was studied
a young woman with long-standing pilonidal disease (a mass/cyst near the tailbone)
What they received
no treatment given; diagnostic biopsy and workup after a chronic pilonidal ulcer
Compared with
none
Main outcome
diagnosis of what was causing a non-healing ulcer at the pilonidal site
Quality
this is a single patient case report, so it cannot tell you what usually happens or how likely this is.
Limitations
only one patient; diagnosis was delayed by missed biopsies, so this describes a rare worst-case complication rather than typical pilonidal pain.
Taken word for word from the abstract
- n We report a case of malignant transformation in a young woman
- population a young woman with pilonidal disease
- intervention Immediate biopsy was performed and confirmed squamous cell carcinoma (SCC).
- comparator The disease was deemed unresectable and systemic therapy was begun.
- primaryOutcome This case emphasizes the importance of biopsy in nonhealing ulcers
- result Fine-needle aspiration confirmed metastatic SCC in the inguinal lymph nodes. The disease was deemed unresectable
J Surg Case Rep · PMID 41466774 · Read it on PubMed ↗
Krieg et al. 2025
Association between pilonidal sinus disease and depression: a population-based cohort study
Higher depression risk, not pain cause.RetrospectiveModerate qualityRelated question
11,245 peoplefive years
higher rate of depression in those with pilonidal sinus disease
Who was studied
adults with pilonidal sinus disease (a cyst/infection near the tailbone)
What they received
having pilonidal sinus disease
Compared with
people without pilonidal sinus disease
Main outcome
developing depression within five years
Quality
Large real-world database study with matching, but it's retrospective so other unmeasured factors could explain the link.
Limitations
Retrospective design using general practice records; excluded people with prior psychiatric conditions; cannot prove cause, only association.
Taken word for word from the abstract
- population patients aged ≥ 18 years diagnosed with PSD (ICD-10: L05) between 2005 and 2022
- intervention pilonidal sinus disease (PSD)
- comparator individuals without PSD
- primaryOutcome Depression diagnoses (ICD-10: F32, F33) within five years after diagnosis
- result PSD was associated with an increased risk of depression (HR: 1.16; 95% CI 1.09–1.24)
- n A total of 11,245 PSD patients (23% women, mean age 35.3 years) were matched to individuals without PSD.
Qual Life Res · PMID 40965774 · Read it on PubMed ↗
Emengo et al. 2025
Adolescent Gluteal Cleft Pathologies Not Due to Pilonidal Disease: A Case Series and Diagnostic Algorithm
Several non-pilonidal causes identified.Case seriesLow qualityRelated question
21 people2025
found 21 patients with causes other than pilonidal disease, including nerve problems, skin conditions, bowel disease, sacral dimples, and a pressure sore; a diagnostic algorithm was created to tell these apart
Who was studied
teenagers with problems at the top of the butt crack
What they received
clinical work-up and examination to find the cause
Compared with
none
Main outcome
identifying the specific non-pilonidal diagnosis causing symptoms
Quality
This is a small retrospective case series without a comparison group, so it only describes possible causes rather than proving what treatment works.
Limitations
Retrospective design, small sample size, single pediatric clinic, and no outcome comparison between treatments.
Taken word for word from the abstract
- population adolescent patients with non-pilonidal gluteal cleft pathologies
- n We identified 21 patients who had diagnoses other than pilonidal disease
- intervention Patients who received a work-up for diseases separate from pilonidal disease were included in our study.
- comparator Patient demographics, clinical work-up, and treatment outcomes were recorded.
- primaryOutcome Diagnostic decisions were based on the presence and location of an open wound, history of immobility, presence of gluteal cleft swelling or pit, clinical symptoms of pain or erythema, and other similar lesions on the body.
- result 4 patients had neurological diseases (schwannoma, central disk protrusion, arachnoid cyst, Tarlov cyst); 7 patients had dermatological diseases (folliculitis, moisture-associated skin damage); 5 patients had inflammatory bowel disease; 4 patients had sacral dimples; and 1 patient had a sacral pressure ulcer.
Clin Med Insights Pediatr · PMID 40861268 · Read it on PubMed ↗
Montebello et al. 2024
Parathyroid Hormone Related Protein Mediated Hypercalcaemia Due to Metastatic Squamous Cell Carcinoma Originating from Pilonidal Disease: A Case Report
Rare cancer mimicked pilonidal disease, proved fatal.Case seriesVery low qualityRelated question
1 peoplewithin a year of diagnosis
despite treatment the cancer spread widely, caused severe high blood calcium that did not respond to treatment, and he died within a year
Who was studied
a 56-year-old man with a long-standing painful skin lesion at the top of the buttock crack
What they received
treatment for squamous cell carcinoma (radiotherapy, chemotherapy, immunotherapy) after the lesion turned out to be cancer, not a pilonidal abscess
Compared with
none - single patient case report
Main outcome
disease control and survival
Quality
this is a single patient's case report, so it cannot tell you how likely this is for anyone else.
Limitations
only one patient; describes a rare cancer misdiagnosed as a pilonidal abscess, not ordinary pilonidal disease pain
Taken word for word from the abstract
- population A 56-year-old male presented with a longstanding, gradually enlarging, painful, skin lesion over the natal cleft.
- intervention He underwent radiotherapy, cisplatin chemotherapy and cemiplimab immunotherapy to control his disease.
- comparator Complete surgical cure was not possible.
- primaryOutcome His disease progressed, and he developed widespread metastases.
- result He died within a year of diagnosis.
- n A 56-year-old male presented
Br J Hosp Med (Lond) · PMID 39212563 · Read it on PubMed ↗

What actually helps, on this site

More about the condition:

All 179 studiesEvery study that answered the question, with its design, size and result.

The other 171 studiesEverything else the search returned, including anything retracted.

Ehsan et al. 2026
Neighborhood socioeconomic opportunity and clinical presentation, recurrence, and longitudinal treatment intensity in adolescent pilonidal disease
Poorer areas got less laser treatment.RetrospectiveLow qualityRelated question
393 people2026
neighborhood opportunity was not linked to disease severity, symptom duration, recurrence, or getting laser treatment, but patients from the lowest-opportunity neighborhoods completed about 22% fewer laser sessions
Who was studied
adolescents evaluated for pilonidal disease at a specialty clinic
What they received
living in a neighborhood with the lowest socioeconomic opportunity (Q1)
Compared with
living in neighborhoods with higher socioeconomic opportunity
Main outcome
disease stage at presentation, symptom duration, recurrence, receipt of laser therapy, and number of completed laser treatment sessions
Quality
This is a retrospective study from one clinic that can show patterns but not prove cause, and it doesn't address why pilonidal disease causes pain or how to treat it.
Limitations
Retrospective, single-center cohort; cannot establish causation and does not address pain mechanism or treatment effectiveness.
Taken word for word from the abstract
- n Among 393 adolescents (median age 17.0 years[IQR:15.3-18.8])
- population adolescents evaluated for pilonidal disease at a high-volume specialty clinic from 2019 to 2024
- intervention Q1 residence was independently associated with fewer completed laser sessions
- comparator HPI was analyzed continuously, by quintiles, and using a prespecified lowest-quintile (Q1) threshold contrast
- primaryOutcome Outcomes included disease stage at presentation, symptom duration, recurrence, receipt of laser epilation, and number of completed laser sessions
- result neighborhood opportunity was not associated with disease severity, symptom duration, recurrence, or receipt of laser therapy. However, among laser recipients (92%), Q1 residence was independently associated with fewer completed laser sessions (adjusted IRR:0.78; 95% CI:0.65-0.93), reflecting approximately 22% lower treatment intensity
Pediatr Surg Int · PMID 42862392 · Read it on PubMed ↗
Pomper et al. 2026
Sinus Laser-Assisted Closure Under Tumescent Local Anesthesia for Pilonidal Disease: A Pilot Study
Laser surgery well tolerated, low pain.Case seriesLow quality
22 people90 days
low pain scores after surgery, only minor complications, and no recurrences at 90 days
Who was studied
patients with pilonidal sinus disease
What they received
laser treatment of the sinus (SiLaC) using tumescent local anesthesia
Compared with
none - single-group study, no comparison treatment
Main outcome
pain levels, complications, and recurrence of the sinus after 90 days
Quality
It's a small pilot study of 22 people with no comparison group and only 90 days of follow-up, so it can't prove the treatment is better than other options.
Limitations
small sample size, absence of a control group, and limited follow-up
Taken word for word from the abstract
- population 22 consecutive patients with PSD underwent SiLaC under TLA
- intervention Sinus laser-assisted closure (SiLaC) is a minimally invasive option for management of pilonidal sinus disease (PSD)
- intervention Tumescent local anesthesia (TLA) may further facilitate outpatient treatment
- comparator Given the small sample size, absence of a control group, and limited follow-up
- primaryOutcome Pain was assessed preoperatively, intraoperatively, and on postoperative days 1, 2, 3, and 7 using the Visual Analog Scale (VAS; 0-10).
- primaryOutcome no patients were lost to follow-up, and no recurrences, wound healing disorders, or delayed complications were observed in the full evaluable cohort (0/22)
- result Three minor postoperative events occurred: two cases of localized painful swelling and one case of minor bleeding.
- result no recurrences, wound healing disorders, or delayed complications were observed in the full evaluable cohort (0/22)
- n Between September 2025 and January 2026, 22 consecutive patients with PSD underwent SiLaC under TLA.
- followUp All 22 patients completed the 90-day follow-up
Cureus · PMID 42830906 · Read it on PubMed ↗
Ehsan et al. 2026
Evolution of Surgical Management in Pilonidal Disease: A 25-Year Scoping Review and Bibliometric Analysis of Pediatric and Adult Literature
Review of trends, not treatment effectiveness.Systematic reviewLow qualityRelated question
383 people2026
research volume grew, with pediatric studies increasingly using minimally invasive methods while adult studies still mostly rely on surgery
Who was studied
adolescents and young adults with pilonidal disease (sacrococcygeal area)
What they received
surgical treatments for pilonidal disease, including minimally invasive approaches
Compared with
traditional operative excision/flap reconstruction
Main outcome
trends in treatment approach and research focus over time
Quality
this is a descriptive review of publication trends, not a study comparing treatments' effectiveness, so it can't say what works best
Limitations
abstract notes heterogeneity in treatment strategies and research focus, and no pediatric studies from low- or middle-income countries
Taken word for word from the abstract
- n A total of 383 studies were included - 327 adult (85%) and 56 pediatric (15%) studies.
- population Pilonidal disease is a chronic inflammatory condition of the sacrococcygeal region that disproportionately affects adolescents and young adults.
- intervention pediatric studies more frequently evaluated minimally invasive and multimodal strategies
- comparator Operative-only approaches predominated in adult literature (80% vs 61%, p<0.001)
- primaryOutcome Bibliometric analysis assessed publication trends, geographic distribution, and thematic evolution using keyword co-occurrence mapping.
- result Keyword analysis demonstrated temporal evolution from excisional surgery and flap reconstruction toward minimally invasive and adjunctive therapies.
J Pediatr Surg · PMID 42822663 · Read it on PubMed ↗
Sie et al. 2026
Hidradenitis Suppurativa: Part of a Tetrad of Follicular Occlusion Disorders
Review explains causes, no treatment outcomes tested.Narrative reviewVery low qualityRelated question
size not given2026
the abstract describes disease mechanisms and outlines wound care strategies but does not report comparative outcome data on whether treatments work
Who was studied
people with follicular occlusion disorders such as hidradenitis suppurativa, acne conglobata, dissecting cellulitis of the scalp, and pilonidal sinus
What they received
wound care strategies including dressing selection, exudate and odor management, pain and itch control, infection management, and IV ertapenem rescue therapy
Main outcome
understanding of disease mechanisms, clinical features, and wound care management approaches
Quality
this is a general educational review article, not a study testing a treatment, so it cannot show whether any treatment works.
Limitations
this is a narrative review for clinician education, not a study with original outcome data; it does not test or report results of specific treatments against a comparator
Taken word for word from the abstract
- population this grouping includes hidradenitis suppurativa (HS), acne conglobata (AC), dissecting cellulitis of the scalp (DCS), and pilonidal sinus (PS)
- intervention 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.
- primaryOutcome This article aims to provide a comprehensive review of FOD, with a primary emphasis on HS (the most prevalent of the disorders).
- result 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.
Adv Skin Wound Care · PMID 42759045 · Read it on PubMed ↗
Sandroni et al. 2026
Use of Oxygen-Enriched Oil Dressings in Wound Management: A Scoping Review
May help wounds heal, evidence weakSystematic reviewLow qualityRelated question
501 people2026
findings were generally favorable for wound healing outcomes, but evidence was limited and preliminary
Who was studied
patients with surgical wounds, including pediatric postoperative wounds, pilonidal disease, hidradenitis suppurativa wounds, angular cheilitis, and cancer-related wounds
What they received
oxygen-enriched oil dressings applied to wounds
Compared with
not clearly specified across the included studies
Main outcome
healing time, pain, complications, infection, scar quality and patient satisfaction
Quality
This is a review of only nine small studies of mixed designs, some just case reports, so the findings are preliminary and not strong evidence.
Limitations
The abstract notes studies varied widely in design (from RCTs to case reports) and calls for independent controlled studies with larger samples and standardized outcomes.
Taken word for word from the abstract
- n nine studies including a total of 501 patients were included
- population Applications included pediatric postoperative wounds (distal hypospadias and pilonidal disease), postsurgical wounds related to hidradenitis suppurativa, angular cheilitis, and oncological wounds.
- intervention oxygen-enriched oil-based dressings for the management of skin wounds
- comparator The studies comprised different designs, ranging from randomized controlled trials to case reports.
- primaryOutcome The most frequently investigated outcomes included reductions in healing time, pain, local complications, and infectious burden, as well as improvements in scar quality and patient satisfaction.
- result Although preliminary findings are favorable, independent controlled studies with larger samples and standardized outcomes are needed to define their comparative effectiveness and role in clinical practice more precisely.
J Clin Med · PMID 42739779 · Read it on PubMed ↗
Alvandipour et al. 2026
Verrucous carcinoma arising from chronic sacrococcygeal pilonidal disease: a case report
Rare cancer found in long-term cyst.Case seriesVery low qualityRelated question
1 people12 months
The tissue was a rare type of skin cancer (verrucous carcinoma) that had developed from the chronic cyst; surgery removed it completely with no return after a year
Who was studied
63-year-old man with 5 years of chronic pilonidal disease (cyst/sinus near tailbone) with recurring inflammation and discharge
What they received
Surgical removal of the affected tissue with flap reconstruction
Compared with
None
Main outcome
Whether the tissue was cancerous and whether it recurred after surgery
Quality
This is a single patient case report, so it cannot show how common this is or what causes typical pilonidal pain.
Limitations
Only one patient; short follow-up of 12 months; findings cannot be generalized to typical pilonidal cases.
Taken word for word from the abstract
- n A 63-year-old man presented with a 5-year history of chronic pilonidal disease
- population A 63-year-old man presented with a 5-year history of chronic pilonidal disease associated with recurrent inflammation, purulent discharge, and delayed wound healing.
- intervention The patient underwent wide local excision with reconstruction using a Limberg flap.
- comparator CASE PRESENTATION
- primaryOutcome Histopathological examination confirmed well-differentiated verrucous carcinoma without lymphovascular invasion, and the surgical margins were free of tumor, with a clear margin of 5 mm.
- result No recurrence was observed during 12 months of follow-up.
Ann Med Surg (Lond) · PMID 42725170 · Read it on PubMed ↗
Çolak et al. 2026
Comparison of Phenol Application and Endoscopic Pilonidal Sinus Treatment in Pediatric Pilonidal Sinus Disease
Endoscopic treatment worked better than phenol.RetrospectiveLow quality
61 people2026
EPSiT caused less pain, faster return to daily activities, fewer complications, and less recurrence than phenol treatment
Who was studied
children and teenagers with pilonidal sinus disease (hair-filled cyst near the tailbone)
What they received
endoscopic pilonidal sinus treatment (EPSiT)
Compared with
phenol application (chemical treatment)
Main outcome
pain after surgery, recovery time, complications, and recurrence
Quality
This was a retrospective comparison of two treatments, not a randomized trial, with a relatively small number of patients.
Limitations
Retrospective study design; not randomized
Taken word for word from the abstract
- n A total of 61 patients were included in the study
- population Children who underwent EPSiT or phenolization for pilonidal sinus disease
- intervention endoscopic pilonidal sinus treatment (EPSiT)
- comparator phenol application
- primaryOutcome visual analog scale (VAS) pain scores at postoperative 3 h, length of hospital stay, time to return to daily activities, early postoperative complications, and recurrence
- result EPSiT was more advantageous than phenol treatment in terms of postoperative pain, time to return to daily routine, early complications, and recurrence
Pediatr Int · PMID 42717603 · Read it on PubMed ↗
Aldarkhbani et al. 2026
Ectopic Pilonidal Disease Presenting As Anterior Leg Swelling in a Diabetic Patient: A Case Report
Rare pilonidal disease found on the leg, not the tailbone.Case seriesVery low qualityRelated question
1 people2026
The swelling was found to be an unusual case of pilonidal sinus disease occurring on the leg instead of the usual tailbone area
Who was studied
A 33-year-old man with diabetes who had a swelling on his leg
What they received
None (observational case report)
Main outcome
Diagnosis of the cause of the leg swelling
Quality
This is a single patient case report, which cannot show how common this is or whether any treatment works.
Limitations
Only one patient was described; this is a rare, atypical case and not about typical tailbone pilonidal disease.
Taken word for word from the abstract
- population We present a 33-year-old man with an unusual presentation of a pilonidal sinus over his leg.
- n We present a 33-year-old man with an unusual presentation of a pilonidal sinus over his leg.
- primaryOutcome Ectopic pilonidal disease should be considered in the differential diagnosis of chronic subcutaneous swellings, particularly when a punctum or sinus tract is present.
- result We present a 33-year-old man with an unusual presentation of a pilonidal sinus over his leg.
- intervention Pilonidal sinus disease usually presents in the sacrococcygeal region.
Cureus · PMID 42713530 · Read it on PubMed ↗
Osmanov et al. 2026
Comparative outcomes of phenol therapy and Karydakis flap in pilonidal sinus disease: A retrospective cohort study with 1-year follow-up
Faster healing with phenol therapy.RetrospectiveLow qualityRelated question
125 people1 year
Phenol therapy healed faster and let patients return to work sooner, with similar 1-year recurrence rates compared to surgery
Who was studied
patients with primary sacrococcygeal pilonidal sinus disease (crack at top of the buttocks)
What they received
phenol therapy (chemical treatment)
Compared with
Karydakis flap surgery
Main outcome
wound healing time, return-to-work time, and recurrence rate
Quality
This was a retrospective (non-randomized) comparison of two treatments, so differences between groups could be due to factors other than the treatment itself.
Limitations
Retrospective design, non-randomized comparison, and the study addresses treatment of an already-diagnosed condition rather than why the pain occurs.
Taken word for word from the abstract
- n This retrospective cohort study included 125 consecutive patients treated between January 2024 and January 2025.
- population patients with primary sacrococcygeal PSD
- intervention phenol therapy (PT) has emerged as an effective outpatient treatment
- comparator the Karydakis flap (KF) procedure
- primaryOutcome Demographic characteristics, wound healing time, return-to-work time, postoperative complications, and recurrence rates were evaluated.
- result Wound healing time was significantly shorter in the phenol group than in the KF group (15.4 ± 8.4 vs 36.1 ± 7.6 days, P < .005).
- result recurrence occurred in 6 patients (12.5%) in the phenol group and 7 patients (9.1%) in the KF group, with no statistically significant difference between the groups (P = .09).
- followUp Patients completed at least 1 year of follow-up
Medicine (Baltimore) · PMID 42700095 · Read it on PubMed ↗
Liu et al. 2026
MRI susceptibility-related artifacts following prolonged use of silver-containing dressings: A case report
Dressing residue hid a fistula on scan.Case seriesVery low qualityRelated question
1 people2026
Silver dressing residue appeared to cause imaging interference that hid a fistula; after debridement, imaging revealed a fistula connecting to the anal canal, which was then surgically treated with good healing.
Who was studied
a man with a nonhealing wound after pilonidal sinus (butt crack) surgery
What they received
prolonged use of silver-containing wound dressings
Compared with
none (single patient, before and after wound debridement)
Main outcome
finding the cause of the nonhealing wound using pelvic MRI
Quality
This is a single patient case report, so it cannot show how common or reliable this problem is.
Limitations
Silver deposition was not confirmed by elemental analysis or special MRI sequences, and other causes of the imaging artifact could not be ruled out.
Taken word for word from the abstract
- n A 33-year-old man presented with a nonhealing wound after pilonidal sinus excision.
- population A 33-year-old man presented with a nonhealing wound after pilonidal sinus excision.
- intervention He had used silver-containing dressings intermittently for postoperative wound care over an 8-month period.
- comparator Follow-up MRI after debridement showed near-complete reduction of the artifacts and allowed visualization of the fistulous tract.
- primaryOutcome pelvic MRI was performed to evaluate the cause
- result After removal of wound-related material by debridement, follow-up MRI demonstrated a fistulous tract extending from the anal canal to the previous wound site.
Medicine (Baltimore) · PMID 42700038 · Read it on PubMed ↗
Başar et al. 2026
Outcomes of minimally invasive pit-picking treatment in adolescents with uncomplicated pilonidal disease: a retrospective single-center study
Low recurrence after minor pit-picking surgery.RetrospectiveLow quality
42 people15 months
About 1 in 7 patients had the problem come back, and having more than one opening (sinus) raised the chance of recurrence
Who was studied
teenagers aged 12 to 18 with uncomplicated pilonidal disease (a cyst/sinus at top of the buttock crack)
What they received
minimally invasive 'pit-picking' procedure to remove the sinus openings
Main outcome
whether the problem came back (recurrence) and need for further treatment
Quality
This was a small, single-center study looking back at past patients with no comparison group, so it can't prove the procedure works better than other options.
Limitations
Retrospective design, single center, no control group for comparison, and findings based on only 42 patients.
Taken word for word from the abstract
- n A total of 42 patients were included
- population adolescents aged 12-18 years who underwent pit-picking for pilonidal disease
- intervention evaluate the outcomes of the pit-picking procedure in adolescents with uncomplicated pilonidal disease
- primaryOutcome recurrence rates, and need for reintervention were analyzed
- result Recurrence occurred in six patients (14.3%), with a median time to recurrence of 10 months.
- result patients with multiple sinus openings demonstrated a higher recurrence rate compared with those with a single sinus opening
- followUp The median follow-up duration was 15 months.
Pediatr Surg Int · PMID 42593573 · Read it on PubMed ↗
Dainius et al. 2026
The Pilonidal Sinus Disease-Specific Quality of Life Questionnaire (SQoL): Reliability, Validity, and Utilisation
New symptom questionnaire validated, not about pain cause.Prospective cohortLow qualityRelated question
116 people2 months
the new questionnaire showed strong internal consistency and good agreement with the general quality of life scale
Who was studied
adults with pilonidal sinus disease (cyst/sinus near tailbone) having surgery
What they received
a new pilonidal-disease-specific quality of life questionnaire (SQoL)
Compared with
the general SF-36v2 quality of life questionnaire
Main outcome
reliability and validity of the new symptom questionnaire
Quality
this is a single-center tool-validation study, not a treatment trial, so it says nothing about why the area hurts or what helps.
Limitations
Single hospital, modest sample size, and the study tests a questionnaire's measurement properties rather than any treatment or cause of pain.
Taken word for word from the abstract
- population 116 adult patients with chronic and acute symptomatic disease at the Kaunas Hospital of the Lithuanian University of Health Sciences (LUHS)
- intervention a newly developed pilonidal sinus disease-specific quality of life (SQoL) questionnaire
- comparator complete both the SQoL and the SF-36v2 questionnaire
- primaryOutcome Key evaluation criteria for the SQoL questionnaire included internal consistency, measurement stability, as well as construct and discriminant validity.
- result the overall questionnaire achieving a Cronbach's α coefficient of 0.919
- result The highest inverse correlations were found between the corresponding domains of Physical Functioning and Role Physical Functioning (-0.770 and -0.600), with all correlations being statistically significant.
- n A total of 116 adult patients with chronic and acute symptomatic disease
- followUp 2 months after the procedure, 103 patients (response rate 88.79%) completed both questionnaires
J Clin Med · PMID 42589979 · Read it on PubMed ↗
Jo et al. 2026
Development of cold urticaria after cryotherapy during laser epilation for pilonidal disease: a case report
Cold therapy caused allergic hives, not explaining pain.Case seriesVery low qualityRelated question
2 people3 years (Case 1); 6 months (Case 2)
both patients developed cold-induced hives (urticaria) at the site of cryotherapy during laser treatment, which resolved with antihistamines or on its own, and later sessions used topical lidocaine instead
Who was studied
teenagers with pilonidal disease (a condition causing pain near the top of the buttock crack) undergoing laser hair removal
What they received
cryotherapy (cold spray) used for pain relief during laser hair removal treatment
Compared with
none (case reports, no comparison group)
Main outcome
development of skin reaction (urticaria/hives) after cold exposure during treatment
Quality
This is just two patient reports, so it can't tell us how common this reaction is or prove cause and effect.
Limitations
Only two cases; no control group; does not address the underlying cause of pilonidal pain itself, only a treatment side effect.
Taken word for word from the abstract
- n We report two cases of cold urticaria that developed during laser epilation for PD patients.
- population A 14-year-old female with a pilonidal abscess underwent a drainage procedure followed by the Gips procedure and laser epilation.
- intervention Laser epilation is utilized to reduce pilonidal disease (PD) recurrence and commonly employs cryotherapy for analgesia.
- comparator We report two cases of cold urticaria that developed during laser epilation for PD patients.
- primaryOutcome During the initial laser session, she developed urticarial wheals in the area exposed to cryotherapy.
- result The urticaria resolved with oral diphenhydramine. At subsequent laser sessions, analgesia was provided using topical lidocaine.
- followUp She exhibited no PD symptoms 3 years after treatment.
- followUp He experienced no recurrence of PD at 6 months post-treatment.
Int J Surg Case Rep · PMID 42578112 · Read it on PubMed ↗
Kalfoutzou et al. 2026
Beyond the Spine: A Rare Case of Myxopapillary Ependymoma With Extraneural Metastases
Rare tumor mistaken for cyst, spread later.Case seriesVery low qualityRelated question
1 peoplenearly 3 years
the tumor recurred locally three times and eventually spread to the lungs; chemotherapy then stopped progression for almost 3 years
Who was studied
a middle-aged woman with a rare spinal tumor in the tailbone area, initially misdiagnosed as a pilonidal cyst
What they received
surgical excision followed by repeated surgery, radiotherapy, and later chemotherapy (temozolomide) for recurrences and spread
Main outcome
disease recurrence and spread (metastasis) over time, and response to chemotherapy
Quality
this is a single patient case report, so it cannot show what causes or treats this kind of pain in general.
Limitations
single case report with no comparison group, so findings cannot be generalized.
Taken word for word from the abstract
- population a middle-aged female patient with sacrococcygeal MPE, which was initially misdiagnosed as a pilonidal cyst
- intervention subjected to surgical excision
- intervention treated with surgery and radiotherapy
- intervention started on chemotherapy with per os temozolomide
- primaryOutcome she experienced three local recurrences in the sacrococcygeal region
- result has not experienced disease progression for nearly 3 years
- n a middle-aged female patient
Acta Med Acad · PMID 42565513 · Read it on PubMed ↗
Türker Çolak et al. 2026
Laser-assisted endoscopic treatment of pilonidal sinus disease in children: a first pediatric series
Laser treatment cured most cases.RetrospectiveLow quality
45 people32.4 ± 11.3 months
91.1% cured after one procedure; the rest cured after a second procedure; all 45 improved overall, with low pain scores
Who was studied
children and teens with pilonidal sinus disease (a tunnel/infection near the top of the buttock crack)
What they received
laser-assisted endoscopic pilonidal sinus treatment (LEPSIT)
Compared with
none (single-group, before/after outcomes, some had prior external surgery)
Main outcome
successful cure of the pilonidal sinus after treatment
Quality
This was a retrospective case series with no comparison group, so it can't show if this treatment is better than other options.
Limitations
Retrospective design, no control/comparison group, single center experience.
Taken word for word from the abstract
- n Of the 45 patients included
- population Clinical data of children under 18 years of age who underwent LEPSIT for PSD
- intervention laser-assisted endoscopic pilonidal sinus treatment (LEPSIT)
- comparator Six patients had been previously operated on for pilonidal sinus disease at an external center prior to LEPSIT.
- primaryOutcome Successful treatment was achieved in 41 patients (91.1%) after a single procedure
- result Successful treatment was achieved in 41 patients (91.1%) after a single procedure; 4 patients (8.9%) had recurrence, all of whom achieved cure after a second LEPSIT. Improvement was ultimately achieved in all 45 patients.
- followUp Mean follow-up was 32.4 ± 11.3 months.
Pediatr Surg Int · PMID 42560577 · Read it on PubMed ↗
Keener et al. 2026
Race, Area Deprivation, and Patterns of Care in Pediatric Pilonidal Disease
Racial and ethnic gaps in care found.RetrospectiveLow qualityRelated question
133 people6-month
neighborhood deprivation score was not linked to treatment location, follow-up, or recurrence, but Black patients missed follow-up more often and Hispanic patients were less likely to get surgery in the operating room
Who was studied
children and teens under 18 treated for a pilonidal abscess (tailbone area infection)
What they received
neighborhood deprivation level (Area Deprivation Index), plus race and ethnicity
Compared with
patients with lower deprivation index or different race/ethnicity
Main outcome
where treatment happened, whether follow-up occurred within 30 days, and recurrence within 6 months
Quality
this is a small retrospective chart review with a narrow range of deprivation scores, so it can't reliably show cause and effect or be generalized.
Limitations
retrospective design, limited dispersion of ADI scores, single or few institutions implied, preliminary observations needing confirmation
Taken word for word from the abstract
- population We retrospectively reviewed pediatric patients (<18 years) treated for pilonidal abscess during 2020-2024.
- intervention ADI was the primary exposure; race and ethnicity were secondary.
- comparator 59% of Black patients missed follow-up compared with 31% of non-Black patients.
- primaryOutcome Outcomes included treatment location, 30-day follow-up, and 6-month recurrence.
- result ADI was not associated with treatment location, follow-up, or recurrence. Race was associated with 30-day follow-up (P = 0.004); 59% of Black patients missed follow-up compared with 31% of non-Black patients. Ethnicity was associated with treatment location (P = 0.015); Hispanic patients had lower odds of OR management (OR 0.38, 95% CI 0.15-0.91).
- n Among 133 encounters, mean age was 15.6 years and 68% were female.
- followUp 6-month recurrence
Am Surg · PMID 42522216 · Read it on PubMed ↗
Murtadi et al. 2026
The Minimally Invasive Pilonidal Protocol: Low Short-Term Recurrence after Completion in a Single-Center Retrospective Cohort Study
Low recurrence after minimally invasive treatment.RetrospectiveLow qualityRelated question
297 peopleranged from 4 to 55 months
4.0% of patients had recurrence of pilonidal disease, occurring on average about 16 months after finishing treatment
Who was studied
patients with pilonidal disease who completed a minimally invasive treatment protocol
What they received
Minimally Invasive Pilonidal Protocol (pit-picking plus laser hair removal/ablation)
Compared with
none - single group, no comparison treatment
Main outcome
rate of disease recurrence after finishing treatment
Quality
This was a retrospective single-center study with no comparison group and more than half of the original patients were lost to follow-up or still in treatment, so the low recurrence rate may not hold up in other settings.
Limitations
Retrospective design, large proportion of patients lost to follow-up or excluded (353 lost, 226 still in treatment), reliance on text-message self-report for many non-returning patients, and no control group for comparison.
Taken word for word from the abstract
- n leaving the study group of 297 patients who completed the protocol and graduated
- population patients with pilonidal disease who completed the MIPP between January 2021 and December 2024
- intervention two pit-picking procedures, and 5.3 laser epilations
- comparator This retrospective single-center cohort study evaluates the recurrence rate after graduation from our Pilonidal Care Clinic's (PCC) Minimally Invasive Pilonidal Protocol (MIPP).
- primaryOutcome Recurrence was defined as any PCC visit after graduation with pilonidal disease on examination.
- result only 12 (4.0%) showed physical evidence of recurrence
- result Recurrence occurred on average 16.3 months after graduating
- followUp The follow-up period for these patients ranged from 4 to 55 months.
Eur J Pediatr Surg · PMID 42457154 · Read it on PubMed ↗
Beaumont et al. 2026
Keystone Design Perforator Island Flap for the treatment of recurrent pilonidal disease
Flap surgery healed after one setback.Case seriesVery low quality
1 people2026
recovery was satisfactory at first, but the top of the wound opened up and needed a repeat washout surgery, after which it fully healed
Who was studied
a 37-year-old obese man with long-term pilonidal disease that kept coming back despite several prior surgeries
What they received
wide excision of the diseased tissue followed by reconstruction with a Keystone Design Perforator Island Flap (a type of local skin flap)
Compared with
none reported (single patient case, no comparison group)
Main outcome
wound healing and recurrence after surgery
Quality
this is a single patient case report, so it cannot show whether this treatment works better than other options.
Limitations
only one patient was reported, there was a wound complication requiring further surgery, and there is no comparison group or long-term follow-up data given.
Taken word for word from the abstract
- population a 37-year-old obese male with chronic pilonidal disease refractory to multiple prior excisions
- intervention underwent wide local excision and reconstruction with a Keystone Design Perforator Island Flap (KDPIF)
- comparator This report describes the case of a 37-year-old obese male with chronic pilonidal disease refractory to multiple prior excisions
- primaryOutcome Initial recovery was satisfactory, although apical wound dehiscence required subsequent operative washout, ultimately resulting in complete healing.
- result Initial recovery was satisfactory, although apical wound dehiscence required subsequent operative washout, ultimately resulting in complete healing.
- n a 37-year-old obese male
J Surg Case Rep · PMID 42434056 · Read it on PubMed ↗
Wang et al. 2026
[Research on deep learning-based pathological image classification of pilonidal sinus]
Predicts surgery recurrence, not pain cause.RetrospectiveVery low qualityRelated question
size not given2026
the model predicted recurrence with an AUC of 0.751 and 71.5% accuracy
Who was studied
people who have had surgery for pilonidal sinus disease (a tract/abscess at the top of the buttock crease)
What they received
an AI deep-learning model analyzing post-surgery pathology slides to predict recurrence
Compared with
no comparison group specified
Main outcome
predicting whether pilonidal sinus disease will come back after surgery
Quality
this is an early computational model-building study with no reported patient count, no mention of validation in a separate population, and it doesn't address what causes the pain itself.
Limitations
abstract does not report sample size, does not compare to existing predictors, and focuses on recurrence prediction rather than the cause or treatment of pain
Taken word for word from the abstract
- population postoperative hematoxylin and eosin (H&E) stained pathological sections from PSD patients
- intervention The horizontal and vertical distance network (HoVer-Net) deep learning model for automated nuclei segmentation and classification was employed to extract nuclear features from lesion regions
- comparator a recursive feature elimination-balanced random forest (RFE-BalancedRF) ensemble model to predict PSD recurrence
- primaryOutcome to predict PSD recurrence
- result achieves an area under the curve of receiver operating characteristic (ROC_AUC) of 0.751 ± 0.048 and an accuracy (Acc) of 0.715 ± 0.066
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi · PMID 42366440 · Read it on PubMed ↗
Mei et al. 2026
Outcomes reported in comparative studies of surgical management of pilonidal disease: Systematic review to inform a core outcome set
Doesn't test which surgery works best.Systematic reviewModerate qualityRelated question
size not given2026
most studies tracked recurrence, complications, pain and wound healing, but patient-important things like quality of life and appearance were rarely the main outcome measured
Who was studied
people having surgery for pilonidal disease (a cyst near the top of the buttock crease)
What they received
surgical treatments for pilonidal disease, as studied across many trials
Compared with
other surgical treatments for pilonidal disease, as studied across many trials
Main outcome
which outcomes (like recurrence, pain, healing) studies chose to measure and report
Quality
it is a well-conducted review of many studies, but it only maps what outcomes get measured rather than testing whether any treatment actually works better.
Limitations
the authors did not assess risk of bias or rate evidence quality because the goal was to map outcome reporting, not to estimate how well treatments work; this abstract does not say which surgery is better or why the area hurts.
Taken word for word from the abstract
- population comparative studies of surgical management of pilonidal disease
- intervention evaluating surgical interventions for pilonidal disease were eligible
- comparator Randomised controlled trials and comparative observational studies evaluating surgical interventions for pilonidal disease were eligible.
- primaryOutcome identify and describe outcomes reported in comparative studies of surgical management of pilonidal disease
- result Recurrence was reported most frequently (112 studies, 72.3%), followed by non-infective complications (103, 66.5%), pain (83, 53.5%), wound healing (82, 52.9%) and return to normal activities (63, 40.6%).
- result Patient-important domains were less frequently reported, including health-related quality of life or satisfaction (50, 32.3%) and cosmesis (17, 11.0%).
- limitations Because the objective was to map outcome reporting rather than estimate treatment effects, risk-of-bias assessment and GRADE appraisal were not undertaken.
Colorectal Dis · PMID 42347916 · Read it on PubMed ↗
Chew Bonilla et al. 2026
Upadacitinib for Severe Refractory Hidradenitis Suppurativa After Failure of Multiple Systemic Therapies: A Case Report
Severe skin disease improved with new drug.Case seriesVery low qualityRelated question
1 people2026
IHS4 score dropped from 127-145 points at baseline to 20 points, with reduced lesions, pain and drainage
Who was studied
a 64-year-old man with severe hidradenitis suppurativa affecting underarm, groin, buttock crease, belly and trunk areas
What they received
upadacitinib 15 mg taken once daily
Compared with
none (case report, no control group); prior treatments included antibiotics, adalimumab, and secukinumab that had failed
Main outcome
change in disease severity score (IHS4), pain, drainage and functional limitation
Quality
This is a single patient's experience, so it cannot show whether the drug would help others.
Limitations
Only one patient was studied, with no comparison group, and the patient had multiple other health problems that could affect results.
Taken word for word from the abstract
- population a 64-year-old man with severe Hurley stage III HS involving axillary, inguinal, intergluteal, abdominal, and truncal regions
- intervention treatment with upadacitinib 15 mg once daily was initiated
- comparator adalimumab therapy for six years with subsequent secondary failure, and secukinumab, which was discontinued because of clinical worsening
- primaryOutcome reduction in inflammatory lesions, pain, purulent drainage, and functional impairment
- result The International Hidradenitis Suppurativa Severity Score System (IHS4) decreased from baseline values of 127-145 points to 20 points during follow-up.
- n a 64-year-old man
Cureus · PMID 42344817 · Read it on PubMed ↗
Larsen et al. 2026
The association between skin-suturing technique, prolonged healing and recurrence after Bascom's Cleft lift surgery
Suture method didn't change healing or recurrenceRetrospectiveLow qualityRelated question
540 people5 years
no difference in healing time or recurrence between suturing techniques, but slower-healing patients had higher recurrence
Who was studied
patients with complex pilonidal sinus disease having cleft lift surgery
What they received
intracutaneous skin-suturing technique in Bascom's Cleft lift surgery
Compared with
extracutaneous skin-suturing technique in Bascom's Cleft lift surgery
Main outcome
prolonged wound healing and recurrence of pilonidal disease
Quality
This is a retrospective single-hospital comparison before/after a technique change, not a randomized trial, so other factors could explain the results.
Limitations
Retrospective design comparing two time periods rather than randomized groups; abstract does not address pain directly.
Taken word for word from the abstract
- population complex Pilonidal Sinus Disease (PSD)
- n 540 unique patients who underwent BCL surgery
- intervention a shift from extracutaneous to intracutaneous closure creating two groups for comparison
- comparator a shift from extracutaneous to intracutaneous closure creating two groups for comparison
- primaryOutcome influenced risk of prolonged healing or recurrence
- result There was no difference in time-to-healing among the suture groups with a 76% rate of primary healing in both groups.
- result patients experiencing prolonged healing after surgery had significantly higher risk of recurrence
Tech Coloproctol · PMID 42313194 · Read it on PubMed ↗
Habeeb et al. 2026
Karydakis Versus Limberg Flap in Primary Sacrococcygeal Pilonidal Sinus: A Retrospective Comparative Study of Functional Recovery
Faster recovery with Karydakis flap surgery.RetrospectiveLow qualityRelated question
352 people1 year
Patients who had the Karydakis flap resumed sexual activity and driving sooner, with less pain, than those who had the Limberg flap
Who was studied
employed, sexually active patients who underwent surgery for primary sacrococcygeal pilonidal sinus disease
What they received
Karydakis flap (KF) surgery for pilonidal sinus disease
Compared with
Limberg flap (LF) surgery for pilonidal sinus disease
Main outcome
time to resumption of sexual activity after surgery
Quality
It is a retrospective, non-randomized comparison relying on patient-reported Likert-scale answers, which makes it easier for bias to affect the results.
Limitations
Retrospective design, not randomized, outcomes based on patient-reported Likert-scale questionnaire rather than objective measures
Taken word for word from the abstract
- n A total of 352 patients were divided into 176 KF and 176 LF.
- population included employed, sexually active patients who underwent surgery for primary PSD
- intervention compared patient-reported recovery as regards sexual function and driving ability following the KF
- comparator versus the LF for primary sacrococcygeal PSD
- primaryOutcome The primary outcome was time to sexual activity resumption
- result KF patients resumed sexual activity earlier (2.88 ± 0.7 vs. 4.58 ± 1.1 weeks; mean difference -1.7 weeks, 95% CI -1.89 to -1.49, p < 0.001). KF reported significantly less pain, less avoidance, and lower analgesic use during sex.
World J Surg · PMID 42311045 · Read it on PubMed ↗
Komiyama et al. 2026
Minimally Invasive Phenol Treatment for Pilonidal Sinus: A Single-Center Case Series From Japan
No recurrence after phenol treatment.Case seriesLow quality
11 peoplemedian, 331 days; range, 100-979
No recurrence was observed during the follow-up period (median, 331 days), with short operative time and hospital stay; bleeding occurred in 2 of 11 patients and was managed without further surgery
Who was studied
patients with pilonidal sinus (chronic inflamed tunnel near the tailbone/natal cleft)
What they received
phenol injection into the sinus tract after excising pits and scraping out the tunnel, then neutralizing with alcohol
Compared with
no comparison group; compared informally to conventional surgery (wide excision and flap reconstruction)
Main outcome
recurrence and complications after treatment, plus operative time and hospital stay
Quality
This is a small, retrospective case series of only 11 patients with no comparison group, so it can't reliably show the treatment is better than other options.
Limitations
Retrospective design, very small sample size (11 patients), no control group, relatively short and variable follow-up.
Taken word for word from the abstract
- population Pilonidal sinus is a chronic inflammatory condition of the natal cleft that commonly affects young adults.
- intervention After excision of the midline pits and curettage of the sinus tract, undiluted phenol was injected into the cavity and subsequently neutralized with ethanol.
- comparator Conventional surgical treatments, such as wide excision and flap reconstruction, are associated with large wounds and prolonged recovery.
- primaryOutcome Clinical data, including patient characteristics, number of pits, operative time, postoperative hospital stay, complications, and recurrence, were analyzed.
- result No recurrence was observed during the follow-up period (median, 331 days; range, 100-979).
- n A total of 11 patients were included in the study.
J Dermatol · PMID 42304603 · Read it on PubMed ↗
Fathallah et al. 2026
Radiofrequency for the treatment of pilonidal disease: results of a French prospective pilot study
Mostly healed, low pain, satisfied.Prospective cohortLow quality
44 people6 months
no major complications; 77.3% fully healed at 6 months, 13.6% failure, 9.1% recurrence, low pain, high satisfaction
Who was studied
patients with infected pilonidal sinus (tailbone cyst) disease
What they received
radiofrequency treatment of the pilonidal sinus
Compared with
none (single-arm study, before/after comparison with history of prior surgery as a risk factor)
Main outcome
safety of the procedure
Quality
This was a small single-center pilot study with no comparison group, so it can't show if radiofrequency works better than other treatments.
Limitations
Single-center, no control group, small sample size (pilot study).
Taken word for word from the abstract
- n Forty-four patients were enrolled
- population infected pilonidal sinus
- intervention using a radial RF probe (25 W, 4 MHz) following mechanical debridement
- comparator A history of prior surgery significantly increased the risk of failure (odds ratio, 0.2; P=0.005)
- primaryOutcome The primary endpoint was safety
- result No major complications occurred, and minor early events were reported in 6.8% of cases. Complete healing at 6 months was achieved in 77.3% of patients. Failure and recurrence rates were 13.6% and 9.1%, respectively.
Ann Coloproctol · PMID 42266120 · Read it on PubMed ↗
Yildirak et al. 2026
Early postoperative outcomes of sinus laser closure versus crystallized phenol treatment for pilonidal sinus disease: a retrospective comparative study
Laser treatment eased symptoms faster early on.RetrospectiveLow quality
230 people1 month
laser treatment group had less itching, burning, discharge, pain, and better quality of life scores at 1 week, with most differences evening out by 1 month
Who was studied
adults with pilonidal sinus disease (a condition causing a cyst/infection near the top of the buttock crack)
What they received
laser closure of the sinus tract (SiLaC)
Compared with
crystallized phenol treatment
Main outcome
patient satisfaction, quality of life, symptom severity, pain, and time to return to work after treatment
Quality
This was a retrospective comparison, not a randomized trial, so differences between groups could be due to factors other than the treatment itself.
Limitations
Retrospective design; the abstract itself calls for randomized controlled trials to validate findings.
Taken word for word from the abstract
- population Pilonidal sinus disease (PSD), which predominantly affects young adults
- n A total of 230 patients were analyzed (SiLaC n = 93; CPT n = 137)
- intervention sinus laser closure (SiLaC)
- comparator crystallized phenol treatment (CPT)
- primaryOutcome The primary outcomes were patient satisfaction, health-related quality of life (SF-36), symptom severity (itching, burning, purulent discharge), pain intensity (Visual Analogue Scale), and time to return to work
- result At 1 week, itching (1 [1-1] versus 1 [1-2], p < 0.001), burning (1 [1-1] versus 1 [1-2], p = 0.001), and purulent discharge (1 [1-1] versus 1 [1-3], p < 0.001) were less frequent in the SiLaC group.
- result At 1 month, most outcomes were comparable between groups
- limitations Further multicenter randomized controlled trials are warranted to better clarify and validate these findings.
Tech Coloproctol · PMID 42237035 · Read it on PubMed ↗
Li et al. 2026
Exploratory pilot study of minimally invasive therapy: laser ablation combined with acellular dermal matrix implantation for recurrent sacrococcygeal pilonidal disease
Healed well, little pain, no recurrence.Case seriesVery low quality
5 people7 (6-7) months
all 5 patients healed without recurrence, with low pain and median healing time of 34 days
Who was studied
patients with recurrent pilonidal disease (a cyst near the top of the buttock crack)
What they received
laser ablation combined with acellular dermal matrix implantation
Compared with
none (no comparison group)
Main outcome
wound healing time, pain, and recurrence after surgery
Quality
only 5 patients with no comparison group, so it can't show whether this worked better than other treatments.
Limitations
very small sample size, retrospective design, no control group, and only short-term follow-up.
Taken word for word from the abstract
- population five patients who diagnosed with recurrent SPD between October 2023 and April 2024
- intervention laser ablation combined with ADM placement
- comparator No sample size calculation was performed due to the exploratory nature of the study.
- primaryOutcome Clinical outcomes, including healing rates, recurrence rates, and operative data, were recorded.
- result all patients were successfully cured without recurrence and satisfied with this surgery
- n A total of five patients underwent laser ablation combined with ADM.
- followUp Over a median follow-up period of 7 (6-7) months
Front Bioeng Biotechnol · PMID 42183060 · Read it on PubMed ↗
Esposito et al. 2026
Pediatric endoscopic pilonidal sinus treatment (PEPSiT) as standard of care results over 10 years' experience in 507 patients
Minimally invasive surgery, low recurrence, little pain.RetrospectiveLow quality
507 people2026
pain was minimal after surgery, satisfaction was high, and the condition came back in about 1 in 10 patients, usually within 3 months, but re-treatment worked
Who was studied
teenagers and young people with pilonidal sinus disease (a condition causing a pit/abscess at the top of the buttock crack)
What they received
minimally invasive keyhole surgery (PEPSiT) with ozone oil dressing and later platelet-rich plasma
Compared with
none - all patients received this treatment
Main outcome
pain after surgery, healing, recurrence rate, and patient satisfaction
Quality
this looked back at records of one surgical technique without comparing it to other treatments, so it can't show it works better than alternatives.
Limitations
retrospective design with no comparison group, so results could be influenced by other factors not measured.
Taken word for word from the abstract
- population We operated 507 patients (313 boys and 194 girls) with a median age of 15.5 years (IQR 12-18 years).
- intervention pediatric endoscopic pilonidal sinus treatment (PEPSiT)
- intervention Dressing after surgery was performed with ozone oil products in every patient and in the last 18 months Platelet-Rich Plasma (PRP) has been added
- comparator We retrospectively reviewed all patients, with primary or recurrent PSD, undergoing PEPSiT
- primaryOutcome Data regarding success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed.
- result The post-operative course was painless in 100% of patients (median VAS pain score < 2/10, IQR 1-2). Patient satisfaction was excellent (median score 4.8/5, IQR 4-5).
- result Disease recurrence occurred in 53/507 patients (10.4%), mostly within 3 months (range 2 months-23 months), and all were successfully re-operated with PEPSiT with no further recurrence.
- n We operated 507 patients
Sci Rep · PMID 42168379 · Read it on PubMed ↗
Acar et al. 2026
Treatment Outcomes of Presacral Pilonidal Sinus Disease Using Crystallised Phenol: A Single-Centre Clinical Series
More sinus pits meant more treatment sessions.Case seriesLow qualityRelated question
40 people3 months
more sinus pits meant patients needed a third phenol session, and abscess/recurrence after treatment occurred only in those needing three sessions but this was not statistically significant
Who was studied
adults with pilonidal sinus disease at the top of the buttock crack
What they received
crystallised phenol treatment given in two or three sessions
Compared with
two-session group versus three-session group
Main outcome
treatment outcomes and number of sessions needed, including abscess and recurrence
Quality
this is a small single-centre case series with no untreated comparison group and only 3 months of follow-up, so it cannot reliably show whether the treatment works.
Limitations
single-centre series, no control group, short follow-up, and the abscess/recurrence difference between groups did not reach statistical significance (p = 0.061)
Taken word for word from the abstract
- n Consecutive patients treated with crystallised phenol were analysed (n = 40)
- population patients with presacral pilonidal sinus disease managed with crystallised phenol
- intervention crystallised phenol
- comparator Comparisons between the two-session and three-session groups were performed with the Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables
- primaryOutcome To evaluate short-term treatment outcomes and treatment burden in patients with presacral pilonidal sinus disease managed with crystallised phenol
- result 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
- 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); notably, all such events occurred in the three-session group (0/17 vs. 5/23, p = 0.061 for both comparisons)
- followUp All patients completed scheduled clinical reassessment at 5 weeks and 3 months
Int Wound J · PMID 42165106 · Read it on PubMed ↗
Orhan et al. 2026
Disulfiram-like reaction with ornidazole: A case report of a rare interaction
Not about cyst pain itself.Case seriesVery low qualityRelated question
1 people16 h
she developed a probable drug-alcohol reaction with flushing, vomiting, low blood pressure and rapid heartbeat that resolved with supportive care over 16 hours
Who was studied
44-year-old woman with a pilonidal cyst (a cyst near the top of the buttock crease), no other health problems
What they received
taking the antibiotic ornidazole along with drinking alcohol (raki)
Compared with
none (single case report)
Main outcome
development of a disulfiram-like reaction (flushing, nausea, vomiting, low blood pressure, fast heart rate) after drinking alcohol while on the drug
Quality
this is a single patient case report, so it cannot show whether treatments work but only flags a possible drug-alcohol reaction.
Limitations
only one patient reported; no comparison group; does not address the cause of pilonidal cyst pain itself
Taken word for word from the abstract
- population 44-year-old female with no known comorbidities or drug allergies
- intervention Her symptoms began approximately 30 min after consuming two glasses of raki while receiving ornidazole for a pilonidal cyst.
- comparator This case represents a rare instance of a DLR due to ornidazole monotherapy in a patient without chronic alcohol use.
- primaryOutcome A disulfiram-like reaction (DLR) associated with ornidazole is a rare but important adverse drug-alcohol interaction.
- result Her symptoms improved significantly with supportive care over 16 h.
- n We report a 44-year-old female
Turk J Emerg Med · PMID 42137074 · Read it on PubMed ↗
Arslan et al. 2026
Does laser treatment affect outcome in pilonidal sinus disease? Long-term multicenter retrospective analysis of pit-picking alone vs. pit-picking with laser
Faster recovery, same recurrence rate.RetrospectiveLow quality
306 people5 years
no significant difference in 5-year recurrence between groups, but laser group had fewer complications, less pain, and faster return to work
Who was studied
patients with pilonidal sinus disease (a cyst/infection near the top of the buttock crack) who had pit-picking surgery
What they received
pit-picking surgery combined with laser treatment
Compared with
pit-picking surgery alone
Main outcome
sinus coming back within 5 years
Quality
This was a retrospective, non-randomized comparison across multiple centers, so differences between groups could be due to factors other than the treatment itself.
Limitations
Retrospective design, not randomized; authors call for randomized trials to confirm findings.
Taken word for word from the abstract
- n Of 306 patients, 109 (35.6%) underwent pit-picking alone, and 197 (64.4%) received pit-picking with LT.
- population Patients who underwent pit-picking surgery for PSD between June 2017 and March 2025 were included.
- intervention pit-picking combined with LT
- comparator pit-picking alone
- primaryOutcome The primary measure was the recurrence rate at 5 years.
- result Recurrence rates at 5 years were similar (pit-picking: 13.8%, pit-picking + LT: 12.7%, p = 0.460).
- result The complication rate was lower in the LT group (6.1% vs. 14.7%, p = 0.012). Patients treated with LT had shorter times to pain-free sitting (median 5 vs. 7 days, p < 0.001) and return to work (3 vs. 6 days, p < 0.001).
- followUp recurrence rate at 5 years
Tech Coloproctol · PMID 42128975 · Read it on PubMed ↗
de Kort et al. 2026
Sinus laser-assisted closure (SiLaC) in pilonidal sinus disease: a multicenter cohort study
Good symptom relief after laser sinus treatment.RetrospectiveLow quality
231 people33 months
about 1 in 5 patients needed further non-laser surgery, but symptoms were low and quality of life was high at follow-up
Who was studied
people with chronic pilonidal sinus disease (at the top of the buttock crack), either first-time or recurrent
What they received
laser treatment to close the pilonidal sinus tract (SiLaC)
Compared with
no comparison group; primary vs recurrent disease compared within study
Main outcome
symptom control, quality of life, and need for further surgery after treatment
Quality
this is a retrospective study without a comparison group, so it cannot prove the laser treatment is better than other options.
Limitations
retrospective design, no control group, reliance on medical records and a questionnaire
Taken word for word from the abstract
- population Patients with primary or recurrent SPSD were included in this retrospective cohort study.
- intervention Sinus laser-assisted closure (SiLaC) is gaining popularity as a minimally invasive surgical technique to treat chronic sacrococcygeal pilonidal sinus disease (SPSD).
- comparator 128 patients underwent SiLaC for primary SPSD and 103 for recurrent SPSD.
- primaryOutcome Data were collected from medical records, and a validated questionnaire was distributed to all patients at follow-up to assess symptoms, quality of life, and the need for additional surgery.
- result Treatment failure, defined as persistent symptoms and/or the need for surgery other than SiLaC, occurred in 23 patients (18.0%) in the primary group and in 21 patients (20.4%) in the recurrent group. However, SPSD-related symptoms were low at follow-up, and quality of life measured by the SF-36 was reported to be even higher than in the general USA population
- n A total of 231 patients were included
- followUp with a median follow-up of 33 months (IQR 20-44)
Tech Coloproctol · PMID 42126480 · Read it on PubMed ↗
Hlaing et al. 2026
Endoscopic Pilonidal Sinus Treatment Versus Excisional Surgery: A Retrospective Comparison at an Australian Tertiary Centre
Similar healing, fewer opioids with endoscopic treatmentRetrospectiveLow qualityRelated question
180 people2026
both treatments healed at similar rates and had similar recurrence overall, but EPSiT allowed more same-day discharge and less need for opioid painkillers; however, in patients who had a prior abscess drainage, EPSiT had higher recurrence after healing
Who was studied
patients aged 12 or older having elective surgery for pilonidal sinus disease (a condition causing cysts/infection at the top of the buttock crease)
What they received
endoscopic pilonidal sinus treatment (EPSiT), a minimally invasive procedure
Compared with
traditional excisional surgery (cutting out the sinus, with flap closure, open healing, or stitched closure)
Main outcome
wound healing and recurrence after healing
Quality
This was a retrospective comparison at one hospital without randomization, so differences between groups could be due to patient selection rather than the treatments themselves.
Limitations
Retrospective design, single centre, no randomization, and a small subgroup analysis (prior abscess drainage) that may be underpowered.
Taken word for word from the abstract
- n The cohort included 180 elective operative episodes in 144 patients
- population patients aged ≥ 12 at a tertiary Australian hospital
- intervention EPSiT was compared with excisional surgery
- comparator off-midline flap closure, lay-open excision or primary closure
- primaryOutcome The primary outcomes were primary healing and recurrence after healing.
- result Primary healing occurred in 158 episodes (87.8%) and did not differ between EPSiT and excision (89.6% vs. 84.6%; p = 0.330). Recurrence occurred in 26.6% and was similar between groups (29.1% vs. 21.8%; p = 0.322).
- result recurrence after healing was higher following EPSiT (47.1% vs. 20.8%; p = 0.041)
ANZ J Surg · PMID 42112873 · Read it on PubMed ↗
Wael et al. 2026
Comparing keystone and Limberg flaps for pilonidal sinus: Does flap choice influence patient satisfaction?
Faster healing, higher satisfaction with keystone flapRandomised trialModerate quality
50 people6 months
Keystone flap patients healed faster, had fewer complications, and were more satisfied (96% vs 72%) than Limberg flap patients
Who was studied
Young adults with pilonidal sinus disease (a chronic infected pit near the top of the buttock crack) needing surgery
What they received
Keystone perforator island flap surgery to repair the area after removing the sinus
Compared with
Limberg flap surgery to repair the area after removing the sinus
Main outcome
Patient satisfaction at 6 months after surgery
Quality
It was a randomized trial, but very small with only 50 patients, which limits confidence in the results.
Limitations
Small sample size of 50 patients from a single comparative trial; abstract does not mention blinding or multi-center design.
Taken word for word from the abstract
- population Pilonidal sinus disease (PSD) is a chronic condition that mainly affects young adults
- intervention keystone perforator island flap (KSF)
- comparator Limberg flap (LF)
- primaryOutcome Patient satisfaction, the primary endpoint, was assessed at 6 months using a validated 5-point scale.
- result Satisfaction was significantly higher with KSF (96% versus 72%, p = 0.046).
- n A total of 50 patients with simple PSD were randomized equally
- followUp assessed at 6 months
Tech Coloproctol · PMID 42098544 · Read it on PubMed ↗
Jarrin Lopez et al. 2026
Outcomes of Pilonidal Surgery Performed in the Setting of Standard Adjunct Laser Hair Removal: A Retrospective Cohort Study
Flap surgery had fewer repeat operations.RetrospectiveLow qualityRelated question
168 people2026
Flap surgery had fewer repeat procedures and unplanned visits than pilocystectomy, with similar infection rates
Who was studied
patients with pilonidal sinus disease who had surgery, ages 14-89
What they received
Bascom flap closure surgery with laser hair removal
Compared with
pilocystectomy surgery (both with laser hair removal)
Main outcome
need for repeat surgery, wound infection within 30 days, and unplanned clinic visits
Quality
This was a retrospective study without a control group or statistical adjustment for other factors, so it can't prove one surgery is truly better.
Limitations
Descriptive retrospective cohort; multivariable modeling not performed because of low event counts and sparse covariate distributions, which resulted in unstable models; findings do not estimate the independent effect of laser hair removal.
Taken word for word from the abstract
- n Among 168 patients
- population patients aged 14-89 years who underwent operative treatment of PSD with adjunctive LHR
- intervention Patients treated with Bascom flap closure
- comparator those undergoing pilocystectomy
- primaryOutcome Outcomes included repeat procedures, 30-day surgical site infection (SSI), and unplanned clinic visits.
- result Patients treated with Bascom flap closure had fewer repeat procedures (10.4% vs. 20.8%) and fewer unplanned visits (33.8% vs. 43.6%) than those undergoing pilocystectomy, with similar SSI rates (14.9% vs. 14.0%).
Int Wound J · PMID 42089833 · Read it on PubMed ↗
Kirsch et al. 2026
Endoscopic treatment versus open excision for pediatric pilonidal disease: technical description of a modified (P)EPSiT approach using standard equipment and retrospective cohort study
Endoscopic surgery means shorter hospital stay.RetrospectiveLow qualityRelated question
113 people2026
EPSiT had significantly shorter hospital stays and similar recurrence rates and operative times compared to open excision
Who was studied
pediatric patients treated surgically for pilonidal disease
What they received
endoscopic pilonidal sinus treatment (EPSiT) using standard urological instruments
Compared with
open excision surgery
Main outcome
operative time, hospital stay, recurrence, pain, and satisfaction
Quality
This was a retrospective single-center study comparing two different time periods, with patient-reported outcomes only collected for one group.
Limitations
Retrospective design, patient-reported outcomes available for EPSiT cohort only, two surgical cohorts came from different time periods (2014-2018 vs 2019-2023)
Taken word for word from the abstract
- n 113 pediatric patients treated surgically for PD between 2014 and 2023
- population pediatric patients treated surgically for PD
- intervention Endoscopic pilonidal sinus treatment (EPSiT)
- comparator open excision
- primaryOutcome Outcomes included operative time, hospital stay, recurrence, pain, and satisfaction.
- result EPSiT was associated with significantly shorter hospital stays (mean difference -2.55 days; 95% CI -3.10 to -2.00; p < .001). Recurrence rates were comparable (16.7% versus 15.4%; p = .808).
Tech Coloproctol · PMID 42082883 · Read it on PubMed ↗
Monroe et al. 2026
Diabetic Ketoacidosis Reported from U.S. Navy Submarines, 2021-2024
Not about pilonidal disease causes.Case seriesVery low qualityRelated question
3 people2026
Delayed diagnosis occurred in one case where symptoms were initially treated as pilonidal disease; cases of DKA were complicated by renal failure and pancreatitis
Who was studied
active duty male U.S. Navy submariners newly diagnosed with type 1 diabetes
What they received
none; this is an observational report of diagnosis and management, not a tested intervention
Compared with
none; no comparator group
Main outcome
recognition and management of diabetic ketoacidosis in submarine settings
Quality
This is just a report of three cases with no comparison group, so it cannot show whether any treatment works and barely touches pilonidal disease at all.
Limitations
Only 3 cases, no control group, and pilonidal disease is mentioned only as a misdiagnosis in one case of an unrelated condition (type 1 diabetes), not studied as a condition itself.
Taken word for word from the abstract
- n This case series examines three instances of a first diagnosis of T1DM
- population active duty male U.S. Navy submariners
- result In Case 3, a 20-yr-old initially treated for pilonidal disease later manifests classic T1DM symptoms, leading to delayed diagnosis
- primaryOutcome highlighting the challenges of managing this condition in austere military environments
- intervention This case series examines three instances of a first diagnosis of T1DM
- comparator CASE SERIES: This case series examines three instances of a first diagnosis of T1DM among active duty male U.S. Navy submariners
Aerosp Med Hum Perform · PMID 42044893 · Read it on PubMed ↗
Donnelly et al. 2026
Minimally Invasive, Maximally Effective: Outpatient Strategies for Paediatric Pilonidal Disease
Conservative care had fewer recurrencesRetrospectiveLow qualityRelated question
69 people2026
disease came back in 26.1% of patients who had surgery versus 2.2% of those managed without surgery
Who was studied
children and teenagers (median age 15) with pilonidal sinus disease near the tailbone
What they received
structured outpatient care pathway (conservative treatment, in-clinic debridement, or surgery for severe/refractory cases)
Compared with
operative versus non-operative management within the same pathway
Main outcome
recurrence of pilonidal disease after the wound healed
Quality
this was a small retrospective single-centre study without randomisation, and the surgery group likely had worse disease to begin with, which could explain their higher recurrence.
Limitations
retrospective design, single centre, operative patients likely had more severe disease (confounding), and time to healing was prolonged in both groups without clear explanation
Taken word for word from the abstract
- population patients aged ≤ 18 years treated for PNS between February 2023 and August 2024
- intervention structured conservative care, in-clinic debridement and operative intervention (trephination or limited excision) for refractory or severe disease
- comparator Recurrence occurred in 6/23 (26.1%) in the operative group and 1/46 (2.2%) in the non-operative group
- primaryOutcome Primary outcome was recurrence after documented healing.
- result Recurrence occurred in 6/23 (26.1%) in the operative group and 1/46 (2.2%) in the non-operative group (Fisher's exact p = 0.0045).
- n 69 patients were included
Int Wound J · PMID 42020338 · Read it on PubMed ↗
Saleem et al. 2026
Surgical management of pilonidal sinus disease in pediatric population: An updated systematic review and meta-analysis
Minimally invasive surgery works best in kidsMeta-analysisModerate qualityRelated question
5,075 people2026
off-midline closure and minimally invasive surgery had lower recurrence, fewer complications, and faster recovery than open healing or midline closure
Who was studied
children and teenagers (18 years or younger) with pilonidal disease
What they received
different surgical techniques for pilonidal disease, including off-midline closure and minimally invasive surgery with laser hair removal
Compared with
other surgical techniques such as open healing and midline closure
Main outcome
recurrence of the condition, wound complications, and recovery time after surgery
Quality
it pools many studies but these are mostly non-randomized surgical studies with varied quality, so the comparisons are not as reliable as a well-run trial.
Limitations
The abstract notes pediatric-specific evidence is limited and heterogeneity was explored via subgroup analysis and meta-regression, but no mention of randomized controlled trials; this study addresses surgical treatment outcomes in children, not the cause of pain in general.
Taken word for word from the abstract
- n identified 59 studies (N = 5075)
- population patients ≤18 years with PD
- intervention Off-midline closures had the lowest recurrence (10.2%) and moderate complications (19.5%), with healing times as short as 8 days.
- intervention Minimally invasive techniques (MITs), particularly PEPSiT, demonstrated low recurrence (11.4%), minimal complications (6.5%)
- comparator Open healing showed the highest recurrence (20.1%) and moderate wound complication rates (16.2%), with healing times up to 98 days.
- comparator Midline primary closure had a recurrence rate of 17.5%, the highest wound complication rate (43.5%), and a reoperation rate of 29.8%.
- primaryOutcome To compare recurrence, wound complications, and recovery outcomes across surgical techniques
- result Off-midline closure and minimally invasive strategies, especially when combined with laser epilation, offer superior outcomes in recurrence, complications, and recovery.
J Pediatr Surg · PMID 41999968 · Read it on PubMed ↗
Li et al. 2026
A systematic review and meta-analysis of sinus laser associated closure (SiLaC) versus endoscopic pilonidal sinus treatment (EPSiT) in the management of pilonidal sinus disease
Both laser and keyhole surgery work similarly.Meta-analysisLow quality
size not given2026
Both minimally invasive techniques had similar cure rates (~86-88%), recurrence (~9-11%), and complication rates (~7-10%), though SiLaC was faster and EPSiT healed slightly sooner
Who was studied
people with pilonidal sinus disease (a chronic infection/cyst near the top of the buttocks crease)
What they received
laser treatment of the sinus tract (SiLaC)
Compared with
endoscopic pilonidal sinus treatment (EPSiT)
Main outcome
operative time, cure rate, recurrence rate, complication rate, and wound healing time
Quality
The comparison relies on indirect pooling of separate single-arm studies with very high statistical variability, not head-to-head trials.
Limitations
Lack of direct comparative trials; high heterogeneity (I2 often >90%) across included single-arm studies.
Taken word for word from the abstract
- population Various surgical modalities exist for the management of pilonidal sinus disease (PSD)
- intervention Sinus Laser associated Closure (SiLaC)
- comparator endoscopic pilonidal sinus treatment (EPSiT)
- primaryOutcome The primary outcome measures included operative time, cure rate, recurrence rate, postoperative complication rate, and total wound healing time.
- result The cure rate was 86% (95% CI: 80–91%; I2 =92%; P < 0.001) in the SiLaC and 88% (95% CI: 83–94%; I² = 87.1%; P < 0.001) in the EPSiT group.
- result The pooled recurrence rate was 11% (95% CI: 6–15%; I2 = 90.4%; < 0.001) for SiLaC and 9% (95% CI: 5–12%; I² = 82.9%; P < 0.001) for EPSiT.
- limitations These findings, limited by the lack of direct comparative trials, highlight the urgent need for prospective investigations to establish robust comparative effectiveness.
Langenbecks Arch Surg · PMID 41964736 · Read it on PubMed ↗
Chiu et al. 2026
Pilonidal pit fibroblasts release cytokines that differ by sex and are altered by estrogen
Possible hormonal cause of female pain.Laboratory studyVery low qualityRelated question
8 people2026
After estrogen exposure, fibroblasts from female patients released more IL6 and less eotaxin/CCL11 and IL8/CXCL8 than those from male patients
Who was studied
Fibroblast cells cultured from pilonidal pits (skin cysts at the top of the buttock crack) in 4 male and 4 female patients
What they received
Treatment of these fibroblast cells with estrogen (β-estradiol) in the lab
Compared with
Fibroblast cells treated with control (no estrogen)
Main outcome
Levels of inflammatory cytokines released by the fibroblast cells
Quality
This is a lab experiment on a handful of cell cultures (only 4 per sex), not a study in actual patients with pain outcomes.
Limitations
Very small number of cell cultures (4 male, 4 female); this is an in-vitro lab study, not a clinical study measuring pain in patients.
Taken word for word from the abstract
- n Eight fibroblast cultures (4-males, 4-females) were established.
- population Pilonidal pits were cultured.
- intervention Triplicate fibroblast cultures in hormone-free media were treated with β-estradiol or control before media was collected and analyzed for 48 cytokines.
- comparator Percentage change of cytokine level after estrogen was compared to those from control using Mann-Whitney test.
- primaryOutcome media was collected and analyzed for 48 cytokines
- result After estrogen stimulation, female fibroblasts increased IL6 and decreased eotaxin/CCL11 and IL8/CXCL8 secretion compared to males (p≤0.05).
Pediatr Surg Int · PMID 41927853 · Read it on PubMed ↗
Arslan et al. 2026
Shrinking follow-up duration in pilonidal sinus surgery, 1970-2020: a patient-weighted longitudinal analysis of 2,285 studies
Doesn't explain your pain at all.Systematic reviewVery low qualityRelated question
size not given2026
Average follow-up time after surgery has shrunk sharply over decades, so many studies may be missing late recurrences
Who was studied
people included in published studies of pilonidal sinus surgery
What they received
not a treatment study — analysis of how long follow-up periods were in published surgery studies
Compared with
comparison across decades (1970-2020) of follow-up length, not a treatment comparison
Main outcome
how long studies followed patients after pilonidal sinus surgery, used to judge if recurrence was properly tracked
Quality
This is a study-of-studies about reporting practices, not a treatment trial, so it cannot tell you why your symptoms occur or what helps them.
Limitations
Abstract does not address causes of pain, symptoms, or treatment efficacy; it only analyzes follow-up duration reporting in surgical literature.
Taken word for word from the abstract
- population 2,285 pilonidal surgery series (1850–present)
- primaryOutcome Reliable estimation of recurrence after pilonidal sinus surgery requires sufficient follow-up (FUP).
- result Patient-weighted mean FUP peaked in the 1980s at 6.69 years, declining to 5.26 (1990s), 4.26 (2000s), 3.14 (2010s), and 2.55 years (2020s).
- intervention we calculated decade-wise patient-weighted mean FUP
- comparator Relative to the 1970s (3.78 years), the 2020s were − 1.23 years (− 32.5%), and − 4.14 years (− 61.9%) below the 1980s.
Langenbecks Arch Surg · PMID 41904336 · Read it on PubMed ↗
Matteucci et al. 2026
The New Minimally Invasive Techniques for Pilonidal Sinus Disease Surgery: Choosing the Right Technique for the Right Patient-A Narrative Review
Flap surgery best for complex cases.Narrative reviewLow quality
size not given2026
Midline closure had more recurrence and complications; off-midline flaps gave the most durable results in complex cases; minimally invasive methods gave faster recovery and good short-term satisfaction in simpler cases but lack long-term evidence
Who was studied
people with pilonidal sinus disease (a condition near the top of the buttock crack)
What they received
minimally invasive surgical techniques (endoscopic and laser-assisted) and off-midline flap surgery
Compared with
traditional midline excision/closure
Main outcome
healing time, recurrence, complications and patient satisfaction
Quality
This is a narrative review (not a systematic review or meta-analysis) summarizing mixed study types without a standardized method, so it carries less weight.
Limitations
Narrative (non-systematic) review; relies on heterogeneous studies; long-term evidence for minimally invasive techniques is limited.
Taken word for word from the abstract
- population Pilonidal sinus disease (PSD) is a common condition affecting predominantly young adults
- intervention Minimally invasive approaches, including endoscopic and laser-assisted techniques
- comparator Midline primary closure is consistently associated with higher recurrence and complication rates
- primaryOutcome with a focus on healing time, recurrence, postoperative complications and patient-reported outcomes
- result Off-midline flap techniques provide the most durable results in recurrent or complex disease. Minimally invasive approaches, including endoscopic and laser-assisted techniques, offer faster recovery and high short-term patient satisfaction in selected primary cases, but should not be considered equivalent to flap surgery in complex or recurrent PSD due to limited long-term evidence.
Medicina (Kaunas) · PMID 41901600 · Read it on PubMed ↗
Martins et al. 2026
Negative pressure wound therapy in primary closure surgeries for pilonidal disease: a meta-analysis
Less pain, faster return to activity.Meta-analysisLow quality
479 people2026
NPWT linked to lower pain at 24 hours and faster return to normal activities, but no difference in wound closure time, wound reopening, hospital stay, infection, or recurrence
Who was studied
patients with pilonidal sinus (a cyst near the top of the buttock crack) undergoing surgery with wound closure
What they received
negative pressure wound therapy (NPWT) after primary wound closure surgery
Compared with
standard care without negative pressure wound therapy
Main outcome
postoperative pain, return to activities, wound healing, dehiscence, infection, and recurrence rates
Quality
This pooled only six studies with wide uncertainty ranges and says more randomized trials are needed to be sure.
Limitations
Small number of included studies, wide confidence intervals, and the authors state more randomized clinical trials are needed.
Taken word for word from the abstract
- population patients with sacrococcygeal pilonidal sinus
- intervention Primary closure with negative pressure wound therapy (NPWT)
- comparator non-NPWT (control)
- n Six studies with a total of 479 patients were included
- primaryOutcome lower pain score 24 h postoperative
- result NPWT had an association with lower pain score 24 h postoperative (MD - 0.65 points; 95% CI - 0.81 to - 0.50), shorter return time to activities (MD - 2.57 days; 95% CI - 3.74 to - 1.4). However, there was no difference between groups in the time of wound closure
- limitations more randomized clinical trials are needed for greater analysis
Updates Surg · PMID 41880146 · Read it on PubMed ↗
Hosokawa 2026
Perianal Sonographic Approach to Fistula-in-Ano and Perianal Abscesses: A Pictorial Review
Describes ultrasound method, no outcome data.Narrative reviewVery low qualityRelated question
size not given2026
describes a sonographic method and imaging features for identifying fistulas and abscesses, not a treatment outcome study
Who was studied
children with fistula-in-ano or perianal abscess
What they received
perianal ultrasound scanning technique
Compared with
none
Main outcome
ability to detect and describe fistula-in-ano and perianal abscesses on ultrasound
Quality
this is a descriptive pictorial review of an imaging technique, not a study measuring treatment effect or outcomes.
Limitations
abstract does not report patient numbers, outcomes data, or study methodology; it is a technique description, not an outcome study.
Taken word for word from the abstract
- population Fistula-in-ano and perianal abscesses are common conditions in pediatric patients.
- intervention the perianal ultrasound approach has been reported as a useful method for evaluating anal and perianal lesions
- comparator this technique remains unfamiliar to many sonographers
- primaryOutcome we aimed to describe the basic sonographic approach for assessing fistula-in-ano and perianal abscesses
- result An abscess appears as a hypoechoic (low-echoic) mass surrounded by echogenic subcutaneous tissue and a hypervascular rim due to inflammation.
Cureus · PMID 41878163 · Read it on PubMed ↗
Alsalaumy 2026
Comparative study of the Karydakis flap versus conventional surgical techniques for pilonidal sinus disease: a systematic review and meta-analysis
Fewer recurrences with this surgery typeMeta-analysisModerate qualityRelated question
3,108 people2026
Karydakis flap had fewer recurrences and infections, and people returned to work sooner
Who was studied
patients with pilonidal sinus disease having surgery
What they received
Karydakis flap surgery
Compared with
midline closure or excision with healing by secondary intention
Main outcome
recurrence of the condition and infection after surgery
Quality
It pools many studies including randomized trials, but mixes different study designs and some comparisons have wide uncertainty.
Limitations
Abstract does not describe limitations such as risk of bias or study heterogeneity details beyond I2 values.
Taken word for word from the abstract
- n Fifteen studies (n = 3,108) were identified for inclusion (KF = 1,257, MC = 1,593, EHSI = 258).
- population pilonidal sinus disease (PSD)
- intervention The Karydakis flap (KF)
- comparator compared with midline closure (MC) and excision with healing by secondary intention (EHSI)
- primaryOutcome The primary outcomes included recurrence and infection
- result KF was associated with a significant reduction in recurrence compared to MC (OR 0.30, 95% CI 0.16-0.59; p < 0.001; I2 = 34%) and EHSI (OR 0.29, 95% CI 0.12-0.71; p = 0.006; I2 = 11%). KF had fewer infections than EHSI (OR 0.06, 95% CI 0.007-0.486; p = 0.008) and returned to work earlier compared with MC (MD - 6.5 days) and EHSI (MD - 18.9 days).
Updates Surg · PMID 41854814 · Read it on PubMed ↗
Yalcinkaya et al. 2026
Surgical preference and outcomes in pilonidal sinus disease: a national multicenter study evaluating complications, recurrence, and quality of life (PISI TURKEY)
Less invasive surgery, fewer complications, better recovery.RetrospectiveLow quality
1,369 people12 months
non-excisional surgery had fewer wound complications, similar 12-month recurrence, and greater improvement in quality of life than excision-based surgery
Who was studied
adults having their first surgery for pilonidal sinus disease (a painful condition at the top of the buttock crack)
What they received
non-excisional (minimally invasive) surgical procedures
Compared with
excision-based surgery (simple excision or excision plus flap)
Main outcome
complications, recurrence, and quality of life after surgery
Quality
This was a retrospective study with unequal group sizes and baseline differences between groups, so the comparison between surgery types is less reliable.
Limitations
Retrospective design, baseline imbalances between groups, and limited follow-up, as stated by the authors.
Taken word for word from the abstract
- n Data from 1369 patients were analyzed
- population adults undergoing first surgery for PSD in 41 centers between January 2019 and January 2020
- intervention non-excisional procedures were associated with shorter operative time, shorter hospital stay, fewer wound-related complications, and greater early improvements in QoL and patient satisfaction compared with excision-based procedures
- comparator compared with excision-based procedures
- primaryOutcome to compare complications, recurrence, and QoL between excision-based and non-excisional (minimally invasive) procedures
- result non-excisional procedures were associated with shorter operative time, shorter hospital stay, fewer wound-related complications, and greater early improvements in QoL and patient satisfaction compared with excision-based procedures, without an apparent increase in 12-month recurrence
- followUp at baseline and at postoperative day 1, day 7, 6 months, and 12 months
Tech Coloproctol · PMID 41838186 · Read it on PubMed ↗
Jo et al. 2026
Home intense pulsed light (IPL) device is a useful tool to decrease hair burden in pilonidal patients - a case series
Home hair-removal device prevented recurrence.Case seriesVery low qualityRelated question
4 people1-3 years
no injury from home IPL use and no recurrence of pilonidal disease after 1-3 years of follow-up
Who was studied
patients with pilonidal disease (cyst/hair pocket at top of the buttocks crease) who had surgical excision
What they received
home intense pulsed light (IPL) hair removal device
Compared with
in-clinic laser epilation
Main outcome
recurrence of pilonidal disease symptoms and injury from device use
Quality
This is a tiny, uncontrolled report of only four patients with no comparison group, so it can't reliably show the device works.
Limitations
Very small informal case series (n=4), no control group, self-reported outcomes, not a controlled study of pain or disease cause.
Taken word for word from the abstract
- population Four PD patients were referred to our Pilonidal Care Clinic and underwent surgical excision.
- intervention intense pulsed light (IPL) devices at home
- comparator regular laser epilation in the clinic
- primaryOutcome They reported no injury associated with the IPL use and no recurrence of PD after a follow-up period between 1-3 years.
- result They reported no injury associated with the IPL use and no recurrence of PD after a follow-up period between 1-3 years.
- n Four PD patients were referred to our Pilonidal Care Clinic
- followUp follow-up period between 1-3 years
Int J Surg Case Rep · PMID 41837093 · Read it on PubMed ↗
van Kempen et al. 2026
Long-Term Outcomes of Sinus Laser-Assisted Closure in Primary Versus Recurrent Sacrococcygeal Pilonidal Sinus Disease: A Retrospective Cohort Study
Laser treatment works better for first-time cases.RetrospectiveLow qualityRelated question
267 peoplemedian of 4.0 years (IQR: 3.6-5.0 years)
disease came back more often and faster in recurrent cases than in first-time cases, and recurrent cases took longer to heal
Who was studied
people with pilonidal sinus disease at the top of the buttock crack, either first-time or recurrent cases
What they received
laser treatment to close the sinus tract (SiLaC)
Compared with
primary (first-time) disease versus recurrent disease
Main outcome
whether the disease came back after treatment
Quality
this is a retrospective single-center study without randomization, so it shows an association but cannot prove the laser treatment itself caused the different outcomes.
Limitations
retrospective design, single center, no comparison group without treatment, follow-up relied partly on telephone interviews
Taken word for word from the abstract
- population patients undergoing SiLaC at a single center (July 2019-August 2022), stratified by disease status: primary (n = 214) versus recurrent (n = 53)
- intervention Sinus laser-assisted closure (SiLaC)
- comparator primary (n = 214) versus recurrent (n = 53)
- primaryOutcome The primary outcome, disease recurrence, was assessed using Kaplan-Meier analysis
- result Recurrence rates were significantly higher in recurrent versus primary disease (RR 1.76, 95%CI: 1.30-2.40, p = 0.001), with 12-month rates of 34.8% versus 16.8% respectively.
- n analyzed 267 consecutive patients undergoing SiLaC at a single center
World J Surg · PMID 41834241 · Read it on PubMed ↗
Doll et al. 2026
Recurrence Patterns in Pilonidal Sinus Disease Surgery: Navigating Misclassifications and Early Complications
Early 'recurrences' often just unhealed wounds.Meta-analysisModerate qualityRelated question
140,472 people2026
studies that only followed patients for under a year reported much higher 'recurrence' rates than studies that followed patients a year or more, suggesting many early cases were actually unhealed wounds, not true recurrences
Who was studied
people who had surgery for pilonidal sinus disease (a condition causing pain and infection near the top of the buttock crack)
What they received
different pilonidal surgery methods (open healing, midline stitching, pit picking) followed for less than 1 year
Compared with
same surgery methods followed for 1 year or longer
Main outcome
rate of the problem coming back (recurrence) after surgery
Quality
it pools a huge number of studies and patients, but it is an observational analysis of other studies' data rather than a controlled trial, and the original studies varied a lot in quality.
Limitations
the paper itself notes that early follow-up data likely mixes unhealed wounds in with true recurrences, inflating short-term recurrence estimates
Taken word for word from the abstract
- n n=140,472 patients
- population after Pilonidal Sinus Disease (PSD) surgery
- intervention follow-up-studies <1year (n=304 studies)
- comparator versus studies with longer FUP (n=950 studies)
- primaryOutcome The postop. recurrence rate was analyzed
- result First-year recurrence rate (RR) was markedly higher in the studies with <1-year follow-up compared to studies with ≥1-year follow-up (median RR 6.0%/year vs. 2.0%/year, RD=4.0%).
Rev Col Bras Cir · PMID 41810655 · Read it on PubMed ↗
Tekin et al. 2026
Localization-Based Surgical Approaches in Pilonidal Sinus Treatment: A Comparative Study of Laser Therapy and Alternative Techniques
Laser helped overall, worse if mixed locationRetrospectiveLow qualityRelated question
size not givena minimum of two years
Laser therapy had the lowest overall recurrence rate (15.6%), but the highest recurrence rate (83.3%) when the disease was in a mixed location
Who was studied
people with pilonidal sinus disease (a chronic inflammatory condition near the tailbone)
What they received
laser therapy for pilonidal sinus
Compared with
microsinusectomy, surgical resection with phenol application, or platelet-rich plasma (PRP) treatment
Main outcome
rate of disease coming back after treatment (recurrence)
Quality
The study compares treatment groups without describing randomization, doesn't report how many patients were in each group, and shows recurrence results that vary wildly by subgroup.
Limitations
Abstract does not report total patient numbers, group sizes, or whether allocation was randomized; results vary greatly by anatomical subgroup, suggesting small sample sizes in subgroups.
Taken word for word from the abstract
- population Pilonidal sinus disease (PSD) is a chronic inflammatory condition most commonly observed in the sacrococcygeal region and predominantly affecting young individuals
- intervention laser therapy
- comparator microsinusectomy, surgical resection followed by phenol application, platelet-rich plasma (PRP), and laser therapy
- primaryOutcome Treatment outcomes were assessed primarily in terms of postoperative recurrence.
- result laser therapy demonstrated the lowest overall recurrence rate (15.6%). However, in cases of mixed-location PSD, laser treatment was associated with the highest recurrence rate (83.3%).
- followUp All patients were followed for a minimum of two years.
Photobiomodul Photomed Laser Surg · PMID 41804956 · Read it on PubMed ↗
Flor et al. 2025
A Case of Porokeratosis Ptychotropica Treated with Cryotherapy
Lesions fully cleared after freezing treatment.Case seriesVery low qualityRelated question
1 people2025
both lesions completely resolved after two cryotherapy sessions, leaving only mild skin lightening
Who was studied
76-year-old woman with skin lesions near the top of the buttock crack and vulva
What they received
freezing treatment (cryotherapy) applied to the lesions
Compared with
no comparator (single patient case report)
Main outcome
whether the skin lesions cleared up
Quality
This is a single patient case report, so it cannot show whether this treatment works reliably for others.
Limitations
Only one patient was studied, there was no comparison group, and the condition (porokeratosis ptychotropica) is a rare, specific skin disorder diagnosed by biopsy, not simply any pain at the top of the buttock crack.
Taken word for word from the abstract
- population A 76-year-old female with no prior relevant history was referred due to a one-year-long history of cutaneous lesions in the intergluteal region
- intervention Two cycles of cryotherapy were performed (20 seconds per lesion).
- comparator We report a case of porokeratosis ptychotropica successfully treated with cryotherapy.
- primaryOutcome On follow-up, total resolution of lesions was observed
- result On follow-up, total resolution of lesions was observed, with residual hypopigmentation without significant scarring being observed.
- n A 76-year-old female with no prior relevant history was referred
Acta Dermatovenerol Croat · PMID 41804627 · Read it on PubMed ↗
Kupietzky et al. 2026
Benign Presacral Tumor Mimicking a Pilonidal Abscess: A Diagnostic Pitfall
Benign cyst mistaken for pilonidal abscess.Case seriesVery low qualityRelated question
1 people2026
the mass was found to be a benign cyst (retrorectal epidermal cyst), not a pilonidal abscess, and was successfully removed with an uneventful recovery
Who was studied
a 43-year-old woman with a slowly growing lump near the tailbone area
What they received
surgical removal of the mass through a tailbone approach (Kraske approach)
Compared with
no comparison, single case report
Main outcome
correct diagnosis and successful removal of the mass
Quality
this is a single patient case report, so it cannot show how common this problem is or how well treatment works in general
Limitations
only one patient described, no comparison group, and findings may not apply to typical cases of pain at the top of the buttock crack
Taken word for word from the abstract
- population A 43-year-old woman presented with a gradually enlarging mass in the pilonidal region over the course of several months.
- intervention a Kraske approach was selected for surgical excision
- comparator We present the case of a 43-year-old woman
- primaryOutcome The specimen was sent for pathological evaluation, which revealed a retrorectal epidermal cyst.
- result The patient's postoperative course was uneventful, and she was discharged on postoperative day one.
- n a 43-year-old woman
Isr Med Assoc J · PMID 41800580 · Read it on PubMed ↗
Darbandi et al. 2026
Advancing pilonidal disease care through pediatric endoscopic treatment (PEPSiT): early insights
Good healing, few complications.RetrospectiveLow quality
32 people9 months
most healed within a few months, few complications, and recurrences were successfully retreated
Who was studied
adolescents and young adults with pilonidal sinus disease (median age 15)
What they received
endoscopic pilonidal sinus treatment (PEPSiT)
Compared with
none (single-arm case series)
Main outcome
healing, complications, and recurrence after surgery
Quality
small retrospective case series with no comparison group, so it can't show if this works better than other treatments.
Limitations
Retrospective design, small sample size, no control group, and authors state larger prospective studies are needed.
Taken word for word from the abstract
- n Thirty-two patients (18 males) underwent PEPSiT
- population median age 15 years (11-18)
- intervention Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT)
- comparator We retrospectively reviewed all PEPSiT cases
- primaryOutcome surgical time, anesthesia, hospital stay, complications, healing, recurrence, and follow-up
- result Median healing was 3 months (1-24).
- result Three recurrences were successfully treated with redo-PEPSiT.
- followUp Median follow-up was 9 months (1-52).
Pediatr Surg Int · PMID 41758282 · Read it on PubMed ↗
Maak et al. 2026
The Use of Methylene Blue in Pilonidal Sinus Surgery Reduces the Risk of Recurrence: A Systematic Review and Meta-Analysis
Dye may lower surgery recurrence risk.Meta-analysisLow qualityRelated question
130,677 people2026
Using methylene blue dye was linked to significantly lower recurrence for most surgery types, but for one flap technique it was linked to higher recurrence, and data were incomplete for that comparison
Who was studied
patients having surgery for pilonidal sinus disease (a cyst/tunnel near the tailbone)
What they received
staining the sinus tract with methylene blue dye during surgery
Compared with
surgery without methylene blue staining
Main outcome
rate of the condition coming back after surgery (recurrence)
Quality
It pools data from many different studies of varying design rather than controlled trials, and the authors note major missing follow-up data for the results that went against the dye.
Limitations
Notable loss of follow-up data in some surgical subgroups, which the authors say weakens those specific findings; studies span from 1833 to 2023 with differing methods.
Taken word for word from the abstract
- n A total of 1192 studies involving 130,677 patients were eligible for analysis.
- population Pilonidal Sinus Disease shows an increasing incidence. Surgical interventions are often necessary
- intervention the usage of methylene blue (MB) for staining the PSD fistulas for better visualization during surgery
- comparator 929 studies without MB (77.9%, n = 105,075 patients)
- primaryOutcome shows an effect concerning recurrence rates
- result Primary open approach, primary midline closure, primary asymmetric closure, and Limberg/Dufourmentel all showed a significantly lower RR when MB was used (p < 0.0001). The use of MB in Bascom/Karydakis-Flap showed a statistically significant disadvantage concerning RR (p < 0.0001)
Medicina (Kaunas) · PMID 41752637 · Read it on PubMed ↗
Rodríguez Ruiz et al. 2026
Pediatric Pilonidal Disease Surgical Approach (PPiDSA) Study
Less invasive surgery heals faster, fewer complications.Randomised trialModerate qualityRelated question
102 people19 months
endoscopic treatment caused fewer complications and faster healing than wide excision, with similar recurrence rates
Who was studied
children and teens having surgery for pilonidal sinus disease (a cyst/infection near the top of the butt crack)
What they received
endoscopic (minimally invasive) treatment of the pilonidal sinus
Compared with
en bloc (wide) surgical excision
Main outcome
postoperative complications, time to healing, and recurrence of the cyst
Quality
it was a randomized multicenter trial, but it only looked at children already diagnosed with pilonidal disease and had a fairly short follow-up period.
Limitations
Follow-up was limited to a median of 19 months and the abstract itself says longer follow-up is needed to confirm the findings.
Taken word for word from the abstract
- population patients undergoing surgery for pilonidal sinus between January 2023 and December 2024 in four pediatric institutions
- intervention endoscopic treatment
- comparator en bloc excision
- primaryOutcome Demographic and clinical variables, postoperative complications, and recurrence rates were analyzed.
- result Postoperative complications occurred more frequently in Group 1 compared with Group 2 (53.7% vs. 20.8%; p < 0.001).
- result a longer median time to complete healing (100 vs. 45 days; p < 0.001)
- result no significant differences were observed between groups in recurrence rates (14.8% vs. 16.7%; p = 0.797)
- n A total of 102 patients were included in this study (Group 1: n = 54; Group 2: n = 48).
- followUp median follow-up of 19 months (interquartile range, 10-24 months)
Children (Basel) · PMID 41749610 · Read it on PubMed ↗
Oruc et al. 2026
Limberg flap reconstruction for recurrent pilonidal sinus disease: A single-center U.S. Cohort
No recurrence after flap surgery.RetrospectiveLow qualityRelated question
37 peoplemedian follow-up of 4.5 years
no recurrence seen over a median 4.5 years of follow-up, with an 11% complication rate (mostly wound separation)
Who was studied
patients with recurrent pilonidal sinus disease (cyst/infection near the tailbone) who had surgery between 2014 and 2023
What they received
Limberg flap reconstruction surgery
Compared with
none - single group, before/after outcomes tracked over time
Main outcome
recurrence of the pilonidal disease after surgery, plus complications
Quality
this is a small, retrospective study with no comparison group, so it can't prove the surgery works better than other options.
Limitations
retrospective design, no control group, single center, relies partly on telephone interviews for follow-up
Taken word for word from the abstract
- n Thirty-seven patients were included.
- population patients who underwent LF for recurrent PSD between 2014 and 2023
- intervention Limberg flap (LF) reconstruction
- comparator A retrospective analysis was conducted of patients who underwent LF for recurrent PSD
- primaryOutcome Long-term follow-up, including assessment for recurrence, was obtained via structured telephone interviews and chart reviews.
- result No recurrence was observed during the median follow-up of 4.5 years.
- result The postoperative complication rate was 11%, primarily consisting of wound dehiscence.
- followUp median follow-up of 4.5 years
Langenbecks Arch Surg · PMID 41680360 · Read it on PubMed ↗
De Figueiredo Martins et al. 2026
Undiagnosed Sacrococcygeal Fistulas: A Case Report
Long-ignored fistula, cause still unclear.Case seriesVery low quality
1 people2026
extensive fistulous disease found on exam; workup was non-definitive; patient chose watchful waiting over surgery
Who was studied
a 74-year-old man with a long-standing sacrococcygeal fistula
What they received
antibiotics (amoxicillin-clavulanic acid, then added metronidazole) and surgical evaluation
Compared with
no comparator, single patient case
Main outcome
diagnosis and management of the fistula and drainage symptoms
Quality
this is a single patient's case report, so it cannot show whether any treatment works in general.
Limitations
only one patient described; diagnostic workup did not give a clear answer; no long-term outcome reported after the decision to avoid surgery.
Taken word for word from the abstract
- population This case describes a 74-year-old man who, during a routine visit, reports complaints of purulent drainage in the sacrococcygeal region.
- intervention Antibiotic therapy was started (amoxicillin and clavulanic acid - 875 mg plus 125 mg every 12 hours)
- intervention antibiotic therapy with metronidazole (500 mg every 12 hours) was added
- comparator The patient was referred to a surgical consultation
- primaryOutcome a targeted workup was performed but proved non-definitive
- result On physical examination, extensive fistulous disease in the sacrococcygeal region with purulent discharge was observed.
- result the patient opted for a non-invasive expectant attitude, preserving his autonomy in medical decisions.
- n a 74-year-old man
Cureus · PMID 41625041 · Read it on PubMed ↗
Sahakyan et al. 2026
[Clinical experience of using modified Limberg plastic surgery using a polymer hydrogel for recurrent and complex pilonidal sinus]
Possibly fewer recurrences, but unprovenRetrospectiveLow qualityRelated question
97 people2026
Recurrence was 10.9% with traditional surgery, 4.9% with modified surgery, and 2.5% with the hydrogel technique, but complication rates were similar across all groups (p=0.374) and no significance test was reported for the recurrence differences
Who was studied
adults with recurrent or complex pilonidal sinus disease near the top of the buttock crease
What they received
modified Limberg flap surgery combined with a polymer hydrogel
Compared with
traditional Limberg flap surgery and modified Limberg flap without hydrogel
Main outcome
rate of post-surgery complications and later disease recurrence
Quality
This was a small retrospective comparison without randomization, and the authors themselves say more research is needed before concluding the hydrogel technique works better.
Limitations
Retrospective design, no randomization, long-term follow-up data available for only 86.6% of patients, and the authors state further studies are required to confirm results.
Taken word for word from the abstract
- n The study included 97 patients with a diagnosis of recurrent or complex PSD (Pilonidal sinus disease)
- population patients with a diagnosis of recurrent or complex PSD (Pilonidal sinus disease)
- intervention operated using modified Limberg flap and polymer hydrogel
- comparator underwent surgery using the traditional Limberg flap, modified Limberg flap
- primaryOutcome The incidence of complications in the early postoperative period and the frequency of relapses in the late period were assessed.
- result The recurrence of the disease in patients who underwent traditional plastic surgery was 10.9%. In the group with modified plastic surgery, recurrence was detected in 2 patients (4.9%). In the group with the use of polymer hydrogel, 1 case of recurrence (2.5%) was recorded.
- result There were no statistically significant differences in the incidence of complications in the early postoperative period between the groups (p=0.374).
- limitations further studies are required to confirm the results obtained
Khirurgiia (Mosk) · PMID 41590391 · Read it on PubMed ↗
Hurjui et al. 2026
Unexpected metachronous multiple primary cancers: pilonidal sinus‑related squamous cell carcinoma and incidentally detected gastric gastrointestinal stromal tumour
Rare cancer in long-standing pilonidal disease.Case seriesVery low qualityRelated question
1 people2026
the pilonidal sinus had turned into skin cancer, which was removed and treated with radiotherapy, and a separate stomach tumor was later found and removed, with no cancer returning on follow-up
Who was studied
a 62-year-old man with long-standing pilonidal disease at the top of the buttock crease
What they received
surgical removal of the cancerous tissue plus radiotherapy, followed later by removal of an unrelated stomach tumor
Main outcome
whether the cancers came back after treatment
Quality
this is a single patient's case report, so it cannot show how often this happens or what usually helps.
Limitations
single case, no comparison group, cannot be generalized to typical pilonidal pain
Taken word for word from the abstract
- population a 62‑year‑old male with chronic pilonidal disease
- intervention surgically excised and treated with adjuvant radiotherapy
- result No recurrence of either malignancy has been observed on follow‑up
- n a 62‑year‑old male
- primaryOutcome No recurrence of either malignancy has been observed on follow‑up
BJR Case Rep · PMID 41550458 · Read it on PubMed ↗
Kutkut et al. 2026
Light-based Epilation as an Adjunct to Surgery in the Management of Pilonidal Disease: A Meta-analysis
Fewer recurrences when laser hair removal added to surgery.Meta-analysisModerate quality
804 peoplelonger than 6 months
adding light-based hair removal to surgery lowered recurrence; hair removal alone was not better than other treatments
Who was studied
people with pilonidal disease (cysts/infections at the top of the buttock crack)
What they received
laser or light-based hair removal added to surgery
Compared with
surgery alone, or light-based hair removal alone vs conventional treatment
Main outcome
whether the pilonidal disease came back (recurrence)
Quality
it combines real comparative studies including some randomized trials, but mixes different study types and designs together, which can affect reliability.
Limitations
Included a mix of randomized, prospective, and retrospective studies, which were pooled despite differences in quality and design.
Taken word for word from the abstract
- n Eleven comparative studies comprising 804 patients were included
- population evaluate the effectiveness of light-based epilation as an adjunct to surgery in the treatment of pilonidal disease
- intervention Light-based epilation used as an adjunct to surgery
- comparator compared with surgery alone
- primaryOutcome A PubMed search was performed of all studies that evaluated the rate of pilonidal disease recurrence when light-based epilation was used.
- result Light-based epilation used as an adjunct to surgery was found to significantly reduce pilonidal disease recurrence compared with surgery alone (P = 0.02). No statistically significant differences were observed when light-based epilation alone was compared with conventional treatment (P = 0.9) or surgery alone (P = 0.5).
- followUp follow-up longer than 6 months
Plast Reconstr Surg Glob Open · PMID 41497546 · Read it on PubMed ↗
Stoeckel et al. 2026
In-Office Pit Excision for Pilonidal Disease Using Needle-Free Local Anesthesia: A Minimally Invasive, Non-Operative Treatment Approach
Pits healed without surgery.Case seriesVery low quality
100 people6 to 8 weeks
60% of patients had all pits healed at first follow-up, rising to 88% healed overall, with minimal procedure pain and no disability
Who was studied
patients with pilonidal disease (gluteal crease pits), mean age 18 years
What they received
in-office pit excision with needle-free (pneumatic) local anesthesia and laser follicle ablation
Compared with
none - single group, no comparison treatment
Main outcome
whether all pits healed and condition resolved
Quality
This was a single-group study with no comparison treatment and a quarter of patients lost to follow-up, so it can't show the procedure is better than other options.
Limitations
No control/comparison group; 25% of patients were lost to follow-up and excluded from analysis; single clinic experience.
Taken word for word from the abstract
- population Patients with gluteal crease pits at our Pilonidal Care Clinic were offered pit excision as standard care.
- population Mean age was 18.1 years; 50% were male.
- intervention patients received 1% buffered lidocaine via pneumatic injection. Laser follicle ablation was followed by punch excision
- comparator RESULTS: About 130 patients underwent this technique between February and June 2024; 100 were included in the analysis
- n 100 were included in the analysis (5 excluded for concurrent I&D, 25 lost to follow-up)
- primaryOutcome 60% patients healed all pits, resolving their condition
- result 60% patients healed all pits, resolving their condition, with 64% (144/224) of all pits healed.
- result Ultimately, 88% of patients healed all of their pits.
- followUp return in 6 to 8 weeks
Eur J Pediatr Surg · PMID 41461191 · Read it on PubMed ↗
Garcia et al. 2026
Patient characteristics and microbiology in pilonidal abscesses in children
Describes bacteria in abscesses, no recurrence cause found.RetrospectiveLow qualityRelated question
154 people2026
No risk factors for recurrence were identified, and anaerobes and Streptococcus anginosus were the most common bacteria found
Who was studied
children with pilonidal abscesses
What they received
none (descriptive study of abscess microbiology, no treatment tested)
Compared with
none (no comparison group)
Main outcome
recurrence of pilonidal abscess and bacteria found in abscess cultures
Quality
This is a retrospective review of cases at one hospital without a comparison group, so it can describe patterns but not prove what causes or prevents recurrence.
Limitations
Abstract does not describe study design limitations beyond noting no recurrence risk factors were found; single tertiary pediatric center, retrospective.
Taken word for word from the abstract
- n 216 pilonidal abscess episodes among 154 children
- population pilonidal abscess episodes among 154 children
- intervention We described the microbiology of 216 pilonidal abscess episodes among 154 children over a 10-year period
- comparator No risk factors for recurrence were identified.
- primaryOutcome assessed patient characteristics associated with recurrence
- result No risk factors for recurrence were identified.
J Pediatric Infect Dis Soc · PMID 41454773 · Read it on PubMed ↗
Öztaş et al. 2026
Artificial Intelligence-Based Prediction of Recurrence and Personalized Treatment Planning in Pediatric Pilonidal Sinus Disease
AI predicts recurrence risk, not why it hurtsRetrospectiveLow qualityRelated question
242 people2026
Recurrence occurred in 5.7% of patients overall with no significant difference between treatment types; longer healing time, larger lesion size, higher BMI, and more sinus tracts predicted higher recurrence risk, and an AI model built on these features was reported as feasible for predicting recurrence and guiding treatment choice
Who was studied
children with pilonidal sinus disease (a cyst/infection near the top of the buttock crack)
What they received
AI-based machine learning models using clinical data (healing time, BMI, age, number of sinus tracts) to predict recurrence and guide treatment choice
Compared with
three treatment approaches compared retrospectively: surgical excision, crystallized phenol, and silver nitrate
Main outcome
ability to predict recurrence risk and recommend treatment, and recurrence rate across treatments
Quality
This is a retrospective study without an untreated comparison group, so it cannot tell you why the area hurts or whether any treatment clearly beats another.
Limitations
Retrospective design; no untreated/no-treatment comparison; authors call for multicenter prospective validation
Taken word for word from the abstract
- population Clinical data from 242 pediatric PSD patients were retrospectively analyzed.
- intervention Two machine learning (ML) models were developed: (1) a binary classifier for recurrence prediction and (2) a multiclass classifier for treatment modality selection.
- comparator Among 242 patients, 59.1% underwent surgical excision (unroofing with secondary healing), 33.1% received crystallized phenol, and 7.8% were treated with silver nitrate.
- primaryOutcome This study aimed to assess the feasibility of artificial intelligence (AI)-based models for predicting recurrence risk and supporting individualized treatment strategies in pediatric pilonidal sinus disease (PSD).
- result The overall recurrence rate was 5.7%, with no significant differences among treatment modalities. Longer healing duration, larger lesion size, higher body mass index (BMI), and an increased number of sinus tracts were associated with higher recurrence risk.
- n Clinical data from 242 pediatric PSD patients were retrospectively analyzed.
Surg Innov · PMID 41432023 · Read it on PubMed ↗
Chen et al. 2025
[Treatment options for different types of sacrococcygeal pilonidal disease]
Treatment depends on disease severity and type.Narrative reviewVery low quality
size not given2025
the abstract does not report specific outcome results or data, only summarizes treatment strategy recommendations by disease type
Who was studied
people with sacrococcygeal pilonidal disease (cyst/infection at the top of the buttock crease)
What they received
various treatments depending on disease type - observation, drainage, minimally invasive procedures, or surgical excision
Compared with
different treatment approaches compared to each other based on disease severity/type
Main outcome
recurrence rate, complications, and recovery time
Quality
this is a narrative summary of clinical experience and literature rather than a study with original data or results.
Limitations
no original data, patient numbers, or outcome statistics are reported; this is an expert opinion/literature summary
Taken word for word from the abstract
- population sacrococcygeal pilonidal disease (SPD)
- intervention Non-surgical treatment is suitable for asymptomatic SPD patients. For patients in the acute abscess phase, drainage is the primary therapeutic goal, with avoidance of midline incisions. Minimally invasive procedures may be considered for patients with localized lesions after weighing the recurrence risk
- comparator For recurrent SPD or cases with extensive lesions, excision followed by secondary healing or combined with flap techniques is required to pursue a lower recurrence risk
- primaryOutcome reduce recurrence rates, enable patients to quickly return to normal daily activities, and be associated with a low incidence of complications
- result this article summarizes the treatment strategies for different types of SPD, providing a reference for clinicians in formulating diagnosis and treatment plans
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 41397831 · Read it on PubMed ↗
Li et al. 2025
[Clinical efficacy of laser ablation and closure in the treatment of sacrococcygeal pilonidal disease and analysis of risk factors for postoperative recurrence in male patients]
Laser surgery healed pilonidal disease, some recurrence.RetrospectiveLow quality
369 peoplenot specified beyond recurrence tracking
All wounds healed eventually; 5.1% of patients had the condition come back, mostly young patients or those who'd had prior surgery for it
Who was studied
patients with sacrococcygeal pilonidal disease (a condition at the top of the buttock crack), mostly male, including some teenagers
What they received
laser ablation and closure surgery
Compared with
none (single-group outcomes, with subgroup comparison for recurrence risk factors)
Main outcome
wound healing, complications, and recurrence after surgery
Quality
This was a retrospective study of one treatment without a comparison group, so it can't prove the laser method is better than other options.
Limitations
Retrospective design, no control group for comparison, single center.
Taken word for word from the abstract
- population 369 patients with SPD who underwent laser ablation and closure
- intervention laser ablation and closure for the treatment of sacrococcygeal pilonidal disease (SPD)
- comparator A retrospective observational study was conducted to collect clinical data of 369 patients with SPD who underwent laser ablation and closure
- primaryOutcome Perioperative outcomes and postoperative recurrence were analyzed.
- result The wound healing rate was 100%, with a median wound healing time of 35 (IQR: 30, 42) days. Postoperative recurrence occurred in 19 patients (5.1%), all of whom were male.
- n 369 patients with SPD who underwent laser ablation and closure
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 41397828 · Read it on PubMed ↗
Turpin et al. 2026
Identifying Predictors of Recurrent Pilonidal Disease in Adolescents and Young Adults: A Secondary Analysis of a Randomized Controlled Trial
Laser hair removal cuts recurrence, mainly if privately insured.Randomised trialModerate quality
200 people1 y
laser hair removal lowered the odds of recurrence overall, but only helped in patients with private insurance, not public insurance
Who was studied
adolescents and young adults aged 11-21 with a history of at least one episode of pilonidal disease
What they received
laser hair removal added to standard treatment
Compared with
standard treatment alone
Main outcome
disease coming back within 1 year
Quality
it's a secondary analysis of a randomized trial with reasonable size, but subgroup findings by insurance type need further confirmation.
Limitations
this is a secondary analysis, not the trial's main planned analysis, and the insurance-based difference needs further investigation per the authors.
Taken word for word from the abstract
- n Complete 1-y follow-up data to be included in the multivariable analysis were available for 200 patients in the trial.
- population Inclusion criteria were patients 11 to 21 y of age with a history of at least 1 episode of pilonidal disease, without active disease.
- intervention laser depilation as an adjunct to standard care
- comparator versus standard care alone
- primaryOutcome disease recurrence within 1 y
- result laser hair treatment was strongly associated with decreased odds of disease recurrence within 1 y (odds ratio [OR], 0.26 [95% confidence interval (CI), 0.12-0.58]; P = 0.001)
- result Laser hair treatment was significantly associated with lower odds of disease recurrence in patients who were privately insured (OR, 0.29 [95% CI, 0.16-0.55], P < 0.001) but was not associated with lower disease recurrence in those who were publicly insured (OR, 1.20 [95% CI, 0.63-2.28], P = 0.58).
J Surg Res · PMID 41365098 · Read it on PubMed ↗
Yung et al. 2026
Connecting polycystic ovary syndrome and pilonidal disease in adolescents: State of the art review
Possible link between PCOS and cyst.Narrative reviewVery low qualityRelated question
size not given2026
The abstract describes a reported association and shared risk factors between PCOS and pilonidal disease, and proposes a combined management pathway, but reports no new data or statistics on outcomes.
Who was studied
teenage girls with pilonidal disease (cyst/infection at top of buttock crease) or PCOS
What they received
awareness of the link between PCOS and pilonidal disease
Compared with
no comparator described
Main outcome
association between the two conditions and management approach
Quality
This is an opinion-style review without original data, patient numbers, or outcome statistics, so it cannot show how strong the link is.
Limitations
No study design, sample size, or outcome data are given; it is a clinical opinion piece, not original research.
Taken word for word from the abstract
- population female adolescent population
- intervention a recently reported association between polycystic ovary syndrome and pilonidal disease
- comparator This clinical opinion suggests a reciprocal pathway for management of female adolescents who may be suffering from either polycystic ovary syndrome or pilonidal disease
- primaryOutcome The conditions share common risk factors such as obesity, hyperandrogenism, and metabolic syndrome.
- result with the goal of providing comprehensive management and mitigating morbidity
Best Pract Res Clin Obstet Gynaecol · PMID 41337870 · Read it on PubMed ↗
Larney et al. 2025
Grenz Ray Therapy for Porokeratosis Ptychotropica: A Case Report
Cleared briefly, then started returning.Case seriesVery low quality
1 people2 months
Excellent clinical response, but early signs of the condition returning after 2 months
Who was studied
A 56-year-old woman with a rare skin condition called porokeratosis ptychotropica, affecting the crease between the buttocks and the back of the thigh
What they received
Grenz ray therapy (a type of low-dose superficial radiotherapy), 6 sessions totaling 18 Gy
Compared with
Her own prior failed treatments (steroids, vitamin D creams, simvastatin cream, fluorouracil cream, acitretin, laser-assisted photodynamic therapy)
Main outcome
Clinical response of the skin lesions
Quality
This is a single patient case report, so it cannot show whether the treatment reliably works for others.
Limitations
Only one patient was treated, there was no comparison group, and the lesion started recurring within 2 months.
Taken word for word from the abstract
- population Our patient was a 56-year-old female with PP in the intergluteal cleft and on her right posterior thigh.
- intervention She underwent Grenz therapy for 6 sessions, a total dose of 18 Gy to all affected areas, with excellent clinical response.
- comparator She was previously unsuccessfully treated with topical, intralesional and oral corticosteroids, topical vitamin D analogues, topical simvastatin-cholesterol cream, topical fluorouracil cream, acitretin, and CO2 laser assisted photodynamic therapy.
- primaryOutcome with excellent clinical response
- result After 2 months of remission, her porokeratosis showed early signs of recurrence.
- n Our patient was a 56-year-old female
Case Rep Dermatol · PMID 41321606 · Read it on PubMed ↗
Canturk et al. 2025
Combined laser ablation and pit excision for pilonidal sinus: effectiveness, quality of recovery, and patient-reported outcomes
High success treating pilonidal sinus.RetrospectiveLow qualityRelated question
39 people13.6 ± 3.6 months
treatment success in 84.6% (33/39) and recurrence in 15.4% (6/39) of patients
Who was studied
adults with pilonidal sinus disease
What they received
diode laser ablation combined with pit excision
Compared with
none; single-group cohort with no comparison treatment
Main outcome
recurrence and treatment success (no recurrence without re-intervention)
Quality
This was a small, retrospective, single-center study without a comparison group, so the results are uncertain.
Limitations
Findings should be interpreted cautiously given the retrospective design and modest sample size; prospective, adequately powered studies are needed to validate the prognostic performance and comparative effectiveness.
Taken word for word from the abstract
- n the primary analysis included 39 patients
- population Fifty-four adults were treated consecutively
- intervention diode laser ablation combined with pit excision
- comparator a minimally invasive method of diode laser ablation combined with pit excision for pilonidal sinus disease
- primaryOutcome The primary endpoints were recurrence and treatment success (no recurrence without re-intervention).
- result treatment success 84.6% (33/39), recurrence 15.4% (6/39)
- followUp Mean followup was 13.6 ± 3.6 months
BMC Surg · PMID 41316137 · Read it on PubMed ↗
H Amer et al. 2025
A Novel Scoring System for Pilonidal Disease: Predicting Complications and Guiding Surgical Management
Identifies who is more likely to have pilonidal cysts recur.Prospective cohortLow qualityRelated question
156 peopleat least six months
patients who had their pilonidal disease come back had significantly higher risk scores than those who didn't, and several factors (male sex, higher BMI, diabetes, prior recurrence, more pits, hairy back, pits close to the anus, prior abscess) were linked to recurrence
Who was studied
young adults aged 18-45 with pilonidal disease (a condition causing a cyst/abscess at the top of the buttock crack) undergoing surgery
What they received
a new scoring system (Hazem-Talaat score) using patient factors to predict surgical outcomes, alongside standard surgery
Compared with
patients with lower scores on the same scoring system
Main outcome
wound complications and disease recurrence after surgery
Quality
this is a single-center study without a comparison treatment group, so it shows what predicts problems but doesn't test whether a treatment actually helps.
Limitations
single-center study, no untreated or alternative-treatment comparison group, scoring system not yet externally validated
Taken word for word from the abstract
- n A prospective study was carried out on 156 patients (108 males, 48 females) aged 18-45 years admitted with primary or recurrent pilonidal disease
- population Pilonidal disease is a chronic condition of the sacrococcygeal region, frequently affecting young adults
- intervention develop and validate a novel preoperative scoring system, the Hazem-Talaat score, to assess disease severity, predict recurrence, and facilitate surgical planning in pilonidal disease
- comparator Patients who developed recurrence had significantly higher Hazem-Talaat scores (mean 22.1 ± 4.5) compared with those without recurrence (mean 14.0 ± 3.1; p < 0.001).
- primaryOutcome followed for at least six months to assess wound complications and recurrence
- result Recurrence was significantly associated with male gender (p = 0.010), higher BMI (p < 0.001), diabetes mellitus (p < 0.001), prolonged operative time (p < 0.001), prior recurrence (p < 0.001), more than 10 midline pits (p < 0.001), lateral extension (p < 0.001), hairy back (p < 0.001), distance from anus < 5 cm (p < 0.001), and previous abscess formation (p < 0.001).
Cureus · PMID 41306166 · Read it on PubMed ↗
Maclean et al. 2025
Evaluating Risk Factors for Surgical Site Occurrences: Infection and Wound Dehiscence Post Definitive Surgery for Sacrococcygeal Pilonidal Sinus Disease
Surgery choice affects infection and wound risk.RetrospectiveLow qualityRelated question
774 people30-day
some techniques (secondary intention, certain flaps) had much higher infection and wound-breakdown risk, while the modified Karydakis flap had the best outcomes
Who was studied
adults having surgery for pilonidal sinus disease (a pit/cyst at the top of the buttock crease)
What they received
different surgical techniques used to treat pilonidal sinus disease (flap repairs or leaving the wound open to heal)
Compared with
the various surgical techniques compared against each other
Main outcome
rates of surgical site infection and wound breakdown after surgery
Quality
This is a retrospective study looking back at records from multiple hospitals, so it can spot patterns but can't prove which technique actually causes the problems.
Limitations
Retrospective design relying on medical records across multiple hospitals with regional variation in practice.
Taken word for word from the abstract
- n A total of 774 patients were analysed.
- population Patients aged ≥15 years undergoing elective definitive SPD surgery with flap or secondary intention techniques were included.
- intervention flap or secondary intention techniques
- comparator Multivariate analysis demonstrated that secondary intention techniques (OR 6.0, p<0.01), other flap procedures (OR 3.1, p=0.03)
- primaryOutcome Surgical site infections (SSIs) and wound dehiscence (WD) are frequent and clinically significant complications.
- result The modified Karydakis flap demonstrated the most favourable risk profile.
- followUp Outcomes included 30-day re-presentation and readmission rates, with extended follow-up for recurrence.
Cureus · PMID 41278051 · Read it on PubMed ↗
Chiu et al. 2026
Adding gauze sweep technique to pit-picking procedure increases hair removal and lowers recurrence rate of pilonidal disease
Fewer pilonidal recurrences with added technique.RetrospectiveLow quality
175 people2026
more patients had hair removed and far fewer had the condition come back when gauze sweep was added
Who was studied
patients with pilonidal disease undergoing a pit-picking procedure, mean age about 18 years
What they received
pit-picking procedure with an added gauze sweep technique
Compared with
pit-picking procedure alone (no gauze sweep)
Main outcome
amount of hair removed and rate of pilonidal disease recurrence
Quality
This compared two groups of patients treated in different time periods rather than randomly assigning treatment, so differences between groups could explain the result.
Limitations
Non-randomized comparison of sequential patient cohorts from different time periods, which the abstract itself labels as Level IV evidence; follow-up time varied widely between patients.
Taken word for word from the abstract
- n 175 total patients were included.
- population Consecutive pilonidal patients who underwent PP 2/2021-9/2024 were selected.
- intervention the GS technique was added during PP
- comparator 86 patients underwent PP only
- primaryOutcome any hair removed during PP, pilonidal disease recurrence
- result 53 patients (62 %) in cohort PP and 75 patients (84 %) in cohort PP + GS had hair removed during the procedure (p < 0.001). The recurrence rate was 11.6 % (10/86) for cohort PP and 1.1 % (1/89) for cohort PP + GS (p = 0.01).
- quality LEVEL OF EVIDENCE: Level IV.
J Pediatr Surg · PMID 41274599 · Read it on PubMed ↗
O'Guinn et al. 2026
Pilonidal Disease
Flap surgery cuts recurrence, more complications.Narrative reviewLow quality
size not given2026
flap-based closures had fewer recurrences but more complications than other closure methods
Who was studied
people with pilonidal disease (common in teens and young adults)
What they received
surgical treatments such as incision and drainage, pit removal, marsupialization, or flap-based closure (Karydakis, Bascom's cleft lift)
Compared with
different surgical approaches compared to each other
Main outcome
recurrence and complications after treatment
Quality
this is a general review describing typical practice, not a controlled study testing one treatment against another.
Limitations
no study design, patient numbers, or statistical results are given; it is a general overview of management options.
Taken word for word from the abstract
- population Pilonidal disease, common in adolescents and young adults, is linked to hair insertion, friction, and bacterial colonization.
- intervention Closures with flap-based techniques, such as Karydakis and Bascom's cleft lift, offer a lower recurrence rate but higher complication risks.
- comparator Management of chronic pilonidal disease is focused on removal of pits with the possible addition of marsupialization or primary closure.
- primaryOutcome the addition of deroofing identified pits at the time of drainage can reduce recurrence
- result Closures with flap-based techniques, such as Karydakis and Bascom's cleft lift, offer a lower recurrence rate but higher complication risks.
Surg Clin North Am · PMID 41241452 · Read it on PubMed ↗
Detran 2025
Late-adolescent presentation of tethered cord syndrome secondary to filum terminale lipoma
Surgery didn't fully fix symptoms.Case seriesVery low qualityRelated question
1 people2025
still needed urinary catheterization and developed new sensory problems after surgery
Who was studied
young man with urinary problems and skin changes near the lower back/buttock crease
What they received
surgery to release a tethered spinal cord caused by a fatty growth
Compared with
no comparator, single case before and after surgery
Main outcome
neurological and bladder/bowel sphincter function after surgery
Quality
This is a single patient case report, so it cannot show what typically happens or apply broadly.
Limitations
Single case, long delay before diagnosis and treatment, cannot be generalized.
Taken word for word from the abstract
- n a 16-year-old Filipino male developed dysuria, hematuria, urinary incontinence, and recurrent lower urinary tract infections
- population a hyperpigmented patch with superimposed hypertrichosis located left-superolateral to the intergluteal cleft
- intervention Despite surgical untethering, he remained dependent on urinary catheterization postoperatively, and also newly developed additional sensory deficits.
- comparator CASE DESCRIPTION
- primaryOutcome The only neurological finding was impaired anal and urinary sphincter function.
- result Despite surgical untethering, he remained dependent on urinary catheterization postoperatively, and also newly developed additional sensory deficits.
Surg Neurol Int · PMID 41216148 · Read it on PubMed ↗
Sawaqed et al. 2025
Pilonidal sinus beyond the sacrococcygeal region: A penile case report
Rare penile case, unrelated location.Case seriesVery low qualityRelated question
1 people2025
removal revealed a hair-containing sinus with chronic inflammation, confirming pilonidal disease, and recovery was uneventful
Who was studied
30-year-old man with a painless penile shaft mass
What they received
surgical removal of the mass under local anesthesia
Compared with
none
Main outcome
diagnosis and recovery after removal
Quality
This is a single patient case report, which cannot show how common or treatable this condition is in general.
Limitations
Only one patient was studied, and the lesion was on the penis, not the natal cleft (butt crack) region the question is about.
Taken word for word from the abstract
- n a 30-year-old circumcised man with a painless, slowly enlarging penile shaft mass
- population a 30-year-old circumcised man with a painless, slowly enlarging penile shaft mass
- intervention Excision under local anesthesia revealed a hair-containing sinus with chronic granulomatous inflammation on histology
- comparator Excision under local anesthesia revealed a hair-containing sinus with chronic granulomatous inflammation on histology
- primaryOutcome Recovery was uneventful
- result Excision under local anesthesia revealed a hair-containing sinus with chronic granulomatous inflammation on histology, confirming pilonidal disease. Recovery was uneventful.
Urol Case Rep · PMID 41209438 · Read it on PubMed ↗
Bilgin et al. 2025
Comparison of short- and long-term outcomes of diode laser vs. crystallized phenol treatment for pilonidal sinus disease: A propensity score-matched multicentre study
Both treatments worked, different trade-offs.RetrospectiveModerate quality
644 peopleMedian follow-up was 45 months (laser) and 40 months (phenol)
Laser led to faster healing and fewer sessions but more pain and complications, while phenol had shorter procedures and earlier return to daily life but slower complete healing; recurrence and recovery rates were similar between groups.
Who was studied
young adults with pilonidal sinus disease (median age 26 years)
What they received
diode laser treatment for pilonidal sinus
Compared with
crystallized phenol treatment for pilonidal sinus
Main outcome
healing, recovery and recurrence after treatment
Quality
It is a retrospective, matched comparison, not a randomized trial, so results are less certain despite the large sample.
Limitations
Retrospective cohort design with propensity score matching rather than randomization.
Taken word for word from the abstract
- n 644 were included
- population Pilonidal sinus disease (PSD) primarily affects young adults
- population median age: 26 years
- intervention patients treated with laser or phenol were included
- comparator patients treated with laser or phenol were included
- primaryOutcome Readmission, recurrence and recovery rates were comparable (85%-86%).
- result Complications occurred in 6.8% of laser patients, whereas none were reported in the phenol group.
- result Pain scores were higher in the laser group (2 [1-3] vs. 1 [0-2]).
- result Return to daily activities was delayed in the laser group, whereas complete healing was slower in the phenol group.
- result Laser favoured faster healing and fewer sessions, whereas phenol allowed for shorter procedures and earlier return to daily life.
- followUp Median follow-up was 45 months (laser) and 40 months (phenol).
Colorectal Dis · PMID 41146596 · Read it on PubMed ↗
Stoeckel et al. 2026
Topical lidocaine or not for laser follicle ablation in pilonidal disease: A prospective, randomized, double-blinded trial
Numbing cream didn't reduce procedure pain.Randomised trialLow qualityRelated question
20 people2026
no significant difference in pain scores between lidocaine cream and placebo
Who was studied
patients with pilonidal disease (gluteal crease hair follicle condition) getting laser hair removal treatment
What they received
topical lidocaine numbing cream (LMX 4%) applied before laser hair follicle treatment
Compared with
placebo cream applied before laser hair follicle treatment
Main outcome
patient-reported pain/discomfort during the laser procedure, rated 0-10
Quality
very small study of only 20 patients, so it may be too small to detect a real difference.
Limitations
small sample size of 20 patients which was powered only to detect a fairly large difference; this addresses pain during a specific laser hair treatment for pilonidal disease, not pain from pilonidal disease itself.
Taken word for word from the abstract
- n leaving 20 patients for analysis
- population patients presenting to the pilonidal care clinic for laser follicle ablation
- intervention Patients were randomized to blindly receive topical anesthetic cream (LMX, 4 % topical lidocaine, Ferndale Laboratories Inc.) or placebo and crossed over between study arms to serve as their own control for their subsequent laser follicle ablation, 6-8 weeks later.
- comparator Patients were randomized to blindly receive topical anesthetic cream (LMX, 4 % topical lidocaine, Ferndale Laboratories Inc.) or placebo and crossed over between study arms to serve as their own control for their subsequent laser follicle ablation, 6-8 weeks later.
- primaryOutcome After the procedure the patient was asked their level of discomfort with the laser follicle ablation on a 0-10 Likert pain scale.
- result The mean pain score with LMX was 2.25 (SD 1.94) and placebo 1.78 (SD 1.15) (p = 0.18; Fig. 1).
J Pediatr Surg · PMID 41135869 · Read it on PubMed ↗
Jazi et al. 2025
Future of pilonidal cyst surgery: a comparative review of traditional and laser techniques
Laser may heal pilonidal cysts better.Narrative reviewLow quality
size not given2025
laser treatment reduced hospital stay, pain, and recurrence, with healing rates up to 97%, but costs more and may be less effective in severe cases
Who was studied
people with pilonidal cysts (sacrococcygeal cyst or sinus near the top of the buttock crease)
What they received
laser ablation treatment
Compared with
traditional surgery (excision with open/closed healing or flap reconstruction)
Main outcome
effectiveness, recovery time, recurrence, complications, cosmetics, and cost
Quality
this is a narrative review of mixed studies without pooled statistics, so it can't be weighted as strongly as a single rigorous trial.
Limitations
authors note laser may be less effective in severe or complicated cases and that long-term outcomes still need to be established.
Taken word for word from the abstract
- population Pilonidal disease is a common sacrococcygeal cyst or sinus that can significantly impact patients' quality of life
- intervention minimally invasive techniques focusing on laser ablation
- comparator traditional surgical techniques including traditional excision with open and closed healing, flap reconstructions
- primaryOutcome focusing on each method's effectiveness, recovery time, recurrence rates, complications, cosmetics, and costs
- result Laser techniques showed promising results in reducing hospital stays (for at most 3 h vs. days), postoperative pain, and recurrence rates, with healing rates up to 97%.
- limitations laser methods may be less effective in severe or complicated cases, and they have higher costs
BMC Surg · PMID 41094667 · Read it on PubMed ↗
Nyandoro et al. 2026
Sacrococcygeal Pilonidal Sinus Disease: A Decade-In-Review of Patient-Reported Outcome Measures
Flap surgery heals faster, fewer recurrences.RetrospectiveLow quality
136 peopledecade
Modified Limberg and modified Karydakis flaps gave faster return to work, better cosmetic/body image scores and lower recurrence, while secondary intention healing had the slowest recovery (60 days) and highest recurrence (52.2%) and infection (30.4%) rates
Who was studied
people who had surgery for pilonidal sinus disease at the top of the buttock crack
What they received
different surgical flap techniques for pilonidal sinus (Karydakis flap, modified Karydakis flap, Limberg flap, modified Limberg flap, other flap techniques)
Compared with
healing by secondary intention (leaving the wound open to heal on its own) and the other flap techniques compared with each other
Main outcome
patient-reported outcomes including body image, cosmetic appearance, confidence, return to normal function and overall satisfaction, plus recurrence and infection rates
Quality
this was a retrospective, multi-centre survey study without randomisation, so differences between techniques could be influenced by which patients or surgeons chose each approach rather than the surgery itself
Limitations
retrospective design, reliance on mail questionnaires and telephone interviews up to a decade after surgery, and non-random allocation to surgical technique groups
Taken word for word from the abstract
- n A total of 136 patients met the inclusion criteria.
- population Sacrococcygeal pilonidal sinus disease (SPD) is a chronic inflammatory condition
- intervention Six surgical technique groups were analysed: Karydakis flap (KF), modified Karydakis flap (MKF), Limberg flap (LF), modified Limberg flap (MLF), other flap techniques (OFT) and secondary intention healing techniques (SIT).
- comparator secondary intention healing techniques (SIT)
- primaryOutcome PROMs assessed included body image, cosmesis, confidence, functional recovery and overall satisfaction-secondary outcomes examined recurrence, SSI and other complications.
- result MLF and OFT achieved the fastest functional recovery, with median return-to-work times of 14 and 21 days, respectively, compared to 60 days for SIT (p = 0.007). MKF and LF achieved the highest body image and cosmetic satisfaction scores (medians of 20 and 19), whereas SIT and OFT scored the lowest. MKF yielded the highest overall satisfaction (100%). SIT was associated with the highest recurrence rate (52.2%) and SSI rates (30.4%)
- followUp multi-centre retrospective decade follow-up review
ANZ J Surg · PMID 41074563 · Read it on PubMed ↗
Hawezy 2025
Comparison of Simple Drainage Versus Drainage With Tract Destruction in the Management of Pilonidal Abscess
Removing sinus tract cuts recurrence a lot.RetrospectiveLow quality
480 peopleat least nine months
recurrence was much lower with drainage plus sinus destruction (11.8%) than with simple drainage alone (55.7%)
Who was studied
patients with acute pilonidal abscesses (infection at the top of the buttock crack)
What they received
drainage of the abscess combined with destruction of the sinus tract
Compared with
simple drainage of the abscess alone
Main outcome
recurrence of the abscess
Quality
this was not described as randomized, so differences between groups other than treatment could explain the results.
Limitations
abstract does not describe randomization or how patients were assigned to each group, raising risk of bias.
Taken word for word from the abstract
- population a total of 480 patients with acute pilonidal abscesses received treatment
- intervention 245 had drainage with sinus damage (Group B)
- comparator 235 underwent simple drainage (Group A)
- primaryOutcome recurrence rates recorded throughout
- result In Group A, 131 patients (55.7%) experienced a recurrence, compared to only 29 patients (11.8%) in Group B.
- n a total of 480 patients with acute pilonidal abscesses received treatment
- followUp All participants were followed for at least nine months
Cureus · PMID 41058826 · Read it on PubMed ↗
Gallo et al. 2025
Intra-operative ultrasound in the surgical treatment of complex and recurrent pilonidal disease: a retrospective, observational, single-center study
Found hidden tunnels, some recurrence still.RetrospectiveLow quality
19 peopleminimum follow-up of 36 months
ultrasound found extra hidden tracts in about a third of patients and changed the surgery; about a quarter still had the disease persist or come back at 3 years, but all healed after a repeat procedure
Who was studied
patients with complex or repeat pilonidal disease (cyst at top of buttock crack)
What they received
endoscopic pilonidal sinus surgery plus ultrasound guidance during the operation
Compared with
none (single group, before/after comparison of ultrasound findings)
Main outcome
whether ultrasound found extra hidden tunnels and changed the surgery, and whether the disease came back or failed to heal
Quality
this was a small, retrospective study of only 19 patients with no comparison group, so it can't prove ultrasound improves outcomes.
Limitations
retrospective design, very small sample size, single center, no control group for comparison
Taken word for word from the abstract
- population patients with recurrent and complex PD treated between 2018 and 2021
- intervention using IUS in conjunction with EPSiT
- comparator A retrospective cohort, single-center study was conducted on patients with recurrent and complex PD
- primaryOutcome The study recorded the number of cases in which IUS identified additional fistulous tracts and led to a modification of the surgical strategy, as well as clinical outcomes including recurrence rate, time to wound healing, and incidence of incomplete wound healing.
- result IUS identified previously undetected fistulous tracts in 6 patients (31.5%), leading to modifications in the surgical strategy. At 36-month follow-up, disease persistence (recurrence or incomplete healing) was observed in 5 patients (26.3%). Recurrent cases were successfully managed with additional procedures, achieving 100% healing after reintervention.
- n Nineteen patients were included
- followUp All patients had a minimum follow-up of 36 months.
Int J Colorectal Dis · PMID 40974390 · Read it on PubMed ↗
Ertekin et al. 2026
Comparing Square Excision and Transposition Flap Versus Modified Limberg Flap in Sacrococcygeal Pilonidal Sinus Disease Surgery: A New Technique With Fewer Wound Issues
Faster healing, fewer wound problemsRetrospectiveLow quality
102 people6 months
the square excision and transposition flap group healed faster (11 days), returned to work sooner (13 days), had fewer wound infections (3.8% vs 16.3%) and less wound breakdown (vs 18.4%), and reported better cosmetic satisfaction and lower recurrence
Who was studied
patients having surgery for pilonidal sinus disease (a chronic cyst/infection at the top of the buttock crack)
What they received
square excision and transposition flap surgery
Compared with
modified Limberg flap surgery
Main outcome
healing time, wound complications, return to work, and recurrence after surgery
Quality
this was a retrospective comparison of two surgical techniques without randomization, so differences between groups could be due to other factors besides the surgery itself
Limitations
retrospective design, not randomized, relatively small group sizes (53 and 49 patients)
Taken word for word from the abstract
- population Patients who underwent surgical intervention for PSD utilizing SF and LF techniques between January 2016 and January 2022 were evaluated.
- intervention square excision and transposition flap (SF) technique
- comparator modified Limberg flap (LF)
- n the SF (53 patients) and LF (49 patients) groups
- primaryOutcome Demographics, comorbidity, clinical presentation, pain assessment, hospital stay duration, healing time, time to return to work, and recurrence status were compared between the SF and LF groups.
- result Patients in the SF group experienced shorter healing times of 11 days and quicker returns to work at 13 days compared with patients in the LF group ( P <.001). A lower incidence of wound infection was observed in the SF group (3.8%) compared with the LF group (16.3%) ( P =.035). Partial wound dehiscence was more observed in the LF group (18.4%), marking a significant difference ( P =.001).
- followUp Regarding cosmetic satisfaction at the 6-month follow-up, the SF group reported higher satisfaction rates.
Adv Skin Wound Care · PMID 40956974 · Read it on PubMed ↗
Davra et al. 2026
Unraveling the Causes of Perianal Itching: Magnetic Resonance Imaging as a Diagnostic Tool for Perianal Fistulas and Its Mimics
Pilonidal disease was one of several causes found.Prospective cohortLow qualityRelated question
59 people2026
Perianal fistula was the most common cause, followed by abscess, pilonidal sinus and hemorrhoids, with MRI findings matching clinical and surgical data
Who was studied
adults aged 18 and older with perianal itching
What they received
MRI pelvis scan to evaluate perianal itching and classify fistulas
Compared with
clinical and surgical findings
Main outcome
identifying and classifying the cause of perianal itching (fistula, abscess, pilonidal sinus, hemorrhoids)
Quality
This is a small, single-center observational study over six months looking at diagnosis, not treatment, so it can't tell you if any treatment works or how long symptoms last.
Limitations
Small sample size from a single department over a short six-month period, and it studies MRI's diagnostic ability rather than treatment outcomes.
Taken word for word from the abstract
- n included 59 patients aged ≥ 18 years with perianal itching
- population included 59 patients aged ≥ 18 years with perianal itching
- intervention MRI (1.5T) pelvis scans were obtained using T1, T2, short tau inversion recovery, diffusion-weighted imaging, apparent diffusion coefficient and postcontrast sequences
- comparator MRI findings showed high concordance with clinical and surgical data
- primaryOutcome evaluate the diagnostic utility of MRI in patients with perianal itching, focusing on the identification and classification of perianal fistulas and their mimics
- result perianal fistula was most common (57.6%), followed by abscess (33.9%), pilonidal sinus (5.1%) and hemorrhoids (3.4%)
Ann Afr Med · PMID 40952828 · Read it on PubMed ↗
Yalcinkaya et al. 2025
Investigating recurrence in pilonidal sinus disease: results of a nationwide, multicenter study in Turkey (PISI TURKEY)
Low recurrence; infection raises relapse risk.RetrospectiveLow qualityRelated question
1,662 people12 months
6.26% of patients had the condition come back within 12 months; those with prior recurrence, wound infection, or wound separation after surgery were more likely to have it return
Who was studied
adults who had surgery for pilonidal sinus disease (a condition causing pain and infection near the top of the buttock crease)
What they received
pilonidal sinus surgery (index operation)
Main outcome
recurrence of pilonidal sinus disease within 12 months after surgery
Quality
This is a retrospective review of medical records across many hospitals without a comparison treatment group, so it can show patterns but not prove what causes or best treats the pain.
Limitations
Retrospective database study design with no control group; relies on data forms completed by multiple centers, which can introduce inconsistency or missing information.
Taken word for word from the abstract
- n The data of 1662 patients from 41 centers were analyzed.
- population recipients of PSD surgery in 41 select hospitals in Turkey
- intervention index PSD intervention
- primaryOutcome The recurrence rate following index operations was 6.26% in the 12-month period.
- result Multivariable logistic regression revealed that prior recurrence, postoperative wound site infection, and postoperative wound separation were independently associated with recurrence.
Int J Colorectal Dis · PMID 40931185 · Read it on PubMed ↗
Bahadir et al. 2025
Comparison of Endoscopic Pilonidal Sinus Treatment Combined With Platelet-Rich Plasma and Excision With Primary Closure in Pediatric Patients: A Retrospective Comparative Cohort Study on Short-Term Outcomes
Similar recurrence, faster recovery, better cosmetic results.RetrospectiveLow quality
104 peoplepostoperative 1st year
EPSIT + PRP patients went home sooner, had similar recurrence rates to surgery, and reported better cosmetic satisfaction and return to normal life
Who was studied
children and teenagers with pilonidal sinus disease (a tunnel/cyst near the top of the buttock crack)
What they received
minimally invasive endoscopic treatment combined with platelet-rich plasma (EPSIT + PRP)
Compared with
surgical excision with stitched closure (EPC)
Main outcome
hospital stay length, recurrence, complications, recovery time, and cosmetic satisfaction
Quality
This compared two different groups of patients treated years apart at different times, not randomly assigned, so differences could be due to other factors besides the treatment.
Limitations
Retrospective comparison of two historical cohorts treated in different time periods with different follow-up durations and study design, not randomized.
Taken word for word from the abstract
- population A total of 104 patients under 18 years of age were included
- intervention endoscopic pilonidal sinus treatment combined with platelet-rich plasma application (EPSIT + PRP)
- comparator excision with primary closure (EPC)
- primaryOutcome Patients were evaluated based on demographic features, length of hospital stay, recurrence and complication rates, analgesic use, return to daily life, cosmetic outcomes, and satisfaction.
- result Hospital stay was significantly shorter in the EPSIT + PRP group (same-day discharge vs. mean 2.79 days; p < 0.05). In the postoperative 1st year follow-up, recurrence rates were 13.7 % (EPC) and 9.7 % (EPSIT + PRP), not statistically significant (p = 0.750). Cosmetic satisfaction and return to social life favored the EPSIT + PRP group (p = 0.031).
- n A total of 104 patients under 18 years of age were included.
- limitations Despite differences in follow-up duration and study design
J Pediatr Surg · PMID 40921262 · Read it on PubMed ↗
Reynolds et al. 2026
Quantifying recovery time after common pediatric surgical procedures
Not relevant to your symptom.RetrospectiveLow qualityRelated question
192 people2-4 weeks
on average children used non-narcotic pain medication for 2-3 days, were not back to baseline until day 5-6, and returned to school by day 6-8
Who was studied
children who had common outpatient surgeries, including some who had pilonidal cyst removal near the tailbone
What they received
pilonidal cyst excision and other pediatric surgeries
Main outcome
days of pain medication use, time to return to baseline, and time to return to school
Quality
this is a small retrospective survey of mixed surgeries, not a study of why pilonidal area pain occurs, and only 5 of 192 patients had pilonidal surgery.
Limitations
single-center retrospective survey, small subgroup sizes (only 5 pilonidal cyst cases), relies on phone follow-up and parent recall, no information on causes or diagnosis of tailbone pain outside of surgical recovery.
Taken word for word from the abstract
- population patients who underwent laparoscopic appendectomy (uncomplicated appendicitis) (n = 65), umbilical hernia repair (n = 41), laparoscopic inguinal hernia repair (n = 40), out-patient laparoscopic cholecystectomy (n = 14), miscellaneous laparoscopy (n = 5), miscellaneous skin and soft tissue cases (n = 22), and pilonidal cyst excision (n = 5)
- intervention pilonidal cyst excision (n = 5)
- primaryOutcome quantify recovery time and pain medication usage after common pediatric operations
- result On average patients used non-narcotic pain medications for 2-3 days, but parents did not think they were at baseline until post-operative day (POD) 5-6 and patients did not return to school until POD 6-8.
- n Follow-up data from the postoperative phone call was available for 192 patients
J Pediatr Surg · PMID 40845982 · Read it on PubMed ↗
Atallah et al. 2025
Primary cutaneous mucinous carcinoma in unusual location: A case report
Rare cancer mimicked a cyst.Case seriesVery low qualityRelated question
1 people2025
the mass was diagnosed as a rare primary skin cancer called mucinous carcinoma in the area between the buttocks, not an infected cyst
Who was studied
72-year-old man with coccygeal pain and swelling, initially suspected to be an infected pilonidal cyst
What they received
surgical excision of the mass
Compared with
none
Main outcome
final diagnosis of the mass and its origin
Quality
this is a single patient case report, so it cannot show how common this cause is or how well treatment works in general.
Limitations
only one patient reported; findings may not generalize to other causes of similar pain
Taken word for word from the abstract
- n A 72-year-old man with no medical or surgical history presented with a month-long history of coccygeal pain.
- population A 72-year-old man with no medical or surgical history presented with a month-long history of coccygeal pain.
- intervention The patient underwent surgical excision.
- comparator The initial clinical diagnosis was that of an infected pilonidal cyst.
- primaryOutcome Histological analysis and immunohistochemistry confirmed the diagnosis of mucinous carcinoma.
- result confirming a diagnosis of primary cutaneous mucinous carcinoma of the intergluteal cleft
Int J Surg Case Rep · PMID 40829408 · Read it on PubMed ↗
Ukleja et al. 2025
A Case Report of Wound-Vacuum-Assisted Closure (VAC) Treatment Following Pilonidal Cyst Excision
Wound vacuum helped cyst wound heal well.Case seriesVery low quality
1 peoplethree weeks
wound shrank and healed over three weeks with minimal pain and no complications
Who was studied
28-year-old man with a recurrent pilonidal cyst and chronic sinus tract
What they received
wound vacuum-assisted closure (wound-VAC) after cyst removal surgery
Compared with
none described; outcome tracked over time without a comparison group
Main outcome
wound healing after cyst removal
Quality
This is a single patient case report, so it cannot show whether this treatment works better than others in general.
Limitations
Only one patient was described, so the findings may not apply to other people.
Taken word for word from the abstract
- n an otherwise healthy 28-year-old man
- population a recurrent pilonidal cyst with a chronic sinus tract despite previous repeat incision and drainage procedures
- intervention pilonidal cyst excision with vacuum-assisted wound closure (wound-VAC) placement to facilitate the healing process
- comparator healed via secondary intention with a simple dry-to-dry gauze dressing
- primaryOutcome The wound size and the wound depth decreased, requiring no further need for wound-VAC dressing
- result Over the next three weeks, the wound healed via secondary intention with a simple dry-to-dry gauze dressing with minimal intermittent pain and without any complications.
Cureus · PMID 40821131 · Read it on PubMed ↗
de Kort et al. 2025
Minimal Invasive Surgical Treatment in Primary Sacrococcygeal Pilonidal Sinus Disease: Phenolization of the Sinus Tract Versus Sinus Laser Assisted Closure; Long-Term Follow-Up of a Comparative Cohort Study
Similar results, no clear winner.RetrospectiveLow quality
72 people47 months
Pain was slightly lower with phenolization but not meaningfully so, and most quality-of-life measures showed no difference between the two treatments.
Who was studied
adults with primary pilonidal sinus disease at the top of the butt crack
What they received
phenolization of the sinus tract
Compared with
sinus laser-assisted closure (SiLaC)
Main outcome
need for additional surgery, pain, and quality of life after treatment
Quality
This was a matched, non-randomized comparison from patient records with a modest number of patients, so it can't reliably prove one treatment is better.
Limitations
Not randomized; patients were matched rather than randomly assigned, and outcomes relied partly on patient questionnaires.
Taken word for word from the abstract
- n phenolization group (n = 36)
- n SiLaC group (n = 36)
- population patients with primary SPSD
- intervention phenolization of the sinus tract
- comparator sinus laser-assisted closure
- primaryOutcome Patient records were examined for additional surgeries, and quality of life and symptoms were assessed with a questionnaire.
- result Pain as a symptom at the natal cleft was significantly lower in the phenolization group, though not clinically relevant.
- result other quality of life outcomes, such as the VAS score and the SF-36, did not differ significantly between phenolization and SiLaC
World J Surg · PMID 40769774 · Read it on PubMed ↗
Corturillo et al. 2025
Practice patterns of paediatric surgeons on treating pilonidal sinus disease - a national survey study
Surgeons mostly use traditional surgery methods.RegistryVery low qualityRelated question
40 people2025
most institutions used excision and secondary closure, followed by vacuum-assisted closure and pit-picking, and most did not follow adult or paediatric treatment guidelines
Who was studied
German paediatric surgery departments and office-based surgeons treating pilonidal sinus disease in children and adolescents
What they received
various surgical approaches to pilonidal sinus disease (excision with secondary closure, vacuum-assisted closure, pit-picking)
Compared with
different surgical techniques compared to each other across institutions
Main outcome
which surgical approach and practice pattern institutions use for pilonidal sinus disease
Quality
this is a survey of surgeons' practice habits with a low response rate and no patient outcome data, so it cannot say what treatment works best or why pain occurs.
Limitations
only 40% of surveyed institutions responded, and the study reports practice patterns rather than patient outcomes or causes of symptoms.
Taken word for word from the abstract
- n A total of 40 institutions (33 departments and 7 office-based paediatric surgeons) responded (recall rate 40%).
- population 101 German paediatric surgical departments and surgeries with inpatient beds were surveyed for their surgical approach to paediatric pilonidal sinus disease
- intervention The most frequently reported surgical approach was excision and secondary closure with 17/39, followed by excision and vacuum-assisted closure (13/39), and pit-picking (12/39).
- comparator In recurrent cases, the majority of 20/39 does not switch their approach, while 13/39 switch to excision and secondary closure, and 11/39 switch to excision and vacuum-assisted closure.
- primaryOutcome The survey included demographics, information on practice setting, as well as the primary and secondary approach to pilonidal disease and three virtual patient scenarios.
- result German paediatric surgeons prefer traditional approaches to pilonidal sinus diseases, but pit-picking is frequently used. Neither the adult-based national guideline recommendations nor paediatric treatment algorithms have been widely implemented.
Int J Colorectal Dis · PMID 40721961 · Read it on PubMed ↗
Doll et al. 2025
Unveiling Observation Bias in Pilonidal Sinus Disease Studies: A Comparative Analysis of Study Designs and Follow-Up Protocols
Pain studies may undercount disease recurrence.Meta-analysisModerate qualityRelated question
135,349 people10-year follow-up
recurrence rates were much lower in return-on-recurrence studies than in randomized trials, suggesting many recurrences were missed when follow-up was not scheduled
Who was studied
people treated for pilonidal sinus disease (a condition causing pain and infection at the top of the buttock crease)
What they received
studies using structured, scheduled follow-up visits after treatment
Compared with
studies relying on patients only returning if their disease came back
Main outcome
how much follow-up method affects reported recurrence rates after treatment
Quality
it combines a huge number of previously published studies to reveal a measurement bias, but it is not a direct test of any treatment or cause of pain, and the included studies vary greatly in quality.
Limitations
this is an analysis of bias in how other studies measured and reported recurrence, not a direct study of symptoms, causes, or treatment outcomes for an individual patient
Taken word for word from the abstract
- n 135.349 patients treated
- population 1.222 PSD studies with 135.349 patients treated
- intervention Implementing a well-structured, all-encompassing patient follow-up at specific time intervals can effectively mitigate this bias
- comparator studies relying on the patients returning in case of recurrent disease (return on recurrence; ROR)
- primaryOutcome The extent of observation bias in long-term surgical outcomes due to inadequate or unplanned follow-up in pilonidal sinus disease (PSD) studies is unclear.
- result Recurrence rates in the N and the ROR trials were statistically indistinguishable at ten-year follow-up (p = 0.1),whereas RCTs show significantly higher recurrence rates than N or ROR at 10-year follow-ups
- followUp 10-year follow-up
Pol Przegl Chir · PMID 40679024 · Read it on PubMed ↗
Yalçın et al. 2025
Our Experience With Four or More Crystallised Phenol Applications in Pilonidal Sinus Disease
Phenol treatment often worked well.RetrospectiveLow quality
53 people3-year follow-up
92.45% treatment success, with recurrence in 1.9% and 5.7% needing surgery after failure
Who was studied
adults with pilonidal sinus disease (crack at top of buttocks)
What they received
crystallised phenol applied repeatedly (4-9 sessions) in outpatient clinic
Compared with
none (single-arm, compared conceptually to surgery)
Main outcome
treatment success (healing without recurrence or need for surgery)
Quality
This was a retrospective study without a comparison group, so it can't prove phenol works better than other treatments.
Limitations
Retrospective design, no control group, small sample size.
Taken word for word from the abstract
- n We retrospectively evaluated 53 patients (43 male, 10 female) aged ≥ 18 years
- population patients with pilonidal sinus
- intervention received 4-9 crystallised phenol applications for pilonidal sinus disease
- comparator compared to surgical methods
- primaryOutcome Treatment success was achieved in 92.45% of patients
- result Treatment success was achieved in 92.45% of patients, with a 3-year follow-up. Recurrence occurred in one patient (1.9%), while three patients (5.7%) required surgery due to treatment failure.
Int Wound J · PMID 40524141 · Read it on PubMed ↗
Emral et al. 2025
Evaluation of laser ablation for recurrent pilonidal sinus disease: treatment success, recurrence rates, and patient outcomes
Most healed, some recurred after laser.Case seriesLow quality
37 peoplemean follow-up of 9.6 months
70.3% of patients healed completely without recurrence, 21.6% had recurrence, and 13.5% developed superficial infections
Who was studied
adults with recurrent pilonidal sinus disease (a chronic condition causing cysts near the tailbone)
What they received
laser ablation treatment of the sinus tract
Compared with
none - no comparison group used
Main outcome
complete healing without recurrence of the pilonidal sinus
Quality
This was a small retrospective review of one treatment group with no comparison group, so it can't show whether laser ablation works better than other options.
Limitations
Retrospective design, no control/comparator group, single center, relatively small sample size
Taken word for word from the abstract
- population 37 patients with recurrent pilonidal sinus disease
- intervention treated with laser ablation between January 2022 and January 2025
- comparator A retrospective analysis of 37 patients with recurrent pilonidal sinus disease treated with laser ablation
- primaryOutcome treatment success, recurrence rates, complications, and recovery outcomes
- result 70.3% of patients achieved complete healing without recurrence, while 21.6% experienced recurrence within a mean follow-up of 9.6 months. Five patients (13.5%) developed superficial infections
- n A retrospective analysis of 37 patients with recurrent pilonidal sinus disease
- followUp mean follow-up of 9.6 months
Lasers Med Sci · PMID 40522552 · Read it on PubMed ↗
König et al. 2025
Long term results and quality of life after primary excision followed by Limberg plasty in pilonidal sinus disease
Low recurrence, better quality of lifeCase seriesLow qualityRelated question
41 people86 months
only one case came back, and quality of life improved significantly in most daily activities
Who was studied
patients with pilonidal sinus disease who had surgery
What they received
surgical removal of the sinus followed by Limberg flap reconstruction
Compared with
none (before-and-after comparison within same patients)
Main outcome
return of the condition and quality of life afterward
Quality
this was a small retrospective survey of one surgery type with no comparison group, so it cannot show whether this approach is better than other treatments.
Limitations
retrospective design, no comparator group, single center, small sample size
Taken word for word from the abstract
- n Forty- one of these patients were questioned retrospectively
- population forty-seven patients who presented with PSD
- intervention underwent primary excision and LP
- comparator The study enrolled forty-seven patients
- primaryOutcome they reported significant improvements in QoL, notably in five of the six activities of daily living that were evaluated
- result Only one recurrence (2.4%) was reported.
Langenbecks Arch Surg · PMID 40515949 · Read it on PubMed ↗
Huurman et al. 2025
Prospective nationwide audit of short-term outcomes after surgery for chronic pilonidal sinus disease in the Netherlands
Minimally invasive surgery healed faster.Prospective cohortLow qualityRelated question
405 people42 days
Minimally invasive techniques had a higher wound healing rate and a shorter time to healing than excision with secondary healing, and the shortest time to resume daily activities
Who was studied
adults having surgery for long-term pilonidal sinus disease (an infected pit at the top of the buttock crease)
What they received
minimally invasive surgical techniques for pilonidal sinus disease
Compared with
excision with secondary healing (wound left open to heal)
Main outcome
how the pilonidal sinus disease was classified and which type of surgery was performed
Quality
this is an observational audit comparing different surgeries without randomization, so differences could be due to which patients got which treatment rather than the treatment itself
Limitations
Observational design without randomization, short median follow-up of 42 days, and practice variation across 36 hospitals with twelve different treatment types performed
Taken word for word from the abstract
- n 405 patients had chronic disease
- population All patients with PSD and who underwent surgery were included
- intervention Minimally invasive techniques were used the most (61.2%)
- comparator excision with secondary healing
- primaryOutcome Primary endpoints were PSD classification and type and frequency of surgical approach.
- result Minimally invasive techniques showed a significantly higher wound healing rate (41.1% vs 28.6%) and a shorter median time to closure (41 vs 78 days) compared to excision with secondary healing. They also had the shortest median time to resume daily activities (14 days).
- followUp The median follow-up period was 42 days.
Tech Coloproctol · PMID 40498166 · Read it on PubMed ↗
Sarkardeh et al. 2025
Karydakis Flap as a Simple Surgical Method in the Treatment of Pilonidal Disease V.S Open Surgery with Average 30-month-follow up: A Clinical Trial
Faster healing but more wound infectionProspective cohortLow quality
60 people2025
closed surgery (Karydakis flap) had less numbness and faster recovery, but more discharge and superficial wound infection than open surgery; pain eased over time in the closed surgery group
Who was studied
adults with pilonidal sinus disease, average age about 24, treated at a hospital surgical clinic
What they received
closed surgery using a Karydakis flap
Compared with
open surgery
Main outcome
wound healing complications, recovery time, and pain after surgery
Quality
patients were not randomly assigned to groups and the study was small and from a single hospital, so the comparison is less reliable.
Limitations
Nonrandomized allocation of patients to treatment groups, small sample size, single-center design.
Taken word for word from the abstract
- n Sixty patients (43 men and 17 women) with a mean age of 23.90 ± 6.57 years were included.
- population patients diagnosed with pilonidal sinus referred to the surgical clinics of Imam Reza Hospital in Mashhad from 2021 to 2022
- intervention Closed surgery can be done with a Karydakis flap.
- comparator Two common types of treatment for pilonidal disease include open and closed surgery.
- primaryOutcome time to recovery and time to return to work was obtained during follow-up visits. Pain intensity was collected on the first, tenth, and one month after surgery.
- result The frequency of wound paresthesia (P=0.023), and recovery delay (P<0.001) was lower in closed surgery compared to the open surgery group, and the frequency of discharge and superficial SSI (Surgical Site Infection) was higher in closed surgery (P=0.038). Pain severity decreased during the study (P=0.029) among the closed surgery group.
Med J Islam Repub Iran · PMID 40486025 · Read it on PubMed ↗
Doll et al. 2025
Impact of surgical case load on recurrence rates in pilonidal sinus disease: a cross-study data synthesis
More experienced centers had fewer repeat cysts.Meta-analysisLow qualityRelated question
130,599 people5-year recurrence rate
Centers doing more surgeries per year generally had lower recurrence rates, except for one type of closure surgery which showed no improvement regardless of caseload
Who was studied
people having surgery for pilonidal sinus disease (a cyst/infection near the top of the butt crack)
What they received
surgery performed at centers doing a higher number of pilonidal operations per year
Compared with
surgery performed at centers doing fewer operations per year
Main outcome
rate of the pilonidal cyst coming back (recurrence) after surgery
Quality
This pools results across more than a thousand different studies rather than directly comparing surgeons or patients, so differences between studies could explain the pattern as much as surgical volume itself.
Limitations
The study combines many different studies of varying design (RCT and non-RCT) and surgical techniques, which can introduce bias; results also varied inconsistently by treatment type.
Taken word for word from the abstract
- n 130,599 patients
- population Pilonidal Sinus Disease (PSD)
- intervention annual PSD surgery volumes
- comparator fewer than 10 operations per year (group 1), 10-30 operations per year (group 2), and 30 or more operations per year (group 3)
- primaryOutcome recurrence rates (RR)
- result Non-RCT studies generally showed decreasing recurrence rates with higher surgical caseloads for most treatment types. However, midline closure surgery showed no significant improvement in recurrence rates with increased caseloads.
Int J Colorectal Dis · PMID 40407900 · Read it on PubMed ↗
Chiu et al. 2025
Standardized Classification System for Pilonidal Disease and Recurrence Rate after Treatment
Worse disease stage means more recurrence.Prospective cohortLow qualityRelated question
411 people1- and 2-year follow-up
patients with more severe disease stages at first presentation had much higher recurrence rates than those with milder stages
Who was studied
patients presenting with pilonidal disease (a condition causing cysts/pits near the top of the buttock crack)
What they received
a new staging system (PDS stage) assigned when patients first presented, based on disease severity
Compared with
comparing outcomes across the different PDS stages (0, I, II, III)
Main outcome
whether the pilonidal disease came back (recurred) after 1 and 2 years
Quality
it's from one specialized center and only about half of patients completed follow-up, so it's unclear how well this applies elsewhere.
Limitations
single specialized center, no external validation yet, and only 212 of 411 patients (1-year) and 206 (2-year) completed follow-up.
Taken word for word from the abstract
- n A total of 411 patients met criteria, with 212 and 206 patients completing 1- and 2-year follow-up, respectively.
- population All patients presenting with pilonidal disease were included.
- intervention The main effector under study was PDS stage assigned at initial presentation.
- comparator recurrence occurred in 0.0%, 2.3%, 8.3%, and 20.8% of patients with PDS stage 0, I, II, and III disease at initial presentation, respectively
- primaryOutcome The primary outcome was pilonidal disease recurrence at 1- and 2-year follow-up.
- result recurrence occurred in 0.0%, 2.3%, 8.3%, and 20.8% of patients with PDS stage 0, I, II, and III disease at initial presentation, respectively (log-rank test, p = 0.017). At 2 years, recurrence was noted in 0.0%, 4.8%, 12.7%, and 27.5% of patients with PDS stage 0, I, II, and III disease, respectively (log-rank test, p = 0.010).
J Am Coll Surg · PMID 40401769 · Read it on PubMed ↗
Bergus et al. 2025
Evaluating Outcomes in Adolescents With Pilonidal Disease Treated With Pilonidal Sinus Trephination
Most healed, but some recurred.RetrospectiveLow quality
63 people12 mo
about 1 in 5 patients had delayed healing and 1 in 4 had the disease come back within a year; non-White race was linked to higher risk of both
Who was studied
teenagers and young adults (10-21 years old) with chronic pilonidal disease (a hair-related infection/cyst near the top of the buttocks crack)
What they received
a minor surgery called pilonidal sinus trephination (small holes made to drain and treat the cyst)
Compared with
no comparison group; outcomes tracked over time in the same patients
Main outcome
wound healing by 60 days and disease recurrence within 1 year
Quality
this was a retrospective single-hospital chart review without a comparison group, so it can show patterns but not prove what causes them.
Limitations
Retrospective design, single institution, no control group, and race-based findings need further study to understand underlying causes.
Taken word for word from the abstract
- n Among 63 patients, the median age at the time of index operation was 16.5 y.
- population We retrospectively reviewed patients aged 10-21 y who underwent trephination at our tertiary care pediatric hospital
- intervention patients aged 10-21 y who underwent trephination at our tertiary care pediatric hospital between November 2019 and November 2022
- comparator This study investigated wound healing and 1-y disease recurrence in adolescents after trephination.
- primaryOutcome We performed Firth penalized logistic regression to identify independent predictors of healing at 60 d and recurrence by 12 mo.
- result Wound healing was delayed in 20.5% and was associated with non-White race (odds ratio 7.31, 95% confidence interval 1.68, 31.85)
- result Recurrence at 1 y was 25.0% and was also associated with non-White race (odds ratio 8.85, 95% confidence interval 2.02, 38.71)
J Surg Res · PMID 40378664 · Read it on PubMed ↗
Demir et al. 2025
Efficacy of crystallized and liquid form phenol application in pilonidal sinus disease: a single-center retrospective study
Both phenol treatments worked similarly; liquid caused more side effects.RetrospectiveLow quality
80 people1st year
both treatments led to similar healing (90% vs 95% improvement at 1 year) and recurrence, but liquid phenol caused more early complications (37.5% vs 15%)
Who was studied
young adults with pilonidal sinus disease (a cyst/infection at the top of the buttock crack)
What they received
crystallized phenol
Compared with
liquid phenol
Main outcome
recovery rate, complications, and recurrence after treatment
Quality
This was a retrospective, single-center study without randomization, so it can't rule out bias between groups.
Limitations
Retrospective design, single center, no randomization, relatively small sample size.
Taken word for word from the abstract
- population Pilonidal sinus is a frequently observed disease in young adult male patients.
- n Eighty patients were included in the study: 40 treated with crystallized phenol and 40 with liquid phenol.
- intervention this study aims to compare the clinical results of the non-surgical treatment methods for pilonidal sinus: crystallized and liquid phenol applications.
- comparator this study aims to compare the clinical results of the non-surgical treatment methods for pilonidal sinus: crystallized and liquid phenol applications.
- primaryOutcome In the 1st month following the application, the recovery rates, complication rates, persistence of complaints, and recurrence at the end of the 1st year were compared between the groups.
- result Early complications were observed in 15% and 37.5% of patients in groups 1 and 2, respectively (p = 0.042).
- result At the end of the 1st year, 90% improvement was detected in group 1 and 95% in group 2. However, there was no significant difference between the recovery and recurrence rates between the groups.
Tech Coloproctol · PMID 40329097 · Read it on PubMed ↗
Morais et al. 2025
What is the Impact of Negative Pressure Wound Therapy on Healing in Patients Post Excision of Pilonidal Sinus? A Systematic Review and Meta-Analysis
Unclear if vacuum therapy helps wound healingMeta-analysisVery low qualityRelated question
size not given2025
studies suggested less healing time, fewer recurrences, less pain and higher satisfaction with vacuum therapy, but the evidence was very low certainty so it is unclear if it truly helps
Who was studied
people who had surgery to remove a pilonidal sinus (a cyst near the top of the buttock crack)
What they received
negative pressure wound therapy (vacuum dressing) on the surgical wound
Compared with
other types of wound dressings
Main outcome
time to healing, return of the cyst, pain, and patient satisfaction
Quality
the studies were small, mostly not well-controlled, and the review authors rated the overall evidence as very low certainty.
Limitations
Mostly retrospective and small studies with very low certainty of evidence (GRADE); mean sample size only 61 per study.
Taken word for word from the abstract
- population patients with pilonidal sinus following surgical excision
- intervention negative pressure wound therapy
- comparator any other dressings
- primaryOutcome time to healing, recurrence, pain or patient's experience
- result Studies showed reduction in healing time, recurrence rates and postoperative pain, as well as higher patients' satisfaction with the use negative pressure wound therapy, however, the certainty of the evidence was very low.
- result it is unclear whether NPWT makes any difference when compared to any other dressings, on time to healing, recurrence, pain or patient's experience
- n mean sample size of 61 (SD: 33)
Int Wound J · PMID 40288765 · Read it on PubMed ↗
Rubio-López et al. 2025
Pilonidal sinus of perianal location. Difficult differential diagnosis with perianal fistula
Mistaken for anal fistula.Case seriesVery low qualityRelated question
1 people2025
surgery revealed the problem was actually a perianal pilonidal sinus, not a true anal fistula
Who was studied
a 39-year-old man with a perianal fistula
What they received
surgery to treat the suspected fistula
Compared with
none
Main outcome
correctly identifying the true cause of the perianal opening
Quality
this is a single patient case report, so it cannot show whether any treatment works
Limitations
only one patient described, and it focuses on diagnosis rather than treatment outcomes
Taken word for word from the abstract
- population a 39-year-old male with an initial diagnosis of perianal fistula
- n a case of a 39-year-old male
- intervention only during surgery was revealed that the origin of the fistula was in perianal pilonidal disease
- comparator Despite clinical examination and pelvic magnetic resonance image
- primaryOutcome only during surgery was revealed that the origin of the fistula was in perianal pilonidal disease
- result only during surgery was revealed that the origin of the fistula was in perianal pilonidal disease
Cir Cir · PMID 40199281 · Read it on PubMed ↗
Agnesi et al. 2025
Endoscopic pilonidal sinus treatment versus excision with wound closure: a systematic review of the literature
Fewer complications but slower healing with keyhole surgery.Systematic reviewLow qualityRelated question
595 people2025
the minimally invasive surgery had shorter operating time and hospital stay, fewer complications, and no wound splitting, but took longer to fully heal and had a slightly higher recurrence rate
Who was studied
adults having surgery for pilonidal disease (a cyst/infection near the top of the buttock crack)
What they received
minimally invasive keyhole surgery (EPSIT) for pilonidal disease
Compared with
traditional surgical cutting out of the cyst with stitched closure
Main outcome
surgery time, hospital stay, complications, wound problems, recurrence, and healing time
Quality
it combines only six mostly non-randomized studies without describing how study quality or bias was checked, so the comparison is not very reliable.
Limitations
abstract does not mention randomization, blinding, or formal bias assessment, and pools different studies' results directly
Taken word for word from the abstract
- n including 595 patients were included in the present systematic review
- population for the treatment of pilonidal disease (PD)
- intervention endoscopic pilonidal sinus treatment (EPSIT) as the minimally invasive surgical technique
- comparator excision and wound closure
- primaryOutcome to compare minimally invasive procedures versus excision and wound closure for the treatment of pilonidal disease (PD) in terms of perioperative outcomes
- result Patients in Group A experienced shorter operative times (42.1±16 minutes) and hospital stay (0.5±0.3 days) in comparison to Groups B (59.3±19 minutes and 2.4±1 days, respectively). Group A had lower complication rate (12.5%) compared to Group B (35.2%) and recurrence rate (17.9% versus 14.8%). Wound dehiscence rate was 12.8% in Group B. Mean time to complete healing was longer in Group A than Group B (47.9±26.1 days and 39.1±22.3 days, respectively)
Minerva Surg · PMID 40178497 · Read it on PubMed ↗
El Deen et al. 2025
A Comparitive Study Between Early Outcomes of Laser and Lay-Open Technique in Management of Simple Pilonidal Sinus
Laser surgery: less pain, faster healing.Randomised trialLow quality
40 people2025
Laser treatment led to shorter operative time, shorter hospital stay, lower pain scores, and faster wound healing than lay-open surgery, with similar recurrence and infection rates
Who was studied
patients with chronic pilonidal sinus (a tailbone/butt crack cyst condition)
What they received
laser treatment of the sinus (SiLaT)
Compared with
lay-open surgical technique (cutting open the sinus)
Main outcome
pain scores, healing time, operative time, hospital stay, complications and recurrence
Quality
Small study of only 40 patients looking at early outcomes, so results may not hold up or apply broadly.
Limitations
Small sample size; only early postoperative outcomes assessed; authors say long-term studies are needed to evaluate recurrence and effectiveness.
Taken word for word from the abstract
- n including 40 patients, divided into two equal groups
- population treatment of chronic pilonidal sinus disease
- intervention PS treated with diode laser therapy (SiLaT)
- comparator the lay-open group: PS treated with lay-open (sinotomy)
- primaryOutcome Postoperative outcomes such as operative time, hospital stay, pain scores, healing time, complications, and recurrence rates were analyzed.
- result Pain scores were lower in the SiLaT group (2.30 ± 0.92 vs. 4.80 ± 1.01, p < 0.001). Wound healing was significantly faster in the SiLaT group (10.1 ± 2.7 days vs. 34.1 ± 15.1 days, p < 0.0001). Recurrence rates (p = 0.998) and surgical site infection (p = 1.00) were comparable among both groups.
Lasers Surg Med · PMID 40108765 · Read it on PubMed ↗
Layt et al. 2025
Giant natal cleft epidermal inclusion cyst surgically excised in a young male in Australia
Cyst removed, recovered fully.Case seriesVery low quality
1 people2025
the cyst was surgically removed and the patient recovered without problems
Who was studied
a 29-year-old male with a swelling at the top of the buttock crack
What they received
surgical removal of the cyst
Compared with
none
Main outcome
successful removal and recovery without complications
Quality
this is a single patient's case report, so it cannot show how often this works or applies to others
Limitations
only one patient described, no comparison group, no long-term follow-up reported
Taken word for word from the abstract
- n a 29-year-old male with a 7-8 cm swelling in the natal cleft
- population a 29-year-old male with a 7-8 cm swelling in the natal cleft
- intervention Surgical excision was performed with careful dissection to preserve surrounding structures.
- comparator Surgical excision was performed with careful dissection to preserve surrounding structures.
- primaryOutcome The patient had an uneventful recovery.
- result The patient had an uneventful recovery.
J Surg Case Rep · PMID 40103999 · Read it on PubMed ↗
Demir et al. 2025
Is it beneficial to add laser ablation to curettage in the treatment of pilonidal sinus disease?
No benefit from adding laser.Randomised trialLow quality
80 people6 months
no significant difference between laser plus curettage and curettage alone in pain, discharge, bleeding, wound healing, or recurrence
Who was studied
patients with pilonidal sinus disease (tailbone area infection)
What they received
laser ablation combined with curettage (scraping out the sinus tract)
Compared with
curettage alone
Main outcome
postoperative complications, wound healing problems, and recurrence
Quality
small randomized trial with no significant differences found, limiting confidence in any true benefit
Limitations
small sample size; statistical significance not achieved for any outcome
Taken word for word from the abstract
- n laser + curettage (L/C; n = 40) group or the curettage-only (C; n = 40) group
- population patients diagnosed with PSD
- intervention laser application with sinus curettage
- comparator only sinus curettage
- primaryOutcome postoperative complications, wound healing, and recurrence
- result The groups had similar results for postoperative pain, discharge, bleeding, wound healing problems at 30 days, and recurrence at 6 months.
- followUp recurrence within 6 months postoperatively
Lasers Med Sci · PMID 40100423 · Read it on PubMed ↗
Stoeckel et al. 2025
Gender Differences in Adolescent Pilonidal Disease
Girls report more pain, despite milder disease.RetrospectiveLow qualityRelated question
1,356 people2025
Females had earlier onset, lower disease severity, but worse quality-of-life impact including more pain, embarrassment, and disruption, compared to males
Who was studied
adolescents with pilonidal disease (hair-containing cyst/abscess near top of buttock crease)
What they received
being female (gender comparison)
Compared with
being male
Main outcome
disease severity, quality of life impact, and treatment outcomes
Quality
This is a retrospective, non-randomized comparison that describes differences between groups rather than testing a treatment, so it cannot show what causes or relieves the pain.
Limitations
Retrospective cohort study, level of evidence III, no control or randomization, and it compares genders rather than testing an intervention for symptom relief
Taken word for word from the abstract
- n Of 1356 patients with pilonidal disease, 562 (41 %) were female and 794 male.
- population Pilonidal disease is a common, disruptive condition in adolescents.
- intervention females had a higher incidence of diagnosed anxiety (15 % vs 10 %; p-value = 0.005)
- comparator 562 (41 %) were female and 794 male
- primaryOutcome 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)
- result 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)
- result 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)
J Pediatr Surg · PMID 40086161 · Read it on PubMed ↗
Ojo et al. 2025
The validation of a simple and instrument-free technique to measure the depth of the natal cleft (a cohort study)
Tests a measuring tool, not pain.Prospective cohortLow qualityRelated question
63 people2025
the technique showed very good agreement between different clinicians and moderate agreement when the same clinician repeated it
Who was studied
63 volunteers who had their natal cleft (top of the buttock crack) measured
What they received
a new instrument-free technique for measuring the depth of the natal cleft
Compared with
repeated measurements taken by different clinicians and by the same clinician twice
Main outcome
how consistently the measurement technique gave the same result between different clinicians and by the same clinician
Quality
this is a small, single-centre study testing a measuring tool, not testing why the area hurts or whether any treatment helps.
Limitations
Single centre, 63 participants, and intra-observer agreement was only moderate rather than strong.
Taken word for word from the abstract
- n with 63 participants volunteering to take part
- population 63 participants volunteering to take part
- intervention this study proposes a novel and instrument-free technique that can be used as a research tool to measure the depth
- comparator Blinded repeated measurements of the natal cleft were taken by two separate clinicians to assess for inter-observer and intra-observer variation
- primaryOutcome Agreement was measured and assessed by the Bland-Altman limits of agreement method and intra-class correlation (ICC)
- result ICC analysis suggested a value of 0.91 for inter-observer agreement, signifying very good agreement between clinicians. Moderate intra-observer agreement was observed, with an ICC value of 0.74.
Colorectal Dis · PMID 40040301 · Read it on PubMed ↗
Gojayev et al. 2025
Comparative Outcomes of Surgical Techniques for Pilonidal Sinus: A Turkish Retrospective Study
Surgery choice affects healing speed, complications.RetrospectiveLow quality
476 people2025
primary midline closure had more complications and recurrence; Karydakis flap had lower recurrence; laser pilonidotomy had shorter surgery, shorter hospital stay, faster pain-free recovery, and higher satisfaction
Who was studied
adults who had surgery for pilonidal sinus disease (a chronic infection near the tailbone/buttock crease)
What they received
different surgical techniques: primary midline closure, Karydakis flap, Limberg flap, and laser pilonidotomy
Compared with
the four surgical techniques compared against each other
Main outcome
complication rates, recurrence, recovery time, and patient satisfaction
Quality
This was a retrospective, non-randomized comparison from one clinic, so differences between groups could be due to patient selection rather than the surgery itself.
Limitations
Retrospective design; abstract itself calls for studies with larger samples and longer follow-up periods.
Taken word for word from the abstract
- population adult patients with pilonidal sinus disease
- n The data of 476 patients who underwent surgery for pilonidal sinus disease in our clinic between January 2011 and September 2022 were retrospectively evaluated.
- intervention primary midline closure (PMC), Karydakis flap (KF), Limberg flap (LF), and laser pilonidotomy (LP)
- comparator compares outcomes of primary midline closure (PMC), Karydakis flap (KF), Limberg flap (LF), and laser pilonidotomy (LP) in adult patients with pilonidal sinus disease
- primaryOutcome Patient characteristics, surgical findings, and quality of life outcomes were compared between the groups.
- result Seroma (P=0.006), wound dehiscence (P<0.001), and postoperative recurrence (P=0.017) rates were significantly higher in the PMC group.
- result The KF method appears to be more advantageous in terms of postoperative recurrence rate.
- result Pain-free toilet sitting time, pain-free walking time, and return to work time were statistically significantly shorter in the LP group (all P<0.001).
- limitations studies with larger samples and longer follow-up periods are needed
Med Sci Monit · PMID 39995244 · Read it on PubMed ↗
Wiinblad et al. 2025
Outcome After Surgical Treatment for Chronic Pilonidal Sinus Disease: A Systematic Review of Common Surgical Techniques
Flap surgery lowers pilonidal recurrence risk.Meta-analysisLow qualityRelated question
5,762 people2025
flap surgeries had fewer recurrences than primary closure, but were not clearly better than letting the wound heal on its own; flap surgeries also had fewer infections and secondary healing took longest
Who was studied
adults and teenagers with chronic pilonidal sinus disease (a cyst/infection at the top of the buttock crease)
What they received
flap surgeries (Bascom, Limberg, or Karydakis flap operations)
Compared with
primary midline closure or leaving the wound to heal on its own (secondary healing)
Main outcome
whether the pilonidal disease came back after surgery (recurrence)
Quality
most of the 50 trials had high or medium risk of bias, were small, and had short follow-up, so the evidence is rated very low to low certainty.
Limitations
Most studies had a high or medium risk of bias, resulting in very low to low certainty of evidence. The trials generally had small numbers, short follow-ups, and no reported primary outcomes or power calculations.
Taken word for word from the abstract
- n Fifty trials included a total of 5762 participants.
- population operations to treat chronic pilonidal disease in adults and teenagers
- intervention the flap operations had fewer recurrences than primary midline closure
- comparator compared the outcomes of secondary healing, primary midline closure, Bascom, Limberg, and Karydakis flap operations
- primaryOutcome The primary outcome was recurrence
- result the flap operations had fewer recurrences than primary midline closure (OR 0.31; 95% CI, 0.19-0.51; p < 0.01). The trials comparing flap operations with secondary healing were heterogeneous and did not reach significance (OR 0.38; 95% CI, 0.13-1.13; p = 0.08).
Dis Colon Rectum · PMID 39982788 · Read it on PubMed ↗
Qin et al. 2025
Efficacy and safety of laser ablation for recurrent pilonidal sinus: a systematic review and meta‑analysis
Laser ablation healed most recurrent cases.Meta-analysisLow quality
137 people12 months or less; some studies exceeding 12 months
about 82% of patients healed, with lower healing rates seen at longer follow-up
Who was studied
patients with recurrent pilonidal sinus (a skin condition at the top of the buttock crack)
What they received
laser ablation of the sinus tract
Compared with
none (single-arm studies pooled; some with and without pit picking beforehand)
Main outcome
healing rate after treatment
Quality
the pooled studies were mostly small, uncontrolled, and showed high variability between them, so confidence in the exact healing rate is limited
Limitations
high statistical heterogeneity (I2 up to 79%), no randomized controlled trials included, wide confidence intervals, and declining healing rates with longer follow-up
Taken word for word from the abstract
- population patients with recurrent pilonidal sinus
- intervention This procedure uses a circular laser at the tip of a catheter to deliver energy, effectively destroying and ablating the sinus tract while promoting its closure.
- comparator The results of the subgroup analysis indicated that the difference in efficacy between combined pit picking and laser ablation alone was not statistically significant
- primaryOutcome The primary outcome measure was the healing rate after laser ablation
- result The pooled healing rate across these studies was 81.9% (95% CI, 65.4-94.6%; I2 = 69.12%; p < 0.01).
- n In total, 137 patients with recurrent pilonidal sinus were included, of whom 112 achieved healing following laser ablation treatment.
Int J Colorectal Dis · PMID 39969579 · Read it on PubMed ↗
Alwadees et al. 2025
Laser versus rhomboid flap for sacrococcygeal pilonidal sinus: multi-centre comparative study
Laser had more recurrences than surgery.RetrospectiveLow quality
374 people4 weeks or 3 months
the laser group had a significantly higher recurrence rate than the open rhomboid flap group
Who was studied
patients aged 16 to 70 with pilonidal sinus who had never had surgery before
What they received
laser ablation technique
Compared with
open rhomboid flap surgery
Main outcome
rate of the condition coming back (recurrence)
Quality
This was a non-randomized comparison across hospitals, so differences in patient selection or surgeon practice could affect the results.
Limitations
No randomization, government and private hospital settings may differ, and surgeon experience not controlled for.
Taken word for word from the abstract
- n 190 and 184 patients were selected for the laser and open groups, respectively.
- population Patients are included if they are diagnosed with pilonidal sinus, between the ages of 16 and 70, and have never had surgery before.
- intervention laser ablation
- comparator open rhomboid flap
- primaryOutcome This study aims to assess the recurrence rate after both techniques.
- result There is a significantly higher recurrence rate in the laser group value: <0.00001.
- followUp Patients are seen for 4 weeks or 3 months and discharged if there are no complications.
Lasers Med Sci · PMID 39953215 · Read it on PubMed ↗
Chousein et al. 2025
The power of platelet-rich plasma on operated pilonidal disease: a prospective randomized controlled trial
Faster healing after pilonidal surgery.Randomised trialModerate qualityRelated question
140 people2025
wounds healed much faster with PRP (about 24 days) than without it (about 41 days)
Who was studied
patients with pilonidal sinus disease (a chronic condition near the top of the buttock crack) who had surgery
What they received
platelet-rich plasma (PRP) added to standard wound dressing after surgery
Compared with
standard wound dressing alone after surgery
Main outcome
how fast the surgical wound healed
Quality
it was a randomized trial with a reasonable number of patients, but it only looked at post-surgery wound healing, not the original cause of the pain.
Limitations
abstract does not report blinding, dropout rates, or other details; this addresses healing after surgery for a specific disease, not general tailbone-area pain.
Taken word for word from the abstract
- n A total of 140 patients diagnosed with pilonidal sinus disease were included in the study.
- population patients treated using the unroofing and curettage technique
- intervention the patients in the other group were treated with PRP in addition to the standard dressing
- comparator one group was followed up with a standard dressing after the operation
- primaryOutcome the wound healing rate between the 2 groups was determined as the primary objective
- result the average wound healing time of the patients in the control group was 41.1 ± 11.0 days (median, 40; range, 20-65), it was 23.6 ± 8.5 days (median, 25; range, 6-45) in the PRP group (P < 0.001)
Ann Surg Treat Res · PMID 39944926 · Read it on PubMed ↗
Prajapati et al. 2024
Effective Ayurvedic Treatment of Pilonidal Sinus using Udumber Ksheer Sutra: A Case Study
Case report says thread treatment cured it.Case seriesVery low quality
size not given2024
The treatment was described as beneficial and curative for the condition
Who was studied
People with pilonidal sinus (a hair-related cyst/tunnel near the top of the buttock crease)
What they received
Udumber Ksheer Sutra (an Ayurvedic medicated thread treatment, a type of Kshara Sutra)
Compared with
No comparator described (surgical techniques mentioned only as general background)
Main outcome
Whether the pilonidal sinus was cured
Quality
This is a single case study with no comparison group and no reported number of patients, so it cannot show whether the treatment really works.
Limitations
No patient numbers given, no control group, and the abstract gives no details on how outcomes were measured or how long patients were followed.
Taken word for word from the abstract
- population Pilonidal sinus, also known as "jeep bottom," is common among people who sit a lot, such as cab drivers.
- intervention patients who have Naadi Vrana (Pilonidal Sinus) using Udumber Ksheer Sutra
- comparator Surgical techniques are available for treatment, but the condition has a relatively high recurrence rate.
- primaryOutcome This study focuses on the diagnosis and treatment of patients who have Naadi Vrana (Pilonidal Sinus) using Udumber Ksheer Sutra.
- result Udumber Ksheer Sutra management has also proven to be beneficial as a curative therapy for the pilonidal sinus.
J Pharm Bioallied Sci · PMID 39926760 · Read it on PubMed ↗
Doll et al. 2025
Evaluation of Outcomes for Karydakis Operation for Pilonidal Sinus Disease-Comparison of Original Reports With Later Results
Surgery recurs far more than first claimed.Systematic reviewLow qualityRelated question
9,878 people10 years
recurrence rates in later global studies were far higher than in the original report
Who was studied
people with pilonidal sinus disease (a condition that causes pain and infection at the top of the buttock crack) who had a specific surgery
What they received
Karydakis advancement flap surgery for pilonidal sinus disease
Compared with
the original 1992 Karydakis report's own outcomes
Main outcome
rate of the disease coming back (recurrence) at 5 and 10 years after surgery
Quality
it pools many different studies with varying quality and follow-up rather than running a new controlled trial, so the comparison is only as reliable as the original data.
Limitations
abstract does not describe how study quality or bias was assessed across the 113 included studies, and compares to a single historical report
Taken word for word from the abstract
- population pilonidal sinus disease (PSD)
- intervention Karydakis published his advancement flap technique to treat pilonidal sinus disease (PSD) in 1973
- comparator The Karydakis 1992 study reports a recurrence rate < 1% with a follow-up ranging between 2 and 20 years.
- primaryOutcome Recurrence rates at 5- and 10-year follow-ups were compared to the data presented in the Karydakis 1992 paper.
- result In the global literature, the 10-year recurrence rate is 8.8% in RCTs and 14.6% in nonRCTs which is 11.6- and 19.2-fold higher.
- n 113 other studies encompassing 9878 patients undergoing the Karydakis advancement flap surgery
World J Surg · PMID 39900551 · Read it on PubMed ↗
Janek et al. 2025
Laser Hair Removal May Be a Primary Treatment of Pilonidal Disease: A Pilot Study
Fewer needed surgery after laser.Prospective cohortLow quality
22 people18 months
Six of 15 (40%) who completed laser treatments had resolution without surgical intervention; of those who had surgery, 6 of 9 (67%) resolved after one surgery
Who was studied
patients ages 13-35 with moderate to severe pilonidal disease
What they received
laser hair removal (LHR) using a long-pulsed Alexandrite (755 nm) laser
Compared with
no comparison group; patients followed before and after laser treatment, some proceeding to surgery if symptoms persisted
Main outcome
resolution rates without surgical intervention and recurrence rates following surgical resection
Quality
This was a small, single-center pilot study without a comparison group, so it can't prove the laser caused the improvement.
Limitations
Small sample size, no control group, some patients withdrew (including due to COVID-19), single-center design.
Taken word for word from the abstract
- n Twenty-two patients were enrolled
- population Patients ages 13-35 with moderate to severe disease who were referred for surgical excision were recruited.
- intervention Participants underwent 3-8 treatment sessions with the long-pulsed--Alexandrite (755 nm) laser by a dermatologist until hair removal endpoints were met.
- comparator Patients with persistent symptoms after LHR underwent subsequent excision.
- primaryOutcome Primary outcomes included resolution rates without surgical intervention and recurrence rates following surgical resection.
- result Six of 15 (40 %) who completed laser treatments had resolution without surgical intervention. Nine patients underwent surgery, of which 6 (67 %) resolved after one surgery, with 18 months of follow up to evaluate for recurrence.
J Pediatr Surg · PMID 39893840 · Read it on PubMed ↗
Darnis et al. 2025
Management of pilonidal sinus and recurrences in 2025
Different surgeries have trade-offs; recurrence common.Narrative reviewLow quality
size not given2025
Excision with open healing has at least a 10% recurrence/failure rate; closing the wound heals faster but has more infections; minimally invasive techniques have similar recurrence rates to excision but avoid difficult wound care
Who was studied
people with pilonidal sinus (a condition at the top of the buttock crease)
What they received
surgical excision or minimally invasive treatments for pilonidal sinus
Compared with
different surgical closure methods and minimally invasive techniques compared with each other
Main outcome
healing, recurrence, and complication rates
Quality
This is a narrative review describing general management approaches and outcomes without presenting original controlled data or statistics.
Limitations
No original data, no specific study designs, sample sizes, or statistical results given; general overview only.
Taken word for word from the abstract
- population Pilonidal sinus is a common pathology of the intergluteal cleft that can develop into abscess or suppuration.
- intervention Radical excision followed by secondary healing is the most commonly performed option.
- comparator Primary closure after excision can reduce the time for healing and convalescence, but at the cost of more frequent infectious complications.
- primaryOutcome This strategy carries a risk of failure or recurrence for at least 10% of patients.
- result They avoid complex and unpleasant nursing care of secondarily healing wounds, at the cost of a recurrence rate equivalent to that from excision techniques.
J Visc Surg · PMID 39875233 · Read it on PubMed ↗
Faurschou et al. 2025
Gender-specific outcomes in pilonidal sinus disease: Female outcomes after cleft lift surgery in a large prospective Danish cohort
Worse healing in women after surgery.Prospective cohortModerate qualityRelated question
560 people2025
Women had a 30% higher risk of recurrence and a 46% higher risk of prolonged healing compared with men
Who was studied
women and men with pilonidal sinus disease who had cleft lift surgery
What they received
Bascom's cleft lift (BCL) surgery for pilonidal sinus disease
Compared with
male patients undergoing the same surgery
Main outcome
risk of recurrence and prolonged wound healing after surgery
Quality
It is a large, prospective single-center cohort but not randomized, so the sex-based comparison could be influenced by other differences between patients.
Limitations
Observational design without randomization; wide confidence interval for recurrence risk (0.79-2.09) suggests uncertainty.
Taken word for word from the abstract
- population Females affected by the condition account for about 20% of patients
- n In all, 560 patients underwent BCL surgery at our centre during this period.
- intervention Bascom's cleft lift (BCL) surgery
- comparator Risk of recurrence in female patients was 30% higher than in male patients
- primaryOutcome risk of prolonged healing after BCL surgery
- result Risk of recurrence in female patients was 30% higher than in male patients (risk ratio 1.30, 95% CI 0.79-2.09) and the risk of prolonged healing after BCL surgery was 46% higher in women compared to men (risk ratio 1.46, 95% CI 1.02-2.14).
Colorectal Dis · PMID 39871414 · Read it on PubMed ↗
Hiremath et al. 2025
Concurrent pilonidal sinus of the nape of the neck and sacrococcygeal region
Surgery healed pilonidal sinus fully.Case seriesVery low qualityRelated question
1 peopleOne year
complete healing with no recurrence after one year of follow-up
Who was studied
man in his mid-30s with recurring swelling and draining sinuses at the back of the neck and in the crack between the buttocks
What they received
surgical removal of the sinus tract in the neck plus wide excision with flap reconstruction (Limberg flap) in the tailbone area
Compared with
none (single patient treated, no comparison group)
Main outcome
healing and recurrence after surgery
Quality
this is a single patient case report, so it cannot show whether surgery generally works or why the pain happens in other people.
Limitations
only one patient described, no comparison group, and this is an unusual double-site case rather than typical pilonidal disease
Taken word for word from the abstract
- population The patient, in his mid-30s, presented with recurrent swelling and discharging sinuses in both the nape of the neck and the intergluteal region.
- intervention The surgical intervention included excision of the sinus tract in the neck and wide local excision with Limberg flap reconstruction in the sacrococcygeal region.
- comparator Here, we present a rare case of concurrent pilonidal abscess in both the nape of the neck and the natal cleft.
- primaryOutcome One year post-surgery, the patient showed complete healing with no recurrence observed during follow-up.
- result One year post-surgery, the patient showed complete healing with no recurrence observed during follow-up.
- n The patient, in his mid-30s, presented with recurrent swelling and discharging sinuses
BMJ Case Rep · PMID 39842887 · Read it on PubMed ↗
Mansfield et al. 2025
Cutaneous Intertriginous Langerhans Cell Histiocytosis in Adults: A Case Report and Systematic Review
Describes a rare skin disease, not your pain's causeSystematic reviewVery low qualityRelated question
122 people2025
the skin lesions commonly looked like eroded, ulcerated bumps and patches, and could be mistaken for hidradenitis suppurativa, fungal infection, or genital warts
Who was studied
adults with biopsy-confirmed Langerhans cell histiocytosis affecting skin folds (including the area between the buttocks)
What they received
none (this is a review describing how the disease looks and behaves, not treating it)
Compared with
none
Main outcome
the typical appearance, skin findings, and other conditions it can be mistaken for
Quality
it only pools past case reports with no comparison group, so it can describe a rare condition but cannot tell how common it is or what causes typical symptoms
Limitations
based on collected case reports rather than a study designed to find the cause of buttock crack pain in general; focuses only on a rare disease (LCH), not common causes
Taken word for word from the abstract
- n This systematic review identified 1 original and 121 published cases of biopsy-proven, cutaneous, intertriginous LCH in adult patients.
- population all published adult cases of cutaneous, intertriginous Langerhans cell histiocytosis (LCH)
- intervention The authors emphasize the morphology, histopathology, immunohistochemical profiles, and genetic mutations associated with these cases.
- comparator A systematic review of the National Center for Biotechnology Information's PubMed was conducted
- primaryOutcome Morphology commonly included eroded, ulcerated papules and plaques, and rare presentations demonstrated potential mimickers (hidradenitis suppurativa, deep fungal mycosis, condyloma accuminata).
- result Morphology commonly included eroded, ulcerated papules and plaques, and rare presentations demonstrated potential mimickers (hidradenitis suppurativa, deep fungal mycosis, condyloma accuminata).
J Low Genit Tract Dis · PMID 39842024 · Read it on PubMed ↗
Hemantha Kumar et al. 2025
Coexisting pilonidal sinus and anal fistula: Successful management with minimal invasive Kshara Karma Technique and Ksharasutra therapy- A case report
Wound healed in one case.Case seriesVery low quality
1 peoplesix weeks
Thread treatment dissolved after five weeks, and the wound fully healed within six weeks with minimal scarring
Who was studied
27 year old woman with a recurring pilonidal sinus (cyst at top of butt crack) also connected to an anal fistula
What they received
Ayurvedic Ksharasutra thread therapy combined with Minimal Invasive Kshara Karma Technique (medicated alkali treatment)
Compared with
no comparison group; single patient case report
Main outcome
wound healing and prevention of recurrence
Quality
This is a single patient case report with no comparison group, so it cannot show whether this treatment works better than standard care.
Limitations
Only one patient was treated, there was no control group, and long-term recurrence was not tracked beyond the healing period.
Taken word for word from the abstract
- population A 27 year old female patient presented with complaints of non-healing wound in the natal cleft region and pus discharge from wound for 2 months with a past surgical history for PNS
- n A 27 year old female patient presented
- intervention interception of fistulous tract using Ksharasutra (Medicated alkaline thread), followed by Minimal Invasive Kshara Karma Technique (MIKKT) for PNS
- comparator Patient was managed under spinal anaesthesia
- primaryOutcome Ksharasutra was sloughed out after the fifth week, and complete wound healing of PNS was achieved in six weeks
- result Ksharasutra was sloughed out after the fifth week, and complete wound healing of PNS was achieved in six weeks
J Ayurveda Integr Med · PMID 39837200 · Read it on PubMed ↗
Andrew et al. 2025
Laser hair depilation therapy for pilonidal sinus disease: a 5-year, retrospective experience in a university teaching hospital in the UK, 2017-2023
More laser sessions helped healing.RetrospectiveLow quality
97 people2025
more laser sessions linked to better symptom resolution; surgery type did not affect improvement; most non-surgical patients improved
Who was studied
patients referred for pilonidal sinus disease treatment (mostly young men, median age 22)
What they received
laser hair removal therapy
Compared with
number of laser sessions and surgery type compared among patients
Main outcome
healing or improvement of pilonidal sinus disease
Quality
This was a retrospective chart review without a control group, so it can't prove laser treatment caused the improvement.
Limitations
Retrospective design, no control group, single center, outcomes not independently verified.
Taken word for word from the abstract
- population Patient demographics, PSD clinical stage, laser type, number of laser sessions, surgical intervention and treatment outcomes were extracted from electronic medical records of patients (n = 97) referred for laser hair depilation between 2017 and 2023.
- intervention To assess the outcome of laser hair depilation therapy on disease progression in patients with PSD at the Birmingham Skin Regional Laser Centre.
- comparator Neither surgical intervention nor the type of surgery (incision, excision, modified flap, or endoscopic surgical intervention) showed a significant association with improvement in PSD (P = 0.47 and P = 0.65, respectively).
- primaryOutcome Treatment outcomes were categorized as improvement (healed, improved) or no improvement of underlying PSD.
- result The number of laser hair removal sessions was the only predictive factor for symptom resolution (P < 0.001).
- result In the subgroup of patients who did not undergo surgery (n = 32, 33%), 25 patients (78%) had improvement or healing in their PSD.
- n Patient demographics, PSD clinical stage, laser type, number of laser sessions, surgical intervention and treatment outcomes were extracted from electronic medical records of patients (n = 97) referred for laser hair depilation between 2017 and 2023.
Clin Exp Dermatol · PMID 39815683 · Read it on PubMed ↗
Aimar et al. 2025
Lived experience of pilonidal sinus disease: Systematic review and meta-ethnography
Disease disrupts life, causes distress.Systematic reviewVery low qualityRelated question
size not given2025
three themes emerged: disruption to daily activities, impact on psychological well-being, and difficulties navigating healthcare
Who was studied
people living with pilonidal sinus disease
What they received
no treatment tested - qualitative exploration of patients' lived experience
Compared with
none - no comparison group used
Main outcome
patients' lived experience of pilonidal sinus disease
Quality
This is a small qualitative synthesis of only three studies with no reported patient numbers, so it cannot show whether any treatment works or why pain occurs.
Limitations
Only four full texts covering three studies were included, and the abstract does not report participant numbers or address the cause of pain.
Taken word for word from the abstract
- population patients with PSD
- intervention A systematic review was performed to identify papers reporting qualitative studies on the lived experience of PSD.
- comparator A meta-ethnographic approach was used to systemically compare and synthesize frameworks
- primaryOutcome to explore the lived experience of patients with PSD to better inform future person-centred treatment
- result Three key themes emerged: (1) disruption to activities of daily living; (2) impact on psychological well-being; (3) navigating healthcare.
Colorectal Dis · PMID 39809548 · Read it on PubMed ↗
Aljarrah et al. 2024
Limberg flap for previously recurrent complex sacrococcygeal pilonidal sinus surgeries
Flap surgery helped, no recurrence yet.Case seriesLow qualityRelated question
10 people3 months
No recurrences after about 3 months follow-up, but 5 patients had flap swelling, 1 had wound infection, and return to work took 6 weeks
Who was studied
Patients with complex or repeatedly recurring pilonidal sinus disease at the base of the spine
What they received
Limberg flap surgery (a rotational skin flap repair)
Compared with
No control group studied; abstract compares results to open wound procedures based on general knowledge
Main outcome
Wound infection, seroma, pain, recurrence, return to work, cosmetic result, and patient satisfaction after surgery
Quality
Only 10 patients were studied with no comparison group and just 3 months of follow-up, so the findings carry little weight.
Limitations
Very small number of patients, short follow-up time, no control group for comparison.
Taken word for word from the abstract
- n A total of 10 patients were operated from January 2022 to March 2023.
- population patients selected were classified as complex and at least of a second recurrence of the disease
- intervention Limberg flap, is a rotational rhomboid flap
- primaryOutcome regarding the wound infection rate, seroma formation, postoperative pain relief, recurrence rates, return to work, its cosmetic final result and patients' satisfaction
- result there were no recurrences so far for an average follow-up time of about 3 months
- result 5 patients having flap oedema, 1 patient had wound infection, no one had flap necrosis
- followUp average follow-up time of about 3 months
- comparator in comparison to the open procedures
Acta Chir Plast · PMID 39800555 · Read it on PubMed ↗
Breidung et al. 2024
Evaluation of Clinical Outcomes and Quality of Life following the Karydakis Flap Procedure for Pilonidal Sinus Treatment
Low complications, low recurrence after flap surgery.RetrospectiveLow quality
103 people59 months
11.7% had complications, 4.9% needed revision surgery, average healing time was 21.4 days, and 6.8% had the sinus come back within 59 months
Who was studied
patients who had surgery for pilonidal sinus (a cyst near the top of the buttocks crease)
What they received
Karydakis flap surgical procedure to remove the pilonidal sinus
Compared with
none - no comparison group reported
Main outcome
postoperative complications, recurrence rate, wound healing time, and return to daily life
Quality
This was a retrospective review of one surgeon's patients with no comparison group, so it can't show whether this surgery is better than other options.
Limitations
Retrospective data analysis; single surgeon; no control group; some follow-up done by telephone rather than in person.
Taken word for word from the abstract
- n A total of 103 patients were enrolled in the study.
- population patients who underwent reconstruction of pilonidal sinus using the Karydakis technique
- intervention reconstruction of pilonidal sinus using the Karydakis technique
- comparator All cases were performed by a single surgeon.
- primaryOutcome focusing on postoperative complications, recurrence rate, wound healing time, and return to daily life
- result The postoperative complication rate was 11.7%. Revision surgery was required in 4.9% of patients because of a complication. Wound healing time was on average 21.4 days postoperatively. A total of seven patients (6.8%) had a recurrence within 59 months postoperatively.
Adv Skin Wound Care · PMID 39792517 · Read it on PubMed ↗
Iacob et al. 2024
Trephination for primary pediatric pilonidal sinus disease: medium term functional and recurrence outcome of a large cohort
Easy recovery, but sometimes comes back.RetrospectiveLow quality
100 people31.4 (16.2-52.8) months
Recovery was quick and low-pain, but over 2-5 years about a third had recurring pain or discharge, 15% had an abscess, and 18% needed another operation, mostly within 2 years
Who was studied
children with pilonidal sinus disease (a condition causing pain near the top of the buttock crack)
What they received
minimally invasive surgery called trephination
Compared with
none (single group followed over time)
Main outcome
recovery time, pain, discharge, abscesses, and need for repeat surgery
Quality
This was a retrospective chart review of one group of patients with no comparison treatment, so it can show what happened but not whether this surgery is better than other options.
Limitations
Retrospective design, no comparison group, relied partly on telephone follow-up interviews.
Taken word for word from the abstract
- population primary pediatric pilonidal sinus disease
- intervention primary trephination
- comparator Retrospective chart review and additional concluding telephone interviews for all children who underwent primary trephination
- primaryOutcome Post-operative analgesics were used for 1.25 (0-4) days, sick days were 7 (3-11), and time to full activity was 14 (14-30) days. Recurrent pain, discharge, and abscess/es were reported by 37%, 35%, and 15% of patients
- result Recurrent pain, discharge, and abscess/es were reported by 37%, 35%, and 15% of patients, with 80-85% occurring within the first post-operative year. Reoperation rate was 18%, with 95% occurring within 2 years.
- n 100 patients were included.
- followUp Median follow-up time was 31.4 (16.2-52.8) months.
Pediatr Surg Int · PMID 39708093 · Read it on PubMed ↗
Qin et al. 2024
Subarachnoid anesthesia for sacrococcygeal pilonidal disease treatment: A case report
Found a benefitCase seriesVery low qualityRelated question
1 people24 hours
surgery completed successfully with stable vital signs; patient had brief breathing difficulty when repositioned, but no major anesthesia complications in the first 24 hours
Who was studied
48-year-old obese man with recurrent swelling, pain, and pus near the top of the buttock crack (pilonidal disease)
What they received
surgery to remove the pilonidal sinus, done under spinal (subarachnoid) anesthesia
Compared with
none
Main outcome
safety and success of anesthesia and surgery
Quality
this is a single patient case report, so it cannot show whether this treatment generally works for this problem
Limitations
only one patient; focuses on anesthesia technique, not on long-term pain relief or explaining why the area hurts in general
Taken word for word from the abstract
- n A 48-year-old obese male
- population presented with recurrent sacrococcygeal swelling, pain, and purulent discharge for 2 months
- intervention the patient underwent SPD excision under subarachnoid anesthesia
- comparator INTERVENTIONS: Following comprehensive evaluation, the patient underwent SPD excision under subarachnoid anesthesia.
- primaryOutcome The surgery was completed successful with stable hemodynamics. No significant anesthesia-related complications were observed within 24 hours postoperatively.
- result The surgery was completed successful with stable hemodynamics. No significant anesthesia-related complications were observed within 24 hours postoperatively.
- followUp No significant anesthesia-related complications were observed within 24 hours postoperatively.
Medicine (Baltimore) · PMID 39705452 · Read it on PubMed ↗
Akyol 2024
Sinus laser therapy versus Karydakis flap procedure in the management of pilonidal sinus disease: a comparative analysis of intraoperative parameters and postoperative outcome
Laser surgery meant less pain, faster recovery.RetrospectiveLow quality
106 people2024
Laser treatment had shorter operation time, less pain, and quicker return to work, with similar complication and recurrence rates compared to flap surgery
Who was studied
patients with pilonidal sinus disease (average age 26, mostly male)
What they received
laser treatment of the sinus tract (SiLaT)
Compared with
Karydakis flap surgery
Main outcome
operative time, pain after surgery, time to return to work, complications and recurrence
Quality
This was a retrospective comparison of two surgical techniques without randomization, so differences between patient groups could affect results.
Limitations
Retrospective design, not randomized, from a single comparative analysis; small number of complications/recurrences limits statistical power.
Taken word for word from the abstract
- population 106 patients with PSD (mean ± SD age: 26.4 ± 7.0 years, 86.8% male)
- intervention sinus laser therapy (SiLaT group; n = 43)
- comparator Karydakis flap procedure (KF group; n = 63)
- primaryOutcome postoperative (day 1) pain intensity-visual analog scale (VAS) scores, time to return to work after surgery (days), complication rate, and recurrence rate
- result The SiLaT versus KF procedure was associated with significantly shorter operative time [median (min-max) 17 (12-28) versus 27 (20-44) min, p = 0.001], lower pain scores [3 (1-4) versus 5 (3-7), p = 0.001], and earlier return to work [1 (1-3) versus 10 (5-20) days, p = 0.001].
- n A total of 106 patients with PSD
Tech Coloproctol · PMID 39699772 · Read it on PubMed ↗
Pérez-Bertólez et al. 2024
Pediatric endoscopic pilonidal sinus treatment: lessons learned after 100 consecutive cases
Faster, less painful healing with endoscopic surgery.Prospective cohortLow qualityRelated question
149 people2024
Endoscopic surgery healed faster, caused less pain, had far fewer complications, and was less likely to come back than the standard surgeries
Who was studied
Children having surgery for pilonidal sinus (a cyst near the top of the butt crack)
What they received
Endoscopic pilonidal sinus surgery (PEPSiT)
Compared with
Standard surgery - either cutting out and leaving open to heal, or cutting out and stitching closed
Main outcome
How long healing took, how much pain patients had, complications, and whether the cyst came back
Quality
Patients were not randomly assigned to a surgery type - the surgeon chose the technique, which can bias the results.
Limitations
Surgical technique was surgeon-dependent rather than randomly assigned, and this is a pediatric-only sample studying surgical treatment, not the general causes of pain in that area.
Taken word for word from the abstract
- n In total, 149 patients were studied-100 undergoing PEPSiT, 28 undergoing EHSI, and 21 undergoing EPC.
- population A quasi-experimental study was carried out in pediatric patients undergoing pilonidal sinus surgery at a single institution from 2019 to 2022.
- intervention Pediatric endoscopic pilonidal sinus treatment (PEPSiT)
- comparator Excision and healing by secondary intention (EHSI), excision and primary closure (EPC), and PEPSiT were compared.
- primaryOutcome Median full healing process was 4 weeks [interquartile range (IQR): 3-8] in PEPSiT, 16 weeks in EHSI (IQR: 12-26.5), and 7 weeks (IQR: 4-10) in ECP (p < 0.01).
- result Complications with PEPSiT were 9.3 times lower tan EHSI [odds ratio (OR) 9.3; 95% confidence interval (CI) 3.5-24.7] and 8.5 times lower than ECP (OR = 8.5; 95% CI 2.9-24.4).
Tech Coloproctol · PMID 39656288 · Read it on PubMed ↗
Koc et al. 2024
Unroofing and curettage for recurrent sacrococcygeal pilonidal disease
Low recurrence after repeat surgery.RetrospectiveLow quality
74 people81.6 ± 49 months
recurrence occurred in only 1 of 74 patients (1.3%), with quick recovery and short operation time
Who was studied
patients over 16 with recurrent pilonidal disease at the top of the buttock crack, after at least one prior surgery
What they received
unroofing and curettage surgery
Main outcome
recurrence rate, operation time, and recovery/return-to-work duration
Quality
this is a retrospective study without a comparison group, so it cannot prove this surgery is better than other options.
Limitations
retrospective design, no control group, single center/selected patient group with prior recurrence
Taken word for word from the abstract
- population This retrospective study included 74 patients with recurrent disease who were over 16 years of age, experienced recurrence after at least one surgical attempt
- intervention underwent unroofing curettage between 2007 and 2019
- primaryOutcome Operation time, return to work duration, and recurrence rates were assessed.
- result Recurrence was only observed in 1 (1.3%) patient.
- n This retrospective study included 74 patients with recurrent disease
- followUp Mean follow-up duration was 81.6 ± 49 months.
Front Surg · PMID 39634483 · Read it on PubMed ↗
Darnis et al. 2024
Does the holmium laser have a place in the treatment of pilonidal cysts? (Pilolas study)
Similar healing, more pain afterward.RetrospectiveLow quality
size not givenup to a year
Healing rate at one month was 90.7%, similar to SiLaT, but pain, infection and recurrence were more common
Who was studied
people treated for pilonidal cysts (tailbone cysts)
What they received
holmium laser treatment of the cyst
Compared with
SiLaT laser (the standard minimally invasive laser technique)
Main outcome
cure (healing) rate one month after treatment
Quality
It is a retrospective study without a direct comparison group, so the comparison to SiLaT relies on indirect data.
Limitations
Retrospective design, comparison to SiLaT laser not based on a head-to-head trial, and the cause of the pain is only inferred.
Taken word for word from the abstract
- population treatment of pilonidal cysts
- intervention the holmium laser instead of the SiLaT laser in the treatment of pilonidal cysts
- comparator Holmium laser does not differ from SiLaT laser in the healing rate of pilonidal cysts after treatment
- primaryOutcome the primary endpoint being the cure rate one month after treatment
- result healing rate at 1 month was 90.7%
- result it is characterised by a moderately higher incidence of complications, foremost of which is the occurrence of pain that can persist for up to a year after the procedure
- followUp pain that can persist for up to a year after the procedure
Lasers Med Sci · PMID 39578271 · Read it on PubMed ↗
Pedersen et al. 2025
Distinct recurrence patterns according to disease manifestation in pilonidal sinus disease treated with cleft lift surgery at 5 years' follow-up in a large prospective Danish cohort
Mostly healed, but recurrence varies by caseProspective cohortModerate quality
392 people60 months (45-73 months)
87% healed within 3 months overall; recurrence at a median of 60 months was 13% in primary extensive disease, 20% in nonhealing wounds, and 17% in recurrent disease
Who was studied
adults with pilonidal sinus disease (a condition causing pain and infection near the top of the buttock crease), including new severe cases, non-healing wounds after prior surgery, and recurrent disease
What they received
Bascom's cleft lift surgery
Compared with
compared outcomes between three disease subgroups (primary extensive disease, nonhealing wounds, recurrent disease) rather than against another treatment
Main outcome
wound healing and recurrence of the disease after surgery
Quality
it followed a large group of patients prospectively for years, but there was no comparison group getting a different treatment, so it can't prove this surgery is better than alternatives.
Limitations
single high-volume center, no comparator treatment group, and the abstract does not report how missing follow-up data were handled
Taken word for word from the abstract
- n Three hundred and ninety two patients (326 men/66 women) underwent BCL surgery over a 4-year period
- population Of these, 127 (32.4%) presented with primary extensive PSD, 136 (34.7%) with nonhealing wounds and 129 (33.9%) with recurrent PSD.
- intervention Bascom's cleft lift (BCL)
- comparator evaluate the surgical outcomes in a prospective cohort following Bascom's cleft lift (BCL) in primary extensive disease, nonhealing wounds after previous surgery and recurrence
- primaryOutcome Overall, 87% healed uneventfully within the first 3 months, and 17% had recurrence at a median follow-up of 60 months
- result the risk of recurrence was higher among patients with nonhealing wounds (20%) and recurrence (17%) compared with primary extensive manifestation (13%)
- followUp median follow-up of 60 months (45-73 months)
Colorectal Dis · PMID 39551964 · Read it on PubMed ↗
Leung et al. 2024
A novel, double Limberg flap repair for recurrent pilonidal sinus disease
New surgery healed one caseCase seriesVery low quality
1 people3 months
patient recovered well with no recurrence at 3 months
Who was studied
18-year-old male with extensive recurrent pilonidal sinus disease
What they received
double Limberg flap surgery (two rotational skin flaps used together)
Compared with
none (single case, no comparison group)
Main outcome
wound healing and recurrence after surgery
Quality
This is a single patient case report, so it cannot show whether this works in general.
Limitations
Only one patient was treated and followed for just 3 months, so long-term success and general safety are unknown.
Taken word for word from the abstract
- n a case of an eighteen-year-old male with extensive recurrent pilonidal disease
- population an eighteen-year-old male with extensive recurrent pilonidal disease
- intervention A novel technique of a double Limberg flap repair was used
- comparator if a single Limberg flap was considered
- primaryOutcome The patient made an uneventful recovery with no recurrence at 3 months follow-up.
- result The patient made an uneventful recovery with no recurrence at 3 months follow-up.
J Surg Case Rep · PMID 39507353 · Read it on PubMed ↗
Dainius et al. 2024
A Comparative Analysis of Pain Assessment Methods in the Initial Postoperative Phase Following Different Pilonidal Cyst Surgeries
Similar pain scores; more pain on pressure testingRandomised trialLow qualityRelated question
78 peoplethe day after the operation
Pain ratings on the visual analog scale were similar between the two surgery types, but pressure-pain testing showed more pain in the minimally invasive group the day after surgery, and the two pain measures did not agree with each other
Who was studied
adults with symptomatic pilonidal cysts (a cyst/abscess near the top of the buttock crack) undergoing surgery
What they received
minimally invasive 'pit-picking' surgery for pilonidal cyst
Compared with
radical excision surgery for pilonidal cyst
Main outcome
pain intensity after surgery, measured by visual analog scale and pressure algometry
Quality
This is a small study about pain right after pilonidal surgery, not about why pilonidal cysts hurt in general, and its two pain-measuring methods gave conflicting results.
Limitations
Small sample size; abstract states further larger studies are needed; no correlation found between the two pain measurement methods.
Taken word for word from the abstract
- population A total of 78 adult patients with symptomatic pilonidal cysts were enrolled in this study.
- intervention pit-picking surgery (n = 39)
- comparator radical excision (n = 39)
- primaryOutcome to evaluate pain intensity in patients after pilonidal disease surgeries of varying extent using pressure algometry and the visual analog scale
- result There was no statistically significant difference (p > 0.05) in VAS measurement results between surgical groups when comparing pain intensity experienced by patients before, during, and after surgery.
- result significantly lower in the "pit-picking" group compared to the excision group
- result no statistically significant correlation was found between VAS and pressure algometry measurements either before surgery or on the first postoperative day
- n A total of 78 adult patients with symptomatic pilonidal cysts were enrolled in this study.
- limitations further larger studies are needed to compare these pain assessment methods in reporting pain intensity experienced during patient movement
Medicina (Kaunas) · PMID 39459497 · Read it on PubMed ↗
Baños et al. 2025
Short-term results of unroofing and marsupialization compared to the Karydakis technique in the treatment of pilonidal sinus. A randomized prospective study
Simpler surgery, fewer early complications.Randomised trialModerate qualityRelated question
122 people90-day follow-up
Unroofing and marsupialization had significantly fewer complications at 15 and 30 days, shorter surgery time, and faster return to daily activity, but 3 recurrences versus 0 with Karydakis by 90 days
Who was studied
adults having surgery for pilonidal sinus at the top of the buttock crack
What they received
unroofing and marsupialization surgery
Compared with
Karydakis technique surgery
Main outcome
complications in the first 30 days after surgery
Quality
It was a randomized trial, but it was done at one hospital and followed patients for only three months, so long-term results and rare harms aren't known.
Limitations
Single-center study, short 90-day follow-up, and the trial does not address diagnosing or managing pain from causes other than pilonidal sinus.
Taken word for word from the abstract
- population 122 patients with symptomatic primary PS were randomized
- intervention unroofing and marsupialization (UM) is a simple surgery with good results
- comparator The Karydakis (K) technique is widely used
- primaryOutcome To evaluate early postoperative complications (EPC) 30 days after UM surgery compared to the K technique
- result There were statistically significant differences between surgery and postoperative complications at 15 and 30 days in favor of UM. There were also differences in favor of UM in surgical time and return to daily activity. During the 90-day follow-up, there were 3 recurrences in the UM group and 0 in the K group.
- n 122 patients with symptomatic primary PS were randomized: 60 in the K group and 62 in the UM group.
- followUp During the 90-day follow-up, there were 3 recurrences in the UM group and 0 in the K group.
Cir Esp (Engl Ed) · PMID 39427709 · Read it on PubMed ↗
de Kort et al. 2024
Phenolization of the sinus tract in recurrent sacrococcygeal pilonidal sinus disease: long-term results of a prospective cohort study
Less pain, fewer recurrences long-termProspective cohortLow qualityRelated question
47 people76 (SD 21.7) months
about 15% of patients needed repeat surgery for recurrence, and pain, discharge and itching improved over the long term
Who was studied
patients with recurrent sacrococcygeal pilonidal sinus disease
What they received
phenolization (a chemical treatment) of the sinus tract
Compared with
no separate comparison group - outcomes compared to before treatment
Main outcome
whether the sinus came back and needed more surgery
Quality
this was a small single-group study without a comparison treatment, so it's hard to be sure the improvement was due to the procedure itself.
Limitations
small sample, no control group, based partly on patient questionnaires, and only looked at recurrent (not first-time) cases
Taken word for word from the abstract
- population phenolization for recurrent SPSD
- n A total of 47 patients (82.5%) were available for long-term follow-up.
- intervention the phenolization technique for recurrent SPSD
- comparator there was improvement in the quality of life compared to preoperative levels
- primaryOutcome The primary endpoint was recurrence.
- result Recurrence needing further surgery developed in 7 patients (14.9%) after a mean follow-up of 76 (SD 21.7) months.
- result Additionally, symptoms associated with SPSD, including pain, fluid discharge, and itching sensation, also showed significant improvement.
- followUp after a mean follow-up of 76 (SD 21.7) months
Int J Colorectal Dis · PMID 39422799 · Read it on PubMed ↗
Faurschou et al. 2024
Closed-incision negative-pressure wound therapy after Bascom's cleft lift surgery for pilonidal sinus disease: A randomized study comparing healing
No difference in wound healing.Randomised trialModerate qualityRelated question
118 people12 weeks
no significant difference in healing rates between the two wound care methods at either time point
Who was studied
patients undergoing surgery for complicated pilonidal sinus disease
What they received
negative-pressure wound therapy applied to the closed incision after surgery
Compared with
standard drain and dry dressing after surgery
Main outcome
whether the surgical wound had healed at 2 and 12 weeks
Quality
it was a randomized trial with blinded assessment, but it was stopped early at about half the planned number of patients, which weakens confidence in the result.
Limitations
study stopped early after interim analysis before reaching the planned 200 patients
Taken word for word from the abstract
- n the study was terminated at 118 patients (NPWT group, n = 60; control group, n = 58)
- population complicated pilonidal sinus disease
- intervention closed-incision negative-pressure wound therapy (NPWT) promotes wound healing after Bascom's cleft lift (BCL) surgery
- comparator conventional drainage and dressing
- primaryOutcome Healing was evaluated by a wound care nurse blinded for randomization at 2 and 12 weeks postoperatively (primary endpoint)
- result After 12 weeks, 68% of patients were healed in the NPWT group and 72% in the control group [risk difference = -0.03 (95% CI 0.19 to 0.13), p = 0.82]
- followUp at 2 and 12 weeks postoperatively
Colorectal Dis · PMID 39370557 · Read it on PubMed ↗
Jo et al. 2024
Peri anal region is an overlooked location for pilonidal recurrence after surgical excision and closure - A case series
Hair removal healed recurrent pilonidal wounds.Case seriesVery low qualityRelated question
5 people2024
all five patients' wounds healed completely
Who was studied
patients with pilonidal disease that came back after surgery
What they received
hair removal (manual and laser epilation), with one patient needing an additional procedure
Compared with
none
Main outcome
whether the recurrent wounds healed
Quality
This is a tiny report of just five patients with no comparison group, so it cannot reliably show what works.
Limitations
Very small number of patients, no control group, and from a single specialty clinic, so results may not generalize.
Taken word for word from the abstract
- n Five pilonidal patients with recurrent disease after surgical excision and flap closure were referred to our Pilonidal Care Clinic.
- population Five pilonidal patients with recurrent disease after surgical excision and flap closure were referred to our Pilonidal Care Clinic.
- intervention Each patient was treated with regular manual and laser epilation and only one patient required a Gips procedure.
- comparator All five were found to have perianal wounds.
- primaryOutcome All wounds were successfully healed.
- result All wounds were successfully healed.
Int J Surg Case Rep · PMID 39357489 · Read it on PubMed ↗
Banks et al. 2024
Decision regret following surgical management of pilonidal disease
Surgery complications linked to more regret.Prospective cohortModerate qualityRelated question
677 people6 months
patients who had complications or disease come back were more likely to regret their treatment decision
Who was studied
patients with pilonidal disease who had surgery
What they received
surgical treatment of pilonidal disease (mostly major excisional surgery)
Compared with
no direct comparator group; outcomes compared based on complications and recurrence
Main outcome
patient regret about their treatment decision 6 months after surgery
Quality
it followed a large group of patients prospectively but almost 30% were lost to follow-up and there was no comparison group testing one treatment against another.
Limitations
only 71% of patients had 6-month follow-up data, and the study looks at regret and satisfaction rather than the cause of pain itself.
Taken word for word from the abstract
- n Overall, 677 patients were included
- population patients with PD treated between May 2019 and March 2022
- intervention Most (59.5%) patients underwent major excisional surgery
- comparator Of the patients who underwent a 'leave open' approach, 20.6% were dissatisfied or very dissatisfied with their treatment.
- primaryOutcome Post-procedure data consisted of operative outcomes and decision regret.
- result Postoperative complications (β = 3.21, 95% CI: -12.75 to 7.25, p < 0.001) and disease recurrence (β = 11.5, 95% CI: -10.6 to 9.4, p < 0.001) were both associated with higher rates of decision regret.
- followUp quantitative data capture between baseline and 6 months post-procedure
Colorectal Dis · PMID 39323001 · Read it on PubMed ↗
Lan et al. 2024
[Clinical application of parasacral artery perforator flap in the treatment of Pilonidal Sinus Diseases]
All healed well after flap surgery.Case seriesVery low quality
6 people6-16 months
all six patients healed fully with no early or late complications and no recurrence during follow-up
Who was studied
patients with pilonidal sinus disease (infected hair-containing cyst near the tailbone)
What they received
surgical removal of infected tissue plus a parasacral artery perforator flap (skin flap) to cover the wound
Compared with
none (single-arm case series, no comparison group)
Main outcome
wound healing after surgery, including complications and recurrence
Quality
this is a tiny study of only six patients with no comparison group, so it can't reliably show the treatment is better than other options.
Limitations
Very small sample size (6 patients), no control group, short case series design.
Taken word for word from the abstract
- n There were six patients with PSDs whose postoperative wound healing was repaired by PPF
- population patients with PSDs
- intervention To design the PPF according to the wound size and the parasacral perforator arteries' localization
- comparator Results: There were six patients with PSDs whose postoperative wound healing was repaired by PPF
- primaryOutcome To investigate clinical efficacy of parasacral perforator flap (PPF) on postoperative wound healing in pilonidal sinus diseases (PSDs).
- result Incisions of all six cases achieved first-intention healing without early- or late-stage complications. No recurrence occurred during follow-up.
Zhonghua Wei Chang Wai Ke Za Zhi · PMID 39313437 · Read it on PubMed ↗
Bergus et al. 2024
Heterogeneity of Treatment Effects of Laser Epilation on Pilonidal Disease Recurrence: A Randomized Clinical Trial
Laser benefit varied by race and insurance.Randomised trialModerate quality
302 people1-year follow-up
Laser treatment lowered recurrence much more in non-Hispanic white and privately insured patients than in other racial/ethnic groups or publicly insured patients
Who was studied
patients aged 11 to 21 with pilonidal disease (the painful condition at the top of the buttock crack)
What they received
laser hair removal (laser epilation) of the gluteal cleft plus standard care
Compared with
standard care alone (better hygiene and shaving or hair-removal cream)
Main outcome
pilonidal disease coming back (recurrence) within 1 year
Quality
It was a randomized trial, but many patients were lost before the 1-year follow-up and the key findings come from smaller subgroup comparisons.
Limitations
Single institution; 1-year follow-up was only available for 96 of 151 laser patients and 134 of 151 standard-care patients; subgroup sizes were small.
Taken word for word from the abstract
- population including patients aged 11 to 21 years with pilonidal disease undergoing gluteal cleft laser epilation and standard care
- intervention gluteal cleft laser epilation and standard care
- comparator standard care alone
- primaryOutcome preventing pilonidal disease recurrence
- n In total, 302 patients were enrolled with 151 randomized to each intervention.
- result Recurrence among non-Hispanic white patients was 4% (3/75) with laser treatment and 31.6% (31/98) with standard care versus 38.9% (7/18) with laser treatment and 38.2% (13/34) with standard care among all other racial/ethnic groups.
- followUp with 1-year follow-up
Ann Surg Open · PMID 39310334 · Read it on PubMed ↗
Azizoglu et al. 2025
Platelet-rich Plasma as an Adjuvant Therapy to Crystallized Phenol in the Treatment of Pediatric Pilonidal Sinus Disease: A Prospective Randomized Controlled Trial
Faster healing, less pain, fewer recurrencesRandomised trialModerate quality
87 people2025
PRP group healed faster, had better cosmetic scores, less pain, higher success rate, and lower recurrence, with similar complication rates
Who was studied
children and teens (0-18) with pilonidal sinus disease near the tailbone
What they received
crystallized phenol treatment plus platelet-rich plasma (PRP) injection
Compared with
crystallized phenol treatment alone
Main outcome
time to healing, cosmetic appearance, pain, complications, success and recurrence rates
Quality
it was a randomized trial but done at only one hospital with a modest number of patients, so results may not generalize.
Limitations
single-center study
Taken word for word from the abstract
- n Eighty-seven patients aged 0-18 were randomly assigned to two groups: the CP group (n = 42) and the CP + PRP group (n = 45).
- population pediatric pilonidal sinus disease (PSD)
- intervention In CP + PRP group, PRP injections were also administered.
- comparator the CP group (n = 42)
- primaryOutcome evaluate the safety and efficacy of platelet-rich plasma (PRP) as an adjuvant to crystallized phenol (CP) in treating pediatric pilonidal sinus disease
- result The CP + PRP group demonstrated significantly shorter healing times (19.4 ± 7.88 days) compared to the CP group (30.7 ± 12.9 days) (p < 0.001).
- result The success rate was higher in CP + PRP group (98%; n = 44) compared to CP group (86%; n = 36) (p = 0.039).
- result Recurrence rates were lower in CP + PRP group (2%; n = 1) than CP group (14%; n = 6) (p = 0.039).
J Pediatr Surg · PMID 39307596 · Read it on PubMed ↗
Ankersen et al. 2024
Long-term outcomes after cleft lift surgery for pilonidal sinus disease in post-pubertal adolescents: data from a prospective Danish cohort
Similar recurrence as adults.Prospective cohortLow quality
79 people62 months
69% healed without problems; 5-year recurrence was 19% in adolescents versus 17% in adults, not a significant difference
Who was studied
post-pubertal teenagers (median age 17) with pilonidal sinus disease, compared to adult patients
What they received
Bascom's cleft lift surgery
Compared with
same surgery in adult patients
Main outcome
wound healing and recurrence of the condition after surgery
Quality
this is a single-center observational cohort without randomization, so differences between age groups could be due to other factors.
Limitations
Observational study design, no control group outside of comparison to adult cohort, single hospital.
Taken word for word from the abstract
- n n = 79 were post-pubertal adolescents
- population post-pubertal adolescents with a median age at time of surgery of 17.2 years
- intervention Bascom's cleft lift (BCL) surgery
- comparator comparing them to adult patients
- primaryOutcome Fifty-four patients (69%) healed uneventfully
- result 5-year recurrence rate of 19%, compared to 17% (P = 0.6) in the adult population
Colorectal Dis · PMID 39301876 · Read it on PubMed ↗
Gupta 2024
Presacral Keratinous and Dermoid Cyst Masquerading as Meningocele - A Rare Case Report
Rare cyst found and surgically removed.Case seriesVery low qualityRelated question
1 people2024
the mass was fully removed and tissue tests showed it was a keratinous cyst in the presacral area and a dermoid cyst in the buttock; the child later developed and had removed a separate facial dermoid cyst
Who was studied
a fifteen-month-old girl with a mass near the tailbone and buttock
What they received
surgical removal of the cyst and tailbone (coccygectomy)
Compared with
none mentioned
Main outcome
successful removal of the cyst and diagnosis via tissue examination
Quality
this is a single patient case report with no comparison group, so it cannot show whether the treatment works better than any alternative.
Limitations
only one patient described, no control group, and the condition (presacral developmental cyst) is a rare congenital tumor rather than a common cause of tailbone-area pain
Taken word for word from the abstract
- population A fifteen-month-old girl presented with pain in the lower abdomen and dysuria.
- intervention Complete excision of mass along with coccygectomy was done.
- comparator Complete excision of mass along with coccygectomy was done.
- primaryOutcome Histopathology showed presacral as a keratinous cyst and gluteal as a dermoid cyst.
- result Histopathology showed presacral as a keratinous cyst and gluteal as a dermoid cyst. Later on, the child also developed a left facial dermoid cyst which was also excised.
- n A fifteen-month-old girl presented with pain in the lower abdomen and dysuria.
Afr J Paediatr Surg · PMID 39279621 · Read it on PubMed ↗
Hoenig 2025
Introducing the Bender sign for the diagnosis of intergluteal cleft skin disorders
Describes exam technique, not treatment.Narrative reviewVery low qualityRelated question
size not given2025
The abstract does not report a measured outcome; it describes and names a physical examination technique and its history
Who was studied
People with skin conditions near the buttocks crease
What they received
Bending over and spreading the buttocks to examine the skin (the 'Bender sign')
Compared with
No comparator described
Main outcome
Ability to detect skin disease in the gluteal cleft area
Quality
This is a historical/educational note about a physical exam trick, not a study testing whether a treatment works.
Limitations
Not a clinical study; no data, no patients analyzed, no outcomes measured — purely historical/educational commentary.
Taken word for word from the abstract
- population cutaneous diseases that involve the gluteal cleft
- intervention having patients bend over and then manually separating the buttocks
- comparator This contribution formally introduces this delightful eponym into the dermatology literature
- primaryOutcome the importance of examining the intergluteal cleft area, which can often harbor a variety of skin disorders, such as psoriasis
- result This contribution pays tribute to Dr Benjamin Bender, a beloved master teacher of dermatology.
Clin Dermatol · PMID 39222673 · Read it on PubMed ↗
Karita et al. 2024
Long-term follow-up of pilonidal sinus disease treated by radial laser surgery
Laser surgery, some recurrences later.RetrospectiveLow quality
83 peoplemedian of 5.2 years, range 1.5 to 7.4 years
14.5% recurrence and 27.7% needed a second operation over long-term follow-up
Who was studied
patients with pilonidal sinus disease (a condition causing a cyst/infection at the top of the buttock crack)
What they received
radial laser surgery to close the sinus tract
Main outcome
disease coming back (recurrence) and need for a repeat operation
Quality
This is a retrospective study of one group of patients with no comparison treatment, so it can't show whether laser surgery is better than other options.
Limitations
Retrospective design, no comparator group, single center/study records only.
Taken word for word from the abstract
- n We retrospectively studied the medical records of 83 patients who underwent the radial laser procedure for PSD between January 2017 and September 2019.
- population patients who underwent the radial laser procedure for PSD
- intervention radial laser procedure
- primaryOutcome Twelve patients had a PSD recurrence after their laser procedure, which gives a recurrence rate of 14.5% (95% CI 8.2%-23.2%).
- result Twelve patients had a PSD recurrence after their laser procedure, which gives a recurrence rate of 14.5% (95% CI 8.2%-23.2%).
- result A total of 23 patients (27.7%; 95% CI 19.0-38.0) underwent a reoperation, 11 patients due to postoperative infection or prolonged recovery and 12 patients due to PSD recurrence.
- followUp Our follow-up time was a median of 5.2 years, range 1.5 to 7.4 years.
Langenbecks Arch Surg · PMID 39174833 · Read it on PubMed ↗
Fardos et al. 2024
Anogenital Erosive Lichen Sclerosus in a Male With Multiple Autoimmune Conditions
Rare skin disease, resisted all treatments.Case seriesVery low qualityRelated question
1 people11-year case
the lesion persisted despite numerous treatments over 11 years
Who was studied
adult male with multiple autoimmune conditions (porphyria cutanea tarda, discoid lupus, Sjogren's syndrome)
What they received
intralesional corticosteroids and various topical treatments
Compared with
none (no comparator, treatment-resistant case followed over time)
Main outcome
resolution or improvement of the skin lesion in the intergluteal cleft (butt crack area)
Quality
this is a single patient case report, so it cannot show whether treatments generally work or what causes this problem.
Limitations
single case report with no control group, so findings may not apply to other people with similar pain or lesions.
Taken word for word from the abstract
- population an 11-year case of treatment-resistant LS in a male patient with an extensive history of autoimmune disorders, manifesting in the intergluteal cleft as a hypertrophic plaque, a rare location
- intervention Despite numerous treatments, including intralesional corticosteroids and various topicals, the lesion persisted.
- comparator Despite numerous treatments, including intralesional corticosteroids and various topicals, the lesion persisted.
- primaryOutcome Treatment goals for LS focus on symptom relief, cosmetic improvement, and disease prevention.
- result Despite numerous treatments, including intralesional corticosteroids and various topicals, the lesion persisted.
- n we present an 11-year case of treatment-resistant LS in a male patient
- followUp an 11-year case of treatment-resistant LS
Cureus · PMID 39156280 · Read it on PubMed ↗
Liang et al. 2024
Management and outcomes of pilonidal patients with secondary sinuses-a cohort study
Surgery mostly worked, some drainage recurred.Prospective cohortLow qualityRelated question
105 people367.0 days
most patients did not have their disease come back; a small number had drainage recur from the extra opening, which often went away without more surgery
Who was studied
young people (mostly teens) with pilonidal disease and an extra draining opening near the tailbone
What they received
surgical removal of the pilonidal sinus and the extra draining opening (Gips procedure)
Compared with
none - all patients had the same surgery; some also used regular hair removal afterward
Main outcome
return of symptoms (pain/bleeding) or drainage after surgery
Quality
this is a single-group study without a comparison group, so it can't prove the surgery works better than other options, only describe what happened.
Limitations
no comparison group, follow-up time varied a lot between patients, and the study only looked at a severe subgroup of pilonidal disease with an extra sinus
Taken word for word from the abstract
- n One hundred and five patients (seventy-one males)
- population Patients with PD and concurrent secondary sinus who underwent Gips procedure with secondary sinus excision
- intervention underwent Gips procedure with secondary sinus excision
- comparator Without regular epilation, six patients (5.7%, five males, one female) had recurrent PD. With regular epilation, three patients (2.8%, three males) had recurrent PD.
- primaryOutcome Patient demographics, drainage recurrence, symptom resolution, treatment, and follow-up period were recorded.
- result Eight patients (7.5%, six males, two females) had recurrent secondary sinus site drainage.
- result Excision can be complicated by recurrent drainage from the secondary sinus site that can resolve without repeat surgical excision.
- followUp followed for a median of 367.0 days (IQR: 173.2-658.8)
Pediatr Surg Int · PMID 39145895 · Read it on PubMed ↗
Romanova et al. 2024
Adolescent pilonidal disease laser treatment (a-PiLaT): a pilot study
Laser treatment showed promising, low-complication results.Case seriesLow quality
17 people24.5 ± 16.8 months
complication rate 24% and recurrence rate 18%, with low scar scores indicating good cosmetic outcome
Who was studied
adolescents aged 10-17 with pilonidal disease (abscess/sinus at top of buttock crack)
What they received
laser treatment for pilonidal disease (PiLaT)
Compared with
no comparison group; outcomes compared to prior literature on adults
Main outcome
complications, recurrence, and scar appearance after treatment
Quality
This was a small, retrospective case series of only 17 patients with no comparison group, so it can't prove the laser works better than other treatments.
Limitations
Retrospective, small sample size, no control group, single-center experience
Taken word for word from the abstract
- population PiLaT performed in adolescents aged 10-17 years
- intervention pilonidal disease laser treatment (PiLaT)
- comparator complication and recurrence rates comparable to those reported in the literature for adults
- primaryOutcome Data on perioperative characteristics and clinical outcomes at follow-up were retrospectively analysed
- result complication rate of 24% (n = 4) and recurrence rate of 18% (n = 3)
- n A total of 17 consecutive patients (n = 12 female, 71%) underwent a-PiLaT
- followUp the mean follow-up period was 24.5 ± 16.8 months
Tech Coloproctol · PMID 39141158 · Read it on PubMed ↗
Emengo et al. 2024
Standardized pilonidal protocol as rescue therapy for excision-refractory pilonidal disease
Non-surgical protocol healed stubborn pilonidal disease.Prospective cohortLow qualityRelated question
34 people405 days
All 34 patients achieved complete resolution after median 52 days; 5 (14.7%) later had recurrence
Who was studied
patients with severe pilonidal disease that came back after at least one prior surgery
What they received
standardized minimally invasive protocol with wound care, regular hair removal, and selective debridement or small punch procedures
Compared with
none - all patients received the same protocol, compared to their own prior surgical history
Main outcome
complete resolution of the pilonidal disease
Quality
This was a small, single-group study without a comparison group, so it can't rule out that patients would have improved anyway.
Limitations
No control group, single center, selected group of patients who already failed prior surgery
Taken word for word from the abstract
- n We treated 34 refractory patients (23 males)
- population symptomatic patients who underwent ≥ 1 pilonidal excision prior to presentation at our clinic
- intervention standardized protocol incorporating local wound care, regular manual/laser epilation, and selective debridement/pit trephination
- comparator We prospectively collected data from symptomatic patients who underwent ≥ 1 pilonidal excision prior to presentation at our clinic
- primaryOutcome All patients achieved complete resolution after median 52 days.
- result All patients achieved complete resolution after median 52 days. Five (14.7%) recurred
- followUp median follow-up 405 days
Pediatr Surg Int · PMID 39141128 · Read it on PubMed ↗
Yildirim et al. 2024
Results of Laser-assisted Closure (SiLaC) Surgery in Pilonidal Sinus Disease: Factors Associated With Success
Laser closure healed most pilonidal sinuses.RetrospectiveLow quality
64 people17.0±8.06 months (range: 3 to 36)
85.9% recovered; higher body weight and more advanced disease were linked to treatment failure
Who was studied
adults with pilonidal sinus disease (a pocket/tunnel near the top of the buttock crack)
What they received
laser treatment to close the sinus tract (SiLaC)
Main outcome
whether the sinus healed without recurrence
Quality
This was a single-hospital look-back at one group of patients with no comparison treatment, so it can't prove the laser worked better than other options.
Limitations
Retrospective design, no control group, single center, relatively small number of patients.
Taken word for word from the abstract
- n The study cohort consisted of 64 patients.
- population Pilonidal sinus treatment with sinus laser-assisted closure (SiLaC) method
- intervention sinus laser-assisted closure (SiLaC) method
- result Our recovery rate was 85.9%.
- result High BMI and advanced disease were significant factors for recurrence in the comparison of patients with successful and unsuccessful treatment
- primaryOutcome recurrence rates of the patients were compared
- followUp The mean follow-up period was 17.0±8.06 months (range: 3 to 36)
Surg Laparosc Endosc Percutan Tech · PMID 39140695 · Read it on PubMed ↗
Ram et al. 2024
Efficacy and safety of RD2 Ver.02, a whole blood clot therapy, coupled with a minimally invasive procedure in pilonidal sinus: a phase II study
Most pilonidal sinuses healed with treatment.Case seriesLow quality
51 people12 months
82.4% healed by 3 months, 90.2% by 6 months, and 82.4% by 12 months, with recurrence in 11.8% of patients
Who was studied
people with pilonidal sinus (an infected pocket of skin near the top of the buttock crease)
What they received
a minimally invasive trephine procedure plus instillation of RD2 Ver.02, a blood-clot gel made from the patient's own blood
Compared with
none — all patients received the same treatment, no control group
Main outcome
whether the wound had fully healed at 3, 6, and 12 months
Quality
This was a small, single-arm study with no comparison group, so it can't show whether this treatment works better than other options.
Limitations
No control/comparator group, open-label design, and only 51 patients, so results could be due to the procedure itself, natural healing, or chance rather than the blood-clot product.
Taken word for word from the abstract
- n Overall, 51 patients participated in the study.
- population Patients with PNS underwent a minimally invasive trephine procedure
- intervention a minimally invasive trephine procedure under local anesthesia followed by RD2 Ver.02 instillation into the cavity
- comparator Phase II open-label, pilot, single-arm prospective study
- primaryOutcome Primary healing was assessed at 3, 6, and 12 months.
- result At 6 and 12 months, 46/51 (90.2%) and 42/51 (82.4%) achieved complete healing, respectively.
- result a total of recurrence in six patients (11.8%)
Tech Coloproctol · PMID 39136828 · Read it on PubMed ↗
Rodríguez-Gutiérrez et al. 2024
[Hailey-Hailey disease: A case report]
Rare skin disease, not a treatment studyCase seriesVery low qualityRelated question
1 people2024
patient had skin rash and blisters affecting neck, trunk, armpits, groin folds, and the area between the buttocks, with itching and chronic skin changes
Who was studied
a man with Hailey-Hailey disease, a rare inherited skin disorder
What they received
not specified as a treatment study — this is a case description
Compared with
none reported
Main outcome
skin findings and diagnosis of Hailey-Hailey disease
Quality
this is a single patient case report, which cannot show whether any treatment works or establish cause reliably
Limitations
single case report with no treatment comparison; the abstract is descriptive of one patient's condition and a literature review, not a controlled study
Taken word for word from the abstract
- population Male patient diagnosed with Hailey-Hailey disease.
- primaryOutcome On physical examination we observed a dermatosis disseminated to the neck, trunk, axillary and inguinal folds, and intergluteal region
- result unilateral, asymmetric with a polymorphous appearance, constitution due to exulceration, erythema, some pustules and flaccid vesicles that coalesced to form eczematous and hypertrophic plaques with the presence of fine scales on their surface, with a chronic evolution accompanied by pruritus
- n Male patient diagnosed with Hailey-Hailey disease.
- intervention Treatment ranges from general measures to multiple pharmacological options, with topical corticosteroids being the most commonly used.
- comparator CLINICAL CASE: Male patient diagnosed with Hailey-Hailey disease.
Rev Med Inst Mex Seguro Soc · PMID 39116170 · Read it on PubMed ↗
Huurman et al. 2024
Postoperative Outcomes of Bascom Cleft Lift Versus Excision With Secondary Wound Healing for Pilonidal Sinus Disease: A Multicenter Retrospective Analysis
Faster, more complete healing with cleft lift.RetrospectiveLow quality
272 people12 months
Bascom cleft lift had higher wound healing rate (84.4% vs 32.6%) and faster healing (55 vs 101 days), but more complications (28.9% vs 13.2%); recurrence was similar (6.3% vs 11.8%, not statistically significant)
Who was studied
Patients with pilonidal sinus disease (a cyst/wound near the top of the buttock crack) needing surgery
What they received
Bascom cleft lift surgery
Compared with
Excision with secondary wound healing (wound left open to heal)
Main outcome
Rate and time of successful wound healing
Quality
This was a retrospective study without random assignment, so differences between groups (like who got which surgery) could skew results, and follow-up was short.
Limitations
Retrospective design prone to selection bias and residual confounding; short follow-up period limits recurrence data; no patient satisfaction data collected.
Taken word for word from the abstract
- population Patients who underwent excision with secondary wound healing or Bascom cleft lift
- intervention Bascom cleft lift
- comparator excision with secondary wound healing
- primaryOutcome Primary end points included the rate of successful wound healing and the time to achieve healing.
- result The wound healing rate was 84.4% after Bascom cleft lift versus 32.6% after excision and secondary wound healing ( p < 0.001), with a median time to wound healing of 55 and 101 days, respectively ( p < 0.001). Complications were 28.9% for Bascom cleft lift versus 13.2% for excision and secondary wound healing ( p = 0.003). The rate of recurrent disease was 6.3% after Bascom cleft lift and 11.8% after excision and secondary wound healing ( p = 0.113).
- n Of 272 patients, 128 underwent Bascom cleft lift and 144 patients underwent excision and secondary wound healing.
Dis Colon Rectum · PMID 39115207 · Read it on PubMed ↗
Brown et al. 2024
Treatment options for patients with pilonidal sinus disease: PITSTOP, a mixed-methods evaluation
Major surgery: more pain, fewer recurrencesProspective cohortModerate qualityRelated question
667 people2024
major surgery caused more pain and complications and took longer to heal, but had a lower chance of the disease returning
Who was studied
adults referred for surgery to treat pilonidal sinus disease (a condition causing pain near the top of the buttock crack)
What they received
major surgical procedures for pilonidal disease
Compared with
minor surgical procedures for pilonidal disease
Main outcome
pain after surgery, complications, time to heal, return to normal activities, and disease coming back
Quality
it was a large multi-centre observational study with statistical adjustment for confounding, but not a randomized trial and had incomplete follow-up data
Limitations
Incomplete recruitment and follow-up data were an issue, particularly given the multiple interventions. Assumptions were made regarding risk adjustment.
Taken word for word from the abstract
- population Patients aged > 16 years referred for elective surgical treatment of pilonidal disease.
- intervention Over half of patients (60%; N = 667) had a major procedure.
- comparator Outcomes compared between major and minor procedures using regression modelling
- primaryOutcome Pain postoperative days 1 and 7, time to healing and return to normal activities, complications, recurrence.
- result For these procedures, pain was greater on day 1 and day 7
- result There were higher complication rates (adjusted risk difference 17.5%, 95% confidence interval 9.1 to 25.9%, n = 579), lower recurrence (adjusted risk difference -10.1%, 95% confidence interval -18.1 to -2.1%, n = 575), and longer time to healing
- n Over half of patients (60%; N = 667) had a major procedure.
Health Technol Assess · PMID 39045854 · Read it on PubMed ↗
Yailian et al. 2024
Effectiveness and safety of an innovative silicone extender in suture reinforcement or dermatotraction: a retrospective study
Helped close surgical wounds after excision.RetrospectiveLow qualityRelated question
50 people2024
82% of patients healed completely within 7 days after the device was removed, but 16% had complications including inflammation, wound reopening, skin death, or pain
Who was studied
patients with large surgical wounds, mostly after skin cancer removal and a few after pilonidal disease surgery
What they received
a silicone tissue extender device to help close the wound (dermatotraction/suture reinforcement)
Compared with
no comparison group
Main outcome
time for the wound to fully close
Quality
This is a small, single-center retrospective case series without a comparison group, so it can't reliably show the device works better than other methods.
Limitations
Retrospective design, no control group, small sample, mostly skin-cancer-excision patients rather than pilonidal disease, and one author co-owns the patent on the device.
Taken word for word from the abstract
- n We identified 50 patients from July 2017 to December 2018.
- population Patients underwent cutaneous tumour-wide excision (n=44), or pilonidal disease surgical treatment (n=6).
- intervention The tissue extender MID SEW (MID, France) was developed to achieve dermatotraction or suture reinforcement.
- comparator A single-centre retrospective and observational study on an unselected consecutive cohort of patients treated with a tissue extender was conducted.
- primaryOutcome The main outcome measure was the time to complete wound closure.
- result Healing was complete, without secondary dehiscence, within the first seven days after device withdrawal for 41 patients (82%).
- result At least one AE was experienced by eight patients (16%) during the study period: five inflammation; five wound dehiscence; two skin necrosis; and one pain.
J Wound Care · PMID 38967343 · Read it on PubMed ↗
Amir et al. 2024
Endoscopic pilonidal sinus treatment (EPSiT) for sacrococcygeal pilonidal sinus disease: A prospective long-term study
Good healing, low recurrence rate.Case seriesLow quality
67 people1-7 years
most patients healed completely with low recurrence and high satisfaction
Who was studied
people with pilonidal sinus disease (cyst/infection at top of buttock crack)
What they received
minimally invasive endoscopic pilonidal sinus treatment (EPSiT)
Compared with
none (single-group study, before/after surgery)
Main outcome
wound healing time, complications, and recurrence of the sinus
Quality
This was a single-group study without a comparison treatment, so it can't show this procedure is better than other options.
Limitations
No control group for comparison; single surgical team; relies partly on telephone follow-up for recurrence.
Taken word for word from the abstract
- n Of the 67 patients, 55(82%) were males and 12(18%) were females.
- population comprised all pilonidal sinus cases undergoing minimal invasive endoscopic pilonidal sinus treatment
- intervention endoscopic pilonidal sinus treatment
- comparator treated by a single surgical team
- primaryOutcome The primary outcomes were duration of healing, post-operative morbidities, persistence of discharge and recurrence at 1-7 years.
- result Complete wound healing was achieved in 60(89.6%) patients, while recurrence was seen in 7(10.4%).
- followUp recurrence at 1-7 years
J Pak Med Assoc · PMID 38948976 · Read it on PubMed ↗
Towfighi et al. 2024
Propeller Flap Reconstruction Following Pilonidal Cyst Excision: A Single-Center Experience With Same-Day Discharge
Surgical flap repair worked well, low recurrenceRetrospectiveLow qualityRelated question
26 people4.1 ± 5.4 months
all flaps survived, some minor wound problems, and about 1 in 9 patients had the cyst come back
Who was studied
patients having surgery to remove pilonidal cysts (small pockets at top of buttock crease)
What they received
propeller flap skin reconstruction after cyst removal, with same-day discharge
Compared with
none (single-group case series)
Main outcome
flap survival, complications, and disease recurrence after surgery
Quality
this is a small retrospective review of one surgical technique without a comparison group, so it can't show whether this method is better than others.
Limitations
retrospective chart review, small sample, short follow-up, no comparison group
Taken word for word from the abstract
- n Twenty-eight outpatient propeller flap reconstructions following pilonidal cyst resections were identified in 26 patients
- population pilonidal cyst resection
- intervention Propeller flap reconstruction following pilonidal cyst resection and demonstrates the efficacy of same-day discharge
- comparator A single-institution retrospective chart review was performed for propeller flap reconstructions completed from March 2018 to July 2022.
- primaryOutcome Primary outcomes included flap survival, flap complications, and pilonidal disease recurrence.
- result Flap survival was 100% (n = 28), with five flaps (17.9%) experiencing minor wound complications and one patient (3.8%) requiring return to the operating room.
- result Pilonidal disease recurrence occurred in three patients (11.5%).
Ann Plast Surg · PMID 38885167 · Read it on PubMed ↗
Salih et al. 2024
Co-occurrence of posterior chest wall pilonidal sinus with melanocytic nevus: a challenging presentation: a case report
Rare mole plus sinus on back.Case seriesVery low qualityRelated question
1 people2024
the lesion was a mole combined with an inflamed pilonidal sinus in an unusual location on the back, not the buttock crack
Who was studied
46-year-old woman with a painful dark skin lesion on her upper back
What they received
surgical removal of the lesion
Compared with
none
Main outcome
diagnosis of the lesion after removal
Quality
This is a single patient case report, which cannot show how common or treatable this condition is.
Limitations
Only one patient was studied, and the lesion was on the upper back, not the area between the buttocks.
Taken word for word from the abstract
- n A 46-year-old female presented
- population A 46-year-old female presented with a long-standing black lesion on her left upper posterior chest wall, that had become painful in the two months prior to presentation.
- intervention the lesion was excised totally with primary closure under local anaesthesia
- comparator the lesion was excised totally with primary closure under local anaesthesia
- primaryOutcome Histopathological examination revealed intradermal melanocytic nevus with inflamed pilonidal sinus.
- result Histopathological examination revealed intradermal melanocytic nevus with inflamed pilonidal sinus.
J Cardiothorac Surg · PMID 38867278 · Read it on PubMed ↗
Farhat et al. 2024
Partial Gluteus Muscle Flap for Treatment of Chronic, Recalcitrant Pilonidal Cyst Disease
Mostly healed, some infections recurred.Case seriesLow quality
11 people1.6-7 years
7 of 11 patients healed without problems; 3 had infection recur and 1 had the wound reopen
Who was studied
young adults aged 14-31 with recurrent, chronic pilonidal cysts after prior surgeries
What they received
partial gluteus maximus muscle flap surgery to close the wound after cyst removal
Compared with
none - all patients received the flap procedure, compared to their own prior failed treatments
Main outcome
wound healing and recurrence of infection after surgery
Quality
This is a very small study of only 11 patients with no comparison group, so it can't prove this surgery is better than other options.
Limitations
Very small number of patients, no control group for comparison, and some patients still had complications like infection recurrence and wound dehiscence.
Taken word for word from the abstract
- n Eleven patients were included in the study (four women and seven men).
- population 11 patients aged 14-31 with recurrent pilonidal cysts
- intervention wound closure using the partial gluteus muscle flap
- comparator The mean number of previous procedures was 2.25 (range, 2-3).
- primaryOutcome the majority, specifically seven individuals, experienced uneventful healing
- result Three patients developed an infection recurrence: one was treated conservatively, and one required reoperation with resolution of symptoms, and one patient also experienced wound dehiscence, which was closed with a small procedure.
Plast Reconstr Surg Glob Open · PMID 38859808 · Read it on PubMed ↗
Draullette et al. 2024
SiLaT: A paradigm shift in the treatment of pilonidal disease?
High healing rate, patients very satisfied.Case seriesLow quality
111 people339.2 (± 221.4) days
78.4% of patients healed, with a median healing time of 20 days
Who was studied
adults with pilonidal disease (sinus) treated with laser therapy
What they received
sinus laser therapy (SiLaT) for pilonidal disease
Compared with
none (single-arm study, no comparison group)
Main outcome
healing of the pilonidal sinus (closure of skin openings without drainage or abscess)
Quality
This is a single-center retrospective case series without a comparison group, so it cannot prove the laser worked better than other treatments.
Limitations
Retrospective design, no control group, and no predictive factors for healing were identified.
Taken word for word from the abstract
- n 111 consecutive patients
- population All adult patients, who underwent SiLaT in our department for a primary or recurrent pilonidal sinus
- intervention sinus laser therapy (SiLaT)
- comparator All adult patients, who underwent SiLaT in our department
- primaryOutcome Healing was defined as the closure of cutaneous orifices and the absence of seepage or abscesses.
- result A healing rate of 78.4% was observed, with a median time to healing of 20.0 days (15.0-30.0).
- followUp The mean follow-up was 339.2 (± 221.4) days.
J Visc Surg · PMID 38849230 · Read it on PubMed ↗
Dainius et al. 2024
Surgical treatment of pilonidal disease - Short-term follow up results of minimally invasive pit-picking surgery versus radical excision without suturing: A prospective randomised trial
Less pain, faster healing with pit-picking surgery.Randomised trialModerate quality
100 people6 months
pit-picking surgery caused less pain in the first week, healed faster (17 days vs 60 days), with similar failure rates between groups
Who was studied
adults with chronic symptomatic pilonidal disease at the top of the buttock crack
What they received
minimally invasive pit-picking surgery
Compared with
radical excision surgery without stitching the wound closed
Main outcome
pain in the first week after surgery, failed surgery rate, and wound healing time
Quality
it was a randomized trial but only looked at short-term results and some patients were lost to follow-up.
Limitations
only short-term follow-up (6 months), 11% of patients lost to follow-up, recurrence not assessed long-term
Taken word for word from the abstract
- population 100 adult patients with chronic symptomatic PD
- intervention minimally invasive pit-picking surgery
- comparator radical excision with open healing
- primaryOutcome pain within the first postoperative week, failed surgery rates, and wound healing time
- result Pain levels the first postoperative week were significantly lower in the pit-picking group compared to the radical excision group, with median scores of 10.0 and 20.0, respectively (p = 0.002).
- result The complete wound healing time was longer in the radical excision group (60 days) versus the pit-picking group (17 days), with a significant difference noted (p = 0.00).
- result No significant difference was observed between the type of surgery and the rate of failed surgery, with 5 (11.9 %) cases in the pit-picking group and 4 (8.5 %) in the radical excision group.
- n A total of 100 adult patients with chronic symptomatic PD were enrolled in this study
- followUp A total of 89 patients (89 %) were available for follow-up after 6 months.
Heliyon · PMID 38845858 · Read it on PubMed ↗
Tas et al. 2024
A new midline closure technique without skin sutures: Long-term outcomes of primary repair of pilonidal sinus disease
Less recurrence with stitch-free closure.Randomised trialModerate qualityRelated question
160 peoplefive-year mean follow-up
five patients (6.2%) in the standard closure group had the sinus come back compared to none in the stitch-free group, and the stitch-free group also had fewer wound infections/seromas
Who was studied
men who had pilonidal sinus disease needing surgery
What they received
excision followed by midline wound closure without skin stitches
Compared with
excision followed by standard primary closure with skin stitches
Main outcome
long-term wound complications and recurrence of the disease after surgery
Quality
it was a randomized trial, which is strong, but it only studied men without complicated or recurrent disease at two centers, limiting how broadly the result applies.
Limitations
only male patients were included, patients with recurrent, complicated, or previously operated pilonidal disease were excluded, and the study only compares two surgical techniques rather than explaining the underlying cause of pain.
Taken word for word from the abstract
- population male patients with pilonidal sinus disease
- intervention excision and midline closure without skin sutures
- comparator excision and primary closure
- primaryOutcome compare postoperative long-term complications and recurrence of two surgical techniques
- result five patients (6.2%) in Group 1 had recurrence compared to none in Group 2 (p = 0.023)
- n Group 1 (n=80; excision and primary closure) or Group 2 (n=80; excision and midline closure without skin sutures)
- followUp five-year mean follow-up
An Sist Sanit Navar · PMID 38725367 · Read it on PubMed ↗
Paz Oliveira et al. 2024
Minimum energy laser pilonidotomy (MELPi): a multicenter study of a novel method in pilonidal disease
Low pain, quick recovery, some recurrence.RetrospectiveVery low quality
47 people12 months
low pain, low complication rate, fast return to activities, 10% recurrence
Who was studied
patients with pilonidal disease (hair-containing cyst/infection near the tailbone)
What they received
minimal energy laser pilonidotomy (MELPi), a laser procedure to treat the pilonidal tract
Compared with
none (no comparison group; all patients received MELPi)
Main outcome
pain, complications, healing time, recurrence, and return to activities after the procedure
Quality
This was a small retrospective case series with no comparison group, so it can't show whether MELPi works better than other treatments.
Limitations
Retrospective design, no control group, small number of patients, multiple centers may differ in technique.
Taken word for word from the abstract
- n We included 47 consecutive patients who underwent 50 "minimal energy pilonidotomies (MELPi)" between 2019 and 2023 in four centers in Brazil.
- population pilonidal disease (PD)
- intervention "minimal energy pilonidotomies (MELPi)"
- comparator This is a retrospective multicenter study.
- primaryOutcome Age, BMI, gender, smoking, diabetes, Guner classification, duration of illness, energy, hospitalization time, complications, recurrence, wound closure, pain, and return to activities were analyzed.
- result MELPi shows promising initial results: low pain, low complication rates, and a fast activity return.
- result recurrence occurred in 5 (10%)-in 3 patients, a second MELPi procedure was performed and was effective.
- followUp The average following time was 12 months
Updates Surg · PMID 38704463 · Read it on PubMed ↗
Singh et al. 2024
Management of Pilonidal Disease and Hidradenitis Suppurativa
General treatment overview, no outcome data.Narrative reviewVery low quality
size not given2024
the abstract recommends hair removal and surgical options for pilonidal disease, and medical management followed by wide excision for severe hidradenitis suppurativa, without reporting outcome data
Who was studied
healthy young adults with pilonidal disease and hidradenitis suppurativa
What they received
hair removal and surgical treatment for pilonidal disease; topical agents, antibiotics, biologics, and wide excision for hidradenitis suppurativa
Main outcome
approach to managing pilonidal disease and hidradenitis suppurativa
Quality
This is a general review describing treatment options without presenting study data or outcomes to judge effectiveness.
Limitations
No specific patient numbers, outcomes, or comparative data are reported; it is a general management overview rather than a study of effectiveness.
Taken word for word from the abstract
- population Pilonidal disease and hidradenitis suppurativa affect healthy young adults
- intervention Patients with pilonidal disease should engage in hair removal to the sacrococcygeal region and surgical options considered.
- intervention 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.
- primaryOutcome causing discomfort and pain that leads to loss of work productivity and should be approached in a personalized manner
- result Patients with pilonidal disease should engage in hair removal to the sacrococcygeal region and surgical options considered.
Surg Clin North Am · PMID 38677816 · Read it on PubMed ↗
Lee et al. 2024
Classification and stratification in pilonidal sinus disease: findings from the PITSTOP cohort
Classification tool only moderately reliable.Prospective cohortLow qualityRelated question
size not given2024
assessors using the IPS tool agreed on the same classification in only 38% of cases, with moderate chance-corrected agreement, while the tool's items matched other published systems and tracked differences in pain and quality of life between groups
Who was studied
people with pilonidal sinus disease in the PITSTOP cohort study
What they received
the International Pilonidal Society (IPS) four-part classification tool
Compared with
other published pilonidal disease classification tools and agreement between different raters
Main outcome
how valid and reliable the IPS classification system is for describing pilonidal disease
Quality
this is a tool-validation study with modest agreement between raters (38% exact agreement) rather than a treatment trial, so it says little about why symptoms occur or how to treat them.
Limitations
The abstract reports only moderate interrater agreement (38% exact match) and does not give the number of patients in the cohort, only 90 images rated.
Taken word for word from the abstract
- population using data from the PITSTOP cohort study
- intervention The International Pilonidal Society (IPS) proposed a four-part classification in 2017.
- comparator Interrater reliability was assessed using images captured during the PITSTOP cohort. Ninety images were assessed by six raters (two experts, two general surgeons and two trainees), and classified into IPS type.
- primaryOutcome The aim of this work was to assess the validity and reliability of this tool using data from the PITSTOP cohort study.
- result Assessors agreed the same classification in 38% of participants [chance-corrected kappa 0.52 (95% CI 0.42-0.61), Gwet's AC1 0.63 (95% CI 0.56-0.69)].
Colorectal Dis · PMID 38644667 · Read it on PubMed ↗
Dreznik et al. 2024
Recurrence rates of pilonidal sinus disease in the pediatric population following trephine surgery
Low recurrence after minimally invasive surgery.RetrospectiveLow qualityRelated question
565 people2024
the problem came back in 8.1% of patients, and after a second surgery using the same method, only 1% had further recurrence
Who was studied
children and teens who had surgery for a pilonidal sinus (a cyst near the top of the buttock crease)
What they received
minimally invasive surgery (Gips procedure) for pilonidal sinus disease
Compared with
none - all patients received the same procedure; repeat surgery used the same method
Main outcome
how often the problem came back after surgery
Quality
it is a single-center retrospective study with no comparison group, so it can show how often one surgery worked but not how it compares to other treatments.
Limitations
retrospective design, single center, no comparator group to other surgical methods
Taken word for word from the abstract
- population pediatric patients that underwent Gips procedure due to PSD
- intervention Gips procedure
- comparator using the same surgical approach during re-operation
- primaryOutcome assess recurrence rates following the Gips procedure
- result Recurrence rate was 8.1% (n = 46)
- result Following the second surgery, only 8 patients (1%) had multiple recurrences.
- n 565 pediatric patients underwent an elective surgery for PSD in the study period
World J Surg · PMID 38554245 · Read it on PubMed ↗
Gratiashvili et al. 2024
Efficacy of laser obliteration with limited excision of pilonidal sinus
Laser treatment healed faster.Prospective cohortModerate quality
152 people2024
Complete healing occurred in 97.4% of LOLE patients versus 100% of WE patients; healing took about 6.5 weeks with LOLE versus 14.5 weeks with WE; recurrence was 7.9% with LOLE versus 1.3% with WE, not a significant difference.
Who was studied
patients with chronic pilonidal sinus disease
What they received
laser obliteration with limited excision (LOLE) of the pilonidal sinus
Compared with
wide excision (WE) of the pilonidal sinus
Main outcome
complete wound healing, recurrence, and the complication rate
Quality
It compared two treatments in real patients but wasn't randomized, so differences could be due to other factors.
Limitations
Observational, not randomized, which can bias comparisons between treatments.
Taken word for word from the abstract
- n A prospective, cross-sectional observational study of 152 patients with chronic pilonidal sinus disease
- population 152 patients with chronic pilonidal sinus disease
- intervention laser obliteration with limited excision (LOLE)
- comparator wide excision (WE) of the pilonidal sinus
- primaryOutcome The main evaluation criteria were complete wound healing, recurrence, and the complication rate.
- result Complete healing was achieved in 74 (97.4%) patients in the LOLE group and 76 (100%) patients in the WE group. The duration of wound healing was significantly shorter in the LOLE group than in the WE group (6.5 ± 2.4 vs. 14.5 ± 2.6 weeks, respectively). Recurrence developed in six (7.9%) patients in the LOLE group and one (1.3%) patient in the WE group, with no significant difference.
J Int Med Res · PMID 38530042 · Read it on PubMed ↗
Giles et al. 2024
Pit excision with fibrin glue closure versus lateralizing flap procedures in the management of pilonidal sinus disease in adolescents: a 14-year cohort study
Fewer repeat surgeries with simpler technique.RetrospectiveModerate quality
78 people2.21 and 2.52 years
Pit excision with fibrin glue had a non-significantly lower recurrence rate but significantly fewer repeat surgeries, shorter operation time, and less wound breakdown than flap surgery
Who was studied
adolescents with chronic pilonidal sinus disease (hair follicle infection at the top of the butt crack)
What they received
pit excision with fibrin glue closure (a minimally invasive surgery)
Compared with
traditional lateralizing flap surgery
Main outcome
recurrence of the condition and need for repeat surgery
Quality
This was a non-randomized comparison of two surgeries over many years, so differences in patients over time could affect results, but it is a large, long-running study for this condition in children.
Limitations
Retrospective design (not randomized), follow-up time differed between the two groups, single-center study.
Taken word for word from the abstract
- population Pilonidal sinus disease (PSD) arises in the hair follicles of the gluteal cleft with many cases occurring during adolescence.
- intervention pit excision with fibrin glue closure (PEF)
- comparator lateralizing flap procedures (LFP)
- n Seventy-eight children had 33 primary PEF and 45 primary LFP procedures
- primaryOutcome Recurrence and complications rates alongside their demographic and disease severity data were compared
- result The overall recurrence rate in each cohort was 3% for PEF and 11% for LFP, respectively (p = 0.2346). The all-cause repeat intervention rate was 12% and 49% in the PEF and LFP cohorts, respectively (p = 0.0007).
- result Wound dehiscence was significantly decreased in the PEF cohort compared to the LFP cohort (3% vs 31%; p = 0.0026).
- followUp median follow-up of 2.21 and 2.52 years, respectively
Pediatr Surg Int · PMID 38512592 · Read it on PubMed ↗
Liang et al. 2024
Pilonidal disease in the pregnant patient: A case report
Symptoms recurred, resolved after postpartum surgery.Case seriesVery low quality
1 people2024
symptoms came back more than once but resolved; after postpartum surgery there was no further recurrence
Who was studied
a 22-year-old pregnant woman having her first baby
What they received
non-operative management during pregnancy, then minimally invasive surgery after birth
Compared with
no comparison group, just her own course over time
Main outcome
whether her pilonidal disease symptoms went away and stayed away
Quality
this is a single patient's case report, so it cannot show whether treatments generally work.
Limitations
only one patient described, so findings may not apply to others; abstract notes the cause 'warrants further investigation'
Taken word for word from the abstract
- n An otherwise healthy primigravid 22-year-old woman developed pilonidal disease at the beginning of her pregnancy
- population An otherwise healthy primigravid 22-year-old woman developed pilonidal disease at the beginning of her pregnancy
- intervention She was managed non-operatively during pregnancy.
- intervention she underwent definitive management via minimally invasive Gips procedure in the postpartum period, without further recurrence
- comparator Pilonidal disease affects pregnant patients and can be managed non-operatively.
- primaryOutcome Her symptoms recurred again in the postpartum period but they quickly resolved.
- result While pregnant, her symptoms recurred once and resolved without treatment.
- result she underwent definitive management via minimally invasive Gips procedure in the postpartum period, without further recurrence
Int J Surg Case Rep · PMID 38507939 · Read it on PubMed ↗

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

Searched: PubMed · ClinicalTrials.gov · Crossref on 2026-10-13
The exact search — paste this into PubMed to repeat it: ("Pilonidal Sinus"[Mesh] OR "pilonidal cyst"[tiab] OR "pilonidal disease"[tiab] OR "natal cleft"[tiab] OR "intergluteal"[tiab]) AND (symptoms[tiab] OR pain[tiab] OR bleeding[tiab] OR swelling[tiab] OR recurrence[tiab] OR diagnosis[tiab]); PubMed expanded that to: ("Pilonidal Sinus"[MeSH Terms] OR "pilonidal cyst"[Title/Abstract] OR "pilonidal disease"[Title/Abstract] OR "natal cleft"[Title/Abstract] OR "intergluteal"[Title/Abstract]) AND ("symptoms"[Title/Abstract] OR "pain"[Title/Abstract] OR "bleeding"[Title/Abstract] OR "swelling"[Title/Abstract] OR "recurrence"[Title/Abstract] OR "diagnosis"[Title/Abstract])
What came back: 1235 records found · 198 read · 179 answered the question
Included: Human, animal or laboratory studies reporting an outcome relevant to the question
Excluded: Records about a different condition or intervention
Records reporting no outcome
Retracted publications, which are listed but excluded from every count
Limits: Details were read from abstracts, not full papers, so anything reported only in a paper's methods section is not captured here.
Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured.
Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.

1235records came back from the search
198were read
179actually answered the question

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

It's an embarrassing spot, so many people hope the pain or bump will just go away rather than seeing a doctor.
Online advice often suggests home remedies like warm compresses, squeezing, or shaving before seeing a clinician.
Laser hair removal is marketed as a way to prevent this from coming back, so people try it hoping to avoid surgery altogether.
The pain can come and go, so it's easy to assume it isn't serious when it temporarily settles down.

Common questionsShort answers, drawn from the same studies.

Why is there a bump at the top of my butt crack and it hurts?: A painful bump there is most often a pilonidal cyst or abscess — a pocket under the skin that can fill with hair, skin debris, and fluid and become infected. It usually needs a clinician to examine, and sometimes drain, it; studies show draining the abscess and clearing out the tunnel together lowers the chance it comes back, compared with draining alone.
Why is the top of my bum crack split and sore?: This is usually the opening (or 'pit') of a pilonidal sinus — a small tunnel under the skin — rather than a simple skin crack. These pits can become irritated, infected, or start draining fluid, which is why the area can look split and feel sore.
Why is my butt crack bleeding?: Bleeding from this area is a recognised symptom of pilonidal disease, reported alongside pain and discharge in several studies, and it can also happen after some in-clinic treatments. Persistent or heavy bleeding should be checked by a clinician rather than watched at home, since these studies don't tell us how to safely tell causes apart without an exam.
Why does skin crack on top of butt?: What looks like a cracked patch of skin is usually one or more small pits of a pilonidal sinus, sometimes alongside ordinary skin irritation from sweat and friction in that crease. It generally isn't a simple dry-skin crack.
What should I do instead of waiting for it to go away on its own?: See a doctor or nurse, especially if there's swelling, pus, bleeding, or a sore that isn't healing. The studies here found that pilonidal disease often recurs and, when left chronically unresolved, has rarely been linked to serious infection or even skin cancer, so getting a proper diagnosis matters more than waiting it out.

This is information, not advice

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

Contact the office

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

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

Educational information — not medical advice.