{ "slug": "why-does-the-top-of-my-butt-crack-hurt", "question": "Why does the top of my butt crack hurt?", "shortTitle": "Butt Crack Pain (Pilonidal Disease)", "clinicalQuestion": "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?", "pico": { "population": "Adults and adolescents with pain, swelling, a bump, skin splitting, or bleeding localized to the top of the natal cleft (intergluteal fold)", "intervention": "Clinical and imaging evaluation to identify the underlying cause (e.g., pilonidal sinus/cyst, abscess, folliculitis)", "comparator": "Other causes of intergluteal/natal cleft pain such as hidradenitis suppurativa, perianal abscess, or simple skin irritation", "outcomes": [ "Diagnosis of pilonidal sinus disease vs other etiologies", "Rate of abscess formation", "Recurrence after initial resolution", "Need for surgical excision", "Frequency of bleeding or discharge", "Time to symptom resolution" ] }, "category": "anorectal", "relatedConditions": [ "pilonidal-disease", "hidradenitis-suppurativa", "perianal-abscess" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "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.", "detail": "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.", "studyIds": [ "pmid:42633928", "pmid:41631611", "pmid:42730257", "pmid:39212563", "pmid:41466774", "pmid:40965774", "pmid:42027172", "pmid:40861268" ] }, "strength": { "level": "moderate", "why": "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.", "override": null }, "direction": { "level": "harm-signal", "why": "11 studies reported harm or tissue damage, including laboratory evidence.", "override": null }, "counts": { "recordsRetrieved": 1235, "recordsScreened": 198, "included": 179, "rcts": 14, "systematicReviews": 21, "observational": 83, "participants": 736732, "yearFrom": 2024, "yearTo": 2026, "registeredTrialsWithoutResults": 0 }, "excluded": [], "outcomes": [ { "name": "Pilonidal disease vs. other causes of pain at the top of the crease", "status": "insufficient", "note": "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.", "studyIds": [ "pmid:40861268", "pmid:40199281", "pmid:41800580", "pmid:42725170", "pmid:41550458", "pmid:41466774", "pmid:39212563", "pmid:40829408", "pmid:39116170", "pmid:39156280", "pmid:40952828" ] }, { "name": "Abscess (sudden painful swelling with pus)", "status": "insufficient", "note": "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.", "studyIds": [ "pmid:41058826", "pmid:41454773", "pmid:42522216" ] }, { "name": "Recurrence after treatment", "status": "possible-improvement", "note": "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.", "studyIds": [ "pmid:42633928", "pmid:41999968", "pmid:41854814", "pmid:41752637", "pmid:41810655", "pmid:41904336", "pmid:40679024", "pmid:41631611", "pmid:40931185" ] }, { "name": "Need for surgical treatment", "status": "possible-improvement", "note": "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.", "studyIds": [ "pmid:42020338", "pmid:41461191", "pmid:39893840", "pmid:39815683", "pmid:41838186" ] }, { "name": "Bleeding or discharge from the area", "status": "insufficient", "note": "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.", "studyIds": [ "pmid:42830906", "pmid:39708093" ] }, { "name": "Time to symptom resolution", "status": "possible-improvement", "note": "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.", "studyIds": [ "pmid:38845858", "pmid:39115207", "pmid:38530042" ] }, { "name": "Serious complications, including missed cancer diagnosis", "status": "possible-harm", "note": "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.", "studyIds": [ "pmid:42730257", "pmid:42725170", "pmid:41550458", "pmid:41466774", "pmid:39212563" ] } ], "benefits": [ { "text": "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).", "studyIds": [ "pmid:38845858", "pmid:40108765", "pmid:41749610", "pmid:39427709" ] }, { "text": "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.", "studyIds": [ "pmid:42633928", "pmid:41854814", "pmid:41058826", "pmid:41752637" ] }, { "text": "Most people treated for pilonidal disease, across many different techniques, end up healed, even though some need a second procedure.", "studyIds": [ "pmid:42633928", "pmid:42168379", "pmid:41397828", "pmid:41074563" ] } ], "limitations": [ { "text": "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.", "studyIds": [ "pmid:42822663", "pmid:42347916", "pmid:41904336" ] }, { "text": "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.", "studyIds": [ "pmid:42633928", "pmid:41999968", "pmid:39995244" ] }, { "text": "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.", "studyIds": [ "pmid:41904336", "pmid:41810655", "pmid:40679024" ] }, { "text": "No study compared getting any treatment with doing nothing at all, so this evidence cannot describe how the condition behaves if left completely untreated.", "studyIds": [ "pmid:42347916" ] } ], "risks": [ { "text": "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.", "studyIds": [ "pmid:42730257" ], "severity": "serious" }, { "text": "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.", "studyIds": [ "pmid:42725170", "pmid:41550458", "pmid:41466774", "pmid:39212563" ], "severity": "serious" }, { "text": "People with pilonidal sinus disease had a higher rate of depression over five years compared with people without it, in one large population study.", "studyIds": [ "pmid:40965774" ], "severity": "serious" }, { "text": "Women had higher recurrence rates than men after pilonidal surgery in more than one study, including after cleft-lift surgery.", "studyIds": [ "pmid:42027172", "pmid:39871414" ], "severity": "minor" }, { "text": "Cold spray (cryotherapy) used for numbing during laser hair removal caused hives (urticaria) at the treatment site in two reported cases.", "studyIds": [ "pmid:42578112" ], "severity": "minor" }, { "text": "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.", "studyIds": [ "pmid:42137074" ], "severity": "minor" }, { "text": "Residue from silver-containing wound dressings was reported to interfere with MRI imaging, delaying diagnosis of a hidden fistula in one patient.", "studyIds": [ "pmid:42700038" ], "severity": "minor" } ], "whyPeopleTryIt": [ { "text": "It's an embarrassing spot, so many people hope the pain or bump will just go away rather than seeing a doctor." }, { "text": "Online advice often suggests home remedies like warm compresses, squeezing, or shaving before seeing a clinician." }, { "text": "Laser hair removal is marketed as a way to prevent this from coming back, so people try it hoping to avoid surgery altogether." }, { "text": "The pain can come and go, so it's easy to assume it isn't serious when it temporarily settles down." } ], "keyStudies": [ "pmid:42633928", "pmid:41631611", "pmid:42730257", "pmid:39212563", "pmid:41466774", "pmid:40965774", "pmid:42027172", "pmid:40861268" ], "studies": [ { "id": "pmid:42862392", "pmid": "42862392", "doi": "10.1007/s00383-026-06673-3", "nctId": null, "pmcid": null, "title": "Neighborhood socioeconomic opportunity and clinical presentation, recurrence, and longitudinal treatment intensity in adolescent pilonidal disease", "firstAuthor": "Ehsan", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2026, "design": "retrospective", "n": 393, "nField": "reported", "population": "adolescents evaluated for pilonidal disease at a specialty clinic", "intervention": "living in a neighborhood with the lowest socioeconomic opportunity (Q1)", "comparator": "living in neighborhoods with higher socioeconomic opportunity", "primaryOutcome": "disease stage at presentation, symptom duration, recurrence, receipt of laser therapy, and number of completed laser treatment sessions", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective, single-center cohort; cannot establish causation and does not address pain mechanism or treatment effectiveness.", "followUp": "", "plainFinding": "Poorer areas got less laser treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42862392/", "sourceText": "BACKGROUND: Pilonidal disease is a chronic inflammatory condition of adolescence requiring sustained outpatient management, yet the impact of neighborhood-level social determinants of health on disease course and treatment intensity remains unclear. METHOD: We conducted a retrospective cohort study of adolescents evaluated for pilonidal disease at a high-volume specialty clinic from 2019 to 2024. Residential addresses were geocoded and linked to census tract-level socioeconomic opportunity using the California Healthy Places Index (HPI). HPI was analyzed continuously, by quintiles, and using a prespecified lowest-quintile (Q1) threshold contrast. Outcomes included disease stage at presentation, symptom duration, recurrence, receipt of laser epilation, and number of completed laser sessions. Multivariable models adjusted for age and sex; treatment intensity models additionally adjusted for stage and recurrence. RESULTS: Among 393 adolescents (median age 17.0 years[IQR:15.3-18.8]), 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. CONCLUSIONS: Neighborhood-level social determinants were associated with reduced continuity of ambulatory surgical care, reflected by lower longitudinal laser treatment intensity, suggesting structural influences on continuity of ambulatory surgical care rather than biologic disease trajectory.", "provenance": [ { "field": "n", "quote": "Among 393 adolescents (median age 17.0 years[IQR:15.3-18.8])" }, { "field": "population", "quote": "adolescents evaluated for pilonidal disease at a high-volume specialty clinic from 2019 to 2024" }, { "field": "intervention", "quote": "Q1 residence was independently associated with fewer completed laser sessions" }, { "field": "comparator", "quote": "HPI was analyzed continuously, by quintiles, and using a prespecified lowest-quintile (Q1) threshold contrast" }, { "field": "primaryOutcome", "quote": "Outcomes included disease stage at presentation, symptom duration, recurrence, receipt of laser epilation, and number of completed laser sessions" }, { "field": "result", "quote": "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" } ] }, { "id": "pmid:42830906", "pmid": "42830906", "doi": "10.7759/cureus.115748", "nctId": null, "pmcid": "PMC13634159", "title": "Sinus Laser-Assisted Closure Under Tumescent Local Anesthesia for Pilonidal Disease: A Pilot Study", "firstAuthor": "Pomper", "multipleAuthors": true, "journal": "Cureus", "year": 2026, "design": "case-series", "n": 22, "nField": "reported", "population": "patients with pilonidal sinus disease", "intervention": "laser treatment of the sinus (SiLaC) using tumescent local anesthesia", "comparator": "none - single-group study, no comparison treatment", "primaryOutcome": "pain levels, complications, and recurrence of the sinus after 90 days", "result": "low pain scores after surgery, only minor complications, and no recurrences at 90 days", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "direct", "limitations": "small sample size, absence of a control group, and limited follow-up", "followUp": "90 days", "plainFinding": "Laser surgery well tolerated, low pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42830906/", "sourceText": "OBJECTIVES: Sinus laser-assisted closure (SiLaC) is a minimally invasive option for management of pilonidal sinus disease (PSD). Tumescent local anesthesia (TLA) may further facilitate outpatient treatment; however, its use in this setting has not been adequately studied. This pilot study aimed to assess the feasibility of SiLaC performed under TLA. MATERIALS AND METHODS: Between September 2025 and January 2026, 22 consecutive patients with PSD underwent SiLaC under TLA. Demographic characteristics, operative time, total volume of tumescent solution, and calculated lidocaine dose were recorded. Pain was assessed preoperatively, intraoperatively, and on postoperative days 1, 2, 3, and 7 using the Visual Analog Scale (VAS; 0-10). Postoperative complications and outpatient follow-up visits were documented, and early recurrence was assessed at 90 days within a predefined follow-up window of 90 ± 7 days. RESULTS: The median age was 23 years (range, 18-62 years), and 19 of 22 patients were male. Median operative time was 30 minutes (range, 25-45 minutes), and median tumescent volume was 160 mL (range, 80-280 mL). Median VAS scores were 1 preoperatively (range, 1-2), 2 intraoperatively (range, 1-3), 3 on postoperative day 1 (range, 1-6), 2.5 on day 2 (range, 1-5), 2 on day 3 (range, 1-7), and 1 on day 7 (range, 1-2). Three minor postoperative events occurred: two cases of localized painful swelling and one case of minor bleeding. No anesthesia-related or major complications were observed. All 22 patients completed the 90-day follow-up; 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). CONCLUSION: SiLaC performed under TLA appears feasible, well tolerated, and safe for appropriately selected patients in an outpatient setting. Given the small sample size, absence of a control group, and limited follow-up, larger prospective comparative studies with longer follow-up are needed to validate these findings and to determine whether TLA offers advantages over conventional local infiltration anesthesia, particularly in more extensive disease.", "provenance": [ { "field": "population", "quote": "22 consecutive patients with PSD underwent SiLaC under TLA" }, { "field": "intervention", "quote": "Sinus laser-assisted closure (SiLaC) is a minimally invasive option for management of pilonidal sinus disease (PSD)" }, { "field": "intervention", "quote": "Tumescent local anesthesia (TLA) may further facilitate outpatient treatment" }, { "field": "comparator", "quote": "Given the small sample size, absence of a control group, and limited follow-up" }, { "field": "primaryOutcome", "quote": "Pain was assessed preoperatively, intraoperatively, and on postoperative days 1, 2, 3, and 7 using the Visual Analog Scale (VAS; 0-10)." }, { "field": "primaryOutcome", "quote": "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)" }, { "field": "result", "quote": "Three minor postoperative events occurred: two cases of localized painful swelling and one case of minor bleeding." }, { "field": "result", "quote": "no recurrences, wound healing disorders, or delayed complications were observed in the full evaluable cohort (0/22)" }, { "field": "n", "quote": "Between September 2025 and January 2026, 22 consecutive patients with PSD underwent SiLaC under TLA." }, { "field": "followUp", "quote": "All 22 patients completed the 90-day follow-up" } ] }, { "id": "pmid:42822663", "pmid": "42822663", "doi": "10.1016/j.jpedsurg.2026.163513", "nctId": null, "pmcid": null, "title": "Evolution of Surgical Management in Pilonidal Disease: A 25-Year Scoping Review and Bibliometric Analysis of Pediatric and Adult Literature", "firstAuthor": "Ehsan", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2026, "design": "systematic-review", "n": 383, "nField": "reported", "population": "adolescents and young adults with pilonidal disease (sacrococcygeal area)", "intervention": "surgical treatments for pilonidal disease, including minimally invasive approaches", "comparator": "traditional operative excision/flap reconstruction", "primaryOutcome": "trends in treatment approach and research focus over time", "result": "research volume grew, with pediatric studies increasingly using minimally invasive methods while adult studies still mostly rely on surgery", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a descriptive review of publication trends, not a study comparing treatments' effectiveness, so it can't say what works best", "directness": "indirect", "limitations": "abstract notes heterogeneity in treatment strategies and research focus, and no pediatric studies from low- or middle-income countries", "followUp": "", "plainFinding": "Review of trends, not treatment effectiveness.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42822663/", "sourceText": "BACKGROUND: Pilonidal disease is a chronic inflammatory condition of the sacrococcygeal region that disproportionately affects adolescents and young adults. Although numerous treatment approaches exist, optimal management remains debated and practice patterns vary widely. How pediatric treatment strategies and research priorities have evolved relative to adult literature remains incompletely understood. METHODS: A scoping review and bibliometric analysis were conducted to evaluate trends in surgical management of pilonidal disease from 2000 to 2025. A systematic PubMed search identified studies reporting clinical data on pilonidal disease treatment. Extracted data included publication year, origin country, patient population, treatment modality, recurrence outcomes, and follow-up duration. Bibliometric analysis assessed publication trends, geographic distribution, and thematic evolution using keyword co-occurrence mapping. RESULTS: A total of 383 studies were included - 327 adult (85%) and 56 pediatric (15%) studies. Publication volume increased steadily over time, with pediatric literature expanding after 2015. Adult studies originated from 36 countries compared with 12 countries in pediatric literature, with no pediatric studies from low- or middle-income countries identified. Operative-only approaches predominated in adult literature (80% vs 61%, p<0.001), while pediatric studies more frequently evaluated minimally invasive and multimodal strategies. Keyword analysis demonstrated temporal evolution from excisional surgery and flap reconstruction toward minimally invasive and adjunctive therapies. CONCLUSIONS: Research on pilonidal disease surgery has increased but remains heterogeneous in treatment strategies and research focus. Pediatric literature represents a small but evolving portion of the evidence base and increasingly explores minimally invasive approaches. Greater standardization and broader international collaboration are needed to develop consistent evidence-based management strategies.", "provenance": [ { "field": "n", "quote": "A total of 383 studies were included - 327 adult (85%) and 56 pediatric (15%) studies." }, { "field": "population", "quote": "Pilonidal disease is a chronic inflammatory condition of the sacrococcygeal region that disproportionately affects adolescents and young adults." }, { "field": "intervention", "quote": "pediatric studies more frequently evaluated minimally invasive and multimodal strategies" }, { "field": "comparator", "quote": "Operative-only approaches predominated in adult literature (80% vs 61%, p<0.001)" }, { "field": "primaryOutcome", "quote": "Bibliometric analysis assessed publication trends, geographic distribution, and thematic evolution using keyword co-occurrence mapping." }, { "field": "result", "quote": "Keyword analysis demonstrated temporal evolution from excisional surgery and flap reconstruction toward minimally invasive and adjunctive therapies." } ] }, { "id": "pmid:42759045", "pmid": "42759045", "doi": "10.1097/ASW.0000000000000523", "nctId": null, "pmcid": null, "title": "Hidradenitis Suppurativa: Part of a Tetrad of Follicular Occlusion Disorders", "firstAuthor": "Sie", "multipleAuthors": true, "journal": "Adv Skin Wound Care", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with follicular occlusion disorders such as hidradenitis suppurativa, acne conglobata, dissecting cellulitis of the scalp, and pilonidal sinus", "intervention": "wound care strategies including dressing selection, exudate and odor management, pain and itch control, infection management, and IV ertapenem rescue therapy", "comparator": "", "primaryOutcome": "understanding of disease mechanisms, clinical features, and wound care management approaches", "result": "the abstract describes disease mechanisms and outlines wound care strategies but does not report comparative outcome data on whether treatments work", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a general educational review article, not a study testing a treatment, so it cannot show whether any treatment works.", "directness": "indirect", "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", "followUp": "", "plainFinding": "Review explains causes, no treatment outcomes tested.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42759045/", "sourceText": "UNLABELLED: Follicular occlusion disorders (FOD) represent a tetrad of chronic, recurrent inflammatory conditions united by a common pathophysiologic mechanism: follicular hyperkeratosis leading to occlusion, rupture, and subsequent abscess or sinus tract formation. First conceptualized as a triad in the 1950s and later expanded to a tetrad in the 1970s, this grouping includes hidradenitis suppurativa (HS), acne conglobata (AC), dissecting cellulitis of the scalp (DCS), and pilonidal sinus (PS). Despite their shared pathogenesis, each condition carries distinct clinical features, epidemiological profiles, and management considerations. This article aims to provide a comprehensive review of FOD, with a primary emphasis on HS (the most prevalent of the disorders). Hidradenitis suppurativa is a debilitating disease affecting ∼1% of the global population, predominantly in females, and the diagnosis is often delayed by 7 or more years. Multiple genes are linked to FOD patients with a positive familial history in 35% to 40%, along with lifestyle factors (smoking, alcohol consumption, and obesity). Key inflammatory mediators, including TNF-α, IL-1β, and IL-17, drive the chronic tissue destruction characteristic of FOD, frequently resulting in scarring, lymphedema, and significant psychosocial impairment. Wound care is critical and often underemphasized in disease management. This article outlines evidence-informed wound care strategies for both nonsurgical and postsurgical presentations, including dressing selection, exudate and odor management, pain and itch control, infection management, and the emerging role of intravenous ertapenem as rescue therapy. An interprofessional approach, integrating dermatology, surgery, wound care nursing, and psychosocial support, is emphasized throughout as essential to improving patient outcomes and quality of life. GENERAL PURPOSE: To increase clinicians' understanding of follicular occlusion disorders including the associated risk factors, clinical manifestations, and evidence-based approaches for management. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will: Assess clinical characteristics of each follicular occlusion disorderEvaluate the basic disease mechanisms for follicular occlusion disordersDescribe principal disease burdens that require wound care attentionIdentify the unique wound care strategies and follicular occlusion disorder challenges JOURNAL/aswca/04.03/00129334-202610000-00004/figure1/v/2026-09-18T181327Z/r/image-jpeg.", "provenance": [ { "field": "population", "quote": "this grouping includes hidradenitis suppurativa (HS), acne conglobata (AC), dissecting cellulitis of the scalp (DCS), and pilonidal sinus (PS)" }, { "field": "intervention", "quote": "This article outlines evidence-informed wound care strategies for both nonsurgical and postsurgical presentations, including dressing selection, exudate and odor management, pain and itch control, infection management, and the emerging role of intravenous ertapenem as rescue therapy." }, { "field": "primaryOutcome", "quote": "This article aims to provide a comprehensive review of FOD, with a primary emphasis on HS (the most prevalent of the disorders)." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:42739779", "pmid": "42739779", "doi": "10.3390/jcm15176770", "nctId": null, "pmcid": "PMC13566079", "title": "Use of Oxygen-Enriched Oil Dressings in Wound Management: A Scoping Review", "firstAuthor": "Sandroni", "multipleAuthors": true, "journal": "J Clin Med", "year": 2026, "design": "systematic-review", "n": 501, "nField": "reported", "population": "patients with surgical wounds, including pediatric postoperative wounds, pilonidal disease, hidradenitis suppurativa wounds, angular cheilitis, and cancer-related wounds", "intervention": "oxygen-enriched oil dressings applied to wounds", "comparator": "not clearly specified across the included studies", "primaryOutcome": "healing time, pain, complications, infection, scar quality and patient satisfaction", "result": "findings were generally favorable for wound healing outcomes, but evidence was limited and preliminary", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "May help wounds heal, evidence weak", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42739779/", "sourceText": "Background/Objectives: Oxygen-enriched oils represent an emerging class of advanced dressings based on the controlled release of reactive oxygen species, with the potential to modulate the wound microenvironment and support reparative processes. Despite their increasing clinical use, the available evidence remains fragmented, and no comprehensive synthesis is currently available on their fields of application and associated outcomes. Methods: A scoping review was conducted in accordance with the Joanna Briggs Institute methodology and the PRISMA-ScR reporting guidelines. PubMed, CINAHL, Scopus, and Web of Science were searched without time restrictions. Studies conducted in patients and evaluating oxygen-enriched oil-based dressings for the management of skin wounds were included. Two independent reviewers selected the studies, extracted and narratively synthesized the data, and performed the quality appraisal. Results: The search identified 142 records; after the selection process, nine studies including a total of 501 patients were included. The studies comprised different designs, ranging from randomized controlled trials to case reports. Applications included pediatric postoperative wounds (distal hypospadias and pilonidal disease), postsurgical wounds related to hidradenitis suppurativa, angular cheilitis, and oncological wounds. 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. Conclusions: Oxygen-enriched oils represent a promising wound-care strategy in different clinical settings. 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.", "provenance": [ { "field": "n", "quote": "nine studies including a total of 501 patients were included" }, { "field": "population", "quote": "Applications included pediatric postoperative wounds (distal hypospadias and pilonidal disease), postsurgical wounds related to hidradenitis suppurativa, angular cheilitis, and oncological wounds." }, { "field": "intervention", "quote": "oxygen-enriched oil-based dressings for the management of skin wounds" }, { "field": "comparator", "quote": "The studies comprised different designs, ranging from randomized controlled trials to case reports." }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:42730257", "pmid": "42730257", "doi": "10.7759/cureus.114407", "nctId": null, "pmcid": "PMC13564028", "title": "Necrotising Fasciitis Following Sinus Laser-Assisted Closure Treatment for Pilonidal Disease: A Case Report", "firstAuthor": "Suenaert", "multipleAuthors": true, "journal": "Cureus", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 49-year-old man with pilonidal disease (a cyst/sinus at the top of the buttock crack)", "intervention": "Sinus Laser-Assisted Closure (SiLaC), a minimally invasive laser treatment for pilonidal disease", "comparator": "none", "primaryOutcome": "development of serious infection (necrotising fasciitis) after the procedure", "result": "the patient developed necrotising fasciitis with severe pain, fever and spreading infection within 24 hours, requiring emergency surgery and antibiotics, but ultimately recovered well", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how common or rare this problem is, only that it can happen.", "directness": "direct", "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.", "followUp": "", "plainFinding": "Rare serious infection after laser treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42730257/", "sourceText": "Sinus Laser-Assisted Closure (SiLaC®) is a minimally invasive treatment for pilonidal disease, characterised by low reported rates of complications. This case report details a 49-year-old male who developed necrotising fasciitis following SiLaC. Within 24 hours postoperatively, the patient presented with severe pain, high fever, and cellulitis; however, crepitus was absent. Imaging revealed subcutaneous air extending up to the twelfth thoracic vertebra. Urgent surgical debridement and drainage were performed, accompanied by the initiation of broad-spectrum antibiotic therapy. Cultures subsequently identified Streptococcus dysgalactiae, allowing for targeted antibiotic management. The patient achieved a favourable recovery. To the best of our knowledge, this represents the first reported case of necrotising fasciitis as a complication of the SiLaC procedure.", "provenance": [ { "field": "population", "quote": "a 49-year-old male who developed necrotising fasciitis following SiLaC" }, { "field": "intervention", "quote": "Sinus Laser-Assisted Closure (SiLaC®) is a minimally invasive treatment for pilonidal disease" }, { "field": "comparator", "quote": "Sinus Laser-Assisted Closure (SiLaC®) is a minimally invasive treatment for pilonidal disease, characterised by low reported rates of complications." }, { "field": "primaryOutcome", "quote": "developed necrotising fasciitis following SiLaC" }, { "field": "result", "quote": "Within 24 hours postoperatively, the patient presented with severe pain, high fever, and cellulitis; however, crepitus was absent." }, { "field": "result", "quote": "The patient achieved a favourable recovery." }, { "field": "n", "quote": "this case report details a 49-year-old male" } ] }, { "id": "pmid:42725170", "pmid": "42725170", "doi": "10.1097/MS9.0000000000005550", "nctId": null, "pmcid": "PMC13561171", "title": "Verrucous carcinoma arising from chronic sacrococcygeal pilonidal disease: a case report", "firstAuthor": "Alvandipour", "multipleAuthors": true, "journal": "Ann Med Surg (Lond)", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "63-year-old man with 5 years of chronic pilonidal disease (cyst/sinus near tailbone) with recurring inflammation and discharge", "intervention": "Surgical removal of the affected tissue with flap reconstruction", "comparator": "None", "primaryOutcome": "Whether the tissue was cancerous and whether it recurred after surgery", "result": "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", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how common this is or what causes typical pilonidal pain.", "directness": "indirect", "limitations": "Only one patient; short follow-up of 12 months; findings cannot be generalized to typical pilonidal cases.", "followUp": "12 months", "plainFinding": "Rare cancer found in long-term cyst.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42725170/", "sourceText": "INTRODUCTION AND IMPORTANCE: Pilonidal sinus disease is a common benign disorder of the sacrococcygeal region characterized by chronic inflammation, recurrent infection, and sinus tract formation. Although generally nonneoplastic, long-standing and chronically inflamed pilonidal sinuses carry a small risk of malignant transformation. Verrucous carcinoma, a rare well-differentiated variant of squamous cell carcinoma (SCC), is exceptionally uncommon in this setting, highlighting the importance of routine histopathological examination of excised specimens for accurate diagnosis and appropriate management. CASE PRESENTATION: 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. Physical examination revealed a 5 × 5 cm inflamed lesion in the sacrococcygeal region. The patient underwent wide local excision with reconstruction using a Limberg flap. 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. No recurrence was observed during 12 months of follow-up. CLINICAL DISCUSSION: Malignant transformation in pilonidal sinus disease is rare, occurring in approximately 0.1% of chronic cases, with SCC being the most frequently observed malignancy. Verrucous carcinoma represents an uncommon subtype with locally aggressive behavior but low metastatic potential. Chronic inflammation and recurrent infection are believed to contribute to neoplastic transformation through repeated tissue injury and oxidative stress. In cases of delayed healing, rapid lesion growth, or atypical wound characteristics, the possibility of malignancy should be considered. CONCLUSION: Verrucous carcinoma arising from chronic pilonidal sinus disease is an exceptional yet clinically significant entity. Clinicians should maintain vigilance for malignancy in recurrent or poorly healing pilonidal disease.", "provenance": [ { "field": "n", "quote": "A 63-year-old man presented with a 5-year history of chronic pilonidal disease" }, { "field": "population", "quote": "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." }, { "field": "intervention", "quote": "The patient underwent wide local excision with reconstruction using a Limberg flap." }, { "field": "comparator", "quote": "CASE PRESENTATION" }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "No recurrence was observed during 12 months of follow-up." } ] }, { "id": "pmid:42717603", "pmid": "42717603", "doi": "10.1111/ped.70526", "nctId": null, "pmcid": "PMC13559047", "title": "Comparison of Phenol Application and Endoscopic Pilonidal Sinus Treatment in Pediatric Pilonidal Sinus Disease", "firstAuthor": "Çolak", "multipleAuthors": true, "journal": "Pediatr Int", "year": 2026, "design": "retrospective", "n": 61, "nField": "reported", "population": "children and teenagers with pilonidal sinus disease (hair-filled cyst near the tailbone)", "intervention": "endoscopic pilonidal sinus treatment (EPSiT)", "comparator": "phenol application (chemical treatment)", "primaryOutcome": "pain after surgery, recovery time, complications, and recurrence", "result": "EPSiT caused less pain, faster return to daily activities, fewer complications, and less recurrence than phenol treatment", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective comparison of two treatments, not a randomized trial, with a relatively small number of patients.", "directness": "direct", "limitations": "Retrospective study design; not randomized", "followUp": "", "plainFinding": "Endoscopic treatment worked better than phenol.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42717603/", "sourceText": "BACKGROUND: The optimal treatment for pilonidal sinus disease remains controversial; however, minimally invasive methods are becoming increasingly common in children compared to traditional surgical approaches. This study aimed to compare the outcomes of two different minimally invasive methods for treating pediatric pilonidal sinus disease: phenol application and endoscopic pilonidal sinus treatment (EPSiT). METHODS: Children who underwent EPSiT or phenolization for pilonidal sinus disease between January 2016 and January 2023 were included in the study. The patients' age, sex, treatment method, number of phenol applications or EPSiT procedures, visual analog scale (VAS) pain scores at postoperative 3 h, length of hospital stay, time to return to daily activities, early postoperative complications, and recurrence were analyzed. RESULTS: A total of 61 patients were included in the study, 38 males (62.3%) and 23 females (37.7%). The mean age was 15.18 ± 1.7 years. Thirty patients (49.2%) were in the EPSiT treatment group, and 31 patients (50.8%) were in the phenol treatment group. Postoperative VAS pain scores were significantly higher in the phenolization group than in the EPSiT group (2.68 ± 1.92 vs. 1; p < 0.001). Time to return to daily activities, number of applications, early postoperative complications, and recurrence were significantly lower in the EPSiT group compared to the phenol group (p < 0.001, p < 0.001, p = 0.023, and p < 0.001, respectively). CONCLUSION: For pediatric pilonidal sinus disease, EPSiT was more advantageous than phenol treatment in terms of postoperative pain, time to return to daily routine, early complications, and recurrence.", "provenance": [ { "field": "n", "quote": "A total of 61 patients were included in the study" }, { "field": "population", "quote": "Children who underwent EPSiT or phenolization for pilonidal sinus disease" }, { "field": "intervention", "quote": "endoscopic pilonidal sinus treatment (EPSiT)" }, { "field": "comparator", "quote": "phenol application" }, { "field": "primaryOutcome", "quote": "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" }, { "field": "result", "quote": "EPSiT was more advantageous than phenol treatment in terms of postoperative pain, time to return to daily routine, early complications, and recurrence" } ] }, { "id": "pmid:42713530", "pmid": "42713530", "doi": "10.7759/cureus.114215", "nctId": null, "pmcid": "PMC13552623", "title": "Ectopic Pilonidal Disease Presenting As Anterior Leg Swelling in a Diabetic Patient: A Case Report", "firstAuthor": "Aldarkhbani", "multipleAuthors": true, "journal": "Cureus", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "A 33-year-old man with diabetes who had a swelling on his leg", "intervention": "None (observational case report)", "comparator": "", "primaryOutcome": "Diagnosis of the cause of the leg swelling", "result": "The swelling was found to be an unusual case of pilonidal sinus disease occurring on the leg instead of the usual tailbone area", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a single patient case report, which cannot show how common this is or whether any treatment works.", "directness": "indirect", "limitations": "Only one patient was described; this is a rare, atypical case and not about typical tailbone pilonidal disease.", "followUp": "", "plainFinding": "Rare pilonidal disease found on the leg, not the tailbone.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42713530/", "sourceText": "Pilonidal sinus disease usually presents in the sacrococcygeal region. Its occurrence at nonsacrococcygeal sites, such as the lower limb, is exceedingly rare and may mimic other benign lesions. We present a 33-year-old man with an unusual presentation of a pilonidal sinus over his leg. Ectopic pilonidal disease should be considered in the differential diagnosis of chronic subcutaneous swellings, particularly when a punctum or sinus tract is present. Awareness of such atypical presentations ensures ectopic pilonidal disease is considered in the differential diagnosis for unusual anterior leg lesions.", "provenance": [ { "field": "population", "quote": "We present a 33-year-old man with an unusual presentation of a pilonidal sinus over his leg." }, { "field": "n", "quote": "We present a 33-year-old man with an unusual presentation of a pilonidal sinus over his leg." }, { "field": "primaryOutcome", "quote": "Ectopic pilonidal disease should be considered in the differential diagnosis of chronic subcutaneous swellings, particularly when a punctum or sinus tract is present." }, { "field": "result", "quote": "We present a 33-year-old man with an unusual presentation of a pilonidal sinus over his leg." }, { "field": "intervention", "quote": "Pilonidal sinus disease usually presents in the sacrococcygeal region." } ] }, { "id": "pmid:42700095", "pmid": "42700095", "doi": "10.1097/MD.0000000000050616", "nctId": null, "pmcid": "PMC13549620", "title": "Comparative outcomes of phenol therapy and Karydakis flap in pilonidal sinus disease: A retrospective cohort study with 1-year follow-up", "firstAuthor": "Osmanov", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2026, "design": "retrospective", "n": 125, "nField": "reported", "population": "patients with primary sacrococcygeal pilonidal sinus disease (crack at top of the buttocks)", "intervention": "phenol therapy (chemical treatment)", "comparator": "Karydakis flap surgery", "primaryOutcome": "wound healing time, return-to-work time, and recurrence rate", "result": "Phenol therapy healed faster and let patients return to work sooner, with similar 1-year recurrence rates compared to surgery", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective (non-randomized) comparison of two treatments, so differences between groups could be due to factors other than the treatment itself.", "directness": "indirect", "limitations": "Retrospective design, non-randomized comparison, and the study addresses treatment of an already-diagnosed condition rather than why the pain occurs.", "followUp": "1 year", "plainFinding": "Faster healing with phenol therapy.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42700095/", "sourceText": "Sacrococcygeal pilonidal sinus disease (PSD) is commonly treated by surgical excision with flap reconstruction. However, minimally invasive treatment modalities based on chemical ablation have gained increasing interest because PSD is not considered a neoplastic disease. Among these techniques, phenol therapy (PT) has emerged as an effective outpatient treatment associated with rapid recovery, low morbidity, and acceptable recurrence rates. To compare the 1-year clinical outcomes of PT and the Karydakis flap (KF) procedure in patients with primary sacrococcygeal PSD. This retrospective cohort study included 125 consecutive patients treated between January 2024 and January 2025. Seventy-seven patients underwent the KF procedure, whereas 48 patients received PT. Demographic characteristics, wound healing time, return-to-work time, postoperative complications, and recurrence rates were evaluated. Patients completed at least 1 year of follow-up through scheduled outpatient visits and structured telephone interviews. The mean age of the study population was 23.68 ± 8.21 years. No significant differences were observed between the groups regarding age, sex, body mass index, family history, prolonged sitting occupation, or history of preoperative abscess drainage (all P > .05). Wound healing time was significantly shorter in the phenol group than in the KF group (15.4 ± 8.4 vs 36.1 ± 7.6 days, P < .005). Similarly, the return-to-work time was significantly shorter following PT. At 1-year follow-up, recurrence occurred in 6 patients (12.5%) in the phenol group and 7 patients (9.1%) in the KF group, with no statistically significant difference between the groups (P = .09). PT was associated with faster wound healing and earlier return to work, while the 1-year recurrence rate did not differ significantly from that of the KF procedure. It may therefore represent a practical minimally invasive treatment alternative for carefully selected patients with primary sacrococcygeal PSD.", "provenance": [ { "field": "n", "quote": "This retrospective cohort study included 125 consecutive patients treated between January 2024 and January 2025." }, { "field": "population", "quote": "patients with primary sacrococcygeal PSD" }, { "field": "intervention", "quote": "phenol therapy (PT) has emerged as an effective outpatient treatment" }, { "field": "comparator", "quote": "the Karydakis flap (KF) procedure" }, { "field": "primaryOutcome", "quote": "Demographic characteristics, wound healing time, return-to-work time, postoperative complications, and recurrence rates were evaluated." }, { "field": "result", "quote": "Wound healing time was significantly shorter in the phenol group than in the KF group (15.4 ± 8.4 vs 36.1 ± 7.6 days, P < .005)." }, { "field": "result", "quote": "recurrence occurred in 6 patients (12.5%) in the phenol group and 7 patients (9.1%) in the KF group, with no statistically significant difference between the groups (P = .09)." }, { "field": "followUp", "quote": "Patients completed at least 1 year of follow-up" } ] }, { "id": "pmid:42700038", "pmid": "42700038", "doi": "10.1097/MD.0000000000050595", "nctId": null, "pmcid": "PMC13549590", "title": "MRI susceptibility-related artifacts following prolonged use of silver-containing dressings: A case report", "firstAuthor": "Liu", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a man with a nonhealing wound after pilonidal sinus (butt crack) surgery", "intervention": "prolonged use of silver-containing wound dressings", "comparator": "none (single patient, before and after wound debridement)", "primaryOutcome": "finding the cause of the nonhealing wound using pelvic MRI", "result": "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.", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how common or reliable this problem is.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Dressing residue hid a fistula on scan.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42700038/", "sourceText": "RATIONALE: Silver-containing dressings are widely used in postoperative and chronic wound care because of their antimicrobial properties. Although these dressings are generally considered compatible with magnetic resonance imaging (MRI) under standard conditions, prolonged use in chronic open wounds may be associated with local retention or deposition of silver-containing material. This could contribute to susceptibility-related signal loss or distortion on MRI and interfere with the evaluation of underlying anatomical structures. However, clinical evidence supporting this association remains limited, and a definitive causal relationship has not been established. PATIENT CONCERNS: A 33-year-old man presented with a nonhealing wound after pilonidal sinus excision. He had used silver-containing dressings intermittently for postoperative wound care over an 8-month period. Because of delayed wound healing and recurrent symptoms, pelvic MRI was performed to evaluate the cause. DIAGNOSES: MRI demonstrated extensive signal loss and distortion in the sacrococcygeal region, suggestive of susceptibility-related artifacts, which obscured anatomical structures and limited diagnostic assessment. After removal of wound-related material by debridement, follow-up MRI demonstrated a fistulous tract extending from the anal canal to the previous wound site. The patient was diagnosed with an anal fistula associated with a chronic nonhealing postoperative wound. INTERVENTIONS: Given the possibility that wound-related or silver-containing dressing-associated material contributed to the MRI artifacts, wound debridement was performed. After the follow-up MRI clarified the fistulous tract, the patient underwent fistula surgery. OUTCOMES: Follow-up MRI after debridement showed near-complete reduction of the artifacts and allowed visualization of the fistulous tract. The patient underwent surgical treatment, and follow-up showed satisfactory wound healing. LESSONS: Prolonged use of silver-containing dressings may be associated with retention or deposition of dressing-related material, which could represent a possible contributor to susceptibility-related MRI artifacts in selected patients. However, silver deposition was not directly confirmed by elemental analysis or susceptibility-sensitive MRI sequences, and alternative causes could not be completely excluded. Clinicians and radiologists should consider this potential source of imaging interference in patients with chronic wounds and a history of long-term silver dressing use. Careful wound assessment and removal of residual wound-related material before MRI may be helpful when artifact-related diagnostic interference is suspected.", "provenance": [ { "field": "n", "quote": "A 33-year-old man presented with a nonhealing wound after pilonidal sinus excision." }, { "field": "population", "quote": "A 33-year-old man presented with a nonhealing wound after pilonidal sinus excision." }, { "field": "intervention", "quote": "He had used silver-containing dressings intermittently for postoperative wound care over an 8-month period." }, { "field": "comparator", "quote": "Follow-up MRI after debridement showed near-complete reduction of the artifacts and allowed visualization of the fistulous tract." }, { "field": "primaryOutcome", "quote": "pelvic MRI was performed to evaluate the cause" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:42633928", "pmid": "42633928", "doi": "10.1111/iwj.71018", "nctId": null, "pmcid": "PMC13500213", "title": "Surgical Treatment Outcomes for Primary Pilonidal Sinus Disease: A Single-Centre Retrospective Study of 2222 Patients (2006-2020)", "firstAuthor": "Tokocin", "multipleAuthors": true, "journal": "Int Wound J", "year": 2026, "design": "retrospective", "n": 2222, "nField": "reported", "population": "people with pilonidal sinus disease (cyst/tract at top of buttock crease) needing surgery, no prior surgery for it", "intervention": "off-midline flap surgical techniques (e.g. Karydakis flap, Bascom cleft lift, Limberg flap, Dufourmentel flap)", "comparator": "lay-open (midline) surgical treatment", "primaryOutcome": "disease coming back (recurrence) and infection after surgery, over at least 5 years", "result": "Off-midline flap surgeries, especially Karydakis flap and Bascom cleft lift, had much lower rates of the condition coming back than lay-open surgery", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "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.", "directness": "direct", "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.", "followUp": "minimum follow-up of 5 years", "plainFinding": "Flap surgery beats simple open surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42633928/", "sourceText": "Pilonidal sinus disease (PSD) is a common acquired condition of the sacrococcygeal region; despite numerous described surgical techniques, long-term outcomes remain highly variable. We compared long-term recurrence and postoperative infection among nine surgical techniques in a large single-centre cohort. We retrospectively analysed 2222 patients with primary PSD who underwent surgery between January 2006 and December 2020 at a single tertiary referral centre in Turkey and had a minimum follow-up of 5 years. Patients presenting with recurrent disease were excluded. Nine surgical techniques were evaluated. Recurrence was analysed as a time-to-event outcome using Kaplan-Meier estimates and multivariable Cox proportional hazards regression. The 5-year cumulative recurrence was 7.9% (175/2222) and postoperative infection 6.9% (154/2222); overall recurrence was 10.2% (226/2222). Recurrence and infection differed statistically significantly among surgical techniques (both p < 0.001). The lowest recurrence rates were observed with the Karydakis flap (1.5%), Bascom cleft lift (2.3%) and Dufourmentel flap (2.4%). Most recurrences occurred within the first 2 years, with a median time to recurrence of 20 months (IQR 12-36). Compared with lay-open treatment, the Karydakis flap (HR 0.19, 95% CI 0.12-0.30), Bascom cleft lift (HR 0.25, 95% CI 0.14-0.43), Limberg flap (HR 0.32, 95% CI 0.19-0.53) and Dufourmentel flap (HR 0.26, 95% CI 0.12-0.57) were independently associated with lower risk of recurrence, whereas a higher body mass index (HR 1.05 per 1 kg/m2, 95% CI 1.01-1.09) and current smoking (HR 1.98, 95% CI 1.54-2.55) were independently associated with an increased recurrence risk. Off-midline flap techniques were associated with superior long-term outcomes, with lower recurrence and infection than midline or secondary-healing approaches. Taken together, the findings of this study support the use of the Karydakis flap and Bascom cleft lift as first-line surgical options for PSD management.", "provenance": [ { "field": "population", "quote": "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." }, { "field": "intervention", "quote": "Off-midline flap techniques were associated with superior long-term outcomes, with lower recurrence and infection than midline or secondary-healing approaches." }, { "field": "comparator", "quote": "Compared with lay-open treatment" }, { "field": "primaryOutcome", "quote": "We compared long-term recurrence and postoperative infection among nine surgical techniques in a large single-centre cohort." }, { "field": "result", "quote": "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" }, { "field": "n", "quote": "We retrospectively analysed 2222 patients with primary PSD" }, { "field": "followUp", "quote": "had a minimum follow-up of 5 years" } ] }, { "id": "pmid:42593573", "pmid": "42593573", "doi": "10.1007/s00383-026-06579-0", "nctId": null, "pmcid": null, "title": "Outcomes of minimally invasive pit-picking treatment in adolescents with uncomplicated pilonidal disease: a retrospective single-center study", "firstAuthor": "Başar", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2026, "design": "retrospective", "n": 42, "nField": "reported", "population": "teenagers aged 12 to 18 with uncomplicated pilonidal disease (a cyst/sinus at top of the buttock crack)", "intervention": "minimally invasive 'pit-picking' procedure to remove the sinus openings", "comparator": "", "primaryOutcome": "whether the problem came back (recurrence) and need for further treatment", "result": "About 1 in 7 patients had the problem come back, and having more than one opening (sinus) raised the chance of recurrence", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "direct", "limitations": "Retrospective design, single center, no control group for comparison, and findings based on only 42 patients.", "followUp": "15 months", "plainFinding": "Low recurrence after minor pit-picking surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42593573/", "sourceText": "PURPOSE: Pilonidal disease is a common condition in adolescents and is frequently associated with recurrence and postoperative morbidity. Minimally invasive techniques have been proposed to reduce surgical trauma and recovery time. This study aimed to evaluate the outcomes of the pit-picking procedure in adolescents with uncomplicated pilonidal disease. METHODS: A retrospective single-center study was conducted including adolescents aged 12-18 years who underwent pit-picking for pilonidal disease between September 2020 and December 2022. Demographic data, clinical presentation, treatment characteristics, follow-up duration, recurrence rates, and need for reintervention were analyzed. RESULTS: A total of 42 patients were included (24 females and 18 males; mean age 15.1 ± 1.4 years). At presentation, 64.3% of patients had an associated abscess. The median follow-up duration was 15 months. Recurrence occurred in six patients (14.3%), with a median time to recurrence of 10 months. The presence of an abscess at presentation did not increase recurrence risk, whereas patients with multiple sinus openings demonstrated a higher recurrence rate compared with those with a single sinus opening. CONCLUSION: Pit-picking is a safe and effective minimally invasive treatment for adolescents with uncomplicated pilonidal disease. With appropriate patient selection and adequate pre-procedural management, acceptable procedural outcomes can be achieved.", "provenance": [ { "field": "n", "quote": "A total of 42 patients were included" }, { "field": "population", "quote": "adolescents aged 12-18 years who underwent pit-picking for pilonidal disease" }, { "field": "intervention", "quote": "evaluate the outcomes of the pit-picking procedure in adolescents with uncomplicated pilonidal disease" }, { "field": "primaryOutcome", "quote": "recurrence rates, and need for reintervention were analyzed" }, { "field": "result", "quote": "Recurrence occurred in six patients (14.3%), with a median time to recurrence of 10 months." }, { "field": "result", "quote": "patients with multiple sinus openings demonstrated a higher recurrence rate compared with those with a single sinus opening" }, { "field": "followUp", "quote": "The median follow-up duration was 15 months." } ] }, { "id": "pmid:42589979", "pmid": "42589979", "doi": "10.3390/jcm15155875", "nctId": null, "pmcid": "PMC13466662", "title": "The Pilonidal Sinus Disease-Specific Quality of Life Questionnaire (SQoL): Reliability, Validity, and Utilisation", "firstAuthor": "Dainius", "multipleAuthors": true, "journal": "J Clin Med", "year": 2026, "design": "prospective-cohort", "n": 116, "nField": "reported", "population": "adults with pilonidal sinus disease (cyst/sinus near tailbone) having surgery", "intervention": "a new pilonidal-disease-specific quality of life questionnaire (SQoL)", "comparator": "the general SF-36v2 quality of life questionnaire", "primaryOutcome": "reliability and validity of the new symptom questionnaire", "result": "the new questionnaire showed strong internal consistency and good agreement with the general quality of life scale", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a single-center tool-validation study, not a treatment trial, so it says nothing about why the area hurts or what helps.", "directness": "indirect", "limitations": "Single hospital, modest sample size, and the study tests a questionnaire's measurement properties rather than any treatment or cause of pain.", "followUp": "2 months", "plainFinding": "New symptom questionnaire validated, not about pain cause.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42589979/", "sourceText": "Background: Pilonidal sinus disease is an inflammatory condition characterised by formations ranging from minor cysts to extensive sinus tracts in the natal cleft in the sacrococcygeal area. Due to its complex and unique symptoms, the condition may not be adequately captured by the generic quality of life (QoL) instruments. In this study, we evaluated a newly developed pilonidal sinus disease-specific quality of life (SQoL) questionnaire, valuating its validity and applicability for measuring postoperative outcomes of pilonidal sinus disease. Materials and Methods: The study involved developing a SQoL. A total of 116 adult patients with chronic and acute symptomatic disease at the Kaunas Hospital of the Lithuanian University of Health Sciences (LUHS) were asked to complete both the SQoL and the SF-36v2 questionnaire. Key evaluation criteria for the SQoL questionnaire included internal consistency, measurement stability, as well as construct and discriminant validity. Results: 2 months after the procedure, 103 patients (response rate 88.79%) completed both questionnaires. Internal consistency was assessed 1 week after surgery, with the overall questionnaire achieving a Cronbach's α coefficient of 0.919. The Spearman correlation coefficient for the total questionnaire score in the test-retest validation was 0.55 (CI 0.406-0.679), indicating a moderately significant correlation for all questions. Construct validity was evaluated by comparing the SQoL questionnaire with the results from various SF-36v2 domains 1 week after surgery. 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. Conclusions: A newly developed SQoL questionnaire has shown promise in assessing the impact of the disease and its treatment, particularly by addressing disease-specific symptoms. Standardising outcome measures can improve the reliability of meta-analyses and systematic reviews, which in turn helps to create more personalised care plans. The trial was registered in ClinicalTrials.gov with the identifier of NCT05982028.", "provenance": [ { "field": "population", "quote": "116 adult patients with chronic and acute symptomatic disease at the Kaunas Hospital of the Lithuanian University of Health Sciences (LUHS)" }, { "field": "intervention", "quote": "a newly developed pilonidal sinus disease-specific quality of life (SQoL) questionnaire" }, { "field": "comparator", "quote": "complete both the SQoL and the SF-36v2 questionnaire" }, { "field": "primaryOutcome", "quote": "Key evaluation criteria for the SQoL questionnaire included internal consistency, measurement stability, as well as construct and discriminant validity." }, { "field": "result", "quote": "the overall questionnaire achieving a Cronbach's α coefficient of 0.919" }, { "field": "result", "quote": "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." }, { "field": "n", "quote": "A total of 116 adult patients with chronic and acute symptomatic disease" }, { "field": "followUp", "quote": "2 months after the procedure, 103 patients (response rate 88.79%) completed both questionnaires" } ] }, { "id": "pmid:42578112", "pmid": "42578112", "doi": "10.1097/RC9.0000000000000700", "nctId": null, "pmcid": "PMC13456846", "title": "Development of cold urticaria after cryotherapy during laser epilation for pilonidal disease: a case report", "firstAuthor": "Jo", "multipleAuthors": true, "journal": "Int J Surg Case Rep", "year": 2026, "design": "case-series", "n": 2, "nField": "reported", "population": "teenagers with pilonidal disease (a condition causing pain near the top of the buttock crack) undergoing laser hair removal", "intervention": "cryotherapy (cold spray) used for pain relief during laser hair removal treatment", "comparator": "none (case reports, no comparison group)", "primaryOutcome": "development of skin reaction (urticaria/hives) after cold exposure during treatment", "result": "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", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is just two patient reports, so it can't tell us how common this reaction is or prove cause and effect.", "directness": "indirect", "limitations": "Only two cases; no control group; does not address the underlying cause of pilonidal pain itself, only a treatment side effect.", "followUp": "3 years (Case 1); 6 months (Case 2)", "plainFinding": "Cold therapy caused allergic hives, not explaining pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42578112/", "sourceText": "INTRODUCTION: Laser epilation is utilized to reduce pilonidal disease (PD) recurrence and commonly employs cryotherapy for analgesia. Cryotherapy can lead to cold urticaria, particularly in patients with unrecognized cold sensitivity. We report two cases of cold urticaria that developed during laser epilation for PD patients. CASE PRESENTATION: Case 1: A 14-year-old female with a pilonidal abscess underwent a drainage procedure followed by the Gips procedure and laser epilation. During the initial laser session, she developed urticarial wheals in the area exposed to cryotherapy. The urticaria resolved with oral diphenhydramine. At subsequent laser sessions, analgesia was provided using topical lidocaine. She exhibited no PD symptoms 3 years after treatment. Case 2: A 17-year-old male underwent a drainage procedure for a pilonidal abscess and subsequently underwent the Gips procedure. Laser epilation was initiated, during which he developed urticaria in the area exposed to cryotherapy. After the cessation of laser and cryotherapy, his symptoms resolved spontaneously. Analgesia for subsequent laser sessions was provided using topical lidocaine. He experienced no recurrence of PD at 6 months post-treatment. DISCUSSION: Cold urticaria is triggered by cold exposure and presents with wheals during rewarming. Cold-induced autoallergen and IgE-mediated mast cell degranulation lead to histamine release. Recognition is critical, especially in patients who lack prior cold exposure. Timely antihistamine administration and cold stimuli avoidance can effectively mitigate the symptoms. By comparison, laser-induced urticaria can present hours after laser application and may require corticosteroids for treatment. CONCLUSION: Cold urticaria can develop after cryotherapy during laser epilation. Awareness, prompt recognition, and the use of alternative analgesia can ensure the safe continuation of laser therapy for PD patients.", "provenance": [ { "field": "n", "quote": "We report two cases of cold urticaria that developed during laser epilation for PD patients." }, { "field": "population", "quote": "A 14-year-old female with a pilonidal abscess underwent a drainage procedure followed by the Gips procedure and laser epilation." }, { "field": "intervention", "quote": "Laser epilation is utilized to reduce pilonidal disease (PD) recurrence and commonly employs cryotherapy for analgesia." }, { "field": "comparator", "quote": "We report two cases of cold urticaria that developed during laser epilation for PD patients." }, { "field": "primaryOutcome", "quote": "During the initial laser session, she developed urticarial wheals in the area exposed to cryotherapy." }, { "field": "result", "quote": "The urticaria resolved with oral diphenhydramine. At subsequent laser sessions, analgesia was provided using topical lidocaine." }, { "field": "followUp", "quote": "She exhibited no PD symptoms 3 years after treatment." }, { "field": "followUp", "quote": "He experienced no recurrence of PD at 6 months post-treatment." } ] }, { "id": "pmid:42565513", "pmid": "42565513", "doi": "10.5644/ama2006-124.514", "nctId": null, "pmcid": "PMC13641021", "title": "Beyond the Spine: A Rare Case of Myxopapillary Ependymoma With Extraneural Metastases", "firstAuthor": "Kalfoutzou", "multipleAuthors": true, "journal": "Acta Med Acad", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a middle-aged woman with a rare spinal tumor in the tailbone area, initially misdiagnosed as a pilonidal cyst", "intervention": "surgical excision followed by repeated surgery, radiotherapy, and later chemotherapy (temozolomide) for recurrences and spread", "comparator": "", "primaryOutcome": "disease recurrence and spread (metastasis) over time, and response to chemotherapy", "result": "the tumor recurred locally three times and eventually spread to the lungs; chemotherapy then stopped progression for almost 3 years", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show what causes or treats this kind of pain in general.", "directness": "indirect", "limitations": "single case report with no comparison group, so findings cannot be generalized.", "followUp": "nearly 3 years", "plainFinding": "Rare tumor mistaken for cyst, spread later.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42565513/", "sourceText": "OBJECTIVE: Myxopapillary ependymoma (MPE) is a rare tumor of ependymal origin that commonly arises within the spinal canal. It is rather benign and slow-growing; however, it tends to recur along the central nervous system (CNS), usually after incomplete resection or tumor seeding due to surgical manipulation. Extraneural metastases of MPE are extremely rare, with only a few documented cases in the literature. CASE REPORT: We describe a case of a middle-aged female patient with sacrococcygeal MPE, which was initially misdiagnosed as a pilonidal cyst and subjected to surgical excision. Over the following years, she experienced three local recurrences in the sacrococcygeal region, which were treated with surgery and radiotherapy. Ten years after the initial excision, the patient complained of dyspnea and hemoptysis, and imaging studies revealed multiple right lung nodules. A core biopsy of a lung lesion was performed, and histopathology was consistent with metastatic MPE. The patient was started on chemotherapy with per os temozolomide and has not experienced disease progression for nearly 3 years. CONCLUSION: Extraneural metastases of MPE represent an exceptionally rare and diagnostically challenging entity and should be considered in patients with a history of MPE who present with distant lesions, even years after the initial diagnosis.", "provenance": [ { "field": "population", "quote": "a middle-aged female patient with sacrococcygeal MPE, which was initially misdiagnosed as a pilonidal cyst" }, { "field": "intervention", "quote": "subjected to surgical excision" }, { "field": "intervention", "quote": "treated with surgery and radiotherapy" }, { "field": "intervention", "quote": "started on chemotherapy with per os temozolomide" }, { "field": "primaryOutcome", "quote": "she experienced three local recurrences in the sacrococcygeal region" }, { "field": "result", "quote": "has not experienced disease progression for nearly 3 years" }, { "field": "n", "quote": "a middle-aged female patient" } ] }, { "id": "pmid:42560577", "pmid": "42560577", "doi": "10.1007/s00383-026-06553-w", "nctId": null, "pmcid": null, "title": "Laser-assisted endoscopic treatment of pilonidal sinus disease in children: a first pediatric series", "firstAuthor": "Türker Çolak", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2026, "design": "retrospective", "n": 45, "nField": "reported", "population": "children and teens with pilonidal sinus disease (a tunnel/infection near the top of the buttock crack)", "intervention": "laser-assisted endoscopic pilonidal sinus treatment (LEPSIT)", "comparator": "none (single-group, before/after outcomes, some had prior external surgery)", "primaryOutcome": "successful cure of the pilonidal sinus after treatment", "result": "91.1% cured after one procedure; the rest cured after a second procedure; all 45 improved overall, with low pain scores", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective case series with no comparison group, so it can't show if this treatment is better than other options.", "directness": "direct", "limitations": "Retrospective design, no control/comparison group, single center experience.", "followUp": "32.4 ± 11.3 months", "plainFinding": "Laser treatment cured most cases.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42560577/", "sourceText": "BACKGROUND: This study aims to describe the technical details of laser-assisted endoscopic pilonidal sinus treatment (LEPSIT), a method used for the first time in pediatric pilonidal sinus disease (PSD), and to report early-stage clinical outcomes in a pediatric cohort. METHODS: Clinical data of children under 18 years of age who underwent LEPSIT for PSD between November 2021 and July 2023 were retrospectively analyzed. RESULTS: Of the 45 patients included, 19 (42.2%) were female, and 26 (57.8%) were male; the mean age at surgery was 15.2 ± 3.1 years, and the mean body mass index was 25.1 ± 3.2. Of the 45 patients, 35 presented with an acute pilonidal abscess at initial evaluation and had undergone abscess drainage prior to LEPSIT. Six patients had been previously operated on for pilonidal sinus disease at an external center prior to LEPSIT. Mean procedure duration was 30 ± 7.2 min. The mean visual analog scale (VAS) score at 6 h was 1.8, 24 h was 1,1 and the mean analgesic use was 1 ± 0.3 days. Successful treatment was achieved in 41 patients (91.1%) after a single procedure; 4 patients (8.9%) had recurrence, all of whom achieved cure after a second LEPSIT. Improvement was ultimately achieved in all 45 patients. Mean follow-up was 32.4 ± 11.3 months. CONCLUSION: LEPSIT is an easy-to-administer, minimally painful (mean VAS score: 1.1), and minimally invasive treatment that shortens hospital stay and enables rapid return to daily activities. It is also a safe and well-tolerated option for recurrent PSD.", "provenance": [ { "field": "n", "quote": "Of the 45 patients included" }, { "field": "population", "quote": "Clinical data of children under 18 years of age who underwent LEPSIT for PSD" }, { "field": "intervention", "quote": "laser-assisted endoscopic pilonidal sinus treatment (LEPSIT)" }, { "field": "comparator", "quote": "Six patients had been previously operated on for pilonidal sinus disease at an external center prior to LEPSIT." }, { "field": "primaryOutcome", "quote": "Successful treatment was achieved in 41 patients (91.1%) after a single procedure" }, { "field": "result", "quote": "Successful treatment was achieved in 41 patients (91.1%) after a single procedure; 4 patients (8.9%) had recurrence, all of whom achieved cure after a second LEPSIT. Improvement was ultimately achieved in all 45 patients." }, { "field": "followUp", "quote": "Mean follow-up was 32.4 ± 11.3 months." } ] }, { "id": "pmid:42522216", "pmid": "42522216", "doi": "10.1177/00031348261474194", "nctId": null, "pmcid": null, "title": "Race, Area Deprivation, and Patterns of Care in Pediatric Pilonidal Disease", "firstAuthor": "Keener", "multipleAuthors": true, "journal": "Am Surg", "year": 2026, "design": "retrospective", "n": 133, "nField": "reported", "population": "children and teens under 18 treated for a pilonidal abscess (tailbone area infection)", "intervention": "neighborhood deprivation level (Area Deprivation Index), plus race and ethnicity", "comparator": "patients with lower deprivation index or different race/ethnicity", "primaryOutcome": "where treatment happened, whether follow-up occurred within 30 days, and recurrence within 6 months", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "retrospective design, limited dispersion of ADI scores, single or few institutions implied, preliminary observations needing confirmation", "followUp": "6-month", "plainFinding": "Racial and ethnic gaps in care found.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42522216/", "sourceText": "BackgroundPilonidal abscess is common in adolescents and recurs frequently. Management requires wound care, follow-up, and access to surgical resources, all factors that are influenced by social determinants of health (SDOH). Whether neighborhood-level disadvantage, measured by the Area Deprivation Index (ADI), affects treatment location, follow-up, or recurrence in pediatric patients is unknown.MethodsWe retrospectively reviewed pediatric patients (<18 years) treated for pilonidal abscess during 2020-2024. Addresses were geocoded for 2020 ADI scores. Treatment was categorized as emergency department (ED) I&D, operating room (OR) I&D, or non-procedural. ADI was the primary exposure; race and ethnicity were secondary. Outcomes included treatment location, 30-day follow-up, and 6-month recurrence. Bivariate analyses and univariable logistic regression were performed.ResultsAmong 133 encounters, mean age was 15.6 years and 68% were female. Median national ADI was 76 (IQR 48-89). 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).DiscussionIn this predominantly high-disadvantage cohort, racial and ethnic disparities in pilonidal abscess management were identified despite no detectable ADI association. Persistence of patient-level disparities despite uniformly high ADI suggests that census-level metrics may lack the granularity to capture barriers relevant to acute pediatric surgical care. These preliminary observations, limited by narrow ADI dispersion, warrant prospective, multi-institutional confirmation with granular SDOH variables and multivariable modeling.", "provenance": [ { "field": "population", "quote": "We retrospectively reviewed pediatric patients (<18 years) treated for pilonidal abscess during 2020-2024." }, { "field": "intervention", "quote": "ADI was the primary exposure; race and ethnicity were secondary." }, { "field": "comparator", "quote": "59% of Black patients missed follow-up compared with 31% of non-Black patients." }, { "field": "primaryOutcome", "quote": "Outcomes included treatment location, 30-day follow-up, and 6-month recurrence." }, { "field": "result", "quote": "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)." }, { "field": "n", "quote": "Among 133 encounters, mean age was 15.6 years and 68% were female." }, { "field": "followUp", "quote": "6-month recurrence" } ] }, { "id": "pmid:42457154", "pmid": "42457154", "doi": "10.1055/a-2913-8222", "nctId": null, "pmcid": null, "title": "The Minimally Invasive Pilonidal Protocol: Low Short-Term Recurrence after Completion in a Single-Center Retrospective Cohort Study", "firstAuthor": "Murtadi", "multipleAuthors": true, "journal": "Eur J Pediatr Surg", "year": 2026, "design": "retrospective", "n": 297, "nField": "reported", "population": "patients with pilonidal disease who completed a minimally invasive treatment protocol", "intervention": "Minimally Invasive Pilonidal Protocol (pit-picking plus laser hair removal/ablation)", "comparator": "none - single group, no comparison treatment", "primaryOutcome": "rate of disease recurrence after finishing treatment", "result": "4.0% of patients had recurrence of pilonidal disease, occurring on average about 16 months after finishing treatment", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "ranged from 4 to 55 months", "plainFinding": "Low recurrence after minimally invasive treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42457154/", "sourceText": "BACKGROUND: The optimal treatment of pilonidal disease remains uncertain, with recurrence rates up to 30% after resection or sinusectomy. This retrospective single-center cohort study evaluates the recurrence rate after graduation from our Pilonidal Care Clinic's (PCC) Minimally Invasive Pilonidal Protocol (MIPP). METHODS: We conducted a retrospective review of a single center's prospectively collected demographic and treatment data for patients with pilonidal disease who completed the MIPP between January 2021 and December 2024. Follow-up appointments were scheduled every 6 to 8 weeks, continuing until disease resolution and completion of laser ablation sessions. The analysis focused on patients who graduated. Patients still receiving care at study completion and those lost to follow-up were excluded. Recurrence was defined as any PCC visit after graduation with pilonidal disease on examination. Graduated patients who had not returned to the PCC were contacted via text message and queried about new symptoms since graduation. RESULTS: Of the initial 884 patients, 8 patients presented for a second opinion only, 353 were lost to follow-up, and 226 were still receiving care, leaving the study group of 297 patients who completed the protocol and graduated. They graduated after an average of 6.4 PCC visits, two pit-picking procedures, and 5.3 laser epilations. The average disease duration before treatment was 11.4 months. The mean treatment duration was 12.3 months (standard deviation: 8), with a median of 10 months (interquartile range: 6-17). The follow-up period for these patients ranged from 4 to 55 months. Of the 297 graduates, 17 patients (5.7%) returned to the PCC with recurrence concerns; however, only 12 (4.0%) showed physical evidence of recurrence: 8 of them (66.7%) had new pits and 4 (33.3%) had both pits and a nidus. The other 5 showed no signs of pilonidal disease on examination. Recurrence occurred on average 16.3 months after graduating, and 9 of 12 patients with a recurrence were successfully regraduated; 3 were lost to follow-up. Among the 280 patients who did not revisit the clinic, 72 (25.7%) replied to the text survey: 68 (94.4%) of respondents remained disease-free, whereas 4 (5.6%) reported recurrence, 2 of whom sought medical care. CONCLUSION: Completion of the MIPP at this center is associated with a 4.0% recurrence rate within 16 months, with most recurrences mild and again resolved with minimally invasive care.", "provenance": [ { "field": "n", "quote": "leaving the study group of 297 patients who completed the protocol and graduated" }, { "field": "population", "quote": "patients with pilonidal disease who completed the MIPP between January 2021 and December 2024" }, { "field": "intervention", "quote": "two pit-picking procedures, and 5.3 laser epilations" }, { "field": "comparator", "quote": "This retrospective single-center cohort study evaluates the recurrence rate after graduation from our Pilonidal Care Clinic's (PCC) Minimally Invasive Pilonidal Protocol (MIPP)." }, { "field": "primaryOutcome", "quote": "Recurrence was defined as any PCC visit after graduation with pilonidal disease on examination." }, { "field": "result", "quote": "only 12 (4.0%) showed physical evidence of recurrence" }, { "field": "result", "quote": "Recurrence occurred on average 16.3 months after graduating" }, { "field": "followUp", "quote": "The follow-up period for these patients ranged from 4 to 55 months." } ] }, { "id": "pmid:42434056", "pmid": "42434056", "doi": "10.1093/jscr/rjag569", "nctId": null, "pmcid": "PMC13349863", "title": "Keystone Design Perforator Island Flap for the treatment of recurrent pilonidal disease", "firstAuthor": "Beaumont", "multipleAuthors": true, "journal": "J Surg Case Rep", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 37-year-old obese man with long-term pilonidal disease that kept coming back despite several prior surgeries", "intervention": "wide excision of the diseased tissue followed by reconstruction with a Keystone Design Perforator Island Flap (a type of local skin flap)", "comparator": "none reported (single patient case, no comparison group)", "primaryOutcome": "wound healing and recurrence after surgery", "result": "recovery was satisfactory at first, but the top of the wound opened up and needed a repeat washout surgery, after which it fully healed", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether this treatment works better than other options.", "directness": "direct", "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.", "followUp": "", "plainFinding": "Flap surgery healed after one setback.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42434056/", "sourceText": "Pilonidal disease is commonly managed with surgical excision; however, recurrence remains frequent, particularly following midline closure. Off-midline flap techniques are increasingly favoured for complex or recurrent disease, as they are associated with reduced wound healing duration and lower recurrence rates. This report describes the case of a 37-year-old obese male with chronic pilonidal disease refractory to multiple prior excisions, who underwent wide local excision and reconstruction with a Keystone Design Perforator Island Flap (KDPIF). Initial recovery was satisfactory, although apical wound dehiscence required subsequent operative washout, ultimately resulting in complete healing. KDPIF reconstruction represents a viable option for recurrent or extensive pilonidal disease and should be considered early in complex cases, with meticulous postoperative care to optimize outcomes.", "provenance": [ { "field": "population", "quote": "a 37-year-old obese male with chronic pilonidal disease refractory to multiple prior excisions" }, { "field": "intervention", "quote": "underwent wide local excision and reconstruction with a Keystone Design Perforator Island Flap (KDPIF)" }, { "field": "comparator", "quote": "This report describes the case of a 37-year-old obese male with chronic pilonidal disease refractory to multiple prior excisions" }, { "field": "primaryOutcome", "quote": "Initial recovery was satisfactory, although apical wound dehiscence required subsequent operative washout, ultimately resulting in complete healing." }, { "field": "result", "quote": "Initial recovery was satisfactory, although apical wound dehiscence required subsequent operative washout, ultimately resulting in complete healing." }, { "field": "n", "quote": "a 37-year-old obese male" } ] }, { "id": "pmid:42366440", "pmid": "42366440", "doi": "10.7507/1001-5515.202512031", "nctId": null, "pmcid": "PMC13311041", "title": "[Research on deep learning-based pathological image classification of pilonidal sinus]", "firstAuthor": "Wang", "multipleAuthors": true, "journal": "Sheng Wu Yi Xue Gong Cheng Xue Za Zhi", "year": 2026, "design": "retrospective", "n": null, "nField": "not-reported", "population": "people who have had surgery for pilonidal sinus disease (a tract/abscess at the top of the buttock crease)", "intervention": "an AI deep-learning model analyzing post-surgery pathology slides to predict recurrence", "comparator": "no comparison group specified", "primaryOutcome": "predicting whether pilonidal sinus disease will come back after surgery", "result": "the model predicted recurrence with an AUC of 0.751 and 71.5% accuracy", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "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.", "directness": "indirect", "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", "followUp": "", "plainFinding": "Predicts surgery recurrence, not pain cause.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42366440/", "sourceText": "Pilonidal sinus disease (PSD) is a suppurative inflammatory condition characterized by a sinus tract in the sacrococcygeal gluteal cleft and surrounding skin. Surgical resection is an important treatment for PSD; however, postoperative recurrence occurs in some patients, severely affecting their quality of life. Due to the lack of objective clinical indicators for predicting recurrence, developing an artificial intelligence-based prediction model is an effective approach. In this study, postoperative hematoxylin and eosin (H&E) stained pathological sections from PSD patients were used. 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. These features were then integrated with multidimensional clinical characteristics to select key features. And then a machine learning classifier was incorporated to construct a recursive feature elimination-balanced random forest (RFE-BalancedRF) ensemble model to predict PSD recurrence. Experimental results demonstrate that the proposed PSD recurrence prediction model 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. Furthermore, a correlation exists between multimodal features and the risk of PSD recurrence, confirming the effectiveness of the proposed model in predicting PSD recurrence. This study innovatively integrates radiomics features with clinical characteristics from the dual perspectives of pathological image analysis and multimodal feature fusion to construct a PSD recurrence risk prediction model, potentially providing a new pathway with considerable clinical translation potential for artificial intelligence assisted medicine.", "provenance": [ { "field": "population", "quote": "postoperative hematoxylin and eosin (H&E) stained pathological sections from PSD patients" }, { "field": "intervention", "quote": "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" }, { "field": "comparator", "quote": "a recursive feature elimination-balanced random forest (RFE-BalancedRF) ensemble model to predict PSD recurrence" }, { "field": "primaryOutcome", "quote": "to predict PSD recurrence" }, { "field": "result", "quote": "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" } ] }, { "id": "pmid:42347916", "pmid": "42347916", "doi": "10.1111/codi.70534", "nctId": null, "pmcid": null, "title": "Outcomes reported in comparative studies of surgical management of pilonidal disease: Systematic review to inform a core outcome set", "firstAuthor": "Mei", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2026, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people having surgery for pilonidal disease (a cyst near the top of the buttock crease)", "intervention": "surgical treatments for pilonidal disease, as studied across many trials", "comparator": "other surgical treatments for pilonidal disease, as studied across many trials", "primaryOutcome": "which outcomes (like recurrence, pain, healing) studies chose to measure and report", "result": "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", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Doesn't test which surgery works best.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42347916/", "sourceText": "BACKGROUND: Evidence synthesis in pilonidal disease surgery is limited by heterogeneity in outcome selection, definition, measurement and follow-up. This systematic review aimed to identify and describe outcomes reported in comparative studies of surgical management of pilonidal disease to inform development of a core outcome set. METHODS: PubMed, Embase and CENTRAL were searched from inception to 28 November 2025. Randomised controlled trials and comparative observational studies evaluating surgical interventions for pilonidal disease were eligible. Two reviewers independently screened studies and extracted study characteristics and outcome data. Verbatim outcomes were standardised, grouped into domains and summarised descriptively. Because the objective was to map outcome reporting rather than estimate treatment effects, risk-of-bias assessment and GRADE appraisal were not undertaken. RESULTS: A total of 155 studies were included, comprising 93 randomised trials and 62 observational studies. Ten outcome domains were identified. Recurrence was reported most frequently (112 studies, 72.3%), followed by non-infective complications (103, 66.5%), pain (83, 53.5%), wound healing (82, 52.9%) and return to normal activities (63, 40.6%). Patient-important domains were less frequently reported, including health-related quality of life or satisfaction (50, 32.3%) and cosmesis (17, 11.0%). Among outcomes designated as primary, wound healing was most common (51 studies, 32.9%), followed by recurrence (35, 22.6%) and postoperative complications (25, 16.1%). Pain (6, 3.9%), return to normal activities/work (9, 5.8%), and psychological or quality-of-life outcomes (3, 1.9%) were rarely primary outcomes. Definitions, measurement instruments, assessment timepoints and overall follow-up duration varied substantially across studies. CONCLUSIONS: Comparative studies of pilonidal disease surgery predominantly prioritise recurrence, healing and complications, whereas patient-important outcomes are reported less consistently and are infrequently prioritised. Standardisation of outcome selection, definitions and measurement is needed. These findings support development of a core outcome set for future trials in pilonidal disease surgery. TRAIL REGISTRATION: CRD420251128698.", "provenance": [ { "field": "population", "quote": "comparative studies of surgical management of pilonidal disease" }, { "field": "intervention", "quote": "evaluating surgical interventions for pilonidal disease were eligible" }, { "field": "comparator", "quote": "Randomised controlled trials and comparative observational studies evaluating surgical interventions for pilonidal disease were eligible." }, { "field": "primaryOutcome", "quote": "identify and describe outcomes reported in comparative studies of surgical management of pilonidal disease" }, { "field": "result", "quote": "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%)." }, { "field": "result", "quote": "Patient-important domains were less frequently reported, including health-related quality of life or satisfaction (50, 32.3%) and cosmesis (17, 11.0%)." }, { "field": "limitations", "quote": "Because the objective was to map outcome reporting rather than estimate treatment effects, risk-of-bias assessment and GRADE appraisal were not undertaken." } ] }, { "id": "pmid:42344817", "pmid": "42344817", "doi": "10.7759/cureus.109546", "nctId": null, "pmcid": "PMC13289800", "title": "Upadacitinib for Severe Refractory Hidradenitis Suppurativa After Failure of Multiple Systemic Therapies: A Case Report", "firstAuthor": "Chew Bonilla", "multipleAuthors": true, "journal": "Cureus", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 64-year-old man with severe hidradenitis suppurativa affecting underarm, groin, buttock crease, belly and trunk areas", "intervention": "upadacitinib 15 mg taken once daily", "comparator": "none (case report, no control group); prior treatments included antibiotics, adalimumab, and secukinumab that had failed", "primaryOutcome": "change in disease severity score (IHS4), pain, drainage and functional limitation", "result": "IHS4 score dropped from 127-145 points at baseline to 20 points, with reduced lesions, pain and drainage", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient's experience, so it cannot show whether the drug would help others.", "directness": "indirect", "limitations": "Only one patient was studied, with no comparison group, and the patient had multiple other health problems that could affect results.", "followUp": "", "plainFinding": "Severe skin disease improved with new drug.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42344817/", "sourceText": "Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis characterized by recurrent nodules, abscesses, draining sinus tracts, and substantial impairment in quality of life. Management of severe, refractory HS remains challenging, particularly in patients with inadequate response to systemic antibiotics and biologic therapies. Increasing evidence supports the involvement of the Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway in HS pathophysiology, highlighting JAK inhibitors as potential therapeutic alternatives. We report the case of a 64-year-old man with severe Hurley stage III HS involving axillary, inguinal, intergluteal, abdominal, and truncal regions, with extensive inflammatory activity, chronic pain, and marked functional limitation. Relevant comorbidities included folliculitis decalvans, chronic kidney disease stage G3b, anemia, hypoalbuminemia, and malnutrition. The patient had an inadequate response to multiple prolonged systemic antibiotic regimens, adalimumab therapy for six years with subsequent secondary failure, and secukinumab, which was discontinued because of clinical worsening. Due to progressive disease and the absence of effective therapeutic alternatives, treatment with upadacitinib 15 mg once daily was initiated after careful risk-benefit assessment and informed consent. Progressive and sustained clinical improvement was observed, including a reduction in inflammatory lesions, pain, purulent drainage, and functional impairment. The International Hidradenitis Suppurativa Severity Score System (IHS4) decreased from baseline values of 127-145 points to 20 points during follow-up. Treatment was well tolerated, and no significant adverse events were documented. This case highlights the potential role of upadacitinib as a therapeutic alternative in severe, refractory HS after failure of conventional systemic and biologic therapies and supports the need for further studies to better define the efficacy and safety of JAK inhibitors in the management of HS.", "provenance": [ { "field": "population", "quote": "a 64-year-old man with severe Hurley stage III HS involving axillary, inguinal, intergluteal, abdominal, and truncal regions" }, { "field": "intervention", "quote": "treatment with upadacitinib 15 mg once daily was initiated" }, { "field": "comparator", "quote": "adalimumab therapy for six years with subsequent secondary failure, and secukinumab, which was discontinued because of clinical worsening" }, { "field": "primaryOutcome", "quote": "reduction in inflammatory lesions, pain, purulent drainage, and functional impairment" }, { "field": "result", "quote": "The International Hidradenitis Suppurativa Severity Score System (IHS4) decreased from baseline values of 127-145 points to 20 points during follow-up." }, { "field": "n", "quote": "a 64-year-old man" } ] }, { "id": "pmid:42313194", "pmid": "42313194", "doi": "10.1007/s10151-026-03377-7", "nctId": null, "pmcid": "PMC13522066", "title": "The association between skin-suturing technique, prolonged healing and recurrence after Bascom's Cleft lift surgery", "firstAuthor": "Larsen", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "retrospective", "n": 540, "nField": "reported", "population": "patients with complex pilonidal sinus disease having cleft lift surgery", "intervention": "intracutaneous skin-suturing technique in Bascom's Cleft lift surgery", "comparator": "extracutaneous skin-suturing technique in Bascom's Cleft lift surgery", "primaryOutcome": "prolonged wound healing and recurrence of pilonidal disease", "result": "no difference in healing time or recurrence between suturing techniques, but slower-healing patients had higher recurrence", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "This is a retrospective single-hospital comparison before/after a technique change, not a randomized trial, so other factors could explain the results.", "directness": "indirect", "limitations": "Retrospective design comparing two time periods rather than randomized groups; abstract does not address pain directly.", "followUp": "5 years", "plainFinding": "Suture method didn't change healing or recurrence", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42313194/", "sourceText": "BACKGROUND: The optimal treatment for complex Pilonidal Sinus Disease (PSD) is still debated. Despite great advances with the introduction of off-midline closure techniques, healing problems and recurrence remain challenges. We aimed to investigate whether choice of skin-suturing technique in Bascom's Cleft lift (BCL) procedure influenced risk of prolonged healing or recurrence. METHODS: We analysed the data of 540 unique patients who underwent BCL surgery at Randers Regional Hospital between 2016 and 2022. During this period, a technical revision of technique caused a shift from extracutaneous to intracutaneous closure creating two groups for comparison. Prolonged healing was defined as lack of complete epithelialization at the second post-surgical follow-up (maximum 14 weeks post-surgery). RESULTS: There was no difference in time-to-healing among the suture groups with a 76% rate of primary healing in both groups. At 5 years post-surgery, the cumulative incidence proportion (CIP) of recurrence was 9.1% in the intracutaneous group and 5.7% in the extracutaneous group (p = 0.41). At 5 years post-surgery, the CIP of recurrence was 14.0% among patients with prolonged healing and 7.0% among patients with primary healing (p < 0.05). CONCLUSIONS: In our study population, choice of skin-suturing technique did not affect risk of prolonged healing nor recurrence after BCL surgery. However, patients experiencing prolonged healing after surgery had significantly higher risk of recurrence, emphasizing the need for increased efforts to prevent post-surgical wound dehiscence.", "provenance": [ { "field": "population", "quote": "complex Pilonidal Sinus Disease (PSD)" }, { "field": "n", "quote": "540 unique patients who underwent BCL surgery" }, { "field": "intervention", "quote": "a shift from extracutaneous to intracutaneous closure creating two groups for comparison" }, { "field": "comparator", "quote": "a shift from extracutaneous to intracutaneous closure creating two groups for comparison" }, { "field": "primaryOutcome", "quote": "influenced risk of prolonged healing or recurrence" }, { "field": "result", "quote": "There was no difference in time-to-healing among the suture groups with a 76% rate of primary healing in both groups." }, { "field": "result", "quote": "patients experiencing prolonged healing after surgery had significantly higher risk of recurrence" } ] }, { "id": "pmid:42311045", "pmid": "42311045", "doi": "10.1002/wjs.70463", "nctId": null, "pmcid": "PMC13460901", "title": "Karydakis Versus Limberg Flap in Primary Sacrococcygeal Pilonidal Sinus: A Retrospective Comparative Study of Functional Recovery", "firstAuthor": "Habeeb", "multipleAuthors": true, "journal": "World J Surg", "year": 2026, "design": "retrospective", "n": 352, "nField": "reported", "population": "employed, sexually active patients who underwent surgery for primary sacrococcygeal pilonidal sinus disease", "intervention": "Karydakis flap (KF) surgery for pilonidal sinus disease", "comparator": "Limberg flap (LF) surgery for pilonidal sinus disease", "primaryOutcome": "time to resumption of sexual activity after surgery", "result": "Patients who had the Karydakis flap resumed sexual activity and driving sooner, with less pain, than those who had the Limberg flap", "resultDirection": "benefit", "quality": "low", "qualityWhy": "It is a retrospective, non-randomized comparison relying on patient-reported Likert-scale answers, which makes it easier for bias to affect the results.", "directness": "indirect", "limitations": "Retrospective design, not randomized, outcomes based on patient-reported Likert-scale questionnaire rather than objective measures", "followUp": "1 year", "plainFinding": "Faster recovery with Karydakis flap surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42311045/", "sourceText": "BACKGROUND: Successful surgical management of pilonidal sinus disease (PSD) in young, active patients requires rapid restoration of daily functions, including driving and sexual activity. This study compared patient-reported recovery as regards sexual function and driving ability following the KF versus the LF for primary sacrococcygeal PSD. METHODS: This multicenter retrospective cohort study (FLARE study) included employed, sexually active patients who underwent surgery for primary PSD (July 2017-July 2024). The primary outcome was time to sexual activity resumption; the secondary outcome was time to resumption of driving. Outcomes were assessed at 1 year using a structured Likert-scale questionnaire. Kaplan-Meier curves and Cox regression analyses with adjustment were used. RESULTS: A total of 352 patients were divided into 176 KF and 176 LF. KF patients resumed sexual activity earlier (2.88 ± 0.7 vs. 4.58 ± 1.1 weeks; mean difference -1.7 weeks, 95% CI -1.89 to -1.49, p < 0.001). KF reported significantly less pain, less avoidance, and lower analgesic use during sex. LF reported lower sexual satisfaction (mean 3.94 vs. 2.15; mean difference -1.78, 95% CI -2.02 to -1.53). KF resumed driving earlier (median 9 vs. 19 days; r = 0.7, large effect, p < 0.001) and had longer sitting tolerance (OR 0.3, 95% CI 0.2-0.4, p < 0.001). LF had higher pain while sitting (mean Likert 4 vs. 2; mean difference of -1.94, 95% CI -2.19 to -1.68), higher VAS pain (median 4 vs. 2; r = 0.5), greater need for cushions/analgesics, and more driving-related work/social limitations (all p < 0.001). Time to resume sexual activity and driving was significantly shorter for KF. On multivariable analysis, LF was independently associated with delayed return to sexual activity (adjusted OR 4.02, 95% CI 2.1-7.5, p < 0.001) and delayed return to driving (adjusted OR 2.8, 95% CI 1.5-5.2, p < 0.001). CONCLUSIONS: In this retrospective cohort, KF may be associated with significantly faster return to sexual and driving activity compared with LF. These results underscore the importance of incorporating patient-centered functional outcomes into surgical decision-making for PSD. TRIAL REGISTRATION: Number: NCT07271537.", "provenance": [ { "field": "n", "quote": "A total of 352 patients were divided into 176 KF and 176 LF." }, { "field": "population", "quote": "included employed, sexually active patients who underwent surgery for primary PSD" }, { "field": "intervention", "quote": "compared patient-reported recovery as regards sexual function and driving ability following the KF" }, { "field": "comparator", "quote": "versus the LF for primary sacrococcygeal PSD" }, { "field": "primaryOutcome", "quote": "The primary outcome was time to sexual activity resumption" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:42304603", "pmid": "42304603", "doi": "10.1111/1346-8138.70354", "nctId": null, "pmcid": "PMC13435018", "title": "Minimally Invasive Phenol Treatment for Pilonidal Sinus: A Single-Center Case Series From Japan", "firstAuthor": "Komiyama", "multipleAuthors": true, "journal": "J Dermatol", "year": 2026, "design": "case-series", "n": 11, "nField": "reported", "population": "patients with pilonidal sinus (chronic inflamed tunnel near the tailbone/natal cleft)", "intervention": "phenol injection into the sinus tract after excising pits and scraping out the tunnel, then neutralizing with alcohol", "comparator": "no comparison group; compared informally to conventional surgery (wide excision and flap reconstruction)", "primaryOutcome": "recurrence and complications after treatment, plus operative time and hospital stay", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "direct", "limitations": "Retrospective design, very small sample size (11 patients), no control group, relatively short and variable follow-up.", "followUp": "median, 331 days; range, 100-979", "plainFinding": "No recurrence after phenol treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42304603/", "sourceText": "Pilonidal sinus is a chronic inflammatory condition of the natal cleft that commonly affects young adults. Conventional surgical treatments, such as wide excision and flap reconstruction, are associated with large wounds and prolonged recovery. Phenol treatment has been reported as a minimally invasive alternative in several countries; however, clinical experience in Japan remains limited. We retrospectively reviewed patients with pilonidal sinus who underwent phenol treatment at our institution between 2020 and 2025. After excision of the midline pits and curettage of the sinus tract, undiluted phenol was injected into the cavity and subsequently neutralized with ethanol. Clinical data, including patient characteristics, number of pits, operative time, postoperative hospital stay, complications, and recurrence, were analyzed. A total of 11 patients were included in the study. The median age was 27 years (range, 13-50), and 10 patients were male. The median number of pits was 3 (range, 1-5). The median operative time was 32 min (range, 19-56), and the median postoperative hospital stay was 2 days (range, 1-6). Postoperative bleeding occurred in two patients and was successfully managed conservatively. No recurrence was observed during the follow-up period (median, 331 days; range, 100-979). Phenol treatment for pilonidal sinus appears to be a simple and minimally invasive procedure associated with short hospitalization and favorable short-term outcomes. This technique may represent a useful treatment option for pilonidal sinus in Japan.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus is a chronic inflammatory condition of the natal cleft that commonly affects young adults." }, { "field": "intervention", "quote": "After excision of the midline pits and curettage of the sinus tract, undiluted phenol was injected into the cavity and subsequently neutralized with ethanol." }, { "field": "comparator", "quote": "Conventional surgical treatments, such as wide excision and flap reconstruction, are associated with large wounds and prolonged recovery." }, { "field": "primaryOutcome", "quote": "Clinical data, including patient characteristics, number of pits, operative time, postoperative hospital stay, complications, and recurrence, were analyzed." }, { "field": "result", "quote": "No recurrence was observed during the follow-up period (median, 331 days; range, 100-979)." }, { "field": "n", "quote": "A total of 11 patients were included in the study." } ] }, { "id": "pmid:42266120", "pmid": "42266120", "doi": "10.3393/ac.2025.00850.0121", "nctId": null, "pmcid": "PMC13254772", "title": "Radiofrequency for the treatment of pilonidal disease: results of a French prospective pilot study", "firstAuthor": "Fathallah", "multipleAuthors": true, "journal": "Ann Coloproctol", "year": 2026, "design": "prospective-cohort", "n": 44, "nField": "reported", "population": "patients with infected pilonidal sinus (tailbone cyst) disease", "intervention": "radiofrequency treatment of the pilonidal sinus", "comparator": "none (single-arm study, before/after comparison with history of prior surgery as a risk factor)", "primaryOutcome": "safety of the procedure", "result": "no major complications; 77.3% fully healed at 6 months, 13.6% failure, 9.1% recurrence, low pain, high satisfaction", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small single-center pilot study with no comparison group, so it can't show if radiofrequency works better than other treatments.", "directness": "direct", "limitations": "Single-center, no control group, small sample size (pilot study).", "followUp": "6 months", "plainFinding": "Mostly healed, low pain, satisfied.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42266120/", "sourceText": "PURPOSE: Minimally invasive techniques are increasingly applied in the management of pilonidal disease. While laser therapy is well established, radiofrequency (RF) represents a newer alternative with theoretical advantages. However, no prospective data have yet been published on its use. This study aimed to assess the safety, efficacy, and patient satisfaction associated with RF treatment for infected pilonidal sinus. METHODS: We conducted a prospective, single-center pilot study including consecutive patients treated with RF between March and December 2023. The procedure was performed under spinal or general anesthesia in an outpatient setting using a radial RF probe (25 W, 4 MHz) following mechanical debridement. Patients were followed up at 15 days and at 1, 3, and 6 months. The primary endpoint was safety; secondary endpoints included healing rate, predictors of failure, postoperative pain, return to activities, and patient satisfaction. RESULTS: Forty-four patients were enrolled (median age, 25.5 years; 31 men, 70.5%), of whom 38.6% had undergone previous surgery. The median operative time was 12 minutes. 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. A history of prior surgery significantly increased the risk of failure (odds ratio, 0.2; P=0.005). The median peak pain score was 2 out of 10, with a median duration of 2 days. Overall, 33 patients (75.0%) were very satisfied, and 40 (90.9%) stated they would undergo the procedure again or recommend it to others. CONCLUSION: RF appears to be a safe, minimally invasive outpatient treatment option for pilonidal disease, demonstrating promising efficacy, minimal postoperative pain, and high patient satisfaction. Trial registration: ClinicalTrials.gov identifier: NCT05855733.", "provenance": [ { "field": "n", "quote": "Forty-four patients were enrolled" }, { "field": "population", "quote": "infected pilonidal sinus" }, { "field": "intervention", "quote": "using a radial RF probe (25 W, 4 MHz) following mechanical debridement" }, { "field": "comparator", "quote": "A history of prior surgery significantly increased the risk of failure (odds ratio, 0.2; P=0.005)" }, { "field": "primaryOutcome", "quote": "The primary endpoint was safety" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:42237035", "pmid": "42237035", "doi": "10.1007/s10151-026-03345-1", "nctId": null, "pmcid": "PMC13447342", "title": "Early postoperative outcomes of sinus laser closure versus crystallized phenol treatment for pilonidal sinus disease: a retrospective comparative study", "firstAuthor": "Yildirak", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "retrospective", "n": 230, "nField": "reported", "population": "adults with pilonidal sinus disease (a condition causing a cyst/infection near the top of the buttock crack)", "intervention": "laser closure of the sinus tract (SiLaC)", "comparator": "crystallized phenol treatment", "primaryOutcome": "patient satisfaction, quality of life, symptom severity, pain, and time to return to work after treatment", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective comparison, not a randomized trial, so differences between groups could be due to factors other than the treatment itself.", "directness": "direct", "limitations": "Retrospective design; the abstract itself calls for randomized controlled trials to validate findings.", "followUp": "1 month", "plainFinding": "Laser treatment eased symptoms faster early on.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42237035/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD), which predominantly affects young adults, has increasingly been managed with minimally invasive techniques aimed at reducing postoperative pain, accelerating recovery, and minimizing work absenteeism. This study aimed to compare the early term outcomes of patients treated with crystallized phenol treatment (CPT) or sinus laser closure (SiLaC) for PSD. METHODS: We retrospectively analyzed a prospectively maintained cohort at a tertiary center between January 2023 and August 2024. Patients with PSD undergoing SiLaC or CPT with scheduled 1-week and 1-month follow-up assessments were included. The primary outcomes were patient satisfaction, health-related quality of life (SF-36), symptom severity (itching, burning, purulent discharge), pain intensity (Visual Analogue Scale), and time to return to work, all assessed at 1 week and 1 month postoperatively. Secondary outcomes included pit orifice closure rates and perioperative complications. RESULTS: A total of 230 patients were analyzed (SiLaC n = 93; CPT n = 137), with comparable baseline characteristics. At 1 week, itching (1 [1-1] versus 1 [1-2], p < 0.001), burning (1 [1-1] versus 1 [1-2], p = 0.001), and purulent discharge (1 [1-1] versus 1 [1-3], p < 0.001) were less frequent in the SiLaC group. Pain scores were also lower in the SiLaC group (VAS: 0 [0-1] versus 0 [0-5], p = 0.034). SF-36 scores were significantly higher in the SiLaC group for physical functioning (100 [90-100] versus 95 [85-100], p < 0.001), physical role limitation (100 [100-100] versus 100 [75-100], p = 0.005), social functioning (100 [87.5-100] versus 87.5 [62.5-100], p < 0.001), and pain (100 [67.5-100] versus 90 [67.5-100], p = 0.008). Return to daily activities was shorter in the SiLaC group (0 [0-0] versus 0 [0-1] days, p < 0.001). At 1 month, most outcomes were comparable between groups, although purulent discharge remained higher in the CPT group (1 [1-2] versus 1 [1-1], p = 0.045). Complication rates were low and similar between groups (9.6% versus 12.4%, p = 0.489). CONCLUSIONS: The SiLaC method was associated with more favorable quality of life (QoL) outcomes compared with CPT during the first postoperative week. Subgroup analyses suggested that SiLaC may offer advantages in certain clinical scenarios. Further multicenter randomized controlled trials are warranted to better clarify and validate these findings.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus disease (PSD), which predominantly affects young adults" }, { "field": "n", "quote": "A total of 230 patients were analyzed (SiLaC n = 93; CPT n = 137)" }, { "field": "intervention", "quote": "sinus laser closure (SiLaC)" }, { "field": "comparator", "quote": "crystallized phenol treatment (CPT)" }, { "field": "primaryOutcome", "quote": "The primary outcomes were patient satisfaction, health-related quality of life (SF-36), symptom severity (itching, burning, purulent discharge), pain intensity (Visual Analogue Scale), and time to return to work" }, { "field": "result", "quote": "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." }, { "field": "result", "quote": "At 1 month, most outcomes were comparable between groups" }, { "field": "limitations", "quote": "Further multicenter randomized controlled trials are warranted to better clarify and validate these findings." } ] }, { "id": "pmid:42183060", "pmid": "42183060", "doi": "10.3389/fbioe.2026.1792099", "nctId": null, "pmcid": "PMC13189769", "title": "Exploratory pilot study of minimally invasive therapy: laser ablation combined with acellular dermal matrix implantation for recurrent sacrococcygeal pilonidal disease", "firstAuthor": "Li", "multipleAuthors": true, "journal": "Front Bioeng Biotechnol", "year": 2026, "design": "case-series", "n": 5, "nField": "reported", "population": "patients with recurrent pilonidal disease (a cyst near the top of the buttock crack)", "intervention": "laser ablation combined with acellular dermal matrix implantation", "comparator": "none (no comparison group)", "primaryOutcome": "wound healing time, pain, and recurrence after surgery", "result": "all 5 patients healed without recurrence, with low pain and median healing time of 34 days", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "only 5 patients with no comparison group, so it can't show whether this worked better than other treatments.", "directness": "direct", "limitations": "very small sample size, retrospective design, no control group, and only short-term follow-up.", "followUp": "7 (6-7) months", "plainFinding": "Healed well, little pain, no recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42183060/", "sourceText": "PURPOSE: Recurrent sacrococcygeal pilonidal disease (SPD) poses significant therapeutic challenges. Recently, minimally invasive techniques, notably laser ablation, have emerged as promising alternatives to conventional surgery. Concurrently, the application of acellular dermal matrix (ADM) has shown potential in facilitating wound healing and tissue regeneration. This small retrospective exploratory pilot study aims to evaluate the efficacy and safety of a combined therapeutic approach utilizing laser ablation and ADM implantation for the management of recurrent SPD. METHODS: We retrospectively analyzed clinical data of our five patients who diagnosed with recurrent SPD between October 2023 and April 2024. All patients underwent laser ablation combined with ADM placement. Clinical outcomes, including healing rates, recurrence rates, and operative data, were recorded. Postoperative pain was quantified using the Visual Analog Scale (VAS), and the time to return to work and daily activities was documented. No sample size calculation was performed due to the exploratory nature of the study. RESULTS: A total of five patients underwent laser ablation combined with ADM. The median time to return to work was 10 (9, 11) days, and complete wound healing was achieved in a median of 34 (30, 35) days. Patients experienced minimal postoperative pain. Over a median follow-up period of 7 (6-7) months, all patients were successfully cured without recurrence and satisfied with this surgery. CONCLUSION: Preliminary evidence suggests that laser ablation combined with ADM constitutes a feasible and promising minimally invasive strategy for recurrent SPD. This technique is associated with rapid wound healing, negligible pain, and the absence of recurrence in this cohort. This study is a small-sample retrospective pilot research with inherent limitations, and the findings warrant further verification by large-sample studies with medium and long-term follow-up.", "provenance": [ { "field": "population", "quote": "five patients who diagnosed with recurrent SPD between October 2023 and April 2024" }, { "field": "intervention", "quote": "laser ablation combined with ADM placement" }, { "field": "comparator", "quote": "No sample size calculation was performed due to the exploratory nature of the study." }, { "field": "primaryOutcome", "quote": "Clinical outcomes, including healing rates, recurrence rates, and operative data, were recorded." }, { "field": "result", "quote": "all patients were successfully cured without recurrence and satisfied with this surgery" }, { "field": "n", "quote": "A total of five patients underwent laser ablation combined with ADM." }, { "field": "followUp", "quote": "Over a median follow-up period of 7 (6-7) months" } ] }, { "id": "pmid:42168379", "pmid": "42168379", "doi": "10.1038/s41598-026-50716-7", "nctId": null, "pmcid": "PMC13503781", "title": "Pediatric endoscopic pilonidal sinus treatment (PEPSiT) as standard of care results over 10 years' experience in 507 patients", "firstAuthor": "Esposito", "multipleAuthors": true, "journal": "Sci Rep", "year": 2026, "design": "retrospective", "n": 507, "nField": "reported", "population": "teenagers and young people with pilonidal sinus disease (a condition causing a pit/abscess at the top of the buttock crack)", "intervention": "minimally invasive keyhole surgery (PEPSiT) with ozone oil dressing and later platelet-rich plasma", "comparator": "none - all patients received this treatment", "primaryOutcome": "pain after surgery, healing, recurrence rate, and patient satisfaction", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "direct", "limitations": "retrospective design with no comparison group, so results could be influenced by other factors not measured.", "followUp": "", "plainFinding": "Minimally invasive surgery, low recurrence, little pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42168379/", "sourceText": "Pilonidal sinus disease (PSD) is an acquired inflammatory condition of the gluteal cleft predominantly affecting teenagers. We report our 10-year experience adopting this minimally invasive approach, pediatric endoscopic pilonidal sinus treatment (PEPSiT). We retrospectively reviewed all patients, with primary or recurrent PSD, undergoing PEPSiT in the 2016-2025 period. We operated 507 patients (313 boys and 194 girls) with a median age of 15.5 years (IQR 12-18 years). All patients received our postoperative management. Data regarding success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10, IQR 1-2). Patient satisfaction was excellent (median score 4.8/5, IQR 4-5). Dressing after surgery was performed with ozone oil products in every patient and in the last 18 months Platelet-Rich Plasma (PRP) has been added to the intra and post-operative care too. Disease recurrence occurred in 53/507 patients (10.4%), mostly within 3 months (range 2 months-23 months), and all were successfully re-operated with PEPSiT with no further recurrence. This study demonstrates that a standardized perioperative protocol, including tailored pre- and post-operative management and structured long-term follow-up, is effective in ensuring favorable clinical outcomes, with negligible pain, high patient satisfaction and a low rate of recurrence.", "provenance": [ { "field": "population", "quote": "We operated 507 patients (313 boys and 194 girls) with a median age of 15.5 years (IQR 12-18 years)." }, { "field": "intervention", "quote": "pediatric endoscopic pilonidal sinus treatment (PEPSiT)" }, { "field": "intervention", "quote": "Dressing after surgery was performed with ozone oil products in every patient and in the last 18 months Platelet-Rich Plasma (PRP) has been added" }, { "field": "comparator", "quote": "We retrospectively reviewed all patients, with primary or recurrent PSD, undergoing PEPSiT" }, { "field": "primaryOutcome", "quote": "Data regarding success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed." }, { "field": "result", "quote": "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)." }, { "field": "result", "quote": "Disease recurrence occurred in 53/507 patients (10.4%), mostly within 3 months (range 2 months-23 months), and all were successfully re-operated with PEPSiT with no further recurrence." }, { "field": "n", "quote": "We operated 507 patients" } ] }, { "id": "pmid:42165106", "pmid": "42165106", "doi": "10.1111/iwj.70942", "nctId": null, "pmcid": "PMC13239841", "title": "Treatment Outcomes of Presacral Pilonidal Sinus Disease Using Crystallised Phenol: A Single-Centre Clinical Series", "firstAuthor": "Acar", "multipleAuthors": true, "journal": "Int Wound J", "year": 2026, "design": "case-series", "n": 40, "nField": "reported", "population": "adults with pilonidal sinus disease at the top of the buttock crack", "intervention": "crystallised phenol treatment given in two or three sessions", "comparator": "two-session group versus three-session group", "primaryOutcome": "treatment outcomes and number of sessions needed, including abscess and recurrence", "result": "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", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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)", "followUp": "3 months", "plainFinding": "More sinus pits meant more treatment sessions.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42165106/", "sourceText": "OBJECTIVE: To evaluate short-term treatment outcomes and treatment burden in patients with presacral pilonidal sinus disease managed with crystallised phenol in a single-centre clinical series, with particular emphasis on the relationship between pit burden and session requirement. METHODS: Consecutive patients treated with crystallised phenol were analysed (n = 40). Demographic and clinical characteristics, symptom duration, pit count, number of phenol sessions (2 vs. 3), inter-session intervals, and total treatment duration were recorded. All patients completed scheduled clinical reassessment at 5 weeks and 3 months. Treatment-related abscess and recurrence during follow-up were documented. Continuous variables are presented as mean ± standard deviation and median (minimum-maximum). Comparisons between the two-session and three-session groups were performed with the Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables. RESULTS: The cohort was predominantly male (75%), with a mean age of 29.23 ± 9.85 years and a mean body mass index of 25.81 ± 3.85 kg/m2; 62.5% were smokers. Symptom duration was 6.80 ± 7.20 months, and mean pit count was 1.90 ± 0.93. Two sessions were sufficient in 42.5% (17/40), whereas 57.5% (23/40) required three sessions. The interval between the first and second sessions was 11.32 ± 3.30 days, and the interval between the second and third sessions was 11.96 ± 3.23 days in patients who underwent three sessions; overall treatment duration was 18.2 ± 7.58 days. No patient was lost to follow-up. Pit burden was the strongest determinant of requiring a third session: pit count was significantly higher in the three-session group than in the two-session group (2.39 ± 0.89 vs. 1.24 ± 0.44, p < 0.001), and all patients with ≥ 3 pits required three sessions. Smoking status (p = 1.000) and body mass index (BMI) (p = 0.208) were not associated with session requirement. Treatment-related abscess developed in 12.5% (5/40), and recurrence during the 3-month follow-up was observed in 12.5% (5/40); notably, all such events occurred in the three-session group (0/17 vs. 5/23, p = 0.061 for both comparisons). CONCLUSION: In this single-centre series, crystallised phenol provided acceptable short-term outcomes and a relatively short treatment course in presacral pilonidal sinus disease. Pit count emerged as the main determinant of requiring a third session, whereas smoking status and BMI were not associated with session requirement. Larger studies with longer follow-up are needed to clarify predictors of recurrence and to determine whether higher session requirements simply reflect disease complexity or also influence outcome.", "provenance": [ { "field": "n", "quote": "Consecutive patients treated with crystallised phenol were analysed (n = 40)" }, { "field": "population", "quote": "patients with presacral pilonidal sinus disease managed with crystallised phenol" }, { "field": "intervention", "quote": "crystallised phenol" }, { "field": "comparator", "quote": "Comparisons between the two-session and three-session groups were performed with the Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables" }, { "field": "primaryOutcome", "quote": "To evaluate short-term treatment outcomes and treatment burden in patients with presacral pilonidal sinus disease managed with crystallised phenol" }, { "field": "result", "quote": "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" }, { "field": "result", "quote": "Treatment-related abscess developed in 12.5% (5/40), and recurrence during the 3-month follow-up was observed in 12.5% (5/40); notably, all such events occurred in the three-session group (0/17 vs. 5/23, p = 0.061 for both comparisons)" }, { "field": "followUp", "quote": "All patients completed scheduled clinical reassessment at 5 weeks and 3 months" } ] }, { "id": "pmid:42137074", "pmid": "42137074", "doi": "10.4103/tjem.tjem_308_25", "nctId": null, "pmcid": "PMC13171132", "title": "Disulfiram-like reaction with ornidazole: A case report of a rare interaction", "firstAuthor": "Orhan", "multipleAuthors": true, "journal": "Turk J Emerg Med", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "44-year-old woman with a pilonidal cyst (a cyst near the top of the buttock crease), no other health problems", "intervention": "taking the antibiotic ornidazole along with drinking alcohol (raki)", "comparator": "none (single case report)", "primaryOutcome": "development of a disulfiram-like reaction (flushing, nausea, vomiting, low blood pressure, fast heart rate) after drinking alcohol while on the drug", "result": "she developed a probable drug-alcohol reaction with flushing, vomiting, low blood pressure and rapid heartbeat that resolved with supportive care over 16 hours", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether treatments work but only flags a possible drug-alcohol reaction.", "directness": "indirect", "limitations": "only one patient reported; no comparison group; does not address the cause of pilonidal cyst pain itself", "followUp": "16 h", "plainFinding": "Not about cyst pain itself.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42137074/", "sourceText": "A disulfiram-like reaction (DLR) associated with ornidazole is a rare but important adverse drug-alcohol interaction. We report a 44-year-old female with no known comorbidities or drug allergies who presented to the emergency department with palpitations, nausea, vomiting, facial flushing, and acral hyperemia. Her symptoms began approximately 30 min after consuming two glasses of raki while receiving ornidazole for a pilonidal cyst. On examination, she was found to be hypotensive and tachycardic. Laboratory results were within normal limits. Her symptoms improved significantly with supportive care over 16 h. A Naranjo Adverse Drug Reaction Probability Scale score of 7 indicated a probable relationship with ornidazole. This case represents a rare instance of a DLR due to ornidazole monotherapy in a patient without chronic alcohol use. Clinicians should be aware of this potential interaction and advise patients to avoid alcohol consumption during ornidazole therapy to prevent DLRs.", "provenance": [ { "field": "population", "quote": "44-year-old female with no known comorbidities or drug allergies" }, { "field": "intervention", "quote": "Her symptoms began approximately 30 min after consuming two glasses of raki while receiving ornidazole for a pilonidal cyst." }, { "field": "comparator", "quote": "This case represents a rare instance of a DLR due to ornidazole monotherapy in a patient without chronic alcohol use." }, { "field": "primaryOutcome", "quote": "A disulfiram-like reaction (DLR) associated with ornidazole is a rare but important adverse drug-alcohol interaction." }, { "field": "result", "quote": "Her symptoms improved significantly with supportive care over 16 h." }, { "field": "n", "quote": "We report a 44-year-old female" } ] }, { "id": "pmid:42128975", "pmid": "42128975", "doi": "10.1007/s10151-026-03314-8", "nctId": null, "pmcid": "PMC13342393", "title": "Does laser treatment affect outcome in pilonidal sinus disease? Long-term multicenter retrospective analysis of pit-picking alone vs. pit-picking with laser", "firstAuthor": "Arslan", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "retrospective", "n": 306, "nField": "reported", "population": "patients with pilonidal sinus disease (a cyst/infection near the top of the buttock crack) who had pit-picking surgery", "intervention": "pit-picking surgery combined with laser treatment", "comparator": "pit-picking surgery alone", "primaryOutcome": "sinus coming back within 5 years", "result": "no significant difference in 5-year recurrence between groups, but laser group had fewer complications, less pain, and faster return to work", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized comparison across multiple centers, so differences between groups could be due to factors other than the treatment itself.", "directness": "direct", "limitations": "Retrospective design, not randomized; authors call for randomized trials to confirm findings.", "followUp": "5 years", "plainFinding": "Faster recovery, same recurrence rate.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42128975/", "sourceText": "OBJECTIVES: The optimal management of pilonidal sinus disease (PSD) remains controversial, with multiple treatment approaches available. Pit-picking is a minimally invasive technique, often enhanced with laser treatment (LT), but the long-term benefits of LT remain uncertain. The objective of this study is to compare pit-picking alone versus pit-picking combined with LT. METHODS: This is a multicenter retrospective cohort study including seven centers across Turkey. Patients who underwent pit-picking surgery for PSD between June 2017 and March 2025 were included. Patients receiving adjunctive treatments beyond LT, undergoing excisional procedures, or with incomplete follow-up data were excluded. Pit-picking surgeries performed with or without LT were compared. The primary measure was the recurrence rate at 5 years. Secondary outcomes were postoperative pain, time to complete healing, complications, return to work, and costs. RESULTS: Of 306 patients, 109 (35.6%) underwent pit-picking alone, and 197 (64.4%) received pit-picking with LT. The complication rate was lower in the LT group (6.1% vs. 14.7%, p = 0.012). Patients treated with LT had shorter times to pain-free sitting (median 5 vs. 7 days, p < 0.001) and return to work (3 vs. 6 days, p < 0.001). Complete healing was achieved in 97.4% of patients, with a median time of 14 days. Recurrence rates at 5 years were similar (pit-picking: 13.8%, pit-picking + LT: 12.7%, p = 0.460). Costs were higher for the LT group ($1212 ± 146 vs. $888 ± 148), although complicated pit-picking cases had comparable costs to the LT group ($1198 ± 370, p = 0.004). Risk factors for recurrence included high BMI, family history, advanced Tezel stage, and postoperative complications. CONCLUSIONS: While LT improves early postoperative outcomes, it does not impact long-term recurrence rates. The increased cost of LT should be weighed against its benefits in reducing complications, pain, and recovery time. Further randomized trials are needed to refine patient selection criteria and assess cost-effectiveness. CLINICAL TRIAL REGISTRATION: NCT05569135, Registration date: 05.10.2022.", "provenance": [ { "field": "n", "quote": "Of 306 patients, 109 (35.6%) underwent pit-picking alone, and 197 (64.4%) received pit-picking with LT." }, { "field": "population", "quote": "Patients who underwent pit-picking surgery for PSD between June 2017 and March 2025 were included." }, { "field": "intervention", "quote": "pit-picking combined with LT" }, { "field": "comparator", "quote": "pit-picking alone" }, { "field": "primaryOutcome", "quote": "The primary measure was the recurrence rate at 5 years." }, { "field": "result", "quote": "Recurrence rates at 5 years were similar (pit-picking: 13.8%, pit-picking + LT: 12.7%, p = 0.460)." }, { "field": "result", "quote": "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)." }, { "field": "followUp", "quote": "recurrence rate at 5 years" } ] }, { "id": "pmid:42126480", "pmid": "42126480", "doi": "10.1007/s10151-025-03280-7", "nctId": null, "pmcid": "PMC13342408", "title": "Sinus laser-assisted closure (SiLaC) in pilonidal sinus disease: a multicenter cohort study", "firstAuthor": "de Kort", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "retrospective", "n": 231, "nField": "reported", "population": "people with chronic pilonidal sinus disease (at the top of the buttock crack), either first-time or recurrent", "intervention": "laser treatment to close the pilonidal sinus tract (SiLaC)", "comparator": "no comparison group; primary vs recurrent disease compared within study", "primaryOutcome": "symptom control, quality of life, and need for further surgery after treatment", "result": "about 1 in 5 patients needed further non-laser surgery, but symptoms were low and quality of life was high at follow-up", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a retrospective study without a comparison group, so it cannot prove the laser treatment is better than other options.", "directness": "direct", "limitations": "retrospective design, no control group, reliance on medical records and a questionnaire", "followUp": "33 months", "plainFinding": "Good symptom relief after laser sinus treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42126480/", "sourceText": "BACKGROUND: Sinus laser-assisted closure (SiLaC) is gaining popularity as a minimally invasive surgical technique to treat chronic sacrococcygeal pilonidal sinus disease (SPSD). However, long-term outcomes on this technique are rarely reported in the literature. This multicenter study aimed to report the mid-term outcome of a cohort of patients who underwent SiLaC treatment for primary or recurrent SPSD. METHODS: Patients with primary or recurrent SPSD were included in this retrospective cohort study. 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. RESULTS: A total of 231 patients were included, with a median follow-up of 33 months (IQR 20-44): 128 patients underwent SiLaC for primary SPSD and 103 for recurrent SPSD. Additional interventions were required in 35 patients with primary SPSD (27.3%) and in 30 patients with recurrent SPSD (29.1%). Repeat SiLaC alone, i.e. no other surgical treatment than repeat SiLaC, was performed in 25 patients (19.6%) in the primary group and 22 patients (21.4%) in the recurrent group. 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, both in the primary and recurrent group. CONCLUSIONS: SiLaC for primary and recurrent SPSD appeared to be a safe procedure with excellent symptom control and quality of life, with only 7.8% of patients in both groups requiring other surgical treatment than SiLaC.", "provenance": [ { "field": "population", "quote": "Patients with primary or recurrent SPSD were included in this retrospective cohort study." }, { "field": "intervention", "quote": "Sinus laser-assisted closure (SiLaC) is gaining popularity as a minimally invasive surgical technique to treat chronic sacrococcygeal pilonidal sinus disease (SPSD)." }, { "field": "comparator", "quote": "128 patients underwent SiLaC for primary SPSD and 103 for recurrent SPSD." }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "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" }, { "field": "n", "quote": "A total of 231 patients were included" }, { "field": "followUp", "quote": "with a median follow-up of 33 months (IQR 20-44)" } ] }, { "id": "pmid:42112873", "pmid": "42112873", "doi": "10.1111/ans.70737", "nctId": null, "pmcid": null, "title": "Endoscopic Pilonidal Sinus Treatment Versus Excisional Surgery: A Retrospective Comparison at an Australian Tertiary Centre", "firstAuthor": "Hlaing", "multipleAuthors": true, "journal": "ANZ J Surg", "year": 2026, "design": "retrospective", "n": 180, "nField": "reported", "population": "patients aged 12 or older having elective surgery for pilonidal sinus disease (a condition causing cysts/infection at the top of the buttock crease)", "intervention": "endoscopic pilonidal sinus treatment (EPSiT), a minimally invasive procedure", "comparator": "traditional excisional surgery (cutting out the sinus, with flap closure, open healing, or stitched closure)", "primaryOutcome": "wound healing and recurrence after healing", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design, single centre, no randomization, and a small subgroup analysis (prior abscess drainage) that may be underpowered.", "followUp": "", "plainFinding": "Similar healing, fewer opioids with endoscopic treatment", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42112873/", "sourceText": "BACKGROUND: Endoscopic pilonidal sinus treatment (EPSiT) may reduce recovery burden, but comparative data against contemporary excisional practices in Australia are limited. METHODS: We conducted a retrospective cohort study of consecutive elective pilonidal operations in patients aged ≥ 12 at a tertiary Australian hospital (January 2018-May 2025). Analyses were performed at the operative episode level, including repeat procedures. EPSiT was compared with excisional surgery (off-midline flap closure, lay-open excision or primary closure). The primary outcomes were primary healing and recurrence after healing. Secondary outcomes were same-day discharge and opioid prescription at discharge. RESULTS: The cohort included 180 elective operative episodes in 144 patients: 115 EPSiT (63.9%) and 65 excisional (36.1%). Primary healing occurred in 158 episodes (87.8%) and did not differ between EPSiT and excision (89.6% vs. 84.6%; p = 0.330). Recurrence occurred in 26.6% and was similar between groups (29.1% vs. 21.8%; p = 0.322). EPSiT was associated with higher same-day discharge (86.1% vs. 21.5%; p < 0.001) and lower opioid prescribing at discharge (2.6% vs. 63.1%; p < 0.001). In the subgroup with prior emergency I&D (n = 66), primary healing remained similar (89.5% vs. 85.7%; p = 0.644), but recurrence after healing was higher following EPSiT (47.1% vs. 20.8%; p = 0.041). CONCLUSIONS: EPSiT achieved similar primary healing and recurrence to excisional surgery while enabling ambulatory care and opioid-sparing discharge. Prior abscess I&D was associated with higher recurrence after EPSiT despite comparable primary healing, supporting tailored counselling and selective EPSiT use when long-term durability is prioritised.", "provenance": [ { "field": "n", "quote": "The cohort included 180 elective operative episodes in 144 patients" }, { "field": "population", "quote": "patients aged ≥ 12 at a tertiary Australian hospital" }, { "field": "intervention", "quote": "EPSiT was compared with excisional surgery" }, { "field": "comparator", "quote": "off-midline flap closure, lay-open excision or primary closure" }, { "field": "primaryOutcome", "quote": "The primary outcomes were primary healing and recurrence after healing." }, { "field": "result", "quote": "Primary healing occurred in 158 episodes (87.8%) and did not differ between EPSiT and excision (89.6% vs. 84.6%; p = 0.330). Recurrence occurred in 26.6% and was similar between groups (29.1% vs. 21.8%; p = 0.322)." }, { "field": "result", "quote": "recurrence after healing was higher following EPSiT (47.1% vs. 20.8%; p = 0.041)" } ] }, { "id": "pmid:42098544", "pmid": "42098544", "doi": "10.1007/s10151-025-03283-4", "nctId": null, "pmcid": "PMC13152908", "title": "Comparing keystone and Limberg flaps for pilonidal sinus: Does flap choice influence patient satisfaction?", "firstAuthor": "Wael", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "rct", "n": 50, "nField": "reported", "population": "Young adults with pilonidal sinus disease (a chronic infected pit near the top of the buttock crack) needing surgery", "intervention": "Keystone perforator island flap surgery to repair the area after removing the sinus", "comparator": "Limberg flap surgery to repair the area after removing the sinus", "primaryOutcome": "Patient satisfaction at 6 months after surgery", "result": "Keystone flap patients healed faster, had fewer complications, and were more satisfied (96% vs 72%) than Limberg flap patients", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "It was a randomized trial, but very small with only 50 patients, which limits confidence in the results.", "directness": "direct", "limitations": "Small sample size of 50 patients from a single comparative trial; abstract does not mention blinding or multi-center design.", "followUp": "6 months", "plainFinding": "Faster healing, higher satisfaction with keystone flap", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42098544/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a chronic condition that mainly affects young adults impairing the quality of life. Among several surgical options, flap reconstruction offers faster healing and lower recurrence. This randomized comparative study evaluated the keystone perforator island flap (KSF) versus the Limberg flap (LF) in PSD repair, focusing primarily on patient satisfaction depending on the flap type, alongside perioperative outcomes following PS excision as secondary outcomes. METHODS: A total of 50 patients with simple PSD were randomized equally to undergo KSF or LF reconstruction after sinus excision. Operative data, complications, and recovery metrics were recorded. Patient satisfaction, the primary endpoint, was assessed at 6 months using a validated 5-point scale. Statistical analysis employed the t-test, chi-squared test, and multivariate linear regression to identify independent predictors of satisfaction (p < 0.05 significant). RESULTS: The KSF group showed shorter operative time (54.9 ± 3.7 versus 73.4 ± 7.9 min, p < 0.001), faster wound healing (13.5 ± 3.1 versus 17.1 ± 3.5 days, p < 0.001), and earlier return to activity (6.8 ± 0.8 versus 8.5 ± 0.8 days, p < 0.001). Complications were lower (24% versus 56%, p = 0.02). Satisfaction was significantly higher with KSF (96% versus 72%, p = 0.046). Regression analysis identified wound-healing time (p = 0.008) and return to activity (p < 0.001) as the independent predictors of satisfaction. CONCLUSION: The KSF provides faster recovery, better comfort, and higher patient satisfaction than the LF. Functional recovery parameters, rather than flap type alone, are the strongest determinants of postoperative satisfaction.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus disease (PSD) is a chronic condition that mainly affects young adults" }, { "field": "intervention", "quote": "keystone perforator island flap (KSF)" }, { "field": "comparator", "quote": "Limberg flap (LF)" }, { "field": "primaryOutcome", "quote": "Patient satisfaction, the primary endpoint, was assessed at 6 months using a validated 5-point scale." }, { "field": "result", "quote": "Satisfaction was significantly higher with KSF (96% versus 72%, p = 0.046)." }, { "field": "n", "quote": "A total of 50 patients with simple PSD were randomized equally" }, { "field": "followUp", "quote": "assessed at 6 months" } ] }, { "id": "pmid:42089833", "pmid": "42089833", "doi": "10.1111/iwj.70938", "nctId": null, "pmcid": "PMC13148142", "title": "Outcomes of Pilonidal Surgery Performed in the Setting of Standard Adjunct Laser Hair Removal: A Retrospective Cohort Study", "firstAuthor": "Jarrin Lopez", "multipleAuthors": true, "journal": "Int Wound J", "year": 2026, "design": "retrospective", "n": 168, "nField": "reported", "population": "patients with pilonidal sinus disease who had surgery, ages 14-89", "intervention": "Bascom flap closure surgery with laser hair removal", "comparator": "pilocystectomy surgery (both with laser hair removal)", "primaryOutcome": "need for repeat surgery, wound infection within 30 days, and unplanned clinic visits", "result": "Flap surgery had fewer repeat procedures and unplanned visits than pilocystectomy, with similar infection rates", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Flap surgery had fewer repeat operations.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42089833/", "sourceText": "Pilonidal sinus disease (PSD) is associated with substantial morbidity because of wound complications and recurrence after surgery. Adjunct laser hair removal (LHR) has been incorporated into postoperative management in some settings, but real-world outcomes in cohorts treated uniformly with LHR remain incompletely described. This study aimed to characterize postoperative outcomes after PSD surgery in a large integrated healthcare system in which adjunctive LHR was standard practice and to compare outcomes by surgical approach. We performed a retrospective descriptive cohort study of patients aged 14-89 years who underwent operative treatment of PSD with adjunctive LHR at Kaiser Permanente Northern California between 2012 and 2024. Outcomes included repeat procedures, 30-day surgical site infection (SSI), and unplanned clinic visits. Outcomes were summarized as proportions overall and by surgical approach. Exploratory bivariable logistic regression examined associations between sex or body mass index (BMI) and outcomes. Multivariable modeling was not performed because of low event counts and sparse covariate distributions, which resulted in unstable models. Among 168 patients, the overall repeat procedure rate was 16.7%, the 30-day SSI rate was 14.4%, and 39.3% had at least one unplanned clinic visit. Patients treated with Bascom flap closure had fewer repeat procedures (10.4% vs. 20.8%) and fewer unplanned visits (33.8% vs. 43.6%) than those undergoing pilocystectomy, with similar SSI rates (14.9% vs. 14.0%). In exploratory analyses, sex and BMI were not significantly associated with outcomes in either surgical group. In this real-world cohort managed uniformly with adjunctive LHR, postoperative outcomes appeared to vary more by surgical approach than by sex or BMI. These findings are descriptive and do not estimate the independent effect of LHR. Controlled comparative studies are needed to determine the contribution of LHR to PSD outcomes.", "provenance": [ { "field": "n", "quote": "Among 168 patients" }, { "field": "population", "quote": "patients aged 14-89 years who underwent operative treatment of PSD with adjunctive LHR" }, { "field": "intervention", "quote": "Patients treated with Bascom flap closure" }, { "field": "comparator", "quote": "those undergoing pilocystectomy" }, { "field": "primaryOutcome", "quote": "Outcomes included repeat procedures, 30-day surgical site infection (SSI), and unplanned clinic visits." }, { "field": "result", "quote": "Patients treated with Bascom flap closure had fewer repeat procedures (10.4% vs. 20.8%) and fewer unplanned visits (33.8% vs. 43.6%) than those undergoing pilocystectomy, with similar SSI rates (14.9% vs. 14.0%)." } ] }, { "id": "pmid:42082883", "pmid": "42082883", "doi": "10.1007/s10151-026-03317-5", "nctId": null, "pmcid": "PMC13139232", "title": "Endoscopic treatment versus open excision for pediatric pilonidal disease: technical description of a modified (P)EPSiT approach using standard equipment and retrospective cohort study", "firstAuthor": "Kirsch", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "retrospective", "n": 113, "nField": "reported", "population": "pediatric patients treated surgically for pilonidal disease", "intervention": "endoscopic pilonidal sinus treatment (EPSiT) using standard urological instruments", "comparator": "open excision surgery", "primaryOutcome": "operative time, hospital stay, recurrence, pain, and satisfaction", "result": "EPSiT had significantly shorter hospital stays and similar recurrence rates and operative times compared to open excision", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective single-center study comparing two different time periods, with patient-reported outcomes only collected for one group.", "directness": "indirect", "limitations": "Retrospective design, patient-reported outcomes available for EPSiT cohort only, two surgical cohorts came from different time periods (2014-2018 vs 2019-2023)", "followUp": "", "plainFinding": "Endoscopic surgery means shorter hospital stay.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42082883/", "sourceText": "BACKGROUND: Endoscopic pilonidal sinus treatment (EPSiT) has emerged as a minimally invasive treatment option for pilonidal disease (PD) in adolescents, yet its adoption has been limited by the need for specialized equipment. We developed a modified EPSiT technique using standard urological instruments, saline irrigation, and lateral positioning, which was introduced in 2019. This study provides a technical description of the modified approach and evaluates the outcomes compared with conventional open excision in a pediatric cohort. METHODS: We conducted a single-center retrospective cohort study of 113 pediatric patients treated surgically for PD between 2014 and 2023. Patients were divided into two cohorts: EPSiT (n = 48, 2019-2023) and open excision (n = 65, 2014-2018). Clinical data were collected from medical records for both groups and structured telephone interviews for patients undergoing EPSiT. Outcomes included operative time, hospital stay, recurrence, pain, and satisfaction. RESULTS: Gender distribution was identical in both cohorts (29.2% male, 70.8% female). Operative times were similar between groups (35.8 versus 31.7 min; p = .307). 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). Patient-reported outcomes were available for the EPSiT cohort only and indicated high cosmetic satisfaction and minimal analgesic use. Among patients undergoing EPSiT, 41.7% returned to school immediately after discharge, and most resumed normal activities within a few days. CONCLUSIONS: This modified EPSiT approach is feasible and may increase accessibility in resource-limited settings, representing a less invasive treatment option for PD. Further prospective studies are needed to validate these findings and define the role of EPSiT in the treatment of pediatric PD.", "provenance": [ { "field": "n", "quote": "113 pediatric patients treated surgically for PD between 2014 and 2023" }, { "field": "population", "quote": "pediatric patients treated surgically for PD" }, { "field": "intervention", "quote": "Endoscopic pilonidal sinus treatment (EPSiT)" }, { "field": "comparator", "quote": "open excision" }, { "field": "primaryOutcome", "quote": "Outcomes included operative time, hospital stay, recurrence, pain, and satisfaction." }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:42044893", "pmid": "42044893", "doi": "10.3357/AMHP.6758.2026", "nctId": null, "pmcid": null, "title": "Diabetic Ketoacidosis Reported from U.S. Navy Submarines, 2021-2024", "firstAuthor": "Monroe", "multipleAuthors": true, "journal": "Aerosp Med Hum Perform", "year": 2026, "design": "case-series", "n": 3, "nField": "reported", "population": "active duty male U.S. Navy submariners newly diagnosed with type 1 diabetes", "intervention": "none; this is an observational report of diagnosis and management, not a tested intervention", "comparator": "none; no comparator group", "primaryOutcome": "recognition and management of diabetic ketoacidosis in submarine settings", "result": "Delayed diagnosis occurred in one case where symptoms were initially treated as pilonidal disease; cases of DKA were complicated by renal failure and pancreatitis", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Not about pilonidal disease causes.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42044893/", "sourceText": "BACKGROUND: Type 1 diabetes mellitus (T1DM) is a complex systemic condition that poses unique challenges for diagnosis and management in military environments, particularly on submarines where access to standard medical resources is limited. CASE SERIES: This case series examines three instances of a first diagnosis of T1DM among active duty male U.S. Navy submariners, highlighting the challenges of managing this condition in austere military environments. Case 1 involves a 27-yr-old experiencing gastrointestinal symptoms during deployment and found to have diabetic ketoacidosis (DKA) complicated by renal failure and pancreatitis. Case 2 features a 22-yr-old presenting with weakness and fatigue on board leading to a diagnosis of DKA and pancreatitis. In Case 3, a 20-yr-old initially treated for pilonidal disease later manifests classic T1DM symptoms, leading to delayed diagnosis despite increased access to care in port. DISCUSSION: These cases underscore the importance of early recognition and intervention, particularly in environments with limited medical resources. Delays in communication and access to higher echelons of care further compound the challenges of managing T1DM and DKA on submarines. To address these issues, the Naval Undersea Medical Institute has developed protocols to empower medical personnel in diagnosing and managing T1DM in such settings. By sharing these experiences, this report aims to improve awareness and preparedness for managing T1DM in submarines, ultimately enhancing the care provided to patients in austere military environments. Monroe DM, Earley JP. Diabetic ketoacidosis reported from U.S. Navy submarines, 2021-2024. Aerosp Med Hum Perform. 2026; 97(5):379-383.", "provenance": [ { "field": "n", "quote": "This case series examines three instances of a first diagnosis of T1DM" }, { "field": "population", "quote": "active duty male U.S. Navy submariners" }, { "field": "result", "quote": "In Case 3, a 20-yr-old initially treated for pilonidal disease later manifests classic T1DM symptoms, leading to delayed diagnosis" }, { "field": "primaryOutcome", "quote": "highlighting the challenges of managing this condition in austere military environments" }, { "field": "intervention", "quote": "This case series examines three instances of a first diagnosis of T1DM" }, { "field": "comparator", "quote": "CASE SERIES: This case series examines three instances of a first diagnosis of T1DM among active duty male U.S. Navy submariners" } ] }, { "id": "pmid:42027172", "pmid": "42027172", "doi": "10.17116/hirurgia2026041110", "nctId": null, "pmcid": null, "title": "[Are there any male-to-female disparities in recurrence rates after surgery for Pilonidal Disease? A meta-analysis comparing differing mixed-gender cohorts]", "firstAuthor": "Doll", "multipleAuthors": true, "journal": "Khirurgiia (Mosk)", "year": 2026, "design": "meta-analysis", "n": 113021, "nField": "reported", "population": "adults with pilonidal sinus disease (a cyst/abscess near the top of the buttock crack) who had surgery", "intervention": "surgery for pilonidal disease in women", "comparator": "surgery for pilonidal disease in men", "primaryOutcome": "rate of the disease coming back after surgery (at 5 and 10 years)", "result": "women had higher recurrence rates than men across all surgical methods studied", "resultDirection": "harm", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "abstract notes the female-only cohort was limited in size, precluding further subgroup analyses, and calls for confirmation with individual patient data", "followUp": "5-year and 10-year", "plainFinding": "Women had more recurrences after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42027172/", "sourceText": "OBJECTIVE: Pilonidal Sinus Disease (PSD) manifests globally with a prevalence in adult men fourfold greater than in adult women. Due to the lower incidence in females the course of female PSD remains largely unexplored. In this study we aimed to assess the postoperative recurrence rate in women with PSD. MATERIAL AND METHODS: A systematic search of the existing PSD world literature between 1833 and 2023 employing search terms \"pilonid\" or \"dermoid\" AND \"cyst\" was conducted across all databases available including MEDLINE, PubMed, PubMed Central, Scopus, Ovid, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL). Studies were segregated into male-only (Mo), female-only (Fo), or male-female mixed cohorts (mixG) Kaplan-Meier Survival analysis. Recurrence rates at 5-year and 10-year follow-up following various surgical interventions were compared. Bias estimation was done using Newcastle-Ottawa scale for cohort studies and the Cochrane RoB1 tool for RCTs. RESULTS: 880 studies encompassing 113, 021 patients were surveyed, consisting of 133 randomized controlled trials (RCTs) with 13.275 patients and 747 non-randomized observational studies with 99.746 patients. The patient cohort, numbering 113.0219 individuals, was further categorized into male-only (Mo; 16.843 patients), female-only (Fo; 653 patients), or mixed-gender (mixG; 95.525 patients) cohorts. UNLABELLED: In RCTs involving mixG, a 5-year recurrence rate (RR) of 16.0% (95% CI 14.6%-17.3%) and a 10-year RR of 30.4% (95% CI 27.1%-33.5%) were observed. Conversely, in non-RCTs, the 5-year RR for mixG was 11.7% (95% CI 11.4%-12.0%), with a Mo RR of 2.2% (95% CI 1.9%-2.4%). The 10-year RR for mixG stood at 22.5% (95% CI 22.8%-23.2%), and 5.8% (95% CI 5.4%-6.3%) for the male-only group (p<0.0001; log rank test). These findings were significant consistent across subgroups, including primary midline closure, where the 5-year RR for mixG was 15.1% (95% CI 14.2%-16.0%) versus 7.0% (95% CI 5.7%-8.3%) for Mo, and the 10-year RR for mixG was 29.5% (95% CI 27.6%-31.3%) versus 14.4% (95% CI 12.4%-16.4%) for Mo (p<0.0001). Similar significant differences were noted in the primary open and Karydakis/Bascom subgroups. UNLABELLED: Due to the limited size of the male-only cohort, which precluded further subgroup analyses, studies were stratified based on the proportion of females above or below the mean of 19.87%. Notably, recurrence rates varied significantly based on female representation in RCTs (across all treatments and subgroups of primary midline and Bascom/Karydakis) and in non-RCT studies (across all treatments and subgroups of primary open, midline closure, and Bascom/Karydakis). CONCLUSION: Previously undisclosed, the 5-year recurrence rate in PSD for mixed gender cohorts with female share above mean 19.87% seem to significantly surpass that of their less female cohort counterparts across the analyzed therapeutic modalities in RCT as in non-RCT studies. The substantiation of these observations awaits scrutiny through individual patient data at the population level. Females with PSD seem to have a higher RR as compared to men for all therapies tested. UNLABELLED: Therefore, an establishment of Good Pilonidal Practice (GPP) criteria should be considered to protect our female PSD patients from entering the vicious cycle of repeat recurrences. UNLABELLED: What does this paper add to the literature? It has not uncovered before that females are an especially vulnerable group concerning PSD recurrences following surgical therapy. ABBREVIATIONS: FUP follow-up; GCP Good Clinical Practice; GPP Good Pilonidal Practice; IGF intergluteal fold; mixG mixed gender (male and female participants in published study cohort); Mo male-only; PSD Pilonidal Sinus Disease; pt patient; RCT randomised controlled trial; RR Recurrence rate; ROR return on recurrence; yr year.", "provenance": [ { "field": "n", "quote": "880 studies encompassing 113, 021 patients were surveyed" }, { "field": "population", "quote": "Pilonidal Sinus Disease (PSD) manifests globally with a prevalence in adult men fourfold greater than in adult women" }, { "field": "intervention", "quote": "female-only (Fo; 653 patients)" }, { "field": "comparator", "quote": "male-only (Mo; 16.843 patients)" }, { "field": "primaryOutcome", "quote": "Recurrence rates at 5-year and 10-year follow-up following various surgical interventions were compared." }, { "field": "result", "quote": "Females with PSD seem to have a higher RR as compared to men for all therapies tested." } ] }, { "id": "pmid:42020338", "pmid": "42020338", "doi": "10.1111/iwj.70907", "nctId": null, "pmcid": "PMC13102628", "title": "Minimally Invasive, Maximally Effective: Outpatient Strategies for Paediatric Pilonidal Disease", "firstAuthor": "Donnelly", "multipleAuthors": true, "journal": "Int Wound J", "year": 2026, "design": "retrospective", "n": 69, "nField": "reported", "population": "children and teenagers (median age 15) with pilonidal sinus disease near the tailbone", "intervention": "structured outpatient care pathway (conservative treatment, in-clinic debridement, or surgery for severe/refractory cases)", "comparator": "operative versus non-operative management within the same pathway", "primaryOutcome": "recurrence of pilonidal disease after the wound healed", "result": "disease came back in 26.1% of patients who had surgery versus 2.2% of those managed without surgery", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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", "followUp": "", "plainFinding": "Conservative care had fewer recurrences", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42020338/", "sourceText": "Pilonidal sinus disease (PNS) in children and adolescents lacks standardised management pathways. Minimally invasive and outpatient-based strategies are increasingly adopted, but paediatric-specific data remain limited. This study evaluated outcomes following implementation of a structured, tiered outpatient pathway. A retrospective single-centre cohort study was conducted including patients aged ≤ 18 years treated for PNS between February 2023 and August 2024. Management followed a stepwise protocol: structured conservative care, in-clinic debridement and operative intervention (trephination or limited excision) for refractory or severe disease. Primary outcome was recurrence after documented healing. Secondary outcomes included time to healing, clinic utilisation and associations with clinical variables. 69 patients were included (median age 15 years [IQR 14-16]; 64% male). Twenty-three patients (33.3%) required operative management. Recurrence occurred in 6/23 (26.1%) in the operative group and 1/46 (2.2%) in the non-operative group (Fisher's exact p = 0.0045). Median follow-up duration did not differ significantly between groups. Prior infection at presentation showed a numerical but not statistically significant association with recurrence. Time to healing was prolonged in both groups and did not differ significantly. Within a structured outpatient pathway, paediatric patients demonstrated low overall recurrence rates. Conservative management was associated with lower recurrence; however, patients undergoing operative intervention likely represented a more severe subgroup. Prospective severity-adjusted studies are required to define optimal paediatric wound management strategies for PNS.", "provenance": [ { "field": "population", "quote": "patients aged ≤ 18 years treated for PNS between February 2023 and August 2024" }, { "field": "intervention", "quote": "structured conservative care, in-clinic debridement and operative intervention (trephination or limited excision) for refractory or severe disease" }, { "field": "comparator", "quote": "Recurrence occurred in 6/23 (26.1%) in the operative group and 1/46 (2.2%) in the non-operative group" }, { "field": "primaryOutcome", "quote": "Primary outcome was recurrence after documented healing." }, { "field": "result", "quote": "Recurrence occurred in 6/23 (26.1%) in the operative group and 1/46 (2.2%) in the non-operative group (Fisher's exact p = 0.0045)." }, { "field": "n", "quote": "69 patients were included" } ] }, { "id": "pmid:41999968", "pmid": "41999968", "doi": "10.1016/j.jpedsurg.2026.163145", "nctId": null, "pmcid": null, "title": "Surgical management of pilonidal sinus disease in pediatric population: An updated systematic review and meta-analysis", "firstAuthor": "Saleem", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2026, "design": "meta-analysis", "n": 5075, "nField": "reported", "population": "children and teenagers (18 years or younger) with pilonidal disease", "intervention": "different surgical techniques for pilonidal disease, including off-midline closure and minimally invasive surgery with laser hair removal", "comparator": "other surgical techniques such as open healing and midline closure", "primaryOutcome": "recurrence of the condition, wound complications, and recovery time after surgery", "result": "off-midline closure and minimally invasive surgery had lower recurrence, fewer complications, and faster recovery than open healing or midline closure", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Minimally invasive surgery works best in kids", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41999968/", "sourceText": "BACKGROUND: Pilonidal disease (PD) is a chronic inflammatory condition of the natal cleft that commonly affects pediatric population, leading to high morbidity, frequent recurrences, and impaired quality of life. Despite various surgical approaches, no consensus exists on the optimal technique, and pediatric-specific evidence is limited. OBJECTIVES: To compare recurrence, wound complications, and recovery outcomes across surgical techniques in patients ≤18 years with PD. METHODOLOGY: A systematic search of MEDLINE, Cochrane, and Google Scholar (inception-Dec 2024) identified 59 studies (N = 5075). Data on recurrence, wound complications, healing time, operative time, hospital stay, return to daily activities (ADL), pain scores, and reoperation rates were extracted. Random-effects models were used for pooled estimates. Subgroup analyses and meta-regression explored heterogeneity and impact of follow-up duration. Study quality was assessed using the Newcastle-Ottawa Scale and ROB-2. RESULTS: Open healing showed the highest recurrence (20.1%) and moderate wound complication rates (16.2%), with healing times up to 98 days. Midline primary closure had a recurrence rate of 17.5%, the highest wound complication rate (43.5%), and a reoperation rate of 29.8%. Off-midline closures had the lowest recurrence (10.2%) and moderate complications (19.5%), with healing times as short as 8 days. Minimally invasive techniques (MITs), particularly PEPSiT, demonstrated low recurrence (11.4%), minimal complications (6.5%), short operative times (17-50 min), early return to ADL (1-3 days), and low postoperative pain (VAS 0-2). Adjunctive laser epilation improved outcomes across all techniques. Meta-regression showed longer follow-up was associated with lower recurrence in most groups, except open healing. CONCLUSION: Off-midline closure and minimally invasive strategies, especially when combined with laser epilation, offer superior outcomes in recurrence, complications, and recovery.", "provenance": [ { "field": "n", "quote": "identified 59 studies (N = 5075)" }, { "field": "population", "quote": "patients ≤18 years with PD" }, { "field": "intervention", "quote": "Off-midline closures had the lowest recurrence (10.2%) and moderate complications (19.5%), with healing times as short as 8 days." }, { "field": "intervention", "quote": "Minimally invasive techniques (MITs), particularly PEPSiT, demonstrated low recurrence (11.4%), minimal complications (6.5%)" }, { "field": "comparator", "quote": "Open healing showed the highest recurrence (20.1%) and moderate wound complication rates (16.2%), with healing times up to 98 days." }, { "field": "comparator", "quote": "Midline primary closure had a recurrence rate of 17.5%, the highest wound complication rate (43.5%), and a reoperation rate of 29.8%." }, { "field": "primaryOutcome", "quote": "To compare recurrence, wound complications, and recovery outcomes across surgical techniques" }, { "field": "result", "quote": "Off-midline closure and minimally invasive strategies, especially when combined with laser epilation, offer superior outcomes in recurrence, complications, and recovery." } ] }, { "id": "pmid:41964736", "pmid": "41964736", "doi": "10.1007/s00423-026-04026-1", "nctId": null, "pmcid": "PMC13180761", "title": "A systematic review and meta-analysis of sinus laser associated closure (SiLaC) versus endoscopic pilonidal sinus treatment (EPSiT) in the management of pilonidal sinus disease", "firstAuthor": "Li", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2026, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease (a chronic infection/cyst near the top of the buttocks crease)", "intervention": "laser treatment of the sinus tract (SiLaC)", "comparator": "endoscopic pilonidal sinus treatment (EPSiT)", "primaryOutcome": "operative time, cure rate, recurrence rate, complication rate, and wound healing time", "result": "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", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "The comparison relies on indirect pooling of separate single-arm studies with very high statistical variability, not head-to-head trials.", "directness": "direct", "limitations": "Lack of direct comparative trials; high heterogeneity (I2 often >90%) across included single-arm studies.", "followUp": "", "plainFinding": "Both laser and keyhole surgery work similarly.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41964736/", "sourceText": "BACKGROUND: Various surgical modalities exist for the management of pilonidal sinus disease (PSD), with an increasing trend toward minimally invasive techniques. Sinus Laser associated Closure (SiLaC) and endoscopic pilonidal sinus treatment (EPSiT) are two minimally invasive techniques widely used in clinical practice. However, a systematic comparison of both techniques is lacking. This study conducted separate single-arm analyses of both techniques to compare their efficacy and safety. OBJECTIVE: A systematic literature search was performed across electronic databases including Web of Science, Embase, the Cochrane Library, Google Scholar and PubMed to identify relevant studies investigating SiLaC versus EPSiT for PSD. The primary outcome measures included operative time, cure rate, recurrence rate, postoperative complication rate, and total wound healing time. RESULTS: A total of 29 studies were included. The mean operative time was 18.02 min (95% CI:13.42–22.62; I2 = 99.4%; P < 0.001) for SiLaC and 30.11 min (95% CI: 21.33–38.88; I² = 98.5%; P < 0.001) for EPSiT. The cure rate was 86% (95% CI: 80–91%; I2 =92%; P < 0.001) in the SiLaC and 88% (95% CI: 83–94%; I² = 87.1%; P < 0.001) in the EPSiT group. The pooled recurrence rate was 11% (95% CI: 6–15%; I2 = 90.4%; < 0.001) for SiLaC and 9% (95% CI: 5–12%; I² = 82.9%; P < 0.001) for EPSiT. The complication rate was 10% (95% CI: 7–14%; I2 = 79.6%; P < 0.001) for SiLaC and 7% (95% CI: 1–15%; I² = 74.7%; P < 0.05) for EPSiT. The mean total healing time was 30.08 days (95% CI: 22.73–37.43%; I2 = 99.2%; P < 0.001) for SiLaC and 26.55 days (95% CI: 24.40–28.70; I² = 90.9%; P < 0.001) for EPSiT. CONCLUSION: This indirect comparative analysis suggests comparable efficacy between SiLaC and EPSiT for PSD based on currently available, predominantly single-arm studies. These findings, limited by the lack of direct comparative trials, highlight the urgent need for prospective investigations to establish robust comparative effectiveness.", "provenance": [ { "field": "population", "quote": "Various surgical modalities exist for the management of pilonidal sinus disease (PSD)" }, { "field": "intervention", "quote": "Sinus Laser associated Closure (SiLaC)" }, { "field": "comparator", "quote": "endoscopic pilonidal sinus treatment (EPSiT)" }, { "field": "primaryOutcome", "quote": "The primary outcome measures included operative time, cure rate, recurrence rate, postoperative complication rate, and total wound healing time." }, { "field": "result", "quote": "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." }, { "field": "result", "quote": "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." }, { "field": "limitations", "quote": "These findings, limited by the lack of direct comparative trials, highlight the urgent need for prospective investigations to establish robust comparative effectiveness." } ] }, { "id": "pmid:41927853", "pmid": "41927853", "doi": "10.1007/s00383-026-06402-w", "nctId": null, "pmcid": null, "title": "Pilonidal pit fibroblasts release cytokines that differ by sex and are altered by estrogen", "firstAuthor": "Chiu", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2026, "design": "lab", "n": 8, "nField": "reported", "population": "Fibroblast cells cultured from pilonidal pits (skin cysts at the top of the buttock crack) in 4 male and 4 female patients", "intervention": "Treatment of these fibroblast cells with estrogen (β-estradiol) in the lab", "comparator": "Fibroblast cells treated with control (no estrogen)", "primaryOutcome": "Levels of inflammatory cytokines released by the fibroblast cells", "result": "After estrogen exposure, fibroblasts from female patients released more IL6 and less eotaxin/CCL11 and IL8/CXCL8 than those from male patients", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a lab experiment on a handful of cell cultures (only 4 per sex), not a study in actual patients with pain outcomes.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Possible hormonal cause of female pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41927853/", "sourceText": "PURPOSE: Female pilonidal patients have higher pain scores than males. Pain is often at gluteal cleft pit, which consists of fibroblasts. Skin fibroblasts can express estrogen receptors that secrete cytokines. We hypothesize that estrogen receptor binding on pilonidal pit fibroblast can release cytokines, resulting in pain. METHOD: Pilonidal pits were cultured. Triplicate fibroblast cultures in hormone-free media were treated with β-estradiol or control before media was collected and analyzed for 48 cytokines. Percentage change of cytokine level after estrogen was compared to those from control using Mann-Whitney test. RESULTS: Eight fibroblast cultures (4-males, 4-females) were established. Prior to estrogen, fibroblasts secreted eotaxin/CCL11, GROa, IL6, IL8/CXCL8, IL10/CXCL10, MCP-1/CCL2, VEGF-A. For males, estrogen on average changed eotaxin/CCL11 by 65%±73% compared to control, GROa 19%±17%, IL6 -2.0%±7.2%, IL8/CXCL8 56%±15%, IL10/CXCL10 7.9%±24%, MCP-1/CCL2 9.7%±8.5%, VEGF-A 9.9%±14%. For females, estrogen changed eotaxin/CCL11 by -2.0%±11% compared to control, GROa 22%±48%, IL6 90%±116%, IL8/CXCL8 5.3%±24%, IL10/CXCL10 -1.4%±4.1%, MCP-1/CCL2 18%±44%, VEGF-A -1.6%±10%. After estrogen stimulation, female fibroblasts increased IL6 and decreased eotaxin/CCL11 and IL8/CXCL8 secretion compared to males (p≤0.05). CONCLUSION: Pilonidal pit fibroblasts released cytokines which could contribute to pain symptoms. Estrogen increases IL6 release from female fibroblasts, providing a potential mechanism for females having higher pain intensity than males.", "provenance": [ { "field": "n", "quote": "Eight fibroblast cultures (4-males, 4-females) were established." }, { "field": "population", "quote": "Pilonidal pits were cultured." }, { "field": "intervention", "quote": "Triplicate fibroblast cultures in hormone-free media were treated with β-estradiol or control before media was collected and analyzed for 48 cytokines." }, { "field": "comparator", "quote": "Percentage change of cytokine level after estrogen was compared to those from control using Mann-Whitney test." }, { "field": "primaryOutcome", "quote": "media was collected and analyzed for 48 cytokines" }, { "field": "result", "quote": "After estrogen stimulation, female fibroblasts increased IL6 and decreased eotaxin/CCL11 and IL8/CXCL8 secretion compared to males (p≤0.05)." } ] }, { "id": "pmid:41904336", "pmid": "41904336", "doi": "10.1007/s00423-026-04027-0", "nctId": null, "pmcid": "PMC13152950", "title": "Shrinking follow-up duration in pilonidal sinus surgery, 1970-2020: a patient-weighted longitudinal analysis of 2,285 studies", "firstAuthor": "Arslan", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2026, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people included in published studies of pilonidal sinus surgery", "intervention": "not a treatment study — analysis of how long follow-up periods were in published surgery studies", "comparator": "comparison across decades (1970-2020) of follow-up length, not a treatment comparison", "primaryOutcome": "how long studies followed patients after pilonidal sinus surgery, used to judge if recurrence was properly tracked", "result": "Average follow-up time after surgery has shrunk sharply over decades, so many studies may be missing late recurrences", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Abstract does not address causes of pain, symptoms, or treatment efficacy; it only analyzes follow-up duration reporting in surgical literature.", "followUp": "", "plainFinding": "Doesn't explain your pain at all.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41904336/", "sourceText": "BACKGROUND: Reliable estimation of recurrence after pilonidal sinus surgery requires sufficient follow-up (FUP). Despite evidence suggesting ≥ 5 years is necessary, contemporary reports appear to adopt progressively shorter surveillance windows. METHODS: We assembled a structured database of 2,285 pilonidal surgery series (1850–present) and extracted publication mid-decade, FUP since surgery, and cohort size (n). For 1970–2020, we calculated decade-wise patient-weighted mean FUP. Secular change was estimated using weighted least squares (WLS; weights = n), with unweighted sensitivity analyses. Associations between decade and FUP were assessed via weighted Pearson correlation with Kish effective sample size. We summarized proportions meeting ≥ 2, ≥5, ≥ 10 years and patient shares by FUP bands. RESULTS: Median FUP was 1.67 years; mean 2.50 years. Only 14.2% of studies reported ≥ 5 years and 2.9% ≥10 years. Patient-weighted mean FUP peaked in the 1980s at 6.69 years, declining to 5.26 (1990s), 4.26 (2000s), 3.14 (2010s), and 2.55 years (2020s). Relative to the 1970s (3.78 years), the 2020s were − 1.23 years (− 32.5%), and − 4.14 years (− 61.9%) below the 1980s. The WLS slope was − 0.0766 years·year⁻¹ (95% CI − 0.0856 to − 0.0675; p = 4.57 × 10⁻⁵⁸); unweighted slope − 0.0407 (95% CI − 0.0479 to − 0.0334; p = 1.47 × 10⁻²⁷). Weighted correlation: Rw = − 0.342 (Kish n ≈ 216; p = 2.5 × 10⁻⁷). In the 2020s, patients were distributed as 55.3% <2 years, 26.6% 2–<5, 15.8% 5–<10, 2.3% ≥10. CONCLUSIONS: Follow-up windows have contracted substantially, risking under-ascertainment of late recurrences. A minimum of ≥ 5-year FUP with staged reporting at 5 and 10 years and registry-based surveillance is recommended. The absence of a pilonidal core outcome set (COS) in guidelines impedes consistent, long-horizon reporting; COS development and guideline adoption should be prioritized.", "provenance": [ { "field": "population", "quote": "2,285 pilonidal surgery series (1850–present)" }, { "field": "primaryOutcome", "quote": "Reliable estimation of recurrence after pilonidal sinus surgery requires sufficient follow-up (FUP)." }, { "field": "result", "quote": "Patient-weighted mean FUP peaked in the 1980s at 6.69 years, declining to 5.26 (1990s), 4.26 (2000s), 3.14 (2010s), and 2.55 years (2020s)." }, { "field": "intervention", "quote": "we calculated decade-wise patient-weighted mean FUP" }, { "field": "comparator", "quote": "Relative to the 1970s (3.78 years), the 2020s were − 1.23 years (− 32.5%), and − 4.14 years (− 61.9%) below the 1980s." } ] }, { "id": "pmid:41901600", "pmid": "41901600", "doi": "10.3390/medicina62030518", "nctId": null, "pmcid": "PMC13028323", "title": "The New Minimally Invasive Techniques for Pilonidal Sinus Disease Surgery: Choosing the Right Technique for the Right Patient-A Narrative Review", "firstAuthor": "Matteucci", "multipleAuthors": true, "journal": "Medicina (Kaunas)", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease (a condition near the top of the buttock crack)", "intervention": "minimally invasive surgical techniques (endoscopic and laser-assisted) and off-midline flap surgery", "comparator": "traditional midline excision/closure", "primaryOutcome": "healing time, recurrence, complications and patient satisfaction", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "direct", "limitations": "Narrative (non-systematic) review; relies on heterogeneous studies; long-term evidence for minimally invasive techniques is limited.", "followUp": "", "plainFinding": "Flap surgery best for complex cases.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41901600/", "sourceText": "Background and Objectives: Pilonidal sinus disease (PSD) is a common condition affecting predominantly young adults and it is associated with a substantial impact on quality of life. Despite the wide range of available surgical options, optimal management remains controversial due to heterogeneous recurrence rates, wound complications and prolonged recovery. Over the last decade, a paradigm shift has occurred from midline excision toward off-midline closure techniques and minimally invasive procedures. This narrative review aims to critically appraise contemporary surgical strategies for PSD, comparing outcomes, indications and limitations, with particular emphasis on patient selection. Materials and Methods: A narrative review of the literature was conducted using PubMed, Scopus, and major guideline repositories. Relevant randomized controlled trials, systematic reviews, meta-analyses, observational studies and national and international guidelines were reviewed and synthesized, with a focus on healing time, recurrence, postoperative complications and patient-reported outcomes. Results: Midline primary closure is consistently associated with higher recurrence and complication rates and is no longer recommended. Off-midline flap techniques provide the most durable results in recurrent or complex disease. Minimally invasive approaches, including endoscopic and laser-assisted techniques, offer faster recovery and high short-term patient satisfaction in selected primary cases, but should not be considered equivalent to flap surgery in complex or recurrent PSD due to limited long-term evidence. Current guidelines uniformly advocate individualized, patient-tailored treatment strategies and discourage midline closure. Conclusions: Surgical management of PSD should be individualized according to disease complexity, prior interventions and patient expectations. While minimally invasive techniques represent an attractive option for selected primary disease, off-midline flap procedures remain the standard of care for extensive or recurrent cases. High-quality comparative studies with standardized outcome definitions and long-term follow-up are required to refine treatment algorithms.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus disease (PSD) is a common condition affecting predominantly young adults" }, { "field": "intervention", "quote": "Minimally invasive approaches, including endoscopic and laser-assisted techniques" }, { "field": "comparator", "quote": "Midline primary closure is consistently associated with higher recurrence and complication rates" }, { "field": "primaryOutcome", "quote": "with a focus on healing time, recurrence, postoperative complications and patient-reported outcomes" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:41880146", "pmid": "41880146", "doi": "10.1007/s13304-026-02536-7", "nctId": null, "pmcid": null, "title": "Negative pressure wound therapy in primary closure surgeries for pilonidal disease: a meta-analysis", "firstAuthor": "Martins", "multipleAuthors": true, "journal": "Updates Surg", "year": 2026, "design": "meta-analysis", "n": 479, "nField": "reported", "population": "patients with pilonidal sinus (a cyst near the top of the buttock crack) undergoing surgery with wound closure", "intervention": "negative pressure wound therapy (NPWT) after primary wound closure surgery", "comparator": "standard care without negative pressure wound therapy", "primaryOutcome": "postoperative pain, return to activities, wound healing, dehiscence, infection, and recurrence rates", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This pooled only six studies with wide uncertainty ranges and says more randomized trials are needed to be sure.", "directness": "direct", "limitations": "Small number of included studies, wide confidence intervals, and the authors state more randomized clinical trials are needed.", "followUp": "", "plainFinding": "Less pain, faster return to activity.", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/41880146/", "sourceText": "Primary closure with negative pressure wound therapy (NPWT) has been investigated in patients with sacrococcygeal pilonidal sinus to enhance healing and reduce recurrence. To address existing controversies, we conducted a systematic review and meta-analysis comparing primary closure with NPWT versus non-NPWT (control) for treatment of pilonidal disease. PubMed, Embase, and Cochrane Library databases were searched from inception to December 2024 to identify studies comparing NPWT versus control in primary closure surgeries in pilonidal sinus. Statistical analyses were performed using R Software with a random-effects model. Six studies with a total of 479 patients were included, of whom 164 (34.2%) underwent NPWT. NPWT had an association with lower pain score 24 h postoperative (MD - 0.65 points; 95% CI - 0.81 to - 0.50), shorter return time to activities (MD - 2.57 days; 95% CI - 3.74 to - 1.4). However, there was no difference between groups in the time of wound closure (MD - 18.94; 95% CI - 41.68 to 3.80), rate of wound dehiscence (RR 1.03; 95% CI 0.50 to 2.14), hospital length of stay (MD - 3.05; 95% CI - 15.77 to 9.67), infection rates (RR 0.38; 95% CI 0.05 to 2.84), recurrence rates (RR 0.54; 95% CI 0.07 to 4.48), and pain 6 h post-operative, which showed a borderline trend favoring NPWT but did not reach statistical significance (MD - 1.19; 95% CI - 2.38 to 0.01). NPWT appears to shorten time to resume normal activities and pain 24 h postoperatively. Despite these promising results, more randomized clinical trials are needed for greater analysis.", "provenance": [ { "field": "population", "quote": "patients with sacrococcygeal pilonidal sinus" }, { "field": "intervention", "quote": "Primary closure with negative pressure wound therapy (NPWT)" }, { "field": "comparator", "quote": "non-NPWT (control)" }, { "field": "n", "quote": "Six studies with a total of 479 patients were included" }, { "field": "primaryOutcome", "quote": "lower pain score 24 h postoperative" }, { "field": "result", "quote": "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" }, { "field": "limitations", "quote": "more randomized clinical trials are needed for greater analysis" } ] }, { "id": "pmid:41878163", "pmid": "41878163", "doi": "10.7759/cureus.103963", "nctId": null, "pmcid": "PMC13007988", "title": "Perianal Sonographic Approach to Fistula-in-Ano and Perianal Abscesses: A Pictorial Review", "firstAuthor": "Hosokawa", "multipleAuthors": false, "journal": "Cureus", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "children with fistula-in-ano or perianal abscess", "intervention": "perianal ultrasound scanning technique", "comparator": "none", "primaryOutcome": "ability to detect and describe fistula-in-ano and perianal abscesses on ultrasound", "result": "describes a sonographic method and imaging features for identifying fistulas and abscesses, not a treatment outcome study", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a descriptive pictorial review of an imaging technique, not a study measuring treatment effect or outcomes.", "directness": "indirect", "limitations": "abstract does not report patient numbers, outcomes data, or study methodology; it is a technique description, not an outcome study.", "followUp": "", "plainFinding": "Describes ultrasound method, no outcome data.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41878163/", "sourceText": "Fistula-in-ano and perianal abscesses are common conditions in pediatric patients. Recently, the perianal ultrasound approach has been reported as a useful method for evaluating anal and perianal lesions. However, this technique remains unfamiliar to many sonographers. In this pictorial review, we aimed to describe the basic sonographic approach for assessing fistula-in-ano and perianal abscesses. A sagittal view of the anal canal is obtained by placing the probe on the proctodeum parallel to the intergluteal cleft, providing a longitudinal image of the anus and rectum. The probe is then gently swung from right to left to identify anatomical structures and detect fistula-in-ano or perianal abscesses. When necessary, the probe is rotated perpendicular to the gluteal cleft to obtain additional transverses, offering further diagnostic information. An abscess appears as a hypoechoic (low-echoic) mass surrounded by echogenic subcutaneous tissue and a hypervascular rim due to inflammation. The presence of a fluid-filled, low-echoic mass indicates pus accumulation, prompting surgical incision. The fistula-in-ano typically extends from a rectal crypt to the dermis, and abscess formation may occur along this tract. Perianal ultrasonography is a valuable, noninvasive tool for evaluating perianal lesions, and sonographers should become familiar with this approach. Throughout the procedure, patient comfort and pain management are essential, and further diagnostic imaging or intervention may be warranted when necessary.", "provenance": [ { "field": "population", "quote": "Fistula-in-ano and perianal abscesses are common conditions in pediatric patients." }, { "field": "intervention", "quote": "the perianal ultrasound approach has been reported as a useful method for evaluating anal and perianal lesions" }, { "field": "comparator", "quote": "this technique remains unfamiliar to many sonographers" }, { "field": "primaryOutcome", "quote": "we aimed to describe the basic sonographic approach for assessing fistula-in-ano and perianal abscesses" }, { "field": "result", "quote": "An abscess appears as a hypoechoic (low-echoic) mass surrounded by echogenic subcutaneous tissue and a hypervascular rim due to inflammation." } ] }, { "id": "pmid:41854814", "pmid": "41854814", "doi": "10.1007/s13304-026-02585-y", "nctId": null, "pmcid": null, "title": "Comparative study of the Karydakis flap versus conventional surgical techniques for pilonidal sinus disease: a systematic review and meta-analysis", "firstAuthor": "Alsalaumy", "multipleAuthors": false, "journal": "Updates Surg", "year": 2026, "design": "meta-analysis", "n": 3108, "nField": "reported", "population": "patients with pilonidal sinus disease having surgery", "intervention": "Karydakis flap surgery", "comparator": "midline closure or excision with healing by secondary intention", "primaryOutcome": "recurrence of the condition and infection after surgery", "result": "Karydakis flap had fewer recurrences and infections, and people returned to work sooner", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "It pools many studies including randomized trials, but mixes different study designs and some comparisons have wide uncertainty.", "directness": "indirect", "limitations": "Abstract does not describe limitations such as risk of bias or study heterogeneity details beyond I2 values.", "followUp": "", "plainFinding": "Fewer recurrences with this surgery type", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/41854814/", "sourceText": "The ideal surgical treatment for pilonidal sinus disease (PSD) is controversial. The Karydakis flap (KF) was compared with midline closure (MC) and excision with healing by secondary intention (EHSI). A systematic review and meta-analysis of randomised and comparative cohort studies (through February 2025) was performed. The primary outcomes included recurrence and infection, whereas secondary outcomes were seroma, operative time, hospital stay, overall complications, and return to work. The effect sizes were identified using odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI), using random-effects models. Fifteen studies (n = 3,108) were identified for inclusion (KF = 1,257, MC = 1,593, EHSI = 258). KF was associated with a significant reduction in recurrence compared to MC (OR 0.30, 95% CI 0.16-0.59; p < 0.001; I2 = 34%) and EHSI (OR 0.29, 95% CI 0.12-0.71; p = 0.006; I2 = 11%). KF had fewer infections than EHSI (OR 0.06, 95% CI 0.007-0.486; p = 0.008) and returned to work earlier compared with MC (MD - 6.5 days) and EHSI (MD - 18.9 days). Hospital stay did not differ between KF and MC (MD - 0.08 days). KF provides lower recurrence and faster recovery compared with MC and EHSI, supporting its use as the preferred surgical technique for PSD.", "provenance": [ { "field": "n", "quote": "Fifteen studies (n = 3,108) were identified for inclusion (KF = 1,257, MC = 1,593, EHSI = 258)." }, { "field": "population", "quote": "pilonidal sinus disease (PSD)" }, { "field": "intervention", "quote": "The Karydakis flap (KF)" }, { "field": "comparator", "quote": "compared with midline closure (MC) and excision with healing by secondary intention (EHSI)" }, { "field": "primaryOutcome", "quote": "The primary outcomes included recurrence and infection" }, { "field": "result", "quote": "KF was associated with a significant reduction in recurrence compared to MC (OR 0.30, 95% CI 0.16-0.59; p < 0.001; I2 = 34%) and EHSI (OR 0.29, 95% CI 0.12-0.71; p = 0.006; I2 = 11%). KF had fewer infections than EHSI (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)." } ] }, { "id": "pmid:41838186", "pmid": "41838186", "doi": "10.1007/s10151-026-03290-z", "nctId": null, "pmcid": "PMC12992383", "title": "Surgical preference and outcomes in pilonidal sinus disease: a national multicenter study evaluating complications, recurrence, and quality of life (PISI TURKEY)", "firstAuthor": "Yalcinkaya", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "retrospective", "n": 1369, "nField": "reported", "population": "adults having their first surgery for pilonidal sinus disease (a painful condition at the top of the buttock crack)", "intervention": "non-excisional (minimally invasive) surgical procedures", "comparator": "excision-based surgery (simple excision or excision plus flap)", "primaryOutcome": "complications, recurrence, and quality of life after surgery", "result": "non-excisional surgery had fewer wound complications, similar 12-month recurrence, and greater improvement in quality of life than excision-based surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study with unequal group sizes and baseline differences between groups, so the comparison between surgery types is less reliable.", "directness": "direct", "limitations": "Retrospective design, baseline imbalances between groups, and limited follow-up, as stated by the authors.", "followUp": "12 months", "plainFinding": "Less invasive surgery, fewer complications, better recovery.", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/41838186/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is common in young adults, yet real-world data integrating quality of life (QoL) with surgical outcomes are limited. We aimed to describe national surgical practice for PSD in Turkey and to compare complications, recurrence, and QoL between excision-based and non-excisional (minimally invasive) procedures. METHODS: This was a retrospective analysis of a prospectively maintained nationwide database including adults undergoing first surgery for PSD in 41 centers between January 2019 and January 2020. Sociodemographic and clinical data, perioperative variables, complications, and recurrence were recorded. QoL was assessed using the EQ-5D-5L (including EQ-VAS) and pain using a 10-point visual analog scale (VAS) at baseline and at postoperative day 1, day 7, 6 months, and 12 months. Patients were grouped according to surgical approach: simple excision, excision + flap and non-excisional procedures. RESULTS: Data from 1369 patients were analyzed (simple excision, n = 194; excision + flap, n = 983; non-excisional, n = 192). Overall, postoperative bleeding occurred in 12.3%, wound infection in 9.2%, and wound separation in 10.2% of patients, with wound separation being more frequent after excision + flap than non-excisional procedures. Recurrence at 12 months was observed in 51 patients (3.7% overall), with rates of 3.1% in the simple excision group, 4.1% in the excision + flap group, and 2.6% in the non-excisional group (p = 0.545). Median pain VAS decreased from 4 (IQR 2-6) at baseline to 0 (0-0) at 12 months in all groups (p < 0.001 within groups). EQ-VAS improved by a median of 18 (IQR 8-40) points in the simple excision group, 15 (6-30) in the excision + flap group, and 29 (15-40) in the non-excisional group (p < 0.001 between groups). CONCLUSIONS: In this nationwide real-world cohort, 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. Given the retrospective design, baseline imbalances between groups, and limited follow-up, these findings should be confirmed in prospective comparative studies with longer follow-up.", "provenance": [ { "field": "n", "quote": "Data from 1369 patients were analyzed" }, { "field": "population", "quote": "adults undergoing first surgery for PSD in 41 centers between January 2019 and January 2020" }, { "field": "intervention", "quote": "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" }, { "field": "comparator", "quote": "compared with excision-based procedures" }, { "field": "primaryOutcome", "quote": "to compare complications, recurrence, and QoL between excision-based and non-excisional (minimally invasive) procedures" }, { "field": "result", "quote": "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" }, { "field": "followUp", "quote": "at baseline and at postoperative day 1, day 7, 6 months, and 12 months" } ] }, { "id": "pmid:41837093", "pmid": "41837093", "doi": "10.1097/RC9.0000000000000082", "nctId": null, "pmcid": "PMC12981750", "title": "Home intense pulsed light (IPL) device is a useful tool to decrease hair burden in pilonidal patients - a case series", "firstAuthor": "Jo", "multipleAuthors": true, "journal": "Int J Surg Case Rep", "year": 2026, "design": "case-series", "n": 4, "nField": "reported", "population": "patients with pilonidal disease (cyst/hair pocket at top of the buttocks crease) who had surgical excision", "intervention": "home intense pulsed light (IPL) hair removal device", "comparator": "in-clinic laser epilation", "primaryOutcome": "recurrence of pilonidal disease symptoms and injury from device use", "result": "no injury from home IPL use and no recurrence of pilonidal disease after 1-3 years of follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a tiny, uncontrolled report of only four patients with no comparison group, so it can't reliably show the device works.", "directness": "indirect", "limitations": "Very small informal case series (n=4), no control group, self-reported outcomes, not a controlled study of pain or disease cause.", "followUp": "1-3 years", "plainFinding": "Home hair-removal device prevented recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41837093/", "sourceText": "INTRODUCTION AND IMPORTANCE: Patients with pilonidal disease (PD) often receive laser epilation to reduce hair burden at the gluteal cleft to decrease symptom recurrence. Laser epilation sessions can be burdensome for patients who need to travel long distance to clinic or are away from home for extended periods of time. In this informal case series, we describe four PD patients who manage epilation with intense pulsed light (IPL) devices at home. CASE PRESENTATION: Four PD patients were referred to our Pilonidal Care Clinic and underwent surgical excision. They were all started on regular laser epilation in the clinic. Due to the long travel distance to the clinic, temporary relocating elsewhere, or ease of treatment, they switched to using home IPL for long-term epilation. They reported no injury associated with the IPL use and no recurrence of PD after a follow-up period between 1-3 years. CLINICAL DISCUSSION: Recurrence of PD symptoms has been shown to decrease with regular laser epilation. However, there is considerable burden in frequent traveling to the clinic to receive laser therapy. Our cases demonstrate that home IPL can be safely used to decrease hair burden in PD and minimize future PD recurrence. CONCLUSION: IPL devices can serve as an effective and convenient option for epilation at home to prevent PD recurrence.", "provenance": [ { "field": "population", "quote": "Four PD patients were referred to our Pilonidal Care Clinic and underwent surgical excision." }, { "field": "intervention", "quote": "intense pulsed light (IPL) devices at home" }, { "field": "comparator", "quote": "regular laser epilation in the clinic" }, { "field": "primaryOutcome", "quote": "They reported no injury associated with the IPL use and no recurrence of PD after a follow-up period between 1-3 years." }, { "field": "result", "quote": "They reported no injury associated with the IPL use and no recurrence of PD after a follow-up period between 1-3 years." }, { "field": "n", "quote": "Four PD patients were referred to our Pilonidal Care Clinic" }, { "field": "followUp", "quote": "follow-up period between 1-3 years" } ] }, { "id": "pmid:41834241", "pmid": "41834241", "doi": "10.1002/wjs.70299", "nctId": null, "pmcid": null, "title": "Long-Term Outcomes of Sinus Laser-Assisted Closure in Primary Versus Recurrent Sacrococcygeal Pilonidal Sinus Disease: A Retrospective Cohort Study", "firstAuthor": "van Kempen", "multipleAuthors": true, "journal": "World J Surg", "year": 2026, "design": "retrospective", "n": 267, "nField": "reported", "population": "people with pilonidal sinus disease at the top of the buttock crack, either first-time or recurrent cases", "intervention": "laser treatment to close the sinus tract (SiLaC)", "comparator": "primary (first-time) disease versus recurrent disease", "primaryOutcome": "whether the disease came back after treatment", "result": "disease came back more often and faster in recurrent cases than in first-time cases, and recurrent cases took longer to heal", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "retrospective design, single center, no comparison group without treatment, follow-up relied partly on telephone interviews", "followUp": "median of 4.0 years (IQR: 3.6-5.0 years)", "plainFinding": "Laser treatment works better for first-time cases.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41834241/", "sourceText": "BACKGROUND: Sinus laser-assisted closure (SiLaC) demonstrates favorable outcomes for primary sacrococcygeal pilonidal sinus disease (SPSD), yet its efficacy in recurrent disease remains undefined. This study compared long-term outcomes following SiLaC in primary versus recurrent SPSD, hypothesizing that recurrent disease would predict inferior results. METHODS: This retrospective cohort study analyzed 267 consecutive patients undergoing SiLaC at a single center (July 2019-August 2022), stratified by disease status: primary (n = 214) versus recurrent (n = 53). The primary outcome, disease recurrence, was assessed using Kaplan-Meier analysis; secondary outcomes included healing rates, healing time, and complications. Univariable risk factor analysis was performed. Follow-up through telephone interviews and review of medical records achieved a 90.3% completion rate at a median of 4.0 years (IQR: 3.6-5.0 years). RESULTS: Recurrence rates were significantly higher in recurrent versus primary disease (RR 1.76, 95%CI: 1.30-2.40, p = 0.001), with 12-month rates of 34.8% versus 16.8% respectively. At the final follow-up, the recurrence rate was 34.6% for primary disease and 60.8% for recurrent disease. The time to recurrence was accelerated in recurrent cases (median, 11.4 vs. 14.0 months, p < 0.05). Despite comparable initial healing rates (75.4% primary, 68.0% recurrent), recurrent disease required 10 additional days for complete healing (56 vs. 46 days, p < 0.001). Sequential SiLaC procedures, when necessary, achieved final healing rates exceeding 90% in both groups with minimal complications (5.8%). Three factors predicted recurrence: recurrent disease status in all patients; within recurrent cases, symptom duration greater than 38 weeks (RR 2.14) and four or more medial openings (RR 2.07); all p < 0.05. CONCLUSION: SiLaC demonstrated acceptable recurrence rates for primary SPSD comparable to other minimally invasive techniques at long-term follow-up, but significantly poorer outcomes in recurrent disease. Therefore, SiLaC may be considered a feasible first-line option for primary SPSD, while recurrent cases require careful patient selection and consideration of alternative treatments.", "provenance": [ { "field": "population", "quote": "patients undergoing SiLaC at a single center (July 2019-August 2022), stratified by disease status: primary (n = 214) versus recurrent (n = 53)" }, { "field": "intervention", "quote": "Sinus laser-assisted closure (SiLaC)" }, { "field": "comparator", "quote": "primary (n = 214) versus recurrent (n = 53)" }, { "field": "primaryOutcome", "quote": "The primary outcome, disease recurrence, was assessed using Kaplan-Meier analysis" }, { "field": "result", "quote": "Recurrence rates were significantly higher in recurrent versus primary disease (RR 1.76, 95%CI: 1.30-2.40, p = 0.001), with 12-month rates of 34.8% versus 16.8% respectively." }, { "field": "n", "quote": "analyzed 267 consecutive patients undergoing SiLaC at a single center" } ] }, { "id": "pmid:41810655", "pmid": "41810655", "doi": "10.1590/0100-6991e-20263822-en", "nctId": null, "pmcid": "PMC13193578", "title": "Recurrence Patterns in Pilonidal Sinus Disease Surgery: Navigating Misclassifications and Early Complications", "firstAuthor": "Doll", "multipleAuthors": true, "journal": "Rev Col Bras Cir", "year": 2026, "design": "meta-analysis", "n": 140472, "nField": "reported", "population": "people who had surgery for pilonidal sinus disease (a condition causing pain and infection near the top of the buttock crack)", "intervention": "different pilonidal surgery methods (open healing, midline stitching, pit picking) followed for less than 1 year", "comparator": "same surgery methods followed for 1 year or longer", "primaryOutcome": "rate of the problem coming back (recurrence) after surgery", "result": "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", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "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.", "directness": "indirect", "limitations": "the paper itself notes that early follow-up data likely mixes unhealed wounds in with true recurrences, inflating short-term recurrence estimates", "followUp": "", "plainFinding": "Early 'recurrences' often just unhealed wounds.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41810655/", "sourceText": "INTRODUCTION: Wound healing problems are common after Pilonidal Sinus Disease (PSD) surgery and may come misclassified as recurrence during the first 6-12 postop. month. We hypothesized that misclassification of post-operative wound complications as recurrence would be reflected when comparing early and late annual recurrence rates. METHODS: The postop. recurrence rate was analyzed in 1,254 studies encompassing 2,030 study treatment groups (n=140,472 patients), follow-up-studies <1year (n=304 studies) versus studies with longer FUP (n=950 studies). Recurrence rate was calculated for groups and subanalysis done for therapeutic strategies in this observational study. RESULTS: 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%). Examining individual therapies' recurrences after primary open treatment saw 8%/year versus 2.5%/year (RD=5.5%) RR, for primary midline closure 20%/year vs. 3.2%/year (RD=16.8%) and Pit Picking 20.7%/year vs. 4.0%/year (RD=16.7%). CONCLUSION: The one-year RR is containing a respectable portion of misclassifications (untrue recurrences) that may exceed the true recurrence rate by a factor of 3-5. If reliable recurrence rate needs to be determined, follow ups of 90% cases reported in clinical case series, and affects mainly adults (7). Case presentation is typically sporadic, but familial distribution suggesting an autosomal dominant transmission has been described in some cases (7). Lesions typically have a chronic course, persisting for years prior to a diagnosis is established. Clinical differential diagnosis includes psoriasis, which porokeratosis ptychotropica often emulates, acrodermatitis enteropathica, lichen planus verrucosus, and tuberculosis verrucosa cutis. Lesion biopsy is essential to establish a diagnosis, exclude other differentials and rule out malignant transformation, which can occur in up to 7.5% of porokeratotic lesions, most frequently as squamous cell carcinoma7,8. Histological examination reveals a digitate epidermis with parakeratosis columns over keratinocytes, as well as dyskeratotic keratinocytes and hypogranulosis. Multiple concentric cornoid lamellae combined with digitate epidermis is the hallmark of porokeratosis ptychotropica. Therapeutic options are controversial and include topical corticosteroids, topical tacrolimus, PUVA, systemic retinoids, imiquimod, 5-fluorouracil, CO2 or excimer laser therapy, and cryotherapy2,4. Results are generally poor, with frequent persistence of lesions, recurrence after an initially successful treatment is also common (6,7). We report an extremely rare case of porokeratosis ptychotropica affecting a female patient. This case is also unique due to the successful treatment of the lesions with cryotherapy; further case series using this treatment option may validate it as an acceptable standard treatment for small lesions of porokeratosis ptychotropica.", "provenance": [ { "field": "population", "quote": "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" }, { "field": "intervention", "quote": "Two cycles of cryotherapy were performed (20 seconds per lesion)." }, { "field": "comparator", "quote": "We report a case of porokeratosis ptychotropica successfully treated with cryotherapy." }, { "field": "primaryOutcome", "quote": "On follow-up, total resolution of lesions was observed" }, { "field": "result", "quote": "On follow-up, total resolution of lesions was observed, with residual hypopigmentation without significant scarring being observed." }, { "field": "n", "quote": "A 76-year-old female with no prior relevant history was referred" } ] }, { "id": "pmid:41800580", "pmid": "41800580", "doi": null, "nctId": null, "pmcid": null, "title": "Benign Presacral Tumor Mimicking a Pilonidal Abscess: A Diagnostic Pitfall", "firstAuthor": "Kupietzky", "multipleAuthors": true, "journal": "Isr Med Assoc J", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 43-year-old woman with a slowly growing lump near the tailbone area", "intervention": "surgical removal of the mass through a tailbone approach (Kraske approach)", "comparator": "no comparison, single case report", "primaryOutcome": "correct diagnosis and successful removal of the mass", "result": "the mass was found to be a benign cyst (retrorectal epidermal cyst), not a pilonidal abscess, and was successfully removed with an uneventful recovery", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how common this problem is or how well treatment works in general", "directness": "indirect", "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", "followUp": "", "plainFinding": "Benign cyst mistaken for pilonidal abscess.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41800580/", "sourceText": "Presacral tumors are rare and heterogeneous neoplasms that develop in the space between the rectum and sacrum. Their low prevalence and diverse embryologic origins often complicate diagnosis and management. We present the case of a 43-year-old woman who was initially misdiagnosed with a pilonidal abscess, later identified as a benign presacral tumor. PATIENT DESCRIPTION A 43-year-old woman presented with a gradually enlarging mass in the pilonidal region over the course of several months. She was referred to our colorectal clinic with a presumptive diagnosis of a pilonidal abscess made by her primary care physician. The patient was otherwise healthy, with no complaints of pain, fever, chills, or unintentional weight loss. On physical examination, a non-tender mass was palpated over the coccygeal region. Notably, there were no midline pits or visible hair [Figure 1A]. Given the atypical presentation, a magnetic resonance imaging (MRI) was performed, which revealed a well-defined, large presacral bilobular thin-walled cystic mass, posterior to the rectum, without any post contrast ring-enhancement or intramural solid nodule [Figure 1B]. Due to the low anatomical position of the mass relative to the sacrum, a Kraske approach was selected for surgical excision. Under general anesthesia, the patient was placed in the prone jackknife position. A vertical midline incision was made 7 cm cephalad to the anal verge, over the coccyx. This position exposed a well-encapsulated, large presacral tumor [Figure 1C], which was excised en-bloc along with the tip of the coccyx [Figure 1D, Figure 1E]. The specimen was sent for pathological evaluation, which revealed a retrorectal epidermal cyst. The patient's postoperative course was uneventful, and she was discharged on postoperative day one. Informed consent was obtained from the patient.", "provenance": [ { "field": "population", "quote": "A 43-year-old woman presented with a gradually enlarging mass in the pilonidal region over the course of several months." }, { "field": "intervention", "quote": "a Kraske approach was selected for surgical excision" }, { "field": "comparator", "quote": "We present the case of a 43-year-old woman" }, { "field": "primaryOutcome", "quote": "The specimen was sent for pathological evaluation, which revealed a retrorectal epidermal cyst." }, { "field": "result", "quote": "The patient's postoperative course was uneventful, and she was discharged on postoperative day one." }, { "field": "n", "quote": "a 43-year-old woman" } ] }, { "id": "pmid:41758282", "pmid": "41758282", "doi": "10.1007/s00383-026-06361-2", "nctId": null, "pmcid": null, "title": "Advancing pilonidal disease care through pediatric endoscopic treatment (PEPSiT): early insights", "firstAuthor": "Darbandi", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2026, "design": "retrospective", "n": 32, "nField": "reported", "population": "adolescents and young adults with pilonidal sinus disease (median age 15)", "intervention": "endoscopic pilonidal sinus treatment (PEPSiT)", "comparator": "none (single-arm case series)", "primaryOutcome": "healing, complications, and recurrence after surgery", "result": "most healed within a few months, few complications, and recurrences were successfully retreated", "resultDirection": "benefit", "quality": "low", "qualityWhy": "small retrospective case series with no comparison group, so it can't show if this works better than other treatments.", "directness": "direct", "limitations": "Retrospective design, small sample size, no control group, and authors state larger prospective studies are needed.", "followUp": "9 months", "plainFinding": "Good healing, few complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41758282/", "sourceText": "BACKGROUND: Pilonidal Sinus Disease (PSD) is an acquired inflammatory condition with no standard treatment. We evaluated our initial experience with Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT). METHODS: We retrospectively reviewed all PEPSiT cases from May 2021-January 2025. Data collected included demographics, presentation, comorbidities, BMI, surgical time, anesthesia, hospital stay, complications, healing, recurrence, and follow-up (median, range). RESULTS: Thirty-two patients (18 males) underwent PEPSiT, median age 15 years (11-18), BMI 26.6 kg/m² (16.7-51.6). None had prior surgery for PSD. Three had comorbidities (two with type 1 diabetes, one with Hemophilia B). Median operative time was 39 min (19-58). All were day surgery procedures; 28 under sedation/local and 4 under general anesthesia. Median healing was 3 months (1-24). Complications included one granuloma (treated with silver nitrate) and one hematoma. All resumed normal activities the next day. Median follow-up was 9 months (1-52). Three recurrences were successfully treated with redo-PEPSiT. CONCLUSION: Our outcomes suggest that PEPSiT is a safe, effective option for PSD. However, larger prospective studies are needed.", "provenance": [ { "field": "n", "quote": "Thirty-two patients (18 males) underwent PEPSiT" }, { "field": "population", "quote": "median age 15 years (11-18)" }, { "field": "intervention", "quote": "Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT)" }, { "field": "comparator", "quote": "We retrospectively reviewed all PEPSiT cases" }, { "field": "primaryOutcome", "quote": "surgical time, anesthesia, hospital stay, complications, healing, recurrence, and follow-up" }, { "field": "result", "quote": "Median healing was 3 months (1-24)." }, { "field": "result", "quote": "Three recurrences were successfully treated with redo-PEPSiT." }, { "field": "followUp", "quote": "Median follow-up was 9 months (1-52)." } ] }, { "id": "pmid:41752637", "pmid": "41752637", "doi": "10.3390/medicina62020238", "nctId": null, "pmcid": "PMC12941716", "title": "The Use of Methylene Blue in Pilonidal Sinus Surgery Reduces the Risk of Recurrence: A Systematic Review and Meta-Analysis", "firstAuthor": "Maak", "multipleAuthors": true, "journal": "Medicina (Kaunas)", "year": 2026, "design": "meta-analysis", "n": 130677, "nField": "reported", "population": "patients having surgery for pilonidal sinus disease (a cyst/tunnel near the tailbone)", "intervention": "staining the sinus tract with methylene blue dye during surgery", "comparator": "surgery without methylene blue staining", "primaryOutcome": "rate of the condition coming back after surgery (recurrence)", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Dye may lower surgery recurrence risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41752637/", "sourceText": "Background and Objectives: Pilonidal Sinus Disease shows an increasing incidence. Surgical interventions are often necessary; thus, we wanted to analyze whether the usage of methylene blue (MB) for staining the PSD fistulas for better visualization during surgery shows an effect concerning recurrence rates. Materials and Methods: A thorough data search and cross-study data synthesis of publications in the time period of 1833 to 2023 lead to a total of 7936 studies focusing on PSD. The data sets were scanned for the eligibility criteria, namely treatment information, follow-up, recurrence data, and the use of MB in surgery. The data were sorted into different surgical treatment groups, and the recurrence rates were analyzed using Kaplan-Meier-survival curves. Results: A total of 1192 studies involving 130,677 patients were eligible for analysis. A total of 263 studies were performed with MB (22.1%, n = 25,602 patients) and 929 studies without MB (77.9%, n = 105,075 patients). Overall, there was a highly significant difference in RR between the group of MB-stained patients and those without (p < 0.0001), even if analyzed separately for treatments. Primary open approach, primary midline closure, primary asymmetric closure, and Limberg/Dufourmentel all showed a significantly lower RR when MB was used (p < 0.0001). The use of MB in Bascom/Karydakis-Flap showed a statistically significant disadvantage concerning RR (p < 0.0001), and Other Flaps showed less RR with the use of MB (p = 0.011); both groups showed a notable loss of follow-up data, diminishing the meaning of these p values. Conclusions: This study shows that the use of MB as a staining technique in PSD surgery may be beneficial regarding recurrence rates. Therefore, the routinely use of MB staining in PSD surgery should be considered.", "provenance": [ { "field": "n", "quote": "A total of 1192 studies involving 130,677 patients were eligible for analysis." }, { "field": "population", "quote": "Pilonidal Sinus Disease shows an increasing incidence. Surgical interventions are often necessary" }, { "field": "intervention", "quote": "the usage of methylene blue (MB) for staining the PSD fistulas for better visualization during surgery" }, { "field": "comparator", "quote": "929 studies without MB (77.9%, n = 105,075 patients)" }, { "field": "primaryOutcome", "quote": "shows an effect concerning recurrence rates" }, { "field": "result", "quote": "Primary open approach, primary midline closure, primary asymmetric closure, and Limberg/Dufourmentel all showed a significantly lower RR when MB was used (p < 0.0001). The use of MB in Bascom/Karydakis-Flap showed a statistically significant disadvantage concerning RR (p < 0.0001)" } ] }, { "id": "pmid:41749610", "pmid": "41749610", "doi": "10.3390/children13020254", "nctId": null, "pmcid": "PMC12939669", "title": "Pediatric Pilonidal Disease Surgical Approach (PPiDSA) Study", "firstAuthor": "Rodríguez Ruiz", "multipleAuthors": true, "journal": "Children (Basel)", "year": 2026, "design": "rct", "n": 102, "nField": "reported", "population": "children and teens having surgery for pilonidal sinus disease (a cyst/infection near the top of the butt crack)", "intervention": "endoscopic (minimally invasive) treatment of the pilonidal sinus", "comparator": "en bloc (wide) surgical excision", "primaryOutcome": "postoperative complications, time to healing, and recurrence of the cyst", "result": "endoscopic treatment caused fewer complications and faster healing than wide excision, with similar recurrence rates", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "19 months", "plainFinding": "Less invasive surgery heals faster, fewer complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41749610/", "sourceText": "Background: Wide surgical excision is considered the traditional treatment for pilonidal sinus disease but is associated with prolonged wound healing and delayed recovery. This study aims to compare the outcomes of radical surgery versus a minimally invasive alternative in pediatric patients. Methods: A multicenter randomized comparative study was conducted on patients undergoing surgery for pilonidal sinus between January 2023 and December 2024 in four pediatric institutions. Patients were divided into two groups according to the surgical approach: Group 1 (en bloc excision) and Group 2 (endoscopic treatment). Demographic and clinical variables, postoperative complications, and recurrence rates were analyzed. Results: A total of 102 patients were included in this study (Group 1: n = 54; Group 2: n = 48). Baseline demographic and clinical characteristics were similar between groups. Postoperative complications occurred more frequently in Group 1 compared with Group 2 (53.7% vs. 20.8%; p < 0.001). Moreover, Group 1 presented a higher proportion of emergency department visits (44.4% vs. 8.36%; p < 0.001) and a longer median time to complete healing (100 vs. 45 days; p < 0.001). After a median follow-up of 19 months (interquartile range, 10-24 months), no significant differences were observed between groups in recurrence rates (14.8% vs. 16.7%; p = 0.797) or in median time from treatment to recurrence (198 vs. 184 days; p = 0.672). Conclusions: Endoscopic treatment of pilonidal sinus in pediatric patients is associated with fewer postoperative complications and faster recovery compared to radical surgery, with no observed differences in recurrence rates. Longer follow-up is needed to confirm these findings.", "provenance": [ { "field": "population", "quote": "patients undergoing surgery for pilonidal sinus between January 2023 and December 2024 in four pediatric institutions" }, { "field": "intervention", "quote": "endoscopic treatment" }, { "field": "comparator", "quote": "en bloc excision" }, { "field": "primaryOutcome", "quote": "Demographic and clinical variables, postoperative complications, and recurrence rates were analyzed." }, { "field": "result", "quote": "Postoperative complications occurred more frequently in Group 1 compared with Group 2 (53.7% vs. 20.8%; p < 0.001)." }, { "field": "result", "quote": "a longer median time to complete healing (100 vs. 45 days; p < 0.001)" }, { "field": "result", "quote": "no significant differences were observed between groups in recurrence rates (14.8% vs. 16.7%; p = 0.797)" }, { "field": "n", "quote": "A total of 102 patients were included in this study (Group 1: n = 54; Group 2: n = 48)." }, { "field": "followUp", "quote": "median follow-up of 19 months (interquartile range, 10-24 months)" } ] }, { "id": "pmid:41680360", "pmid": "41680360", "doi": "10.1007/s00423-026-03988-6", "nctId": null, "pmcid": "PMC12975824", "title": "Limberg flap reconstruction for recurrent pilonidal sinus disease: A single-center U.S. Cohort", "firstAuthor": "Oruc", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2026, "design": "retrospective", "n": 37, "nField": "reported", "population": "patients with recurrent pilonidal sinus disease (cyst/infection near the tailbone) who had surgery between 2014 and 2023", "intervention": "Limberg flap reconstruction surgery", "comparator": "none - single group, before/after outcomes tracked over time", "primaryOutcome": "recurrence of the pilonidal disease after surgery, plus complications", "result": "no recurrence seen over a median 4.5 years of follow-up, with an 11% complication rate (mostly wound separation)", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a small, retrospective study with no comparison group, so it can't prove the surgery works better than other options.", "directness": "indirect", "limitations": "retrospective design, no control group, single center, relies partly on telephone interviews for follow-up", "followUp": "median follow-up of 4.5 years", "plainFinding": "No recurrence after flap surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41680360/", "sourceText": "PURPOSE: Recurrent pilonidal sinus disease (PSD) presents a significant surgical challenge. Although Limberg flap (LF) reconstruction has demonstrated favorable outcomes in the international literature, long-term outcome data from U.S. institutions, particularly in recurrent cases, remain limited. This study evaluated the long-term outcomes of LF reconstruction in a single-center U.S. cohort with recurrent PSD. METHODS: A retrospective analysis was conducted of patients who underwent LF for recurrent PSD between 2014 and 2023. Data on patient demographics, operative details, and postoperative courses were collected. Long-term follow-up, including assessment for recurrence, was obtained via structured telephone interviews and chart reviews. RESULTS: Thirty-seven patients were included. The cohort was predominantly male (76%) with a median BMI of 29.4 kg/m². 59% were active smokers, and 52% had undergone multiple previous pilonidal operations. The median operative time was 72 min. 92% of the patients were discharged on the same day, and no surgical drains were used. The postoperative complication rate was 11%, primarily consisting of wound dehiscence. No recurrence was observed during the median follow-up of 4.5 years. CONCLUSION: In this retrospective cohort study of patients with recurrent pilonidal sinus disease, Limberg flap reconstruction was associated with durable disease control and acceptable postoperative morbidity while remaining compatible with early discharge. These findings support Limberg flap reconstruction as a viable option for patients with complex recurrent disease.", "provenance": [ { "field": "n", "quote": "Thirty-seven patients were included." }, { "field": "population", "quote": "patients who underwent LF for recurrent PSD between 2014 and 2023" }, { "field": "intervention", "quote": "Limberg flap (LF) reconstruction" }, { "field": "comparator", "quote": "A retrospective analysis was conducted of patients who underwent LF for recurrent PSD" }, { "field": "primaryOutcome", "quote": "Long-term follow-up, including assessment for recurrence, was obtained via structured telephone interviews and chart reviews." }, { "field": "result", "quote": "No recurrence was observed during the median follow-up of 4.5 years." }, { "field": "result", "quote": "The postoperative complication rate was 11%, primarily consisting of wound dehiscence." }, { "field": "followUp", "quote": "median follow-up of 4.5 years" } ] }, { "id": "pmid:41631611", "pmid": "41631611", "doi": "10.1093/milmed/usag015", "nctId": null, "pmcid": null, "title": "Pilonidal Disease: A Recent Decade of the Disease among Active Duty United States Military Service Members", "firstAuthor": "Griffiths", "multipleAuthors": true, "journal": "Mil Med", "year": 2026, "design": "retrospective", "n": 25039, "nField": "reported", "population": "active duty US military service members diagnosed with pilonidal disease", "intervention": "not applicable (descriptive study of disease burden and treatment patterns)", "comparator": "", "primaryOutcome": "how often pilonidal disease recurs, persists, and requires healthcare visits", "result": "nearly half had recurrence or persistence after initial care, with heavy use of healthcare visits", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a descriptive database review without a comparison group, so it cannot show whether any treatment works better than another.", "directness": "direct", "limitations": "no control group, treatment strategies were inconsistent, and the study only describes patterns rather than testing a treatment.", "followUp": "", "plainFinding": "Pilonidal disease often recurs or persists.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41631611/", "sourceText": "INTRODUCTION: Sacrococcygeal pilonidal disease (PD) is a common surgical problem in the U.S. Military. Despite recent advancements, treatment strategies remain heterogenous and incompletely described, particularly among the active duty component in the Military Health System (MHS). This study's objectives were to identify the burden of PD and describe current healthcare utilization and treatment patterns in the MHS during a recent 10-year study period. MATERIALS AND METHODS: The study population included 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. For each patient, the first PD diagnosis during the study period was the incident case, and a subsequent case was defined as a second PD diagnosis >30 days after the first and categorized as recurrent (procedure performed at incident encounter) or persistent (no procedure performed at incident encounter). Procedures were identified by Current Procedural Terminology codes. RESULTS: During the study period, 25,039 active duty service members were diagnosed with an incident case of PD. The study population was mostly male, less than 30 years old, enlisted, and in the Army or Navy. The overall incidence rate was 1.7 per 1,000 person-years. Prevalence of recurrence was 44.6% (2,494 of 5,598) and persistence was 50.1% (9,731 of 19,441). Overall, there were 115,387 medical encounters with a PD diagnosis during the study period, and service members in the top 25% for healthcare utilization had ≥11 encounters with a PD diagnosis. CONCLUSIONS: Pilonidal disease imposes a significant burden on the MHS and is a threat to overall force medical readiness. Treatment strategies remain heterogeneous, and prospective studies are needed to refine clinical guidelines.", "provenance": [ { "field": "population", "quote": "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" }, { "field": "n", "quote": "25,039 active duty service members were diagnosed with an incident case of PD" }, { "field": "primaryOutcome", "quote": "Prevalence of recurrence was 44.6% (2,494 of 5,598) and persistence was 50.1% (9,731 of 19,441)" }, { "field": "result", "quote": "service members in the top 25% for healthcare utilization had ≥11 encounters with a PD diagnosis" }, { "field": "intervention", "quote": "Treatment strategies remain heterogeneous, and prospective studies are needed to refine clinical guidelines." } ] }, { "id": "pmid:41625041", "pmid": "41625041", "doi": "10.7759/cureus.100561", "nctId": null, "pmcid": "PMC12860388", "title": "Undiagnosed Sacrococcygeal Fistulas: A Case Report", "firstAuthor": "De Figueiredo Martins", "multipleAuthors": true, "journal": "Cureus", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 74-year-old man with a long-standing sacrococcygeal fistula", "intervention": "antibiotics (amoxicillin-clavulanic acid, then added metronidazole) and surgical evaluation", "comparator": "no comparator, single patient case", "primaryOutcome": "diagnosis and management of the fistula and drainage symptoms", "result": "extensive fistulous disease found on exam; workup was non-definitive; patient chose watchful waiting over surgery", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient's case report, so it cannot show whether any treatment works in general.", "directness": "direct", "limitations": "only one patient described; diagnostic workup did not give a clear answer; no long-term outcome reported after the decision to avoid surgery.", "followUp": "", "plainFinding": "Long-ignored fistula, cause still unclear.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41625041/", "sourceText": "The clinical presentation of fistulas can include persistent drainage, pain or swelling. In the perianal, gluteal and sacrococcygeal areas, differential diagnosis may include perianal fistula, malignancy, inflammatory bowel disease or pilonidal disease. Lack of treatment can lead to disease progression. Patient appraisal of symptoms plays an important role in clinical outcomes, a role possibly shared with the shame of exposing symptoms. A behavior of avoidance and withholding of information can directly impact clinical outcomes by not seeking medical help and delays in treatment. This case describes a 74-year-old man who, during a routine visit, reports complaints of purulent drainage in the sacrococcygeal region. This complaint was more than fifty years old and had been undervalued until now, according to the patient, because it lacked significant symptoms and the embarrassment of exposing the condition. The symptoms worsened in the previous two weeks, leading him to report the complaints. On physical examination, extensive fistulous disease in the sacrococcygeal region with purulent discharge was observed. Antibiotic therapy was started (amoxicillin and clavulanic acid - 875 mg plus 125 mg every 12 hours), given the worsening of symptoms described. The patient was referred to a surgical consultation where antibiotic therapy with metronidazole (500 mg every 12 hours) was added, and a targeted workup was performed but proved non-definitive. After considering the risks and benefits of an intervention, the patient opted for a non-invasive expectant attitude, preserving his autonomy in medical decisions.", "provenance": [ { "field": "population", "quote": "This case describes a 74-year-old man who, during a routine visit, reports complaints of purulent drainage in the sacrococcygeal region." }, { "field": "intervention", "quote": "Antibiotic therapy was started (amoxicillin and clavulanic acid - 875 mg plus 125 mg every 12 hours)" }, { "field": "intervention", "quote": "antibiotic therapy with metronidazole (500 mg every 12 hours) was added" }, { "field": "comparator", "quote": "The patient was referred to a surgical consultation" }, { "field": "primaryOutcome", "quote": "a targeted workup was performed but proved non-definitive" }, { "field": "result", "quote": "On physical examination, extensive fistulous disease in the sacrococcygeal region with purulent discharge was observed." }, { "field": "result", "quote": "the patient opted for a non-invasive expectant attitude, preserving his autonomy in medical decisions." }, { "field": "n", "quote": "a 74-year-old man" } ] }, { "id": "pmid:41590391", "pmid": "41590391", "doi": "10.17116/hirurgia202601133", "nctId": null, "pmcid": null, "title": "[Clinical experience of using modified Limberg plastic surgery using a polymer hydrogel for recurrent and complex pilonidal sinus]", "firstAuthor": "Sahakyan", "multipleAuthors": true, "journal": "Khirurgiia (Mosk)", "year": 2026, "design": "retrospective", "n": 97, "nField": "reported", "population": "adults with recurrent or complex pilonidal sinus disease near the top of the buttock crease", "intervention": "modified Limberg flap surgery combined with a polymer hydrogel", "comparator": "traditional Limberg flap surgery and modified Limberg flap without hydrogel", "primaryOutcome": "rate of post-surgery complications and later disease recurrence", "result": "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", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This was a small retrospective comparison without randomization, and the authors themselves say more research is needed before concluding the hydrogel technique works better.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Possibly fewer recurrences, but unproven", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41590391/", "sourceText": "OBJECTIVE: Evaluation of the effectiveness of various surgical techniques, comparison of their results and study of the effect of polymer hydrogel on treatment outcomes. METHODS: The study included 97 patients with a diagnosis of recurrent or complex PSD (Pilonidal sinus disease). Patients were divided into 3 groups who underwent surgery using the traditional Limberg flap, modified Limberg flap, or operated using modified Limberg flap and polymer hydrogel in the coloproctology department of the A.S. Loginov International Research Center from March 2015 to September 2023. The incidence of complications in the early postoperative period and the frequency of relapses in the late period were assessed. RESULTS: 97 patients were included in the study; long-term results were observed in 84 patients (86.6%). 88.7% of them are men, 11.3% are women. There were no statistically significant differences in the incidence of complications in the early postoperative period between the groups (p=0.374). The recurrence of the disease in patients who underwent traditional plastic surgery was 10.9%. In the group with modified plastic surgery, recurrence was detected in 2 patients (4.9%). In the group with the use of polymer hydrogel, 1 case of recurrence (2.5%) was recorded. There are no statistically significant differences in the following parameters: average blood loss, duration of hospitalization, indicators of postoperative control, and the level of inflammatory markers. There were no intraoperative complications in any of the groups. CONCLUSION: Modified plastic using a polymer hydrogel to eliminate \"dead zones\" and avoid drainage in the postoperative period has demonstrated its effectiveness, however, further studies are required to confirm the results obtained.", "provenance": [ { "field": "n", "quote": "The study included 97 patients with a diagnosis of recurrent or complex PSD (Pilonidal sinus disease)" }, { "field": "population", "quote": "patients with a diagnosis of recurrent or complex PSD (Pilonidal sinus disease)" }, { "field": "intervention", "quote": "operated using modified Limberg flap and polymer hydrogel" }, { "field": "comparator", "quote": "underwent surgery using the traditional Limberg flap, modified Limberg flap" }, { "field": "primaryOutcome", "quote": "The incidence of complications in the early postoperative period and the frequency of relapses in the late period were assessed." }, { "field": "result", "quote": "The recurrence of the disease in patients who underwent traditional plastic surgery was 10.9%. In the group with modified plastic surgery, recurrence was detected in 2 patients (4.9%). In the group with the use of polymer hydrogel, 1 case of recurrence (2.5%) was recorded." }, { "field": "result", "quote": "There were no statistically significant differences in the incidence of complications in the early postoperative period between the groups (p=0.374)." }, { "field": "limitations", "quote": "further studies are required to confirm the results obtained" } ] }, { "id": "pmid:41550458", "pmid": "41550458", "doi": "10.1093/bjrcr/uaaf065", "nctId": null, "pmcid": "PMC12804066", "title": "Unexpected metachronous multiple primary cancers: pilonidal sinus‑related squamous cell carcinoma and incidentally detected gastric gastrointestinal stromal tumour", "firstAuthor": "Hurjui", "multipleAuthors": true, "journal": "BJR Case Rep", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 62-year-old man with long-standing pilonidal disease at the top of the buttock crease", "intervention": "surgical removal of the cancerous tissue plus radiotherapy, followed later by removal of an unrelated stomach tumor", "comparator": "", "primaryOutcome": "whether the cancers came back after treatment", "result": "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", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient's case report, so it cannot show how often this happens or what usually helps.", "directness": "indirect", "limitations": "single case, no comparison group, cannot be generalized to typical pilonidal pain", "followUp": "", "plainFinding": "Rare cancer in long-standing pilonidal disease.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41550458/", "sourceText": "This case report presents a 62‑year‑old male with chronic pilonidal disease that underwent malignant transformation into squamous cell carcinoma (SCC), followed 18 months later by incidental detection of a gastric gastrointestinal stromal tumour (GIST) during routine oncologic surveillance. Initial contrast‑enhanced CT revealed the gluteal SCC, which was surgically excised and treated with adjuvant radiotherapy. Subsequent CT scan indicates a well‑circumscribed mass in the submucosa of the stomach. MRI and endoscopic biopsy confirmed a submucosal gastric GIST, which was completely resected. No recurrence of either malignancy has been observed on follow‑up. This case underscores the pivotal role of multimodality imaging in diagnosis, staging, and longitudinal care.", "provenance": [ { "field": "population", "quote": "a 62‑year‑old male with chronic pilonidal disease" }, { "field": "intervention", "quote": "surgically excised and treated with adjuvant radiotherapy" }, { "field": "result", "quote": "No recurrence of either malignancy has been observed on follow‑up" }, { "field": "n", "quote": "a 62‑year‑old male" }, { "field": "primaryOutcome", "quote": "No recurrence of either malignancy has been observed on follow‑up" } ] }, { "id": "pmid:41497546", "pmid": "41497546", "doi": "10.1097/GOX.0000000000007364", "nctId": null, "pmcid": "PMC12768063", "title": "Light-based Epilation as an Adjunct to Surgery in the Management of Pilonidal Disease: A Meta-analysis", "firstAuthor": "Kutkut", "multipleAuthors": true, "journal": "Plast Reconstr Surg Glob Open", "year": 2026, "design": "meta-analysis", "n": 804, "nField": "reported", "population": "people with pilonidal disease (cysts/infections at the top of the buttock crack)", "intervention": "laser or light-based hair removal added to surgery", "comparator": "surgery alone, or light-based hair removal alone vs conventional treatment", "primaryOutcome": "whether the pilonidal disease came back (recurrence)", "result": "adding light-based hair removal to surgery lowered recurrence; hair removal alone was not better than other treatments", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it combines real comparative studies including some randomized trials, but mixes different study types and designs together, which can affect reliability.", "directness": "direct", "limitations": "Included a mix of randomized, prospective, and retrospective studies, which were pooled despite differences in quality and design.", "followUp": "longer than 6 months", "plainFinding": "Fewer recurrences when laser hair removal added to surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41497546/", "sourceText": "BACKGROUND: There is currently no widely accepted treatment protocol for pilonidal disease. Although surgery is often the first line of treatment, it is associated with a high recurrence rate. Noninvasive approaches to treating pilonidal disease, such as light-based epilation, have shown promise in small studies. Systematic reviews on this subject have been limited by small sample sizes, lack of comparative groups, and substantial heterogeneity. The purpose of this systematic review and meta-analysis was to address these limitations and evaluate the effectiveness of light-based epilation as an adjunct to surgery in the treatment of pilonidal disease. METHODS: A PubMed search was performed of all studies that evaluated the rate of pilonidal disease recurrence when light-based epilation was used. Only English-language comparative studies with more than 10 subjects and a follow-up longer than 6 months were included. Data from all studies were compiled, and a systematic review and meta-analysis were conducted to evaluate the effectiveness of light-based epilation in reducing pilonidal disease recurrence. RESULTS: Eleven comparative studies comprising 804 patients were included, including 3 randomized controlled trials, 4 prospective studies, and 4 retrospective studies. 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). CONCLUSIONS: This study demonstrated that light-based epilation as an adjunct to surgery results in significantly lower pilonidal recurrence rates than surgery alone.", "provenance": [ { "field": "n", "quote": "Eleven comparative studies comprising 804 patients were included" }, { "field": "population", "quote": "evaluate the effectiveness of light-based epilation as an adjunct to surgery in the treatment of pilonidal disease" }, { "field": "intervention", "quote": "Light-based epilation used as an adjunct to surgery" }, { "field": "comparator", "quote": "compared with surgery alone" }, { "field": "primaryOutcome", "quote": "A PubMed search was performed of all studies that evaluated the rate of pilonidal disease recurrence when light-based epilation was used." }, { "field": "result", "quote": "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)." }, { "field": "followUp", "quote": "follow-up longer than 6 months" } ] }, { "id": "pmid:41466774", "pmid": "41466774", "doi": "10.1093/jscr/rjaf964", "nctId": null, "pmcid": "PMC12744393", "title": "Marjolin's ulcer arising in pilonidal disease: a case report and historical perspective", "firstAuthor": "Curcio", "multipleAuthors": true, "journal": "J Surg Case Rep", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a young woman with long-standing pilonidal disease (a mass/cyst near the tailbone)", "intervention": "no treatment given; diagnostic biopsy and workup after a chronic pilonidal ulcer", "comparator": "none", "primaryOutcome": "diagnosis of what was causing a non-healing ulcer at the pilonidal site", "result": "the ulcer was found to be a cancer (squamous cell carcinoma) that had already spread to lymph nodes and could not be surgically removed", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot tell you what usually happens or how likely this is.", "directness": "indirect", "limitations": "only one patient; diagnosis was delayed by missed biopsies, so this describes a rare worst-case complication rather than typical pilonidal pain.", "followUp": "", "plainFinding": "Rare case: pilonidal ulcer turned out to be cancer.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41466774/", "sourceText": "We report a case of malignant transformation in a young woman with pilonidal disease-a rare manifestation of 'Marjolin's ulcer'. The patient initially presented to an outside hospital emergency department with an ulcer of the left buttock. Her family reported a longstanding mass present at this site prior to rupture. The patient had two ED visits and a surgical referral that did not result in biopsy, contributing to delayed diagnosis. She eventually presented to our wound clinic with a full-thickness, friable, frond-like ulcer with probable sacral extension. Immediate biopsy was performed and confirmed squamous cell carcinoma (SCC). Imaging revealed a buttock mass with lymphadenopathy. Fine-needle aspiration confirmed metastatic SCC in the inguinal lymph nodes. The disease was deemed unresectable and systemic therapy was begun. This case emphasizes the importance of biopsy in nonhealing ulcers, underscores the need for system-level processes to ensure follow-up, and demonstrates the enduring relevance of Marjolin's original 19th-century observations.", "provenance": [ { "field": "n", "quote": "We report a case of malignant transformation in a young woman" }, { "field": "population", "quote": "a young woman with pilonidal disease" }, { "field": "intervention", "quote": "Immediate biopsy was performed and confirmed squamous cell carcinoma (SCC)." }, { "field": "comparator", "quote": "The disease was deemed unresectable and systemic therapy was begun." }, { "field": "primaryOutcome", "quote": "This case emphasizes the importance of biopsy in nonhealing ulcers" }, { "field": "result", "quote": "Fine-needle aspiration confirmed metastatic SCC in the inguinal lymph nodes. The disease was deemed unresectable" } ] }, { "id": "pmid:41461191", "pmid": "41461191", "doi": "10.1055/a-2773-3657", "nctId": null, "pmcid": null, "title": "In-Office Pit Excision for Pilonidal Disease Using Needle-Free Local Anesthesia: A Minimally Invasive, Non-Operative Treatment Approach", "firstAuthor": "Stoeckel", "multipleAuthors": true, "journal": "Eur J Pediatr Surg", "year": 2026, "design": "case-series", "n": 100, "nField": "reported", "population": "patients with pilonidal disease (gluteal crease pits), mean age 18 years", "intervention": "in-office pit excision with needle-free (pneumatic) local anesthesia and laser follicle ablation", "comparator": "none - single group, no comparison treatment", "primaryOutcome": "whether all pits healed and condition resolved", "result": "60% of patients had all pits healed at first follow-up, rising to 88% healed overall, with minimal procedure pain and no disability", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "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.", "directness": "direct", "limitations": "No control/comparison group; 25% of patients were lost to follow-up and excluded from analysis; single clinic experience.", "followUp": "6 to 8 weeks", "plainFinding": "Pits healed without surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41461191/", "sourceText": "INTRODUCTION: Treatment of pilonidal disease traditionally involves an operation under general anesthesia, which may have a period of postoperative disability and a significant recurrence rate. We report a novel treatment for pilonidal disease performed in-office using a pneumatic lidocaine injection device, requiring no pain medication or activity restrictions-supporting a non-operative standard of care. METHODS: Patients with gluteal crease pits at our Pilonidal Care Clinic were offered pit excision as standard care. Prospective data on demographics, pain scores (0-10), and outcomes were collected in REDCap. Under sterile conditions, patients received 1% buffered lidocaine via pneumatic injection. Laser follicle ablation was followed by punch excision (1.5 or 2 mm) of full-thickness pit epithelium. Sinus tracts were probed but not excised. Patients were asked to wash the area twice daily, maintain normal activities, and return in 6 to 8 weeks. Patients requiring nidus incision and drainage (I&D) were excluded. RESULTS: About 130 patients underwent this technique between February and June 2024; 100 were included in the analysis (5 excluded for concurrent I&D, 25 lost to follow-up). Mean age was 18.1 years; 50% were male. At subsequent follow-up, 60% patients healed all pits, resolving their condition, with 64% (144/224) of all pits healed. Patients with three or more pits were more likely to need an additional pit excision. Mean procedure pain score was 1.6/10 (SD 1.21); no patient used pain medication or experienced disability. Ultimately, 88% of patients healed all of their pits. CONCLUSION: Pilonidal disease may be resolved non-operatively in a single outpatient clinic visit, without even a shot.", "provenance": [ { "field": "population", "quote": "Patients with gluteal crease pits at our Pilonidal Care Clinic were offered pit excision as standard care." }, { "field": "population", "quote": "Mean age was 18.1 years; 50% were male." }, { "field": "intervention", "quote": "patients received 1% buffered lidocaine via pneumatic injection. Laser follicle ablation was followed by punch excision" }, { "field": "comparator", "quote": "RESULTS: About 130 patients underwent this technique between February and June 2024; 100 were included in the analysis" }, { "field": "n", "quote": "100 were included in the analysis (5 excluded for concurrent I&D, 25 lost to follow-up)" }, { "field": "primaryOutcome", "quote": "60% patients healed all pits, resolving their condition" }, { "field": "result", "quote": "60% patients healed all pits, resolving their condition, with 64% (144/224) of all pits healed." }, { "field": "result", "quote": "Ultimately, 88% of patients healed all of their pits." }, { "field": "followUp", "quote": "return in 6 to 8 weeks" } ] }, { "id": "pmid:41454773", "pmid": "41454773", "doi": "10.1093/jpids/piaf115", "nctId": null, "pmcid": null, "title": "Patient characteristics and microbiology in pilonidal abscesses in children", "firstAuthor": "Garcia", "multipleAuthors": true, "journal": "J Pediatric Infect Dis Soc", "year": 2026, "design": "retrospective", "n": 154, "nField": "reported", "population": "children with pilonidal abscesses", "intervention": "none (descriptive study of abscess microbiology, no treatment tested)", "comparator": "none (no comparison group)", "primaryOutcome": "recurrence of pilonidal abscess and bacteria found in abscess cultures", "result": "No risk factors for recurrence were identified, and anaerobes and Streptococcus anginosus were the most common bacteria found", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Abstract does not describe study design limitations beyond noting no recurrence risk factors were found; single tertiary pediatric center, retrospective.", "followUp": "", "plainFinding": "Describes bacteria in abscesses, no recurrence cause found.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41454773/", "sourceText": "We described the microbiology of 216 pilonidal abscess episodes among 154 children over a 10-year period at a tertiary pediatric center and assessed patient characteristics associated with recurrence. Anaerobes and Streptococcus anginosus group were the most common organisms isolated from surgical cultures. No risk factors for recurrence were identified.", "provenance": [ { "field": "n", "quote": "216 pilonidal abscess episodes among 154 children" }, { "field": "population", "quote": "pilonidal abscess episodes among 154 children" }, { "field": "intervention", "quote": "We described the microbiology of 216 pilonidal abscess episodes among 154 children over a 10-year period" }, { "field": "comparator", "quote": "No risk factors for recurrence were identified." }, { "field": "primaryOutcome", "quote": "assessed patient characteristics associated with recurrence" }, { "field": "result", "quote": "No risk factors for recurrence were identified." } ] }, { "id": "pmid:41432023", "pmid": "41432023", "doi": "10.1177/15533506251411009", "nctId": null, "pmcid": null, "title": "Artificial Intelligence-Based Prediction of Recurrence and Personalized Treatment Planning in Pediatric Pilonidal Sinus Disease", "firstAuthor": "Öztaş", "multipleAuthors": true, "journal": "Surg Innov", "year": 2026, "design": "retrospective", "n": 242, "nField": "reported", "population": "children with pilonidal sinus disease (a cyst/infection near the top of the buttock crack)", "intervention": "AI-based machine learning models using clinical data (healing time, BMI, age, number of sinus tracts) to predict recurrence and guide treatment choice", "comparator": "three treatment approaches compared retrospectively: surgical excision, crystallized phenol, and silver nitrate", "primaryOutcome": "ability to predict recurrence risk and recommend treatment, and recurrence rate across treatments", "result": "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", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design; no untreated/no-treatment comparison; authors call for multicenter prospective validation", "followUp": "", "plainFinding": "AI predicts recurrence risk, not why it hurts", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41432023/", "sourceText": "PurposeThis study aimed to assess the feasibility of artificial intelligence (AI)-based models for predicting recurrence risk and supporting individualized treatment strategies in pediatric pilonidal sinus disease (PSD).MethodsClinical data from 242 pediatric PSD patients were retrospectively analyzed. Two machine learning (ML) models were developed: (1) a binary classifier for recurrence prediction and (2) a multiclass classifier for treatment modality selection. Model performance was evaluated using 5-fold cross-validation based on accuracy, area under the receiver operating characteristic curve (ROC-AUC), F1 score, and confusion matrix. Model interpretability was assessed using SHapley Additive exPlanations (SHAP) analysis to identify the most influential predictive features.ResultsAmong 242 patients, 59.1% underwent surgical excision (unroofing with secondary healing), 33.1% received crystallized phenol, and 7.8% were treated with silver nitrate. The overall recurrence rate was 5.7%, with no significant differences among treatment modalities. Longer healing duration, larger lesion size, higher body mass index (BMI), and an increased number of sinus tracts were associated with higher recurrence risk. SHAP analysis revealed that healing time, BMI, age, and the number of sinus tracts were the most influential predictors in both recurrence and treatment selection models.ConclusionAI-based predictive models can effectively estimate recurrence risk and assist in tailoring individualized management strategies for pediatric PSD. Further multicenter, prospective studies are warranted to validate these findings and support clinical integration of AI-assisted decision systems.", "provenance": [ { "field": "population", "quote": "Clinical data from 242 pediatric PSD patients were retrospectively analyzed." }, { "field": "intervention", "quote": "Two machine learning (ML) models were developed: (1) a binary classifier for recurrence prediction and (2) a multiclass classifier for treatment modality selection." }, { "field": "comparator", "quote": "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." }, { "field": "primaryOutcome", "quote": "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)." }, { "field": "result", "quote": "The overall recurrence rate was 5.7%, with no significant differences among treatment modalities. Longer healing duration, larger lesion size, higher body mass index (BMI), and an increased number of sinus tracts were associated with higher recurrence risk." }, { "field": "n", "quote": "Clinical data from 242 pediatric PSD patients were retrospectively analyzed." } ] }, { "id": "pmid:41397831", "pmid": "41397831", "doi": "10.3760/cma.j.cn441530-20251104-00417", "nctId": null, "pmcid": null, "title": "[Treatment options for different types of sacrococcygeal pilonidal disease]", "firstAuthor": "Chen", "multipleAuthors": true, "journal": "Zhonghua Wei Chang Wai Ke Za Zhi", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with sacrococcygeal pilonidal disease (cyst/infection at the top of the buttock crease)", "intervention": "various treatments depending on disease type - observation, drainage, minimally invasive procedures, or surgical excision", "comparator": "different treatment approaches compared to each other based on disease severity/type", "primaryOutcome": "recurrence rate, complications, and recovery time", "result": "the abstract does not report specific outcome results or data, only summarizes treatment strategy recommendations by disease type", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a narrative summary of clinical experience and literature rather than a study with original data or results.", "directness": "direct", "limitations": "no original data, patient numbers, or outcome statistics are reported; this is an expert opinion/literature summary", "followUp": "", "plainFinding": "Treatment depends on disease severity and type.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41397831/", "sourceText": "The treatment of sacrococcygeal pilonidal disease (SPD) remains challenging due to its high recurrence rate and treatment-related complications. An ideal treatment plan for SPD should be simple to perform, reduce recurrence rates, enable patients to quickly return to normal daily activities, and be associated with a low incidence of complications. Various surgical techniques have been employed for the treatment of SPD, but discrepancies and controversies persist in current clinical practice. Non-surgical treatment is suitable for asymptomatic SPD patients. For patients in the acute abscess phase, drainage is the primary therapeutic goal, with avoidance of midline incisions. Minimally invasive procedures may be considered for patients with localized lesions after weighing the recurrence risk, aiming for faster recovery and better cosmetic outcomes. For recurrent SPD or cases with extensive lesions, excision followed by secondary healing or combined with flap techniques is required to pursue a lower recurrence risk. Based on clinical experience and literature review, this article summarizes the treatment strategies for different types of SPD, providing a reference for clinicians in formulating diagnosis and treatment plans.", "provenance": [ { "field": "population", "quote": "sacrococcygeal pilonidal disease (SPD)" }, { "field": "intervention", "quote": "Non-surgical treatment is suitable for asymptomatic SPD patients. For patients in the acute abscess phase, drainage is the primary therapeutic goal, with avoidance of midline incisions. Minimally invasive procedures may be considered for patients with localized lesions after weighing the recurrence risk" }, { "field": "comparator", "quote": "For recurrent SPD or cases with extensive lesions, excision followed by secondary healing or combined with flap techniques is required to pursue a lower recurrence risk" }, { "field": "primaryOutcome", "quote": "reduce recurrence rates, enable patients to quickly return to normal daily activities, and be associated with a low incidence of complications" }, { "field": "result", "quote": "this article summarizes the treatment strategies for different types of SPD, providing a reference for clinicians in formulating diagnosis and treatment plans" } ] }, { "id": "pmid:41397828", "pmid": "41397828", "doi": "10.3760/cma.j.cn441530-20250805-00292", "nctId": null, "pmcid": null, "title": "[Clinical efficacy of laser ablation and closure in the treatment of sacrococcygeal pilonidal disease and analysis of risk factors for postoperative recurrence in male patients]", "firstAuthor": "Li", "multipleAuthors": true, "journal": "Zhonghua Wei Chang Wai Ke Za Zhi", "year": 2025, "design": "retrospective", "n": 369, "nField": "reported", "population": "patients with sacrococcygeal pilonidal disease (a condition at the top of the buttock crack), mostly male, including some teenagers", "intervention": "laser ablation and closure surgery", "comparator": "none (single-group outcomes, with subgroup comparison for recurrence risk factors)", "primaryOutcome": "wound healing, complications, and recurrence after surgery", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "direct", "limitations": "Retrospective design, no control group for comparison, single center.", "followUp": "not specified beyond recurrence tracking", "plainFinding": "Laser surgery healed pilonidal disease, some recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41397828/", "sourceText": "Objective: To investigate the clinical efficacy and safety of laser ablation and closure for the treatment of sacrococcygeal pilonidal disease (SPD) and to analyze risk factors for postoperative recurrence in male patients. Methods: A retrospective observational study was conducted to collect clinical data of 369 patients with SPD who underwent laser ablation and closure in the Anorectal Department of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine between March 2019 and December 2024. Perioperative outcomes and postoperative recurrence were analyzed. The cohort included 313 males and 56 females, with 43 patients aged ≤18 years. The median body mass index was 26.3 (IQR: 22.9, 29.6) kg/m², and the median disease duration was 28 months (IQR: 4, 76). Among them, 218 male SPD patients who underwent surgery received preoperative sex hormone testing. A logistic regression model was used to analyze the risk factors for recurrence. Results: All patients completed the surgery. The median intraoperative ablation energy delivered was 426.8 (IQR: 243.9, 683.9) J, with no occurrence of major intraoperative complications. Postoperatively, a total of 31 patients (8.4%) required analgesic medication. Within the first postoperative week, 12 patients experienced wound oozing/bleeding; hemostasis was achieved by compression alone in 5 cases, while the remaining 7 instances required suture hemostasis after failed compression attempts. No other complications were observed. The median postoperative hospital stay was 6 (IQR: 4, 8) days, and the median time to return to regular work and life was 7 (IQR: 5, 12) days. The wound healing rate was 100%, with a median wound healing time of 35 (IQR: 30, 42) days. Postoperative recurrence occurred in 19 patients (5.1%), all of whom were male. Multivariate logistic regression analysis identified age ≤18 years (OR = 4.764, 95%CI: 2.424-34.905, P = 0.008) and a history of previous SPD surgery (OR = 5.078, 95%CI: 1.431-18.019, P = 0.012) as independent risk factors for recurrence after SPD laser ablation and closure surgery. Conclusion: Laser ablation and closure are safe, effective, and minimally invasive treatments for SPD. However, particular attention should be paid to the risk of recurrence in young male patients and those with a history of previous SPD surgery.", "provenance": [ { "field": "population", "quote": "369 patients with SPD who underwent laser ablation and closure" }, { "field": "intervention", "quote": "laser ablation and closure for the treatment of sacrococcygeal pilonidal disease (SPD)" }, { "field": "comparator", "quote": "A retrospective observational study was conducted to collect clinical data of 369 patients with SPD who underwent laser ablation and closure" }, { "field": "primaryOutcome", "quote": "Perioperative outcomes and postoperative recurrence were analyzed." }, { "field": "result", "quote": "The wound healing rate was 100%, with a median wound healing time of 35 (IQR: 30, 42) days. Postoperative recurrence occurred in 19 patients (5.1%), all of whom were male." }, { "field": "n", "quote": "369 patients with SPD who underwent laser ablation and closure" } ] }, { "id": "pmid:41365098", "pmid": "41365098", "doi": "10.1016/j.jss.2025.11.005", "nctId": null, "pmcid": null, "title": "Identifying Predictors of Recurrent Pilonidal Disease in Adolescents and Young Adults: A Secondary Analysis of a Randomized Controlled Trial", "firstAuthor": "Turpin", "multipleAuthors": true, "journal": "J Surg Res", "year": 2026, "design": "rct", "n": 200, "nField": "reported", "population": "adolescents and young adults aged 11-21 with a history of at least one episode of pilonidal disease", "intervention": "laser hair removal added to standard treatment", "comparator": "standard treatment alone", "primaryOutcome": "disease coming back within 1 year", "result": "laser hair removal lowered the odds of recurrence overall, but only helped in patients with private insurance, not public insurance", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it's a secondary analysis of a randomized trial with reasonable size, but subgroup findings by insurance type need further confirmation.", "directness": "direct", "limitations": "this is a secondary analysis, not the trial's main planned analysis, and the insurance-based difference needs further investigation per the authors.", "followUp": "1 y", "plainFinding": "Laser hair removal cuts recurrence, mainly if privately insured.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41365098/", "sourceText": "INTRODUCTION: Pilonidal disease is a common condition affecting adolescents and young adults with high recurrence rates and disease-associated morbidity. Identification of patient-specific factors and treatments associated with decreased disease recurrence can assist providers with treatment selection and patient counseling. MATERIALS AND METHODS: This is a planned secondary analysis of a single institution, randomized controlled trial which compared laser depilation as an adjunct to standard care versus standard care alone. Inclusion criteria were patients 11 to 21 y of age with a history of at least 1 episode of pilonidal disease, without active disease. Patients were randomized to receive laser depilation in conjunction with standard treatment versus standard treatment alone. Multivariable logistic regression modeling was performed to identify variables independently associated with disease recurrence including laser depilation, patient variables (biologic sex, body mass index, prior episodes of disease, prior surgical treatment, race and ethnicity, health insurance status), and annual family income. RESULTS: Complete 1-y follow-up data to be included in the multivariable analysis were available for 200 patients in the trial. After adjusting for sex, body mass index, prior episodes of disease, prior surgical treatment, race and ethnicity, type of health insurance, and household income, laser hair treatment was strongly associated with decreased odds of disease recurrence within 1 y (odds ratio [OR], 0.26 [95% confidence interval (CI), 0.12-0.58]; P = 0.001). After adjusting for other covariables, there was a significant interaction between laser hair treatment and health insurance type. Laser hair treatment was significantly associated with lower odds of disease recurrence in patients who were privately insured (OR, 0.29 [95% CI, 0.16-0.55], P < 0.001) but was not associated with lower disease recurrence in those who were publicly insured (OR, 1.20 [95% CI, 0.63-2.28], P = 0.58). CONCLUSIONS: Laser depilation is associated with decreased pilonidal disease recurrence. However, there may be heterogeneity of treatment effect based on insurance status with laser depilation decreasing recurrence in patients with private insurance and being less effective in patients with public insurance. This heterogeneity of treatment effect may be related to barriers to care and social determinants of health and warrants further investigation.", "provenance": [ { "field": "n", "quote": "Complete 1-y follow-up data to be included in the multivariable analysis were available for 200 patients in the trial." }, { "field": "population", "quote": "Inclusion criteria were patients 11 to 21 y of age with a history of at least 1 episode of pilonidal disease, without active disease." }, { "field": "intervention", "quote": "laser depilation as an adjunct to standard care" }, { "field": "comparator", "quote": "versus standard care alone" }, { "field": "primaryOutcome", "quote": "disease recurrence within 1 y" }, { "field": "result", "quote": "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)" }, { "field": "result", "quote": "Laser hair treatment was significantly associated with lower odds of disease recurrence in patients who were privately insured (OR, 0.29 [95% CI, 0.16-0.55], P < 0.001) but was not associated with lower disease recurrence in those who were publicly insured (OR, 1.20 [95% CI, 0.63-2.28], P = 0.58)." } ] }, { "id": "pmid:41337870", "pmid": "41337870", "doi": "10.1016/j.bpobgyn.2025.102691", "nctId": null, "pmcid": null, "title": "Connecting polycystic ovary syndrome and pilonidal disease in adolescents: State of the art review", "firstAuthor": "Yung", "multipleAuthors": true, "journal": "Best Pract Res Clin Obstet Gynaecol", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "teenage girls with pilonidal disease (cyst/infection at top of buttock crease) or PCOS", "intervention": "awareness of the link between PCOS and pilonidal disease", "comparator": "no comparator described", "primaryOutcome": "association between the two conditions and management approach", "result": "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.", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is an opinion-style review without original data, patient numbers, or outcome statistics, so it cannot show how strong the link is.", "directness": "indirect", "limitations": "No study design, sample size, or outcome data are given; it is a clinical opinion piece, not original research.", "followUp": "", "plainFinding": "Possible link between PCOS and cyst.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41337870/", "sourceText": "Pilonidal disease is a dermatologic condition of the natal cleft that affects primarily adolescents. Its severity ranges from asymptomatic to chronically recurring disease. Like pilonidal disease, polycystic ovary syndrome commonly begins to affect women in their adolescence. PCOS is increasing in prevalence, affecting 6-20 % of women, and can significantly compromise quality of life by contributing to acne, weight gain, hirsutism, development of diabetes mellitus, hypertension, mental disorders and infertility. It is therefore increasingly important to be aware of a recently reported association between polycystic ovary syndrome and pilonidal disease within the female adolescent population. The conditions share common risk factors such as obesity, hyperandrogenism, and metabolic syndrome. Early diagnosis of these conditions is important in mitigating morbidity associated with either disease. This clinical opinion suggests a reciprocal pathway for management of female adolescents who may be suffering from either polycystic ovary syndrome or pilonidal disease, with the goal of providing comprehensive management and mitigating morbidity.", "provenance": [ { "field": "population", "quote": "female adolescent population" }, { "field": "intervention", "quote": "a recently reported association between polycystic ovary syndrome and pilonidal disease" }, { "field": "comparator", "quote": "This clinical opinion suggests a reciprocal pathway for management of female adolescents who may be suffering from either polycystic ovary syndrome or pilonidal disease" }, { "field": "primaryOutcome", "quote": "The conditions share common risk factors such as obesity, hyperandrogenism, and metabolic syndrome." }, { "field": "result", "quote": "with the goal of providing comprehensive management and mitigating morbidity" } ] }, { "id": "pmid:41321606", "pmid": "41321606", "doi": "10.1159/000547242", "nctId": null, "pmcid": "PMC12659013", "title": "Grenz Ray Therapy for Porokeratosis Ptychotropica: A Case Report", "firstAuthor": "Larney", "multipleAuthors": true, "journal": "Case Rep Dermatol", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "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", "intervention": "Grenz ray therapy (a type of low-dose superficial radiotherapy), 6 sessions totaling 18 Gy", "comparator": "Her own prior failed treatments (steroids, vitamin D creams, simvastatin cream, fluorouracil cream, acitretin, laser-assisted photodynamic therapy)", "primaryOutcome": "Clinical response of the skin lesions", "result": "Excellent clinical response, but early signs of the condition returning after 2 months", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether the treatment reliably works for others.", "directness": "direct", "limitations": "Only one patient was treated, there was no comparison group, and the lesion started recurring within 2 months.", "followUp": "2 months", "plainFinding": "Cleared briefly, then started returning.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41321606/", "sourceText": "INTRODUCTION: Porokeratosis ptychotropica (PP) is a rare form of porokeratosis that poses significant diagnostic and therapeutic challenges. Given the rarity of PP, there is a paucity of evidence about effective treatment options. We present the first case of PP being managed with Grenz therapy (a type of superficial, low radiation radiotherapy). CASE PRESENTATION: Our patient was a 56-year-old female with PP in the intergluteal cleft and on her right posterior thigh. 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. She underwent Grenz therapy for 6 sessions, a total dose of 18 Gy to all affected areas, with excellent clinical response. After 2 months of remission, her porokeratosis showed early signs of recurrence. CONCLUSION: This is the first reported case of PP being treated with Grenz rays. With no effective treatment, Grenz therapy may present a potential effective treatment for some patients.", "provenance": [ { "field": "population", "quote": "Our patient was a 56-year-old female with PP in the intergluteal cleft and on her right posterior thigh." }, { "field": "intervention", "quote": "She underwent Grenz therapy for 6 sessions, a total dose of 18 Gy to all affected areas, with excellent clinical response." }, { "field": "comparator", "quote": "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." }, { "field": "primaryOutcome", "quote": "with excellent clinical response" }, { "field": "result", "quote": "After 2 months of remission, her porokeratosis showed early signs of recurrence." }, { "field": "n", "quote": "Our patient was a 56-year-old female" } ] }, { "id": "pmid:41316137", "pmid": "41316137", "doi": "10.1186/s12893-025-03319-4", "nctId": null, "pmcid": "PMC12661896", "title": "Combined laser ablation and pit excision for pilonidal sinus: effectiveness, quality of recovery, and patient-reported outcomes", "firstAuthor": "Canturk", "multipleAuthors": true, "journal": "BMC Surg", "year": 2025, "design": "retrospective", "n": 39, "nField": "reported", "population": "adults with pilonidal sinus disease", "intervention": "diode laser ablation combined with pit excision", "comparator": "none; single-group cohort with no comparison treatment", "primaryOutcome": "recurrence and treatment success (no recurrence without re-intervention)", "result": "treatment success in 84.6% (33/39) and recurrence in 15.4% (6/39) of patients", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, retrospective, single-center study without a comparison group, so the results are uncertain.", "directness": "indirect", "limitations": "Findings should be interpreted cautiously given the retrospective design and modest sample size; prospective, adequately powered studies are needed to validate the prognostic performance and comparative effectiveness.", "followUp": "13.6 ± 3.6 months", "plainFinding": "High success treating pilonidal sinus.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41316137/", "sourceText": "BACKGROUND: This retrospective study aimed to evaluate the efficacy, safety, and patient-reported long-term results of a minimally invasive method of diode laser ablation combined with pit excision for pilonidal sinus disease, reveal predictive factors affecting treatment success, and quantitatively examine patient satisfaction and quality of life dimensions. METHODS: Fifty-four adults were treated consecutively, and the primary analysis included 39 patients who 6month patientreported outcomes (PROs: QoR15, SAPS, PROMIS Global10) assessed by an independent investigator. The primary endpoints were recurrence and treatment success (no recurrence without re-intervention). Delayed healing was a composite of epithelialization > 30 days or discharge > 14 days. Exploratory subgroup analyses (sex and BMI) reported effect sizes with Benjamini-Hochberg-adjusted qvalues. Receiver operating characteristic (ROC) curve analysis assessed PRO discrimination for recurrence with 95% confidence intervals (CIs). RESULTS: Mean followup was 13.6 ± 3.6 months; treatment success 84.6% (33/39), recurrence 15.4% (6/39), and delayed healing 20.5% (8/39). Mean PROs were: QoR15 136.8 ± 19.9, SAPS 30.4 ± 4.3, PROMIS 46.2 ± 6.8; early postoperative pain (VAS) 1.9 ± 1.3. QoR15, SAPS, and PROMIS correlated inversely with recurrence (r = - 0.46 to - 0.36; all p < 0.05) and showed AUCs of 0.79 (95% CI 0.65-0.93), 0.73 (0.58-0.88), and 0.70 (0.54-0.86), respectively. Age was associated with a longer recovery time (p = 0.002). No material differences in PROs by sex or BMI were observed after multiplicity control. CONCLUSIONS: In this single-center consecutive cohort, combined diode laser ablation with a pit excision technique was associated with short perioperative timelines, high patient-reported recovery/satisfaction, and acceptable mid-term recurrence, whereas PRO scores demonstrated fair discrimination for recurrence. Findings should be interpreted cautiously given the retrospective design and modest sample size; prospective, adequately powered studies are needed to validate the prognostic performance and comparative effectiveness.", "provenance": [ { "field": "n", "quote": "the primary analysis included 39 patients" }, { "field": "population", "quote": "Fifty-four adults were treated consecutively" }, { "field": "intervention", "quote": "diode laser ablation combined with pit excision" }, { "field": "comparator", "quote": "a minimally invasive method of diode laser ablation combined with pit excision for pilonidal sinus disease" }, { "field": "primaryOutcome", "quote": "The primary endpoints were recurrence and treatment success (no recurrence without re-intervention)." }, { "field": "result", "quote": "treatment success 84.6% (33/39), recurrence 15.4% (6/39)" }, { "field": "followUp", "quote": "Mean followup was 13.6 ± 3.6 months" } ] }, { "id": "pmid:41306166", "pmid": "41306166", "doi": "10.7759/cureus.95454", "nctId": null, "pmcid": "PMC12646291", "title": "A Novel Scoring System for Pilonidal Disease: Predicting Complications and Guiding Surgical Management", "firstAuthor": "H Amer", "multipleAuthors": true, "journal": "Cureus", "year": 2025, "design": "prospective-cohort", "n": 156, "nField": "reported", "population": "young adults aged 18-45 with pilonidal disease (a condition causing a cyst/abscess at the top of the buttock crack) undergoing surgery", "intervention": "a new scoring system (Hazem-Talaat score) using patient factors to predict surgical outcomes, alongside standard surgery", "comparator": "patients with lower scores on the same scoring system", "primaryOutcome": "wound complications and disease recurrence after surgery", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "single-center study, no untreated or alternative-treatment comparison group, scoring system not yet externally validated", "followUp": "at least six months", "plainFinding": "Identifies who is more likely to have pilonidal cysts recur.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41306166/", "sourceText": "BACKGROUND: Pilonidal disease is a chronic condition of the sacrococcygeal region, frequently affecting young adults and associated with high rates of recurrence and postoperative complications. Numerous surgical techniques have been described, yet there is no universally accepted classification or staging system to guide treatment decisions. This lack of standardization contributes to inconsistent outcomes and difficulty in predicting prognosis. OBJECTIVE: This study aimed to 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. METHODS: A prospective study was carried out on 156 patients (108 males, 48 females) aged 18-45 years admitted with primary or recurrent pilonidal disease to the General Surgery Department at Tanta University, Egypt, between June 2023 and June 2024. Patients with recurrent disease after flap repair or with hematological disorders were excluded, as the reason for this is to avoid anatomical distortions caused by flap surgeries. Preoperative variables, including BMI, sex, hair distribution, diabetes mellitus, number and location of pits, distance from the anus, history of abscess, and prior recurrence, were incorporated into the Hazem-Talaat score. All patients underwent standardized asymmetrical elliptical excision with off-midline closure and were followed for at least six months to assess wound complications and recurrence. RESULTS: The mean age of participants was 27.3 ± 6.5 years, and the mean BMI was 29.1 ± 4.6 kg/m². Recurrence occurred in 19 patients (12.2%), while wound dehiscence was noted in 26 patients (16.7%). 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). 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). A cut-off value of 21 was determined using a receiver operating characteristic (ROC) curve. CONCLUSION: The Hazem-Talaat score provides an objective, multifactorial tool that integrates clinical and anatomical factors to predict recurrence and stratify patients with pilonidal disease. Its application in surgical planning may improve outcomes by tailoring the choice of operative technique to disease severity. Further multicenter studies with longer follow-up are warranted to externally validate this system.", "provenance": [ { "field": "n", "quote": "A prospective study was carried out on 156 patients (108 males, 48 females) aged 18-45 years admitted with primary or recurrent pilonidal disease" }, { "field": "population", "quote": "Pilonidal disease is a chronic condition of the sacrococcygeal region, frequently affecting young adults" }, { "field": "intervention", "quote": "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" }, { "field": "comparator", "quote": "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)." }, { "field": "primaryOutcome", "quote": "followed for at least six months to assess wound complications and recurrence" }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:41278051", "pmid": "41278051", "doi": "10.7759/cureus.97368", "nctId": null, "pmcid": "PMC12634152", "title": "Evaluating Risk Factors for Surgical Site Occurrences: Infection and Wound Dehiscence Post Definitive Surgery for Sacrococcygeal Pilonidal Sinus Disease", "firstAuthor": "Maclean", "multipleAuthors": true, "journal": "Cureus", "year": 2025, "design": "retrospective", "n": 774, "nField": "reported", "population": "adults having surgery for pilonidal sinus disease (a pit/cyst at the top of the buttock crease)", "intervention": "different surgical techniques used to treat pilonidal sinus disease (flap repairs or leaving the wound open to heal)", "comparator": "the various surgical techniques compared against each other", "primaryOutcome": "rates of surgical site infection and wound breakdown after surgery", "result": "some techniques (secondary intention, certain flaps) had much higher infection and wound-breakdown risk, while the modified Karydakis flap had the best outcomes", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective design relying on medical records across multiple hospitals with regional variation in practice.", "followUp": "30-day", "plainFinding": "Surgery choice affects infection and wound risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41278051/", "sourceText": "BACKGROUND: Sacrococcygeal pilonidal sinus disease (SPD) predominantly affects young adults and is associated with high morbidity after surgery. Surgical site infections (SSIs) and wound dehiscence (WD) are frequent and clinically significant complications. This study evaluated their rates and identified associated risk factors across multiple surgical techniques. METHODS: A retrospective multi-centre cohort study was conducted across eight hospitals in Western Australia (2010-2019). Patients aged ≥15 years undergoing elective definitive SPD surgery with flap or secondary intention techniques were included. Data were extracted from medical records and electronic databases. SSI risk was analysed with univariate and multivariate logistic regression, while WD was examined using Cox proportional hazards modelling. Outcomes included 30-day re-presentation and readmission rates, with extended follow-up for recurrence. RESULTS: A total of 774 patients were analysed. SSIs occurred in 28.8% and WD in 28.4%. The cohort included 79.7% male patients, with a mean age of 27.08 (SD±9.06) years and a BMI of 28.58 (SD±6.15). Multivariate analysis demonstrated that secondary intention techniques (OR 6.0, p<0.01), other flap procedures (OR 3.1, p=0.03), overweight status (OR 1.9, p=0.01), and WD (OR 50.6, p<0.01) were independent risk factors for SSIs. In contrast, clear surgical margins and methylene blue use were protective. Cox regression showed increased WD risk with Karydakis flap (HR 1.8, p=0.04), modified Limberg flap (HR 2.0, p=0.03), and smoking (HR 1.4, p=0.04). Within 30 days, 27% re-presented and 7.5% were readmitted, mainly for SSIs or WD, with regional variation reflecting practice differences. CONCLUSION: SSIs and WD remain common and burdensome after SPD surgery. The modified Karydakis flap demonstrated the most favourable risk profile. Optimising patient factors, meticulous surgical technique, and structured training are essential to reduce complications and improve outcomes.", "provenance": [ { "field": "n", "quote": "A total of 774 patients were analysed." }, { "field": "population", "quote": "Patients aged ≥15 years undergoing elective definitive SPD surgery with flap or secondary intention techniques were included." }, { "field": "intervention", "quote": "flap or secondary intention techniques" }, { "field": "comparator", "quote": "Multivariate analysis demonstrated that secondary intention techniques (OR 6.0, p<0.01), other flap procedures (OR 3.1, p=0.03)" }, { "field": "primaryOutcome", "quote": "Surgical site infections (SSIs) and wound dehiscence (WD) are frequent and clinically significant complications." }, { "field": "result", "quote": "The modified Karydakis flap demonstrated the most favourable risk profile." }, { "field": "followUp", "quote": "Outcomes included 30-day re-presentation and readmission rates, with extended follow-up for recurrence." } ] }, { "id": "pmid:41274599", "pmid": "41274599", "doi": "10.1016/j.jpedsurg.2025.162828", "nctId": null, "pmcid": null, "title": "Adding gauze sweep technique to pit-picking procedure increases hair removal and lowers recurrence rate of pilonidal disease", "firstAuthor": "Chiu", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2026, "design": "retrospective", "n": 175, "nField": "reported", "population": "patients with pilonidal disease undergoing a pit-picking procedure, mean age about 18 years", "intervention": "pit-picking procedure with an added gauze sweep technique", "comparator": "pit-picking procedure alone (no gauze sweep)", "primaryOutcome": "amount of hair removed and rate of pilonidal disease recurrence", "result": "more patients had hair removed and far fewer had the condition come back when gauze sweep was added", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This compared two groups of patients treated in different time periods rather than randomly assigning treatment, so differences between groups could explain the result.", "directness": "direct", "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.", "followUp": "", "plainFinding": "Fewer pilonidal recurrences with added technique.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41274599/", "sourceText": "INTRODUCTION: Pit-picking (PP) procedure has been used to treat pilonidal patients, with the main goal of removing all hair within the pilonidal sinus. We hypothesized that adding a gauze sweep (GS) technique to PP could increase hair removal and decrease recurrence rate. METHOD: Consecutive pilonidal patients who underwent PP 2/2021-9/2024 were selected. Starting 3/2023, the GS technique was added during PP. Patient demographics, procedure details, any hair removed during PP, pilonidal disease recurrence, and follow-up period were recorded. Data were analyzed using chi-squared or t-test; p < 0.05 was statistically significant. RESULTS: 175 total patients were included. From 2/2021-3/2023, 86 patients underwent PP only. Cohort PP had 51 males (59 %) and 35 females (41 %) with a mean presentation age at 18.3 ± 4.1 years and were followed for a mean of 425.5 ± 244.8 days. From 4/2023-9/2024, 89 patients underwent PP with GS. Cohort PP + GS had 52 males (58 %) and 37 females (42 %) with a mean presentation age at 18.3 ± 3.8 years and were followed for a mean of 359.1 ± 316.7 days. There was no difference between cohorts PP and PP + HR in patient sex, presentation age, and follow up length (p > 0.05). 53 patients (62 %) in cohort PP and 75 patients (84 %) in cohort PP + GS had hair removed during the procedure (p < 0.001). The recurrence rate was 11.6 % (10/86) for cohort PP and 1.1 % (1/89) for cohort PP + GS (p = 0.01). CONCLUSION: Addition of GS to PP increased the probability of removing hair from the pilonidal sinus and was associated with a lower recurrence rate. GS should be incorporated into PP procedure. LEVEL OF EVIDENCE: Level IV.", "provenance": [ { "field": "n", "quote": "175 total patients were included." }, { "field": "population", "quote": "Consecutive pilonidal patients who underwent PP 2/2021-9/2024 were selected." }, { "field": "intervention", "quote": "the GS technique was added during PP" }, { "field": "comparator", "quote": "86 patients underwent PP only" }, { "field": "primaryOutcome", "quote": "any hair removed during PP, pilonidal disease recurrence" }, { "field": "result", "quote": "53 patients (62 %) in cohort PP and 75 patients (84 %) in cohort PP + GS had hair removed during the procedure (p < 0.001). The recurrence rate was 11.6 % (10/86) for cohort PP and 1.1 % (1/89) for cohort PP + GS (p = 0.01)." }, { "field": "quality", "quote": "LEVEL OF EVIDENCE: Level IV." } ] }, { "id": "pmid:41241452", "pmid": "41241452", "doi": "10.1016/j.suc.2025.08.005", "nctId": null, "pmcid": null, "title": "Pilonidal Disease", "firstAuthor": "O'Guinn", "multipleAuthors": true, "journal": "Surg Clin North Am", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal disease (common in teens and young adults)", "intervention": "surgical treatments such as incision and drainage, pit removal, marsupialization, or flap-based closure (Karydakis, Bascom's cleft lift)", "comparator": "different surgical approaches compared to each other", "primaryOutcome": "recurrence and complications after treatment", "result": "flap-based closures had fewer recurrences but more complications than other closure methods", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is a general review describing typical practice, not a controlled study testing one treatment against another.", "directness": "direct", "limitations": "no study design, patient numbers, or statistical results are given; it is a general overview of management options.", "followUp": "", "plainFinding": "Flap surgery cuts recurrence, more complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41241452/", "sourceText": "Pilonidal disease, common in adolescents and young adults, is linked to hair insertion, friction, and bacterial colonization. Risk factors including obesity, sedentary lifestyle, and hirsutism should be addressed with initial non-operative management. Acute disease is primarily managed by incision and drainage; the addition of deroofing identified pits at the time of drainage can reduce recurrence. Management of chronic pilonidal disease is focused on removal of pits with the possible addition of marsupialization or primary closure. Closures with flap-based techniques, such as Karydakis and Bascom's cleft lift, offer a lower recurrence rate but higher complication risks.", "provenance": [ { "field": "population", "quote": "Pilonidal disease, common in adolescents and young adults, is linked to hair insertion, friction, and bacterial colonization." }, { "field": "intervention", "quote": "Closures with flap-based techniques, such as Karydakis and Bascom's cleft lift, offer a lower recurrence rate but higher complication risks." }, { "field": "comparator", "quote": "Management of chronic pilonidal disease is focused on removal of pits with the possible addition of marsupialization or primary closure." }, { "field": "primaryOutcome", "quote": "the addition of deroofing identified pits at the time of drainage can reduce recurrence" }, { "field": "result", "quote": "Closures with flap-based techniques, such as Karydakis and Bascom's cleft lift, offer a lower recurrence rate but higher complication risks." } ] }, { "id": "pmid:41216148", "pmid": "41216148", "doi": "10.25259/SNI_973_2025", "nctId": null, "pmcid": "PMC12596792", "title": "Late-adolescent presentation of tethered cord syndrome secondary to filum terminale lipoma", "firstAuthor": "Detran", "multipleAuthors": false, "journal": "Surg Neurol Int", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "young man with urinary problems and skin changes near the lower back/buttock crease", "intervention": "surgery to release a tethered spinal cord caused by a fatty growth", "comparator": "no comparator, single case before and after surgery", "primaryOutcome": "neurological and bladder/bowel sphincter function after surgery", "result": "still needed urinary catheterization and developed new sensory problems after surgery", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show what typically happens or apply broadly.", "directness": "indirect", "limitations": "Single case, long delay before diagnosis and treatment, cannot be generalized.", "followUp": "", "plainFinding": "Surgery didn't fully fix symptoms.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41216148/", "sourceText": "BACKGROUND: Filum terminale lipoma (FTL) is a form of occult spinal dysraphism that can cause a spectrum of neurological symptoms, including tethered cord syndrome (TCS). While FTL commonly manifests in infancy and childhood, symptomatic presentations in adolescence and adulthood are increasingly recognized. CASE DESCRIPTION: Originally, a 16-year-old Filipino male developed dysuria, hematuria, urinary incontinence, and recurrent lower urinary tract infections. At age 22, the physical examination revealed a hyperpigmented patch with superimposed hypertrichosis located left-superolateral to the intergluteal cleft. The sacral region demonstrated diminished convexity due to a subcutaneous fat pad, displacing the superior portion of the cleft to the right; the sacrum and coccyx were impalpable. The only neurological finding was impaired anal and urinary sphincter function. Despite surgical untethering, he remained dependent on urinary catheterization postoperatively, and also newly developed additional sensory deficits. CONCLUSION: It is important to recognize late-adolescent onset TCS in patients presenting with unexplained urological dysfunction and sacral cutaneous stigmata. Surgical untethering remains the treatment of choice, but outcomes are often diminished by the more protracted duration of preoperative neurological/sphincteric deficits.", "provenance": [ { "field": "n", "quote": "a 16-year-old Filipino male developed dysuria, hematuria, urinary incontinence, and recurrent lower urinary tract infections" }, { "field": "population", "quote": "a hyperpigmented patch with superimposed hypertrichosis located left-superolateral to the intergluteal cleft" }, { "field": "intervention", "quote": "Despite surgical untethering, he remained dependent on urinary catheterization postoperatively, and also newly developed additional sensory deficits." }, { "field": "comparator", "quote": "CASE DESCRIPTION" }, { "field": "primaryOutcome", "quote": "The only neurological finding was impaired anal and urinary sphincter function." }, { "field": "result", "quote": "Despite surgical untethering, he remained dependent on urinary catheterization postoperatively, and also newly developed additional sensory deficits." } ] }, { "id": "pmid:41209438", "pmid": "41209438", "doi": "10.1016/j.eucr.2025.103249", "nctId": null, "pmcid": "PMC12595277", "title": "Pilonidal sinus beyond the sacrococcygeal region: A penile case report", "firstAuthor": "Sawaqed", "multipleAuthors": true, "journal": "Urol Case Rep", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "30-year-old man with a painless penile shaft mass", "intervention": "surgical removal of the mass under local anesthesia", "comparator": "none", "primaryOutcome": "diagnosis and recovery after removal", "result": "removal revealed a hair-containing sinus with chronic inflammation, confirming pilonidal disease, and recovery was uneventful", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, which cannot show how common or treatable this condition is in general.", "directness": "indirect", "limitations": "Only one patient was studied, and the lesion was on the penis, not the natal cleft (butt crack) region the question is about.", "followUp": "", "plainFinding": "Rare penile case, unrelated location.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41209438/", "sourceText": "Pilonidal sinus disease (PSD) is an acquired pathological illness that typically manifests in the natal cleft of the sacrococcygeal region, but it can rarely occur in other locations, including the penis. We report a 30-year-old circumcised man with a painless, slowly enlarging penile shaft mass. Excision under local anesthesia revealed a hair-containing sinus with chronic granulomatous inflammation on histology, confirming pilonidal disease. Recovery was uneventful. Although uncommon, penile pilonidal sinus should be considered in the differential diagnosis of chronic penile lesions. Histopathology is essential for confirmation, and complete surgical excision provides a definitive cure.", "provenance": [ { "field": "n", "quote": "a 30-year-old circumcised man with a painless, slowly enlarging penile shaft mass" }, { "field": "population", "quote": "a 30-year-old circumcised man with a painless, slowly enlarging penile shaft mass" }, { "field": "intervention", "quote": "Excision under local anesthesia revealed a hair-containing sinus with chronic granulomatous inflammation on histology" }, { "field": "comparator", "quote": "Excision under local anesthesia revealed a hair-containing sinus with chronic granulomatous inflammation on histology" }, { "field": "primaryOutcome", "quote": "Recovery was uneventful" }, { "field": "result", "quote": "Excision under local anesthesia revealed a hair-containing sinus with chronic granulomatous inflammation on histology, confirming pilonidal disease. Recovery was uneventful." } ] }, { "id": "pmid:41146596", "pmid": "41146596", "doi": "10.1111/codi.70282", "nctId": null, "pmcid": null, "title": "Comparison of short- and long-term outcomes of diode laser vs. crystallized phenol treatment for pilonidal sinus disease: A propensity score-matched multicentre study", "firstAuthor": "Bilgin", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2025, "design": "retrospective", "n": 644, "nField": "reported", "population": "young adults with pilonidal sinus disease (median age 26 years)", "intervention": "diode laser treatment for pilonidal sinus", "comparator": "crystallized phenol treatment for pilonidal sinus", "primaryOutcome": "healing, recovery and recurrence after treatment", "result": "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.", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It is a retrospective, matched comparison, not a randomized trial, so results are less certain despite the large sample.", "directness": "direct", "limitations": "Retrospective cohort design with propensity score matching rather than randomization.", "followUp": "Median follow-up was 45 months (laser) and 40 months (phenol)", "plainFinding": "Both treatments worked, different trade-offs.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41146596/", "sourceText": "AIM: Pilonidal sinus disease (PSD) primarily affects young adults; rapid recovery is essential and yet lacks a standardized treatment approach. While excisional techniques delay recovery, minimally invasive options like laser ablation and phenol application are gaining interest, yet comparative long-term evidence is scarce. This study compared short- and long-term outcomes of laser versus phenol treatment in PSD. METHOD: In this multicentre retrospective cohort study (Nov. 2017-Sep. 2024), patients treated with laser or phenol were included. 1:3 propensity score matching using the nearest neighbour algorithm was performed based on age, gender, prior surgical history and year of operation. Categorical variables were analysed using chi-squared or Fisher's exact tests, whereas continuous variables were compared using Student's t-test or Mann-Whitney U test depending on distribution normality. RESULTS: Out of 897 eligible patients, 644 were included (median age: 26 years, body mass index [BMI]: 26.2 kg/m2, male-to-female ratio: 4:1). The number of sinuses/pits was 2-3 in both groups. Operating time was significantly longer in the laser group. Complications occurred in 6.8% of laser patients, whereas none were reported in the phenol group. Pain scores were higher in the laser group (2 [1-3] vs. 1 [0-2]). Median follow-up was 45 months (laser) and 40 months (phenol). Return to daily activities was delayed in the laser group, whereas complete healing was slower in the phenol group. Readmission, recurrence and recovery rates were comparable (85%-86%). CONCLUSION: Both treatments demonstrated low complication and recurrence rates with high recovery rates. Laser favoured faster healing and fewer sessions, whereas phenol allowed for shorter procedures and earlier return to daily life.", "provenance": [ { "field": "n", "quote": "644 were included" }, { "field": "population", "quote": "Pilonidal sinus disease (PSD) primarily affects young adults" }, { "field": "population", "quote": "median age: 26 years" }, { "field": "intervention", "quote": "patients treated with laser or phenol were included" }, { "field": "comparator", "quote": "patients treated with laser or phenol were included" }, { "field": "primaryOutcome", "quote": "Readmission, recurrence and recovery rates were comparable (85%-86%)." }, { "field": "result", "quote": "Complications occurred in 6.8% of laser patients, whereas none were reported in the phenol group." }, { "field": "result", "quote": "Pain scores were higher in the laser group (2 [1-3] vs. 1 [0-2])." }, { "field": "result", "quote": "Return to daily activities was delayed in the laser group, whereas complete healing was slower in the phenol group." }, { "field": "result", "quote": "Laser favoured faster healing and fewer sessions, whereas phenol allowed for shorter procedures and earlier return to daily life." }, { "field": "followUp", "quote": "Median follow-up was 45 months (laser) and 40 months (phenol)." } ] }, { "id": "pmid:41135869", "pmid": "41135869", "doi": "10.1016/j.jpedsurg.2025.162747", "nctId": null, "pmcid": null, "title": "Topical lidocaine or not for laser follicle ablation in pilonidal disease: A prospective, randomized, double-blinded trial", "firstAuthor": "Stoeckel", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2026, "design": "rct", "n": 20, "nField": "reported", "population": "patients with pilonidal disease (gluteal crease hair follicle condition) getting laser hair removal treatment", "intervention": "topical lidocaine numbing cream (LMX 4%) applied before laser hair follicle treatment", "comparator": "placebo cream applied before laser hair follicle treatment", "primaryOutcome": "patient-reported pain/discomfort during the laser procedure, rated 0-10", "result": "no significant difference in pain scores between lidocaine cream and placebo", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "very small study of only 20 patients, so it may be too small to detect a real difference.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Numbing cream didn't reduce procedure pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41135869/", "sourceText": "BACKGROUND: Laser follicle ablation is a significant component of the care in pilonidal disease, but may be uncomfortable secondary to absorption of the light energy by pigment present in the underlying skin. Multiple methods have been proposed to ameliorate the discomfort, including the pre-procedure application of topical lidocaine creams; however, little data exists as to the efficacy of the creams, which must be applied 30-40 min prior to laser treatment. We studied the efficacy of a topical local anesthetic cream for this purpose. METHODS: A prospective, double-blinded, randomized case-control trial was conducted and included patients presenting to the pilonidal care clinic for laser follicle ablation. Power calculation was based on a superiority design where a sample size of 20 participants had 80 % power to detect a standardized difference of 0.67 in pain scores between treatments (difference in means = 2 and standard deviation = 3) using a paired t-test with 5 % alpha. 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. The topical cream remained applied to each patients' gluteal crease for 30-40 min and was then removed prior to laser follicle ablation with accompanying cold air by personnel blinded to the selection of cream. After the procedure the patient was asked their level of discomfort with the laser follicle ablation on a 0-10 Likert pain scale. Follicle ablations were performed using a Cynosure Elite Plus laser, with Alexandrite for patients who were Fitzpatrick 1 or 2, and YAG (yttrium aluminum garnet) for those who were Fitzpatrick 3 to 5. RESULTS: Twenty-two patients were recruited to participate, 2 of whom did not return for their next clinic visit in a timely fashion, 1 secondary to a snowstorm and the other secondary to insurance issues, leaving 20 patients for analysis. The mean age was 20 years (range: 15 to 33), including 11 males (55 %). The mean pain score with LMX was 2.25 (SD 1.94) and placebo 1.78 (SD 1.15) (p = 0.18; Fig. 1). There were no noted complications. CONCLUSION: Application of topical anesthetic cream prior to laser follicle ablation adds significant time to a patient's clinic visit and does not appear to improve pain control when compared to placebo for gluteal laser follicle ablation for pilonidal disease.", "provenance": [ { "field": "n", "quote": "leaving 20 patients for analysis" }, { "field": "population", "quote": "patients presenting to the pilonidal care clinic for laser follicle ablation" }, { "field": "intervention", "quote": "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." }, { "field": "comparator", "quote": "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." }, { "field": "primaryOutcome", "quote": "After the procedure the patient was asked their level of discomfort with the laser follicle ablation on a 0-10 Likert pain scale." }, { "field": "result", "quote": "The mean pain score with LMX was 2.25 (SD 1.94) and placebo 1.78 (SD 1.15) (p = 0.18; Fig. 1)." } ] }, { "id": "pmid:41094667", "pmid": "41094667", "doi": "10.1186/s12893-025-03222-y", "nctId": null, "pmcid": "PMC12529851", "title": "Future of pilonidal cyst surgery: a comparative review of traditional and laser techniques", "firstAuthor": "Jazi", "multipleAuthors": true, "journal": "BMC Surg", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal cysts (sacrococcygeal cyst or sinus near the top of the buttock crease)", "intervention": "laser ablation treatment", "comparator": "traditional surgery (excision with open/closed healing or flap reconstruction)", "primaryOutcome": "effectiveness, recovery time, recurrence, complications, cosmetics, and cost", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a narrative review of mixed studies without pooled statistics, so it can't be weighted as strongly as a single rigorous trial.", "directness": "direct", "limitations": "authors note laser may be less effective in severe or complicated cases and that long-term outcomes still need to be established.", "followUp": "", "plainFinding": "Laser may heal pilonidal cysts better.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41094667/", "sourceText": "Pilonidal disease is a common sacrococcygeal cyst or sinus that can significantly impact patients' quality of life, necessitating an analysis of evolving treatments to optimize patient outcomes. This review compares traditional and minimally invasive techniques focusing on laser ablation, in treating pilonidal cysts, focusing on each method's effectiveness, recovery time, recurrence rates, complications, cosmetics, and costs. We conducted a comprehensive assessment of literature exploring PubMed, Scopus, Web of Science, Google Scholar, and Embase for studies comparing traditional surgical techniques including traditional excision with open and closed healing, flap reconstructions, with minimally invasive procedures focusing on laser-assisted. Although traditional surgical techniques were practical, but they were associated with a relatively high risk of wound complications, recurrence, extended healing periods, and poor cosmetics. Laser techniques showed promising results in reducing hospital stays (for at most 3 h vs. days), postoperative pain, and recurrence rates, with healing rates up to 97%. However, laser methods may be less effective in severe or complicated cases, and they have higher costs. Laser-assisted techniques offer a less invasive option compared to traditional surgery, with greater patient fulfillment. However, additional research is needed to optimize laser procedures, especially in complex cases, and to establish long-term outcomes. For simpler pilonidal cysts, laser treatments are a promising option that could eventually replace traditional surgery as the standard of care.", "provenance": [ { "field": "population", "quote": "Pilonidal disease is a common sacrococcygeal cyst or sinus that can significantly impact patients' quality of life" }, { "field": "intervention", "quote": "minimally invasive techniques focusing on laser ablation" }, { "field": "comparator", "quote": "traditional surgical techniques including traditional excision with open and closed healing, flap reconstructions" }, { "field": "primaryOutcome", "quote": "focusing on each method's effectiveness, recovery time, recurrence rates, complications, cosmetics, and costs" }, { "field": "result", "quote": "Laser techniques showed promising results in reducing hospital stays (for at most 3 h vs. days), postoperative pain, and recurrence rates, with healing rates up to 97%." }, { "field": "limitations", "quote": "laser methods may be less effective in severe or complicated cases, and they have higher costs" } ] }, { "id": "pmid:41074563", "pmid": "41074563", "doi": "10.1111/ans.70330", "nctId": null, "pmcid": "PMC13006718", "title": "Sacrococcygeal Pilonidal Sinus Disease: A Decade-In-Review of Patient-Reported Outcome Measures", "firstAuthor": "Nyandoro", "multipleAuthors": true, "journal": "ANZ J Surg", "year": 2026, "design": "retrospective", "n": 136, "nField": "reported", "population": "people who had surgery for pilonidal sinus disease at the top of the buttock crack", "intervention": "different surgical flap techniques for pilonidal sinus (Karydakis flap, modified Karydakis flap, Limberg flap, modified Limberg flap, other flap techniques)", "comparator": "healing by secondary intention (leaving the wound open to heal on its own) and the other flap techniques compared with each other", "primaryOutcome": "patient-reported outcomes including body image, cosmetic appearance, confidence, return to normal function and overall satisfaction, plus recurrence and infection rates", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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", "directness": "direct", "limitations": "retrospective design, reliance on mail questionnaires and telephone interviews up to a decade after surgery, and non-random allocation to surgical technique groups", "followUp": "decade", "plainFinding": "Flap surgery heals faster, fewer recurrences.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41074563/", "sourceText": "BACKGROUND: Sacrococcygeal pilonidal sinus disease (SPD) is a chronic inflammatory condition that can significantly impact quality of life. While recurrence and surgical site infection (SSI) rates are well documented, less is known about how different surgical techniques affect patient-reported outcome measures (PROMs). METHODS: This study employed mixed methods, including standardised mail questionnaires and telephone interviews (May-September 2020), to conduct a multi-centre retrospective decade follow-up review of definitive SPD surgery participants from Western Australia. Six surgical technique groups were analysed: Karydakis flap (KF), modified Karydakis flap (MKF), Limberg flap (LF), modified Limberg flap (MLF), other flap techniques (OFT) and secondary intention healing techniques (SIT). PROMs assessed included body image, cosmesis, confidence, functional recovery and overall satisfaction-secondary outcomes examined recurrence, SSI and other complications. RESULTS: A total of 136 patients met the inclusion criteria. MLF and OFT achieved the fastest functional recovery, with median return-to-work times of 14 and 21 days, respectively, compared to 60 days for SIT (p = 0.007). MKF and LF achieved the highest body image and cosmetic satisfaction scores (medians of 20 and 19), whereas SIT and OFT scored the lowest. MKF yielded the highest overall satisfaction (100%). SIT was associated with the highest recurrence rate (52.2%) and SSI rates (30.4%), while MLF and MKF combined had low recurrence rates with favourable PROMs. CONCLUSION: Flap-based techniques, particularly the MKF and MLF, offer an optimal balance of functional recovery, cosmetic outcomes and low recurrence rates. Incorporating PROMs into SPD surgical planning can better align treatment with patient priorities and the underlying pathophysiology of the disease.", "provenance": [ { "field": "n", "quote": "A total of 136 patients met the inclusion criteria." }, { "field": "population", "quote": "Sacrococcygeal pilonidal sinus disease (SPD) is a chronic inflammatory condition" }, { "field": "intervention", "quote": "Six surgical technique groups were analysed: Karydakis flap (KF), modified Karydakis flap (MKF), Limberg flap (LF), modified Limberg flap (MLF), other flap techniques (OFT) and secondary intention healing techniques (SIT)." }, { "field": "comparator", "quote": "secondary intention healing techniques (SIT)" }, { "field": "primaryOutcome", "quote": "PROMs assessed included body image, cosmesis, confidence, functional recovery and overall satisfaction-secondary outcomes examined recurrence, SSI and other complications." }, { "field": "result", "quote": "MLF and OFT achieved the fastest functional recovery, with median return-to-work times of 14 and 21 days, respectively, compared to 60 days for SIT (p = 0.007). 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%)" }, { "field": "followUp", "quote": "multi-centre retrospective decade follow-up review" } ] }, { "id": "pmid:41058826", "pmid": "41058826", "doi": "10.7759/cureus.91699", "nctId": null, "pmcid": "PMC12498115", "title": "Comparison of Simple Drainage Versus Drainage With Tract Destruction in the Management of Pilonidal Abscess", "firstAuthor": "Hawezy", "multipleAuthors": false, "journal": "Cureus", "year": 2025, "design": "retrospective", "n": 480, "nField": "reported", "population": "patients with acute pilonidal abscesses (infection at the top of the buttock crack)", "intervention": "drainage of the abscess combined with destruction of the sinus tract", "comparator": "simple drainage of the abscess alone", "primaryOutcome": "recurrence of the abscess", "result": "recurrence was much lower with drainage plus sinus destruction (11.8%) than with simple drainage alone (55.7%)", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was not described as randomized, so differences between groups other than treatment could explain the results.", "directness": "direct", "limitations": "abstract does not describe randomization or how patients were assigned to each group, raising risk of bias.", "followUp": "at least nine months", "plainFinding": "Removing sinus tract cuts recurrence a lot.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41058826/", "sourceText": "INTRODUCTION: Pilonidal disease is an acquired condition primarily affecting the gluteal cleft and sacrococcygeal area, often complicated by the formation of sinuses and abscesses. Despite multiple surgical options, there is no universally accepted standard treatment. This study aimed to compare the outcomes of simple drainage alone versus drainage combined with sinus destruction using the same incision technique. METHODS: Between February 2019 and March 2024, a total of 480 patients with acute pilonidal abscesses received treatment. Of these, 235 underwent simple drainage (Group A), while 245 had drainage with sinus damage (Group B). All participants were followed for at least nine months, with recurrence rates recorded throughout. Statistical analysis was performed using SPSS version 28 (IBM Corp., Armonk, NY, USA). RESULTS: In Group A, 131 patients (55.7%) experienced a recurrence, compared to only 29 patients (11.8%) in Group B. This difference is statistically significant (p < 0.001). The majority of recurrences occurred in younger, male, and overweight individuals. CONCLUSION: Removing the sinus tract during the same procedure as abscess drainage greatly lowers the chance of the abscess recurring, compared to drainage alone. Incorporating sinus destruction into the initial surgery might eliminate the need for subsequent operations for people with pilonidal abscesses.", "provenance": [ { "field": "population", "quote": "a total of 480 patients with acute pilonidal abscesses received treatment" }, { "field": "intervention", "quote": "245 had drainage with sinus damage (Group B)" }, { "field": "comparator", "quote": "235 underwent simple drainage (Group A)" }, { "field": "primaryOutcome", "quote": "recurrence rates recorded throughout" }, { "field": "result", "quote": "In Group A, 131 patients (55.7%) experienced a recurrence, compared to only 29 patients (11.8%) in Group B." }, { "field": "n", "quote": "a total of 480 patients with acute pilonidal abscesses received treatment" }, { "field": "followUp", "quote": "All participants were followed for at least nine months" } ] }, { "id": "pmid:40974390", "pmid": "40974390", "doi": "10.1007/s00384-025-04961-3", "nctId": null, "pmcid": "PMC12450213", "title": "Intra-operative ultrasound in the surgical treatment of complex and recurrent pilonidal disease: a retrospective, observational, single-center study", "firstAuthor": "Gallo", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2025, "design": "retrospective", "n": 19, "nField": "reported", "population": "patients with complex or repeat pilonidal disease (cyst at top of buttock crack)", "intervention": "endoscopic pilonidal sinus surgery plus ultrasound guidance during the operation", "comparator": "none (single group, before/after comparison of ultrasound findings)", "primaryOutcome": "whether ultrasound found extra hidden tunnels and changed the surgery, and whether the disease came back or failed to heal", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this was a small, retrospective study of only 19 patients with no comparison group, so it can't prove ultrasound improves outcomes.", "directness": "direct", "limitations": "retrospective design, very small sample size, single center, no control group for comparison", "followUp": "minimum follow-up of 36 months", "plainFinding": "Found hidden tunnels, some recurrence still.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40974390/", "sourceText": "BACKGROUND: Pilonidal disease (PD) is frequently associated with high recurrence rates and delayed healing, particularly in complex or recurrent cases. While Endoscopic Pilonidal Sinus Treatment (EPSiT) has improved postoperative recovery and patient satisfaction, its effectiveness can be limited by incomplete identification of fistulous tracts. Intraoperative ultrasound (IUS) offers real-time visualization of subcutaneous structures and may aid in detecting hidden tracts during surgery. This study evaluates the clinical outcomes of combining IUS with EPSiT in the treatment of complex and recurrent PD. MATERIALS AND METHODS: A retrospective cohort, single-center study was conducted on patients with recurrent and complex PD treated between 2018 and 2021 using IUS in conjunction with EPSiT. All patients had a minimum follow-up of 36 months. The study recorded the number of cases in which IUS identified additional fistulous tracts and led to a modification of the surgical strategy, as well as clinical outcomes including recurrence rate, time to wound healing, and incidence of incomplete wound healing. RESULTS: Nineteen patients were included (14 males, 73.7%; mean age of 35.4 ± 6.4 years). The mean operative time was 42 min, with IUS requiring an additional 6 min. IUS identified previously undetected fistulous tracts in 6 patients (31.5%), leading to modifications in the surgical strategy. At 36-month follow-up, disease persistence (recurrence or incomplete healing) was observed in 5 patients (26.3%). Recurrent cases were successfully managed with additional procedures, achieving 100% healing after reintervention. CONCLUSIONS: Intraoperative IUS identified previously undetected secondary tracts in 31.5% of patients, leading to a modification of the surgical approach. Further comparative studies are needed to validate its effectiveness and assess its potential role as a standard adjunct in the surgical management of pilonidal disease.", "provenance": [ { "field": "population", "quote": "patients with recurrent and complex PD treated between 2018 and 2021" }, { "field": "intervention", "quote": "using IUS in conjunction with EPSiT" }, { "field": "comparator", "quote": "A retrospective cohort, single-center study was conducted on patients with recurrent and complex PD" }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "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." }, { "field": "n", "quote": "Nineteen patients were included" }, { "field": "followUp", "quote": "All patients had a minimum follow-up of 36 months." } ] }, { "id": "pmid:40965774", "pmid": "40965774", "doi": "10.1007/s11136-025-04056-0", "nctId": null, "pmcid": "PMC12689659", "title": "Association between pilonidal sinus disease and depression: a population-based cohort study", "firstAuthor": "Krieg", "multipleAuthors": true, "journal": "Qual Life Res", "year": 2025, "design": "retrospective", "n": 11245, "nField": "reported", "population": "adults with pilonidal sinus disease (a cyst/infection near the tailbone)", "intervention": "having pilonidal sinus disease", "comparator": "people without pilonidal sinus disease", "primaryOutcome": "developing depression within five years", "result": "higher rate of depression in those with pilonidal sinus disease", "resultDirection": "harm", "quality": "moderate", "qualityWhy": "Large real-world database study with matching, but it's retrospective so other unmeasured factors could explain the link.", "directness": "indirect", "limitations": "Retrospective design using general practice records; excluded people with prior psychiatric conditions; cannot prove cause, only association.", "followUp": "five years", "plainFinding": "Higher depression risk, not pain cause.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40965774/", "sourceText": "PURPOSE: The aim of this study was to evaluate the association between pilonidal sinus disease (PSD) and the subsequent development of depression, addressing an unmet need to examine the psychosocial impact of PSD in a large, representative outpatient cohort in Germany. METHODS: A retrospective cohort study was conducted using data from the IQVIA Disease Analyzer database, which contains anonymized medical records from 1,293 general practices across Germany. The study included patients aged ≥ 18 years diagnosed with PSD (ICD-10: L05) between 2005 and 2022, excluding those with pre-existing psychiatric conditions. Propensity score matching (5:1) was performed to pair PSD patients with individuals without PSD. Depression diagnoses (ICD-10: F32, F33) within five years after diagnosis were assessed using Kaplan-Meier curves and Cox regression analysis. RESULTS: A total of 11,245 PSD patients (23% women, mean age 35.3 years) were matched to individuals without PSD. The incidence of depression was higher in PSD patients (11.7%) compared to non-PSD cohort (10.5%) over five years (p < 0.001). PSD was associated with an increased risk of depression (HR: 1.16; 95% CI 1.09–1.24), with stronger associations observed in women (HR: 1.25; 95% CI 1.11–1.41) and patients > 45 years of age (HR: 1.44; 95% CI 1.26–1.64). CONCLUSION: This study demonstrates a significant association between PSD and depression, highlighting the need for integrated treatment approaches that address both physical and psychological aspects of PSD. Future research should further explore causal mechanisms and develop strategies for prevention and treatment of depression in PSD patients.", "provenance": [ { "field": "population", "quote": "patients aged ≥ 18 years diagnosed with PSD (ICD-10: L05) between 2005 and 2022" }, { "field": "intervention", "quote": "pilonidal sinus disease (PSD)" }, { "field": "comparator", "quote": "individuals without PSD" }, { "field": "primaryOutcome", "quote": "Depression diagnoses (ICD-10: F32, F33) within five years after diagnosis" }, { "field": "result", "quote": "PSD was associated with an increased risk of depression (HR: 1.16; 95% CI 1.09–1.24)" }, { "field": "n", "quote": "A total of 11,245 PSD patients (23% women, mean age 35.3 years) were matched to individuals without PSD." } ] }, { "id": "pmid:40956974", "pmid": "40956974", "doi": "10.1097/ASW.0000000000000362", "nctId": null, "pmcid": null, "title": "Comparing Square Excision and Transposition Flap Versus Modified Limberg Flap in Sacrococcygeal Pilonidal Sinus Disease Surgery: A New Technique With Fewer Wound Issues", "firstAuthor": "Ertekin", "multipleAuthors": true, "journal": "Adv Skin Wound Care", "year": 2026, "design": "retrospective", "n": 102, "nField": "reported", "population": "patients having surgery for pilonidal sinus disease (a chronic cyst/infection at the top of the buttock crack)", "intervention": "square excision and transposition flap surgery", "comparator": "modified Limberg flap surgery", "primaryOutcome": "healing time, wound complications, return to work, and recurrence after surgery", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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", "directness": "direct", "limitations": "retrospective design, not randomized, relatively small group sizes (53 and 49 patients)", "followUp": "6 months", "plainFinding": "Faster healing, fewer wound problems", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40956974/", "sourceText": "OBJECTIVE: Pilonidal sinus disease (PSD) is a common disease that is an important health problem. Using new flap methods in defect closure in PSD surgery may be useful in obtaining ideal surgical outcomes. This study aimed to present the early outcomes of the square excision and transposition flap (SF) technique compared with the modified Limberg flap (LF). METHODS: Patients who underwent surgical intervention for PSD utilizing SF and LF techniques between January 2016 and January 2022 were evaluated. Demographics, comorbidity, clinical presentation, pain assessment, hospital stay duration, healing time, time to return to work, and recurrence status were compared between the SF and LF groups. RESULTS: There was no significant difference between the SF (53 patients) and LF (49 patients) groups regarding demographic and most clinical characteristics. Patients in the SF group experienced shorter healing times of 11 days and quicker returns to work at 13 days compared with patients in the LF group ( P <.001). A lower incidence of wound infection was observed in the SF group (3.8%) compared with the LF group (16.3%) ( P =.035). Partial wound dehiscence was more observed in the LF group (18.4%), marking a significant difference ( P =.001). Regarding cosmetic satisfaction at the 6-month follow-up, the SF group reported higher satisfaction rates. The SF group had a lower recurrence rate. CONCLUSIONS: The SF method had lower wound dehiscence, shorter healing time, and shorter return-to-work time compared with the modified LF. Patients have more cosmetic satisfaction. The SF technique can be considered as an option in the surgical treatment of PSD.", "provenance": [ { "field": "population", "quote": "Patients who underwent surgical intervention for PSD utilizing SF and LF techniques between January 2016 and January 2022 were evaluated." }, { "field": "intervention", "quote": "square excision and transposition flap (SF) technique" }, { "field": "comparator", "quote": "modified Limberg flap (LF)" }, { "field": "n", "quote": "the SF (53 patients) and LF (49 patients) groups" }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "Patients in the SF group experienced shorter healing times of 11 days and quicker returns to work at 13 days compared with patients in the LF group ( P <.001). 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)." }, { "field": "followUp", "quote": "Regarding cosmetic satisfaction at the 6-month follow-up, the SF group reported higher satisfaction rates." } ] }, { "id": "pmid:40952828", "pmid": "40952828", "doi": "10.4103/aam.aam_258_25", "nctId": null, "pmcid": "PMC13375006", "title": "Unraveling the Causes of Perianal Itching: Magnetic Resonance Imaging as a Diagnostic Tool for Perianal Fistulas and Its Mimics", "firstAuthor": "Davra", "multipleAuthors": true, "journal": "Ann Afr Med", "year": 2026, "design": "prospective-cohort", "n": 59, "nField": "reported", "population": "adults aged 18 and older with perianal itching", "intervention": "MRI pelvis scan to evaluate perianal itching and classify fistulas", "comparator": "clinical and surgical findings", "primaryOutcome": "identifying and classifying the cause of perianal itching (fistula, abscess, pilonidal sinus, hemorrhoids)", "result": "Perianal fistula was the most common cause, followed by abscess, pilonidal sinus and hemorrhoids, with MRI findings matching clinical and surgical data", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Pilonidal disease was one of several causes found.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40952828/", "sourceText": "BACKGROUND: Perianal itching is a common complaint associated with a variety of anorectal conditions such as fistulas, abscesses, hemorrhoids and pilonidal disease. Accurate diagnosis is essential for effective treatment and magnetic resonance imaging (MRI) plays a pivotal role due to its excellent soft-tissue resolution and multiplanar imaging. OBJECTIVE: The objective of this study was to evaluate the diagnostic utility of MRI in patients with perianal itching, focusing on the identification and classification of perianal fistulas and their mimics, using St. James and Parks classification systems. MATERIALS AND METHODS: This prospective observational study was conducted in the department of radiodiagnosis over 6 months (December 2023-May 2024) and included 59 patients aged ≥ 18 years with perianal itching. MRI (1.5T) pelvis scans were obtained using T1, T2, short tau inversion recovery, diffusion-weighted imaging, apparent diffusion coefficient and postcontrast sequences. Fistulas were classified using the St. James and Parks systems. Chi-square test assessed the correlation between the classifications. RESULTS: Among 59 cases, perianal fistula was most common (57.6%), followed by abscess (33.9%), pilonidal sinus (5.1%) and hemorrhoids (3.4%). The mean age was 45.8 ± 10.6 years with male predominance. Grade 2 fistulas ( 47.06%) and intersphincteric type (64.70%) were most frequent. A strong correlation ( P < 0.001) was observed between St. James and Parks classifications. Common complications included abscesses (70.6%) and horseshoe tracts (14.7%). MRI findings showed high concordance with clinical and surgical data. CONCLUSION: MRI is a sensitive, noninvasive tool for evaluating perianal itching. It effectively characterizes underlying pathology, guides treatment planning, shows strong classification correlation and enhancing clinical decision-making.", "provenance": [ { "field": "n", "quote": "included 59 patients aged ≥ 18 years with perianal itching" }, { "field": "population", "quote": "included 59 patients aged ≥ 18 years with perianal itching" }, { "field": "intervention", "quote": "MRI (1.5T) pelvis scans were obtained using T1, T2, short tau inversion recovery, diffusion-weighted imaging, apparent diffusion coefficient and postcontrast sequences" }, { "field": "comparator", "quote": "MRI findings showed high concordance with clinical and surgical data" }, { "field": "primaryOutcome", "quote": "evaluate the diagnostic utility of MRI in patients with perianal itching, focusing on the identification and classification of perianal fistulas and their mimics" }, { "field": "result", "quote": "perianal fistula was most common (57.6%), followed by abscess (33.9%), pilonidal sinus (5.1%) and hemorrhoids (3.4%)" } ] }, { "id": "pmid:40931185", "pmid": "40931185", "doi": "10.1007/s00384-025-04921-x", "nctId": null, "pmcid": "PMC12423239", "title": "Investigating recurrence in pilonidal sinus disease: results of a nationwide, multicenter study in Turkey (PISI TURKEY)", "firstAuthor": "Yalcinkaya", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2025, "design": "retrospective", "n": 1662, "nField": "reported", "population": "adults who had surgery for pilonidal sinus disease (a condition causing pain and infection near the top of the buttock crease)", "intervention": "pilonidal sinus surgery (index operation)", "comparator": "", "primaryOutcome": "recurrence of pilonidal sinus disease within 12 months after surgery", "result": "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", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective database study design with no control group; relies on data forms completed by multiple centers, which can introduce inconsistency or missing information.", "followUp": "12 months", "plainFinding": "Low recurrence; infection raises relapse risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/40931185/", "sourceText": "PURPOSE: The purpose of this study is to investigate the recurrence rates for the treatment of pilonidal sinus disease (PSD) in Turkey and the factors associated with recurrence of PSD after surgery on a nationwide scale. METHODS: This national, multicenter, database review was conducted in Turkey by the PISI TURKEY Research Group, and included recipients of PSD surgery in 41 select hospitals in Turkey, between January 2019 and January 2020. Data were collected by completion of standardized data forms. Sociodemographic and anthropometric data, comorbidities, PSD type, previous PSD interventions, index PSD intervention, recurrence, and complications were collected from baseline to postoperative 12 months. RESULTS: The data of 1662 patients from 41 centers were analyzed. The median age was 25 (21-32) years, and 80.26% of the cases were male. The recurrence rate following index operations was 6.26% in the 12-month period. Age (p = 0.594) and sex distribution (p = 0.441) were similar in patients with and without recurrence. The recurrent group had significantly higher frequencies of type V PSD (p < 0.001), wound site infection (p < 0.001), and wound separation (p < 0.001), whereas the non-recurrent group had a significantly higher frequency of type III PSD (p < 0.001). Multivariable logistic regression revealed that prior recurrence, postoperative wound site infection, and postoperative wound separation were independently associated with recurrence. CONCLUSIONS: The recurrence rate after PSD surgery in Turkey was close to the lower ranges reported in prior literature. Turkish patients with a history of prior recurrence, postoperative wound site infection, or postoperative wound separation should be considered to have higher risks for recurrence.", "provenance": [ { "field": "n", "quote": "The data of 1662 patients from 41 centers were analyzed." }, { "field": "population", "quote": "recipients of PSD surgery in 41 select hospitals in Turkey" }, { "field": "intervention", "quote": "index PSD intervention" }, { "field": "primaryOutcome", "quote": "The recurrence rate following index operations was 6.26% in the 12-month period." }, { "field": "result", "quote": "Multivariable logistic regression revealed that prior recurrence, postoperative wound site infection, and postoperative wound separation were independently associated with recurrence." } ] }, { "id": "pmid:40921262", "pmid": "40921262", "doi": "10.1016/j.jpedsurg.2025.162644", "nctId": null, "pmcid": null, "title": "Comparison of Endoscopic Pilonidal Sinus Treatment Combined With Platelet-Rich Plasma and Excision With Primary Closure in Pediatric Patients: A Retrospective Comparative Cohort Study on Short-Term Outcomes", "firstAuthor": "Bahadir", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2025, "design": "retrospective", "n": 104, "nField": "reported", "population": "children and teenagers with pilonidal sinus disease (a tunnel/cyst near the top of the buttock crack)", "intervention": "minimally invasive endoscopic treatment combined with platelet-rich plasma (EPSIT + PRP)", "comparator": "surgical excision with stitched closure (EPC)", "primaryOutcome": "hospital stay length, recurrence, complications, recovery time, and cosmetic satisfaction", "result": "EPSIT + PRP patients went home sooner, had similar recurrence rates to surgery, and reported better cosmetic satisfaction and return to normal life", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "direct", "limitations": "Retrospective comparison of two historical cohorts treated in different time periods with different follow-up durations and study design, not randomized.", "followUp": "postoperative 1st year", "plainFinding": "Similar recurrence, faster recovery, better cosmetic results.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40921262/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a common condition in adolescents, often resulting in recurrence, prolonged recovery, and significant discomfort. Although multiple surgical approaches exist, the optimal treatment for pediatric patients remains unclear. This study aimed to compare the short-term outcomes of endoscopic pilonidal sinus treatment combined with platelet-rich plasma application (EPSIT + PRP) and excision with primary closure (EPC) in children and adolescents with PSD. MATERIAL AND METHODS: This retrospective comparative cohort study analyzed two historical cohorts of pediatric patients with pilonidal sinus disease treated during different time periods at the same institution. A total of 104 patients under 18 years of age were included. EPC was performed in 73 patients between 2010 and 2015, with data retrospectively analyzed. Starting in 2024, 31 newly diagnosed patients were prospectively treated with EPSIT + PRP. PRP was prepared by centrifuging 15 mL of autologous blood at 4000 rpm for 10 min. Patients were evaluated based on demographic features, length of hospital stay, recurrence and complication rates, analgesic use, return to daily life, cosmetic outcomes, and satisfaction. RESULTS: Of the 104 patients, 65.4 % were male and 34.6 % female. Median age was 16 years in the EPC group and 17 years in the EPSIT + PRP group. Hospital stay was significantly shorter in the EPSIT + PRP group (same-day discharge vs. mean 2.79 days; p < 0.05). In the postoperative 1st year follow-up, recurrence rates were 13.7 % (EPC) and 9.7 % (EPSIT + PRP), not statistically significant (p = 0.750). Cosmetic satisfaction and return to social life favored the EPSIT + PRP group (p = 0.031). CONCLUSION: EPSIT + PRP appears to be a feasible and well-tolerated minimally invasive alternative to EPC in the treatment of PSD in children and adolescents. Despite differences in follow-up duration and study design, short-term outcomes suggest lower recurrence, faster recovery, and better cosmetic satisfaction with EPSIT + PRP.", "provenance": [ { "field": "population", "quote": "A total of 104 patients under 18 years of age were included" }, { "field": "intervention", "quote": "endoscopic pilonidal sinus treatment combined with platelet-rich plasma application (EPSIT + PRP)" }, { "field": "comparator", "quote": "excision with primary closure (EPC)" }, { "field": "primaryOutcome", "quote": "Patients were evaluated based on demographic features, length of hospital stay, recurrence and complication rates, analgesic use, return to daily life, cosmetic outcomes, and satisfaction." }, { "field": "result", "quote": "Hospital stay was significantly shorter in the EPSIT + PRP group (same-day discharge vs. mean 2.79 days; p < 0.05). In the postoperative 1st year follow-up, recurrence rates were 13.7 % (EPC) and 9.7 % (EPSIT + PRP), not statistically significant (p = 0.750). Cosmetic satisfaction and return to social life favored the EPSIT + PRP group (p = 0.031)." }, { "field": "n", "quote": "A total of 104 patients under 18 years of age were included." }, { "field": "limitations", "quote": "Despite differences in follow-up duration and study design" } ] }, { "id": "pmid:40861268", "pmid": "40861268", "doi": "10.1177/11795565251366775", "nctId": null, "pmcid": "PMC12374114", "title": "Adolescent Gluteal Cleft Pathologies Not Due to Pilonidal Disease: A Case Series and Diagnostic Algorithm", "firstAuthor": "Emengo", "multipleAuthors": true, "journal": "Clin Med Insights Pediatr", "year": 2025, "design": "case-series", "n": 21, "nField": "reported", "population": "teenagers with problems at the top of the butt crack", "intervention": "clinical work-up and examination to find the cause", "comparator": "none", "primaryOutcome": "identifying the specific non-pilonidal diagnosis causing symptoms", "result": "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", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a small retrospective case series without a comparison group, so it only describes possible causes rather than proving what treatment works.", "directness": "indirect", "limitations": "Retrospective design, small sample size, single pediatric clinic, and no outcome comparison between treatments.", "followUp": "", "plainFinding": "Several non-pilonidal causes identified.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40861268/", "sourceText": "BACKGROUND: Problems of the gluteal cleft are often due to pilonidal disease, but at times need to be distinguished from other diseases. We reported a series of adolescent patients with non-pilonidal gluteal cleft pathologies. METHODS: We performed a retrospective review of all patients who presented to our pediatric Pilonidal Clinic from 1/2019 to 12/2023. Patients who received a work-up for diseases separate from pilonidal disease were included in our study. Patient demographics, clinical work-up, and treatment outcomes were recorded. RESULTS: We identified 21 patients who had diagnoses other than pilonidal disease: 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. 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. These characteristics were utilized to differentiate the diagnoses and construct a diagnostic algorithm. CONCLUSIONS: We developed a practical diagnostic algorithm for differentiating gluteal cleft pathologies in adolescents, including dermatologic, colorectal, neurologic, and traumatic causes.", "provenance": [ { "field": "population", "quote": "adolescent patients with non-pilonidal gluteal cleft pathologies" }, { "field": "n", "quote": "We identified 21 patients who had diagnoses other than pilonidal disease" }, { "field": "intervention", "quote": "Patients who received a work-up for diseases separate from pilonidal disease were included in our study." }, { "field": "comparator", "quote": "Patient demographics, clinical work-up, and treatment outcomes were recorded." }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:40845982", "pmid": "40845982", "doi": "10.1016/j.jpedsurg.2025.162593", "nctId": null, "pmcid": null, "title": "Quantifying recovery time after common pediatric surgical procedures", "firstAuthor": "Reynolds", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2026, "design": "retrospective", "n": 192, "nField": "reported", "population": "children who had common outpatient surgeries, including some who had pilonidal cyst removal near the tailbone", "intervention": "pilonidal cyst excision and other pediatric surgeries", "comparator": "", "primaryOutcome": "days of pain medication use, time to return to baseline, and time to return to school", "result": "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", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "2-4 weeks", "plainFinding": "Not relevant to your symptom.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40845982/", "sourceText": "PURPOSE: Parents need to plan for patients' recovery after pediatric operations. Standard guidance for pain medication use and time off school is not evidence based, for lack of data. This study aims to quantify recovery time and pain medication usage after common pediatric operations to improve the post-operative experience for families. METHODS: We performed a single-center retrospective survey at an academic tertiary care center. By protocol, patients who are discharged after routine outpatient surgeries are called 2-4 weeks later for follow up. We modified the post-operative call template to include asking when the patient returned to school and baseline behavior, when parent(s) returned to work, and how many days patients required pain medications. We abstracted encounters from December 2022-August 2024. RESULTS: Follow-up data from the postoperative phone call was available for 192 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). 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. On average, parents returned to work on POD 1-2. CONCLUSION: Children miss a predictable number of school days after common pediatric surgeries, which may be more than pediatric surgeons anticipate. Data driven pre-operative counseling can improve families' trust in their health care team and facilitate anticipation of discharge needs.", "provenance": [ { "field": "population", "quote": "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)" }, { "field": "intervention", "quote": "pilonidal cyst excision (n = 5)" }, { "field": "primaryOutcome", "quote": "quantify recovery time and pain medication usage after common pediatric operations" }, { "field": "result", "quote": "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." }, { "field": "n", "quote": "Follow-up data from the postoperative phone call was available for 192 patients" } ] }, { "id": "pmid:40829408", "pmid": "40829408", "doi": "10.1016/j.ijscr.2025.111827", "nctId": null, "pmcid": "PMC12395430", "title": "Primary cutaneous mucinous carcinoma in unusual location: A case report", "firstAuthor": "Atallah", "multipleAuthors": true, "journal": "Int J Surg Case Rep", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "72-year-old man with coccygeal pain and swelling, initially suspected to be an infected pilonidal cyst", "intervention": "surgical excision of the mass", "comparator": "none", "primaryOutcome": "final diagnosis of the mass and its origin", "result": "the mass was diagnosed as a rare primary skin cancer called mucinous carcinoma in the area between the buttocks, not an infected cyst", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how common this cause is or how well treatment works in general.", "directness": "indirect", "limitations": "only one patient reported; findings may not generalize to other causes of similar pain", "followUp": "", "plainFinding": "Rare cancer mimicked a cyst.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40829408/", "sourceText": "INTRODUCTION: Primary mucinous carcinoma of the skin is a very rare malignant tumor arising from sweat glands, with just over 200 cases reported in the literature. Typically, a low-grade neoplasm with low metastatic potential yet a high recurrence rate, it most commonly occurs in the head and periorbital region and predominantly affects patients over 60 years. PRESENTATION OF CASE: A 72-year-old man with no medical or surgical history presented with a month-long history of coccygeal pain. Physical examination revealed a swelling in the coccygeal region with multiple fistulous openings discharging gelatinous fluid. The initial clinical diagnosis was that of an infected pilonidal cyst. The patient underwent surgical excision. Histological analysis and immunohistochemistry confirmed the diagnosis of mucinous carcinoma. A comprehensive workup including endoscopy, colonoscopy, and computed tomography ruled out other primary sites, thereby confirming a diagnosis of primary cutaneous mucinous carcinoma of the intergluteal cleft. DISCUSSION: This case underlines the diagnostic challenges of mucinous carcinoma in atypical locations, where clinical features may mimic benign conditions. Differentiation from secondary lesions is crucial, given the significant implications for prognosis and treatment. CONCLUSION: Primary cutaneous mucinous carcinoma of the intergluteal cleft is exceptionally rare. Complete surgical excision with clear margins and vigilant follow-up are imperative to manage the high risk of local recurrence. This report significantly broadens the spectrum of primary mucinous carcinoma presentations and underscores the need for comprehensive evaluation.", "provenance": [ { "field": "n", "quote": "A 72-year-old man with no medical or surgical history presented with a month-long history of coccygeal pain." }, { "field": "population", "quote": "A 72-year-old man with no medical or surgical history presented with a month-long history of coccygeal pain." }, { "field": "intervention", "quote": "The patient underwent surgical excision." }, { "field": "comparator", "quote": "The initial clinical diagnosis was that of an infected pilonidal cyst." }, { "field": "primaryOutcome", "quote": "Histological analysis and immunohistochemistry confirmed the diagnosis of mucinous carcinoma." }, { "field": "result", "quote": "confirming a diagnosis of primary cutaneous mucinous carcinoma of the intergluteal cleft" } ] }, { "id": "pmid:40821131", "pmid": "40821131", "doi": "10.7759/cureus.88193", "nctId": null, "pmcid": "PMC12357775", "title": "A Case Report of Wound-Vacuum-Assisted Closure (VAC) Treatment Following Pilonidal Cyst Excision", "firstAuthor": "Ukleja", "multipleAuthors": true, "journal": "Cureus", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "28-year-old man with a recurrent pilonidal cyst and chronic sinus tract", "intervention": "wound vacuum-assisted closure (wound-VAC) after cyst removal surgery", "comparator": "none described; outcome tracked over time without a comparison group", "primaryOutcome": "wound healing after cyst removal", "result": "wound shrank and healed over three weeks with minimal pain and no complications", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether this treatment works better than others in general.", "directness": "direct", "limitations": "Only one patient was described, so the findings may not apply to other people.", "followUp": "three weeks", "plainFinding": "Wound vacuum helped cyst wound heal well.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40821131/", "sourceText": "Pilonidal cysts are subcutaneous cysts that typically occur in the sacrococcygeal region and are more prevalent in obese, hirsute males. Pilonidal cysts are believed to be caused by a pore that forms as hairs become drawn deeper within the pore, ultimately creating a sinus. Different therapeutic options have been described, including excision with primary closure, healing by secondary intention, or flap creation; however, finding the optimal approach is a work in progress. We report a case of an otherwise healthy 28-year-old man who presented with a recurrent pilonidal cyst with a chronic sinus tract despite previous repeat incision and drainage procedures. The patient underwent pilonidal cyst excision with vacuum-assisted wound closure (wound-VAC) placement to facilitate the healing process. After two changes of the wound-VAC dressing (postoperative day eight), fresh granulations formed. The wound size and the wound depth decreased, requiring no further need for wound-VAC dressing. 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.", "provenance": [ { "field": "n", "quote": "an otherwise healthy 28-year-old man" }, { "field": "population", "quote": "a recurrent pilonidal cyst with a chronic sinus tract despite previous repeat incision and drainage procedures" }, { "field": "intervention", "quote": "pilonidal cyst excision with vacuum-assisted wound closure (wound-VAC) placement to facilitate the healing process" }, { "field": "comparator", "quote": "healed via secondary intention with a simple dry-to-dry gauze dressing" }, { "field": "primaryOutcome", "quote": "The wound size and the wound depth decreased, requiring no further need for wound-VAC dressing" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:40769774", "pmid": "40769774", "doi": "10.1002/wjs.70028", "nctId": null, "pmcid": "PMC12435601", "title": "Minimal Invasive Surgical Treatment in Primary Sacrococcygeal Pilonidal Sinus Disease: Phenolization of the Sinus Tract Versus Sinus Laser Assisted Closure; Long-Term Follow-Up of a Comparative Cohort Study", "firstAuthor": "de Kort", "multipleAuthors": true, "journal": "World J Surg", "year": 2025, "design": "retrospective", "n": 72, "nField": "reported", "population": "adults with primary pilonidal sinus disease at the top of the butt crack", "intervention": "phenolization of the sinus tract", "comparator": "sinus laser-assisted closure (SiLaC)", "primaryOutcome": "need for additional surgery, pain, and quality of life after treatment", "result": "Pain was slightly lower with phenolization but not meaningfully so, and most quality-of-life measures showed no difference between the two treatments.", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "direct", "limitations": "Not randomized; patients were matched rather than randomly assigned, and outcomes relied partly on patient questionnaires.", "followUp": "47 months", "plainFinding": "Similar results, no clear winner.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40769774/", "sourceText": "BACKGROUND: No consensus has been reached on the preferred minimally invasive technique for treating primary, chronic sacrococcygeal pilonidal sinus disease. This study will compare two extensively used minimally invasive techniques: phenolization of the sinus tract and sinus laser-assisted closure. METHODS: A comparative cohort study was conducted in two hospitals. Patients were matched on sex, age, number of sinus pits at surgery, and duration of follow-up. Patient records were examined for additional surgeries, and quality of life and symptoms were assessed with a questionnaire. RESULTS: After a mean follow-up of 47 months, seven patients (19.4%) in the phenolization group (n = 36) required additional surgery and 11 patients (30.6%) in the SiLaC group (n = 36) underwent additional surgery. Pain as a symptom at the natal cleft was significantly lower in the phenolization group, though not clinically relevant. The question regarding general health compared to preoperatively was reported to be significantly better in the phenolization group. However, other quality of life outcomes, such as the VAS score and the SF-36, did not differ significantly between phenolization and SiLaC. CONCLUSION: Both phenolization and sinus laser-assisted closure appear to be feasible for patients with primary SPSD, with no clear superiority of either technique.", "provenance": [ { "field": "n", "quote": "phenolization group (n = 36)" }, { "field": "n", "quote": "SiLaC group (n = 36)" }, { "field": "population", "quote": "patients with primary SPSD" }, { "field": "intervention", "quote": "phenolization of the sinus tract" }, { "field": "comparator", "quote": "sinus laser-assisted closure" }, { "field": "primaryOutcome", "quote": "Patient records were examined for additional surgeries, and quality of life and symptoms were assessed with a questionnaire." }, { "field": "result", "quote": "Pain as a symptom at the natal cleft was significantly lower in the phenolization group, though not clinically relevant." }, { "field": "result", "quote": "other quality of life outcomes, such as the VAS score and the SF-36, did not differ significantly between phenolization and SiLaC" } ] }, { "id": "pmid:40721961", "pmid": "40721961", "doi": "10.1007/s00384-025-04959-x", "nctId": null, "pmcid": "PMC12304014", "title": "Practice patterns of paediatric surgeons on treating pilonidal sinus disease - a national survey study", "firstAuthor": "Corturillo", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2025, "design": "registry", "n": 40, "nField": "reported", "population": "German paediatric surgery departments and office-based surgeons treating pilonidal sinus disease in children and adolescents", "intervention": "various surgical approaches to pilonidal sinus disease (excision with secondary closure, vacuum-assisted closure, pit-picking)", "comparator": "different surgical techniques compared to each other across institutions", "primaryOutcome": "which surgical approach and practice pattern institutions use for pilonidal sinus disease", "result": "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", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "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.", "directness": "indirect", "limitations": "only 40% of surveyed institutions responded, and the study reports practice patterns rather than patient outcomes or causes of symptoms.", "followUp": "", "plainFinding": "Surgeons mostly use traditional surgery methods.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40721961/", "sourceText": "PURPOSE: Paediatric pilonidal sinus disease is considered a separate entity of disease due to differing recurrence dynamics. However, there are almost no data on real-world surgical care and practice patterns for children and adolescents. We therefore aimed to gather such data surveying a representative sample of German paediatric surgeons. METHODS: Some 101 German paediatric surgical departments and surgeries with inpatient beds were surveyed for their surgical approach to paediatric pilonidal sinus disease. The survey included demographics, information on practice setting, as well as the primary and secondary approach to pilonidal disease and three virtual patient scenarios. RESULTS: A total of 40 institutions (33 departments and 7 office-based paediatric surgeons) responded (recall rate 40%). Of these, 18/40 reported performing 10-20, and 9/40 perform 5-10 pilonidal sinus operations annually. 17/39 respondents have less than 10% recurrences among their patient cohort and 15/39 operate on 11-20% recurrences among their patients. 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). Intraoperative use of blue dyes report 15/39 and 29/39 continue postoperative outpatient care at their institution. Acute pilonidal sinus with abscess is treated with a two-staged approach within four weeks by 15/39 while 11 institutions wait more than four weeks until definitive surgery. 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. CONCLUSION: 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. The reasons for these deviations from recommendations and favouring traditional approaches remain unclear.", "provenance": [ { "field": "n", "quote": "A total of 40 institutions (33 departments and 7 office-based paediatric surgeons) responded (recall rate 40%)." }, { "field": "population", "quote": "101 German paediatric surgical departments and surgeries with inpatient beds were surveyed for their surgical approach to paediatric pilonidal sinus disease" }, { "field": "intervention", "quote": "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)." }, { "field": "comparator", "quote": "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." }, { "field": "primaryOutcome", "quote": "The survey included demographics, information on practice setting, as well as the primary and secondary approach to pilonidal disease and three virtual patient scenarios." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:40679024", "pmid": "40679024", "doi": "10.5604/01.3001.0055.0465", "nctId": null, "pmcid": null, "title": "Unveiling Observation Bias in Pilonidal Sinus Disease Studies: A Comparative Analysis of Study Designs and Follow-Up Protocols", "firstAuthor": "Doll", "multipleAuthors": true, "journal": "Pol Przegl Chir", "year": 2025, "design": "meta-analysis", "n": 135349, "nField": "reported", "population": "people treated for pilonidal sinus disease (a condition causing pain and infection at the top of the buttock crease)", "intervention": "studies using structured, scheduled follow-up visits after treatment", "comparator": "studies relying on patients only returning if their disease came back", "primaryOutcome": "how much follow-up method affects reported recurrence rates after treatment", "result": "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", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "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.", "directness": "indirect", "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", "followUp": "10-year follow-up", "plainFinding": "Pain studies may undercount disease recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40679024/", "sourceText": "<b>Introduction:</b> The extent of observation bias in long-term surgical outcomes due to inadequate or unplanned follow-up in pilonidal sinus disease (PSD) studies is unclear. We made a hypothesis on the high risk of underreported recurrence in studies relying on the patients returning in case of recurrent disease (return on recurrence; ROR).<b>Aim:</b> To investigate and quantify the amount of bias associated with regular <i>vs.</i> return-on-recurrence follow-up of patients.<b>Materials and methods:</b> A total of 5.485 retrievable PSD publications were screened for eligibility, yielding 1.222 PSD studies with 135.349 patients treated, published between 1833 and 2023, included for analysis. Of these, 139 were Randomized Controlled Trials (RCT), 54 were ROR trials, and 1,029 were non-RCT non-ROR (N) trials. Recurrence rates were compared between groups<b>Results:</b> The five-year recurrence rates across all treatments in PSD were 18.9% for RCTs, 10.4% for N trials, and 12.4% forROR trials. Recurrence rates in the N and the ROR trials were statistically indistinguishable at ten-year follow-up (p = 0.1),whereas RCTs show significantly higher recurrence rates than N or ROR at 10-year follow-ups (p<0.001, p<0.001). Comparingonly primary open treatment, the five-year recurrence rate was 18.6% for RCT trials, 11.5% for N trials, and 4.1% for ROR trials.The recurrence rates at 10-year follow-up in the ROR and N trials were 20.1% and 19.7%, respectively. Notably, there was nodata available for 10-year follow-up in RCTs.<b>Conclusions:</b> Observation bias seems to significantly impact the results of ROR studies. Implementing a well-structured, all-encompassing patient follow-up at specific time intervals can effectively mitigate this bias, which might otherwise compromise the validity of our findings.<b>Significance of work:</b> The extent of observation bias in ROR studies compared to RCTs and non-RCTs remains unknown. Ourscrutiny of excision and primary open therapy, the largest therapeutic cohort globally, reveals ROR recurrence rates potentiallydeflated by three to fourfold relative to RCTs or non-RCT findings.", "provenance": [ { "field": "n", "quote": "135.349 patients treated" }, { "field": "population", "quote": "1.222 PSD studies with 135.349 patients treated" }, { "field": "intervention", "quote": "Implementing a well-structured, all-encompassing patient follow-up at specific time intervals can effectively mitigate this bias" }, { "field": "comparator", "quote": "studies relying on the patients returning in case of recurrent disease (return on recurrence; ROR)" }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "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" }, { "field": "followUp", "quote": "10-year follow-up" } ] }, { "id": "pmid:40524141", "pmid": "40524141", "doi": "10.1111/iwj.70689", "nctId": null, "pmcid": "PMC12170226", "title": "Our Experience With Four or More Crystallised Phenol Applications in Pilonidal Sinus Disease", "firstAuthor": "Yalçın", "multipleAuthors": true, "journal": "Int Wound J", "year": 2025, "design": "retrospective", "n": 53, "nField": "reported", "population": "adults with pilonidal sinus disease (crack at top of buttocks)", "intervention": "crystallised phenol applied repeatedly (4-9 sessions) in outpatient clinic", "comparator": "none (single-arm, compared conceptually to surgery)", "primaryOutcome": "treatment success (healing without recurrence or need for surgery)", "result": "92.45% treatment success, with recurrence in 1.9% and 5.7% needing surgery after failure", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study without a comparison group, so it can't prove phenol works better than other treatments.", "directness": "direct", "limitations": "Retrospective design, no control group, small sample size.", "followUp": "3-year follow-up", "plainFinding": "Phenol treatment often worked well.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40524141/", "sourceText": "The aim of this study was to analyse the clinical outcomes of patients with pilonidal sinus who underwent daily phenol treatment in the local intervention room of the outpatient clinic. We retrospectively evaluated 53 patients (43 male, 10 female) aged ≥ 18 years who received 4-9 crystallised phenol applications for pilonidal sinus disease. The mean number of phenol applications was 4.84 sessions (range: 4-9). Treatment success was achieved in 92.45% of patients, with a 3-year follow-up. Recurrence occurred in one patient (1.9%), while three patients (5.7%) required surgery due to treatment failure. Complications included skin necrosis (n = 2) and transient pain (n = 2). Phenol treatment is an effective and simple procedure compared to surgical methods, which can be easily applied in outpatient treatment. Therefore, we believe that it can be applied in many sessions to suitable patients without the need for aggressive surgical excision.", "provenance": [ { "field": "n", "quote": "We retrospectively evaluated 53 patients (43 male, 10 female) aged ≥ 18 years" }, { "field": "population", "quote": "patients with pilonidal sinus" }, { "field": "intervention", "quote": "received 4-9 crystallised phenol applications for pilonidal sinus disease" }, { "field": "comparator", "quote": "compared to surgical methods" }, { "field": "primaryOutcome", "quote": "Treatment success was achieved in 92.45% of patients" }, { "field": "result", "quote": "Treatment success was achieved in 92.45% of patients, with a 3-year follow-up. Recurrence occurred in one patient (1.9%), while three patients (5.7%) required surgery due to treatment failure." } ] }, { "id": "pmid:40522552", "pmid": "40522552", "doi": "10.1007/s10103-025-04525-5", "nctId": null, "pmcid": "PMC12170725", "title": "Evaluation of laser ablation for recurrent pilonidal sinus disease: treatment success, recurrence rates, and patient outcomes", "firstAuthor": "Emral", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2025, "design": "case-series", "n": 37, "nField": "reported", "population": "adults with recurrent pilonidal sinus disease (a chronic condition causing cysts near the tailbone)", "intervention": "laser ablation treatment of the sinus tract", "comparator": "none - no comparison group used", "primaryOutcome": "complete healing without recurrence of the pilonidal sinus", "result": "70.3% of patients healed completely without recurrence, 21.6% had recurrence, and 13.5% developed superficial infections", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "direct", "limitations": "Retrospective design, no control/comparator group, single center, relatively small sample size", "followUp": "mean follow-up of 9.6 months", "plainFinding": "Most healed, some recurred after laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40522552/", "sourceText": "PURPOSE: Pilonidal sinus disease (PD) is a chronic, recurrent inflammatory condition primarily affecting the sacrococcygeal region, often resulting in discomfort, abscess formation, and recurrent disease. Various surgical interventions, including laser ablation, have been employed to treat recurrent PD. This study evaluates the efficacy of laser ablation in patients with recurrent PD, focusing on treatment success, recurrence rates, complications, and recovery outcomes. METHODS: A retrospective analysis of 37 patients with recurrent pilonidal sinus disease treated with laser ablation between January 2022 and January 2025 was conducted. Preoperative data, postoperative complications, healing time, Visual Analog Scale values, and return to normal activities were collected. RESULTS: The results showed that 70.3% of patients achieved complete healing without recurrence, while 21.6% experienced recurrence within a mean follow-up of 9.6 months. Five patients (13.5%) developed superficial infections, which were managed with local dressing. The median time for wound healing was 35 days, and patients returned to normal activities in an median of 1 day. Persistent disease was observed in 8 patients (21.6%), of whom 5 patients (62.5%) achieved full epithelialization after retreatment with laser ablation. CONCLUSION: The ease of application, avoidance of hospitalization, minimal postoperative care, and rapid return to daily activities make laser treatment a safe and effective therapeutic option for patients with recurrent pilonidal disease, supported by favorable outcomes and low morbidity.", "provenance": [ { "field": "population", "quote": "37 patients with recurrent pilonidal sinus disease" }, { "field": "intervention", "quote": "treated with laser ablation between January 2022 and January 2025" }, { "field": "comparator", "quote": "A retrospective analysis of 37 patients with recurrent pilonidal sinus disease treated with laser ablation" }, { "field": "primaryOutcome", "quote": "treatment success, recurrence rates, complications, and recovery outcomes" }, { "field": "result", "quote": "70.3% of patients achieved complete healing without recurrence, while 21.6% experienced recurrence within a mean follow-up of 9.6 months. Five patients (13.5%) developed superficial infections" }, { "field": "n", "quote": "A retrospective analysis of 37 patients with recurrent pilonidal sinus disease" }, { "field": "followUp", "quote": "mean follow-up of 9.6 months" } ] }, { "id": "pmid:40515949", "pmid": "40515949", "doi": "10.1007/s00423-025-03776-8", "nctId": null, "pmcid": "PMC12167314", "title": "Long term results and quality of life after primary excision followed by Limberg plasty in pilonidal sinus disease", "firstAuthor": "König", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2025, "design": "case-series", "n": 41, "nField": "reported", "population": "patients with pilonidal sinus disease who had surgery", "intervention": "surgical removal of the sinus followed by Limberg flap reconstruction", "comparator": "none (before-and-after comparison within same patients)", "primaryOutcome": "return of the condition and quality of life afterward", "result": "only one case came back, and quality of life improved significantly in most daily activities", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "retrospective design, no comparator group, single center, small sample size", "followUp": "86 months", "plainFinding": "Low recurrence, better quality of life", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40515949/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a frequently occurring condition that can have a significant impact on quality of life (QoL). In addition to severe pain, particularly with movement or while sitting, this disease imposes restrictions that affect one's professional and private life. These patients frequently suffer from recurrence requiring multiple interventions and hospital stays. METHODS: The study enrolled forty-seven patients who presented with PSD from August 2010 until June 2019 and underwent primary excision and LP at the Department of General, Visceral, and Vascular Surgery at University Hospital, Jena. Forty- one of these patients were questioned retrospectively in writing or by telephone interviews between July 2021 to September 2022. The data processed using SPSS software. RESULTS: The median follow-up for all patients was 86 months (range, 23-140 months). Only one recurrence (2.4%) was reported. While the participants' BMIs remained unchanged, they reported significant improvements in QoL, notably in five of the six activities of daily living that were evaluated. CONCLUSION: The low rate of recurrence suggests that LP is an effective option for post-excision surgical repair of pilonidal sinus. The use of this procedure has no impact on patient's BMI but can significantly improve patients' QoL.", "provenance": [ { "field": "n", "quote": "Forty- one of these patients were questioned retrospectively" }, { "field": "population", "quote": "forty-seven patients who presented with PSD" }, { "field": "intervention", "quote": "underwent primary excision and LP" }, { "field": "comparator", "quote": "The study enrolled forty-seven patients" }, { "field": "primaryOutcome", "quote": "they reported significant improvements in QoL, notably in five of the six activities of daily living that were evaluated" }, { "field": "result", "quote": "Only one recurrence (2.4%) was reported." } ] }, { "id": "pmid:40498166", "pmid": "40498166", "doi": "10.1007/s10151-025-03159-7", "nctId": null, "pmcid": "PMC12158824", "title": "Prospective nationwide audit of short-term outcomes after surgery for chronic pilonidal sinus disease in the Netherlands", "firstAuthor": "Huurman", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2025, "design": "prospective-cohort", "n": 405, "nField": "reported", "population": "adults having surgery for long-term pilonidal sinus disease (an infected pit at the top of the buttock crease)", "intervention": "minimally invasive surgical techniques for pilonidal sinus disease", "comparator": "excision with secondary healing (wound left open to heal)", "primaryOutcome": "how the pilonidal sinus disease was classified and which type of surgery was performed", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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", "directness": "indirect", "limitations": "Observational design without randomization, short median follow-up of 42 days, and practice variation across 36 hospitals with twelve different treatment types performed", "followUp": "42 days", "plainFinding": "Minimally invasive surgery healed faster.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40498166/", "sourceText": "BACKGROUND: The optimal surgical approach for chronic pilonidal sinus disease (PSD) remains unclear, resulting in variation in surgical practice. This study aimed to provide an overview of PSD subtypes and assess practice variation and short-term outcomes. METHODS: A nationwide prospective observational cohort study was conducted. All patients with PSD and who underwent surgery were included during a 3-month inclusion period between March 1, 2020 and March 1, 2021. Primary endpoints were PSD classification and type and frequency of surgical approach. Secondary endpoints included symptoms, complications, recurrent open wounds, wound healing rate, time to wound healing, time to resume daily activities, reasons for selecting therapy, antibiotic prophylaxis, type of anesthesia, and hospital admission. RESULTS: A total of 36 hospitals participated in the study, and 405 patients had chronic disease. The median follow-up period was 42 days. Mean age was 28 years and 335 (82.7%) patients were male. Simple (n = 213) and complex PSD (n = 192) was equally common. Twelve different treatment modalities were performed. Minimally invasive techniques were used the most (61.2%) and off-midline closure in only a small proportion of patients (5.7%). Minimally invasive techniques showed a significantly higher wound healing rate (41.1% vs 28.6%) and a shorter median time to closure (41 vs 78 days) compared to excision with secondary healing. They also had the shortest median time to resume daily activities (14 days). CONCLUSIONS: Simple and complex PSD were equally common. Practice variation in surgery is substantial. Minimally invasive techniques were most frequently performed and showed good short-term outcomes.", "provenance": [ { "field": "n", "quote": "405 patients had chronic disease" }, { "field": "population", "quote": "All patients with PSD and who underwent surgery were included" }, { "field": "intervention", "quote": "Minimally invasive techniques were used the most (61.2%)" }, { "field": "comparator", "quote": "excision with secondary healing" }, { "field": "primaryOutcome", "quote": "Primary endpoints were PSD classification and type and frequency of surgical approach." }, { "field": "result", "quote": "Minimally invasive techniques showed a significantly higher wound healing rate (41.1% vs 28.6%) and a shorter median time to closure (41 vs 78 days) compared to excision with secondary healing. They also had the shortest median time to resume daily activities (14 days)." }, { "field": "followUp", "quote": "The median follow-up period was 42 days." } ] }, { "id": "pmid:40486025", "pmid": "40486025", "doi": "10.47176/mjiri.39.12", "nctId": null, "pmcid": "PMC12138641", "title": "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", "firstAuthor": "Sarkardeh", "multipleAuthors": true, "journal": "Med J Islam Repub Iran", "year": 2025, "design": "prospective-cohort", "n": 60, "nField": "reported", "population": "adults with pilonidal sinus disease, average age about 24, treated at a hospital surgical clinic", "intervention": "closed surgery using a Karydakis flap", "comparator": "open surgery", "primaryOutcome": "wound healing complications, recovery time, and pain after surgery", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "patients were not randomly assigned to groups and the study was small and from a single hospital, so the comparison is less reliable.", "directness": "direct", "limitations": "Nonrandomized allocation of patients to treatment groups, small sample size, single-center design.", "followUp": "", "plainFinding": "Faster healing but more wound infection", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40486025/", "sourceText": "BACKGROUND: Two common types of treatment for pilonidal disease include open and closed surgery. Closed surgery can be done with a Karydakis flap. The aim of this study was to compare the outcomes of pilonidal sinus management between Karydakis flap and open surgery. METHODS: This clinical trial was conducted on patients diagnosed with pilonidal sinus referred to the surgical clinics of Imam Reza Hospital in Mashhad from 2021 to 2022. Patients were nonrandomly divided into closed and open surgical treatment groups. Demographic information was collected from patients' medical records, the severity of the disease was obtained from operation notes, and 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. To describe the data, the number and percentage for qualitative variables and mean± standard deviation for quantitative variables have been used. Normality of variables investigated by Shapiro-Wilk test. A comparison of quantitative variables was done with an independent sample t-test. The comparison of pain changes within each group was done using Friedman's test. A comparison of qualitative variables in two groups was done with the Chi-Square test. The significance level of the tests is 5%, and the software used is SPSS25. RESULTS: Sixty patients (43 men and 17 women) with a mean age of 23.90 ± 6.57 years were included. 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. CONCLUSION: Closed surgical treatment was associated with shorter hospitalization time and return to work time than open surgery. Therefore, Karydakis flap can be a simple and acceptable method for the treatment of pilonidal sinus.", "provenance": [ { "field": "n", "quote": "Sixty patients (43 men and 17 women) with a mean age of 23.90 ± 6.57 years were included." }, { "field": "population", "quote": "patients diagnosed with pilonidal sinus referred to the surgical clinics of Imam Reza Hospital in Mashhad from 2021 to 2022" }, { "field": "intervention", "quote": "Closed surgery can be done with a Karydakis flap." }, { "field": "comparator", "quote": "Two common types of treatment for pilonidal disease include open and closed surgery." }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:40407900", "pmid": "40407900", "doi": "10.1007/s00384-025-04883-0", "nctId": null, "pmcid": "PMC12102125", "title": "Impact of surgical case load on recurrence rates in pilonidal sinus disease: a cross-study data synthesis", "firstAuthor": "Doll", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2025, "design": "meta-analysis", "n": 130599, "nField": "reported", "population": "people having surgery for pilonidal sinus disease (a cyst/infection near the top of the butt crack)", "intervention": "surgery performed at centers doing a higher number of pilonidal operations per year", "comparator": "surgery performed at centers doing fewer operations per year", "primaryOutcome": "rate of the pilonidal cyst coming back (recurrence) after surgery", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "5-year recurrence rate", "plainFinding": "More experienced centers had fewer repeat cysts.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40407900/", "sourceText": "PURPOSE: A higher surgical caseload has been associated with better outcomes in various diseases. However, this relationship has not yet been studied for Pilonidal Sinus Disease (PSD). This study aimed to examine the impact of annual PSD surgery volumes on recurrence rates (RR). METHODS: A comparative cross-study data synthesis was conducted, including 1074 studies with 130,599 patients, focusing on PSD recurrence rates. Studies were categorized based on annual case load (ACL) into three groups: fewer than 10 operations per year (group 1), 10-30 operations per year (group 2), and 30 or more operations per year (group 3). Kaplan-Meier analyses were performed to evaluate recurrence rates, with additional stratification by study design (randomized controlled trial (RCT) or non-RCT) and surgical treatment type. RESULTS: In randomized controlled trials (RCTs) of primary open treatment, group 1 (< 10 surgeries/year) had a 5-year recurrence rate of 23.5%, while group 2 (10-30 surgeries/year) had a rate of 12.5% (p < 0.0001). No data was available for group 3. For primary midline closure (pmc), the 5-year recurrence rates were 14.8% for group 1, 26.3% for group 2, and 12.8% for group 3. Non-RCT studies generally showed decreasing recurrence rates with higher surgical caseloads for most treatment types. However, midline closure surgery showed no significant improvement in recurrence rates with increased caseloads. CONCLUSION: The study demonstrates that higher surgical caseloads significantly reduce PSD recurrence rates, with notable benefits observed for centers treating 30 or more patients annually. Specialization in high-volume centers may lead to improved outcomes for PSD, particularly in flap surgeries. However, midline closure surgery continues to show persistently high recurrence rates, regardless of caseload.", "provenance": [ { "field": "n", "quote": "130,599 patients" }, { "field": "population", "quote": "Pilonidal Sinus Disease (PSD)" }, { "field": "intervention", "quote": "annual PSD surgery volumes" }, { "field": "comparator", "quote": "fewer than 10 operations per year (group 1), 10-30 operations per year (group 2), and 30 or more operations per year (group 3)" }, { "field": "primaryOutcome", "quote": "recurrence rates (RR)" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:40401769", "pmid": "40401769", "doi": "10.1097/XCS.0000000000001454", "nctId": null, "pmcid": null, "title": "Standardized Classification System for Pilonidal Disease and Recurrence Rate after Treatment", "firstAuthor": "Chiu", "multipleAuthors": true, "journal": "J Am Coll Surg", "year": 2025, "design": "prospective-cohort", "n": 411, "nField": "reported", "population": "patients presenting with pilonidal disease (a condition causing cysts/pits near the top of the buttock crack)", "intervention": "a new staging system (PDS stage) assigned when patients first presented, based on disease severity", "comparator": "comparing outcomes across the different PDS stages (0, I, II, III)", "primaryOutcome": "whether the pilonidal disease came back (recurred) after 1 and 2 years", "result": "patients with more severe disease stages at first presentation had much higher recurrence rates than those with milder stages", "resultDirection": "unclear", "quality": "low", "qualityWhy": "it's from one specialized center and only about half of patients completed follow-up, so it's unclear how well this applies elsewhere.", "directness": "indirect", "limitations": "single specialized center, no external validation yet, and only 212 of 411 patients (1-year) and 206 (2-year) completed follow-up.", "followUp": "1- and 2-year follow-up", "plainFinding": "Worse disease stage means more recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40401769/", "sourceText": "BACKGROUND: Current classification systems for pilonidal disease do not objectively profile disease severity, limiting their clinical applicability. This study aimed to validate a novel pilonidal disease severity (PDS) staging system by testing its correlation with disease recurrence. STUDY DESIGN: This was a prospective cohort study set at a high-volume, specialized pilonidal care center. All patients presenting with pilonidal disease were included. The main effector under study was PDS stage assigned at initial presentation. Secondary effector variables were an open wound greater than 1 cm on presentation (descriptor W) or previous surgical resection (descriptor R). The primary outcome was pilonidal disease recurrence at 1- and 2-year follow-up. RESULTS: A total of 411 patients met criteria, with 212 and 206 patients completing 1- and 2-year follow-up, respectively. Among patients who completed 1-year follow-up, recurrence occurred in 0.0%, 2.3%, 8.3%, and 20.8% of patients with PDS stage 0, I, II, and III disease at initial presentation, respectively (log-rank test, p = 0.017). At 2 years, recurrence was noted in 0.0%, 4.8%, 12.7%, and 27.5% of patients with PDS stage 0, I, II, and III disease, respectively (log-rank test, p = 0.010). The presence of an open wound at initial presentation and previous surgical resection was not associated with risk of recurrence (W, p = 0.94; R, p = 0.98). CONCLUSIONS: This study described the first staging system for pilonidal disease that correlates with risk of recurrence. On further external validation, the PDS staging system may be used both clinically to tailor treatment regimens to risk of disease recurrence and in research to standardize disease severity when comparing different therapeutic interventions.", "provenance": [ { "field": "n", "quote": "A total of 411 patients met criteria, with 212 and 206 patients completing 1- and 2-year follow-up, respectively." }, { "field": "population", "quote": "All patients presenting with pilonidal disease were included." }, { "field": "intervention", "quote": "The main effector under study was PDS stage assigned at initial presentation." }, { "field": "comparator", "quote": "recurrence occurred in 0.0%, 2.3%, 8.3%, and 20.8% of patients with PDS stage 0, I, II, and III disease at initial presentation, respectively" }, { "field": "primaryOutcome", "quote": "The primary outcome was pilonidal disease recurrence at 1- and 2-year follow-up." }, { "field": "result", "quote": "recurrence occurred in 0.0%, 2.3%, 8.3%, and 20.8% of patients with PDS stage 0, I, II, and III disease at initial presentation, 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)." } ] }, { "id": "pmid:40378664", "pmid": "40378664", "doi": "10.1016/j.jss.2025.04.010", "nctId": null, "pmcid": null, "title": "Evaluating Outcomes in Adolescents With Pilonidal Disease Treated With Pilonidal Sinus Trephination", "firstAuthor": "Bergus", "multipleAuthors": true, "journal": "J Surg Res", "year": 2025, "design": "retrospective", "n": 63, "nField": "reported", "population": "teenagers and young adults (10-21 years old) with chronic pilonidal disease (a hair-related infection/cyst near the top of the buttocks crack)", "intervention": "a minor surgery called pilonidal sinus trephination (small holes made to drain and treat the cyst)", "comparator": "no comparison group; outcomes tracked over time in the same patients", "primaryOutcome": "wound healing by 60 days and disease recurrence within 1 year", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this was a retrospective single-hospital chart review without a comparison group, so it can show patterns but not prove what causes them.", "directness": "direct", "limitations": "Retrospective design, single institution, no control group, and race-based findings need further study to understand underlying causes.", "followUp": "12 mo", "plainFinding": "Most healed, but some recurred.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40378664/", "sourceText": "INTRODUCTION: Pilonidal disease is a common chronic infectious process caused by entrapment of hair follicles in the gluteal cleft that can be managed with conservative therapies or operative intervention, including pilonidal sinus trephination. While trephination has been found to be safe and effective in adults, outcomes in adolescents are limited. This study investigated wound healing and 1-y disease recurrence in adolescents after trephination. METHODS: We retrospectively reviewed patients aged 10-21 y who underwent trephination at our tertiary care pediatric hospital between November 2019 and November 2022. Patient demographics, treatment history, operative management, and clinical outcomes up to 12 mo postoperatively were collected. We performed Firth penalized logistic regression to identify independent predictors of healing at 60 d and recurrence by 12 mo. RESULTS: Among 63 patients, the median age at the time of index operation was 16.5 y. Most patients were male (52.4%), and most were White (73.0%). At the time of initial clinic intake, all patients had a current or prior chronic gluteal cleft fistula and/or pilonidal sinus, and 93.7% had experienced ≥1 flare of pilonidal disease. Patients more commonly underwent trephination for a chronic wound than active disease (81.0% versus 19.0%). Nearly half of patients had at least one fistula present (49.2%) and a median of three pits. Wound healing was delayed in 20.5% and was associated with non-White race (odds ratio 7.31, 95% confidence interval 1.68, 31.85) but not Fitzpatrick skin type (P = 0.29) in univariable analysis. Recurrence at 1 y was 25.0% and was also associated with non-White race (odds ratio 8.85, 95% confidence interval 2.02, 38.71) but not Fitzpatrick skin type (P = 0.10) in univariable analysis. CONCLUSIONS: Pilonidal sinus trephination may be an appropriate surgical option for select adolescents with chronic, fistulous pilonidal disease. Further research is needed to determine if race and ethnicity are associated with healing complications and recurrence of pilonidal disease.", "provenance": [ { "field": "n", "quote": "Among 63 patients, the median age at the time of index operation was 16.5 y." }, { "field": "population", "quote": "We retrospectively reviewed patients aged 10-21 y who underwent trephination at our tertiary care pediatric hospital" }, { "field": "intervention", "quote": "patients aged 10-21 y who underwent trephination at our tertiary care pediatric hospital between November 2019 and November 2022" }, { "field": "comparator", "quote": "This study investigated wound healing and 1-y disease recurrence in adolescents after trephination." }, { "field": "primaryOutcome", "quote": "We performed Firth penalized logistic regression to identify independent predictors of healing at 60 d and recurrence by 12 mo." }, { "field": "result", "quote": "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)" }, { "field": "result", "quote": "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)" } ] }, { "id": "pmid:40329097", "pmid": "40329097", "doi": "10.1007/s10151-025-03143-1", "nctId": null, "pmcid": "PMC12055917", "title": "Efficacy of crystallized and liquid form phenol application in pilonidal sinus disease: a single-center retrospective study", "firstAuthor": "Demir", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2025, "design": "retrospective", "n": 80, "nField": "reported", "population": "young adults with pilonidal sinus disease (a cyst/infection at the top of the buttock crack)", "intervention": "crystallized phenol", "comparator": "liquid phenol", "primaryOutcome": "recovery rate, complications, and recurrence after treatment", "result": "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%)", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, single-center study without randomization, so it can't rule out bias between groups.", "directness": "direct", "limitations": "Retrospective design, single center, no randomization, relatively small sample size.", "followUp": "1st year", "plainFinding": "Both phenol treatments worked similarly; liquid caused more side effects.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40329097/", "sourceText": "AIM AND OBJECTIVE: Pilonidal sinus is a frequently observed disease in young adult male patients. Although its treatment is traditionally surgical, the tendency to use minimally invasive interventions has increased over time. This study aims to compare the clinical results of the non-surgical treatment methods for pilonidal sinus: crystallized and liquid phenol applications. MATERIALS AND METHODS: We retrospectively analyzed the data of 102 patients treated with phenol application in the General Surgery Clinic of our hospital between July 2017 and July 2019. Eighty patients were included in the study: 40 treated with crystallized phenol and 40 with liquid phenol. In the 1st month following the application, the recovery rates, complication rates, persistence of complaints, and recurrence at the end of the 1st year were compared between the groups. RESULTS: The mean age was 25.60 ± 7.16 and 25.78 ± 7.83 years in the crystallized (group 1) and liquid phenol group (group 2), respectively. Complications observed up to the 3rd week of follow-up were considered early complications, while those observed after the 3rd week were considered late complications. Early complications were observed in 15% and 37.5% of patients in groups 1 and 2, respectively (p = 0.042). Early complications were significantly higher in the liquid phenol group compared to the crystallized phenol group. At the end of the 1st year, 90% improvement was detected in group 1 and 95% in group 2. However, there was no significant difference between the recovery and recurrence rates between the groups. CONCLUSION: In pilonidal sinus treatment, successful results are obtained with both crystallized and liquid phenol application. Both methods can be performed safely and easily as an alternative treatment method to surgery.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus is a frequently observed disease in young adult male patients." }, { "field": "n", "quote": "Eighty patients were included in the study: 40 treated with crystallized phenol and 40 with liquid phenol." }, { "field": "intervention", "quote": "this study aims to compare the clinical results of the non-surgical treatment methods for pilonidal sinus: crystallized and liquid phenol applications." }, { "field": "comparator", "quote": "this study aims to compare the clinical results of the non-surgical treatment methods for pilonidal sinus: crystallized and liquid phenol applications." }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "Early complications were observed in 15% and 37.5% of patients in groups 1 and 2, respectively (p = 0.042)." }, { "field": "result", "quote": "At the end of the 1st year, 90% improvement was detected in group 1 and 95% in group 2. However, there was no significant difference between the recovery and recurrence rates between the groups." } ] }, { "id": "pmid:40288765", "pmid": "40288765", "doi": "10.1111/iwj.70194", "nctId": null, "pmcid": "PMC12034373", "title": "What is the Impact of Negative Pressure Wound Therapy on Healing in Patients Post Excision of Pilonidal Sinus? A Systematic Review and Meta-Analysis", "firstAuthor": "Morais", "multipleAuthors": true, "journal": "Int Wound J", "year": 2025, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "people who had surgery to remove a pilonidal sinus (a cyst near the top of the buttock crack)", "intervention": "negative pressure wound therapy (vacuum dressing) on the surgical wound", "comparator": "other types of wound dressings", "primaryOutcome": "time to healing, return of the cyst, pain, and patient satisfaction", "result": "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", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "the studies were small, mostly not well-controlled, and the review authors rated the overall evidence as very low certainty.", "directness": "indirect", "limitations": "Mostly retrospective and small studies with very low certainty of evidence (GRADE); mean sample size only 61 per study.", "followUp": "", "plainFinding": "Unclear if vacuum therapy helps wound healing", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/40288765/", "sourceText": "This systematic review aimed to determine the impact of negative pressure wound therapy on healing in patients with pilonidal sinus following surgical excision. Using systematic review methodology, we included original research studies written in English. The search was conducted using CINAHL Plus, Ovid, PubMed, EBSCO Host and Cochrane databases. Quality appraisal was undertaken using the Cochrane Collaboration tool for assessing risk of bias and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Data were analysed using meta-analysis where appropriate; otherwise, the data are presented narratively. Ten studies were included with a mean sample size of 61 (SD: 33). Three studies were randomised control trials, four were retrospective studies, two were prospective cohort studies and one was pre-post study. Studies showed reduction in healing time, recurrence rates and postoperative pain, as well as higher patients' satisfaction with the use negative pressure wound therapy, however, the certainty of the evidence was very low. The evidence for the intervention is uncertain thus, it is unclear whether NPWT makes any difference when compared to any other dressings, on time to healing, recurrence, pain or patient's experience. Further high-quality research with larger sample sizes is recommended to clearly explore the impact of NPWT on PS healing, recurrence, pain and patient's satisfaction.", "provenance": [ { "field": "population", "quote": "patients with pilonidal sinus following surgical excision" }, { "field": "intervention", "quote": "negative pressure wound therapy" }, { "field": "comparator", "quote": "any other dressings" }, { "field": "primaryOutcome", "quote": "time to healing, recurrence, pain or patient's experience" }, { "field": "result", "quote": "Studies showed reduction in healing time, recurrence rates and postoperative pain, as well as higher patients' satisfaction with the use negative pressure wound therapy, however, the certainty of the evidence was very low." }, { "field": "result", "quote": "it is unclear whether NPWT makes any difference when compared to any other dressings, on time to healing, recurrence, pain or patient's experience" }, { "field": "n", "quote": "mean sample size of 61 (SD: 33)" } ] }, { "id": "pmid:40199281", "pmid": "40199281", "doi": "10.24875/CIRU.22000314", "nctId": null, "pmcid": null, "title": "Pilonidal sinus of perianal location. Difficult differential diagnosis with perianal fistula", "firstAuthor": "Rubio-López", "multipleAuthors": true, "journal": "Cir Cir", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "a 39-year-old man with a perianal fistula", "intervention": "surgery to treat the suspected fistula", "comparator": "none", "primaryOutcome": "correctly identifying the true cause of the perianal opening", "result": "surgery revealed the problem was actually a perianal pilonidal sinus, not a true anal fistula", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether any treatment works", "directness": "indirect", "limitations": "only one patient described, and it focuses on diagnosis rather than treatment outcomes", "followUp": "", "plainFinding": "Mistaken for anal fistula.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40199281/", "sourceText": "Pilonidal disease usually arises in the sacrococcygeal area in young men. We present a case of a 39-year-old male with an initial diagnosis of perianal fistula. Despite clinical examination and pelvic magnetic resonance image, only during surgery was revealed that the origin of the fistula was in perianal pilonidal disease. Perianal pilonidal sinus are very rare in the literature. It is often confused with other perianal diseases such as anal fistula. Thus, perianal pilonidal disease should be considered in the differential diagnosis of perianal fistula.", "provenance": [ { "field": "population", "quote": "a 39-year-old male with an initial diagnosis of perianal fistula" }, { "field": "n", "quote": "a case of a 39-year-old male" }, { "field": "intervention", "quote": "only during surgery was revealed that the origin of the fistula was in perianal pilonidal disease" }, { "field": "comparator", "quote": "Despite clinical examination and pelvic magnetic resonance image" }, { "field": "primaryOutcome", "quote": "only during surgery was revealed that the origin of the fistula was in perianal pilonidal disease" }, { "field": "result", "quote": "only during surgery was revealed that the origin of the fistula was in perianal pilonidal disease" } ] }, { "id": "pmid:40178497", "pmid": "40178497", "doi": "10.23736/S2724-5691.25.10615-1", "nctId": null, "pmcid": null, "title": "Endoscopic pilonidal sinus treatment versus excision with wound closure: a systematic review of the literature", "firstAuthor": "Agnesi", "multipleAuthors": true, "journal": "Minerva Surg", "year": 2025, "design": "systematic-review", "n": 595, "nField": "reported", "population": "adults having surgery for pilonidal disease (a cyst/infection near the top of the buttock crack)", "intervention": "minimally invasive keyhole surgery (EPSIT) for pilonidal disease", "comparator": "traditional surgical cutting out of the cyst with stitched closure", "primaryOutcome": "surgery time, hospital stay, complications, wound problems, recurrence, and healing time", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "it combines only six mostly non-randomized studies without describing how study quality or bias was checked, so the comparison is not very reliable.", "directness": "indirect", "limitations": "abstract does not mention randomization, blinding, or formal bias assessment, and pools different studies' results directly", "followUp": "", "plainFinding": "Fewer complications but slower healing with keyhole surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40178497/", "sourceText": "INTRODUCTION: The aim of this systematic review was to compare minimally invasive procedures versus excision and wound closure for the treatment of pilonidal disease (PD) in terms of perioperative outcomes. EVIDENCE ACQUISITION: Search was performed in PubMed, Embase and Web of Science, founding 581 articles. EVIDENCE SYNTHESIS: Six articles published between 2018 and 2023, including 595 patients were included in the present systematic review. All of these studies presented endoscopic pilonidal sinus treatment (EPSIT) as the minimally invasive surgical technique for the treatment of pilonidal disease, while no articles meeting the inclusion and exclusion criteria addressed video-assisted ablation of pilonidal sinus. One hundred eighty-two patients (30.6%) underwent EPSIT (Group A), whereas 413 (69.4%) underwent excision and wound closure (Group B). Patients in Group A experienced shorter operative times (42.1±16 minutes) and hospital stay (0.5±0.3 days) in comparison to Groups B (59.3±19 minutes and 2.4±1 days, respectively). Group A had lower complication rate (12.5%) compared to Group B (35.2%) and recurrence rate (17.9% versus 14.8%). Wound dehiscence rate was 12.8% in Group B. Mean time to complete healing was longer in Group A than Group B (47.9±26.1 days and 39.1±22.3 days, respectively). CONCLUSIONS: EPSIT requires approximately 9 additional days to fully heal, but it avoids the risk of wound dehiscence, and had fewer complications, along with a shorter hospital stay, compared to those treated with excision and wound closure. The choice of treatment should be personalized, considering the individual needs and specific risk factors for wound dehiscence.", "provenance": [ { "field": "n", "quote": "including 595 patients were included in the present systematic review" }, { "field": "population", "quote": "for the treatment of pilonidal disease (PD)" }, { "field": "intervention", "quote": "endoscopic pilonidal sinus treatment (EPSIT) as the minimally invasive surgical technique" }, { "field": "comparator", "quote": "excision and wound closure" }, { "field": "primaryOutcome", "quote": "to compare minimally invasive procedures versus excision and wound closure for the treatment of pilonidal disease (PD) in terms of perioperative outcomes" }, { "field": "result", "quote": "Patients in Group A experienced shorter operative times (42.1±16 minutes) and hospital stay (0.5±0.3 days) in comparison to Groups B (59.3±19 minutes and 2.4±1 days, respectively). Group A had lower complication rate (12.5%) compared to Group B (35.2%) and recurrence rate (17.9% versus 14.8%). Wound dehiscence rate was 12.8% in Group B. Mean time to complete healing was longer in Group A than Group B (47.9±26.1 days and 39.1±22.3 days, respectively)" } ] }, { "id": "pmid:40108765", "pmid": "40108765", "doi": "10.1002/lsm.70008", "nctId": null, "pmcid": null, "title": "A Comparitive Study Between Early Outcomes of Laser and Lay-Open Technique in Management of Simple Pilonidal Sinus", "firstAuthor": "El Deen", "multipleAuthors": true, "journal": "Lasers Surg Med", "year": 2025, "design": "rct", "n": 40, "nField": "reported", "population": "patients with chronic pilonidal sinus (a tailbone/butt crack cyst condition)", "intervention": "laser treatment of the sinus (SiLaT)", "comparator": "lay-open surgical technique (cutting open the sinus)", "primaryOutcome": "pain scores, healing time, operative time, hospital stay, complications and recurrence", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Small study of only 40 patients looking at early outcomes, so results may not hold up or apply broadly.", "directness": "direct", "limitations": "Small sample size; only early postoperative outcomes assessed; authors say long-term studies are needed to evaluate recurrence and effectiveness.", "followUp": "", "plainFinding": "Laser surgery: less pain, faster healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40108765/", "sourceText": "BACKGROUND: Pilonidal sinus (PS) predominantly impacts adolescent and young adult males. This condition may be asymptomatically or escalate to painful acute abscesses and recurrent discharge. OBJECTIVE: To evaluate the early postoperative outcomes of laser therapy compared to the lay-open technique in the treatment of chronic pilonidal sinus disease. METHODS: Prospective randomized comparative study including 40 patients, divided into two equal groups: (a) The SiLaT group: PS treated with diode laser therapy (SiLaT) and (b) the lay-open group: PS treated with lay-open (sinotomy). Postoperative outcomes such as operative time, hospital stay, pain scores, healing time, complications, and recurrence rates were analyzed. RESULTS: Operative time was significantly shorter in the SiLaT group (18.4 ± 2.1 min vs. 26.2 ± 3.7 min, p = 0.022). Hospital stay was shorter in the SiLaT group (6.60 ± 1.47 h vs. 15.10 ± 5.52 h, p < 0.001). Pain scores were lower in the SiLaT group (2.30 ± 0.92 vs. 4.80 ± 1.01, p < 0.001). Wound healing was significantly faster in the SiLaT group (10.1 ± 2.7 days vs. 34.1 ± 15.1 days, p < 0.0001). Recurrence rates (p = 0.998) and surgical site infection (p = 1.00) were comparable among both groups. CONCLUSION: Sinus laser therapy (SiLaT) demonstrated superior early outcomes, including faster recovery, reduced pain, and fewer complications with earlier resumption of daily activities compared to the lay-open technique. However, recurrence rates remain similar, necessitating long-term studies to evaluate its effectiveness as a first-line treatment. These findings support the use of SiLaT as a day-case surgical procedure, for treating simple PS disease, particularly in young active patients seeking rapid recovery with minimal morbidity.", "provenance": [ { "field": "n", "quote": "including 40 patients, divided into two equal groups" }, { "field": "population", "quote": "treatment of chronic pilonidal sinus disease" }, { "field": "intervention", "quote": "PS treated with diode laser therapy (SiLaT)" }, { "field": "comparator", "quote": "the lay-open group: PS treated with lay-open (sinotomy)" }, { "field": "primaryOutcome", "quote": "Postoperative outcomes such as operative time, hospital stay, pain scores, healing time, complications, and recurrence rates were analyzed." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:40103999", "pmid": "40103999", "doi": "10.1093/jscr/rjaf141", "nctId": null, "pmcid": "PMC11915847", "title": "Giant natal cleft epidermal inclusion cyst surgically excised in a young male in Australia", "firstAuthor": "Layt", "multipleAuthors": true, "journal": "J Surg Case Rep", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "a 29-year-old male with a swelling at the top of the buttock crack", "intervention": "surgical removal of the cyst", "comparator": "none", "primaryOutcome": "successful removal and recovery without complications", "result": "the cyst was surgically removed and the patient recovered without problems", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient's case report, so it cannot show how often this works or applies to others", "directness": "direct", "limitations": "only one patient described, no comparison group, no long-term follow-up reported", "followUp": "", "plainFinding": "Cyst removed, recovered fully.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40103999/", "sourceText": "Epidermal inclusion cysts are benign lesions commonly found in hair-bearing areas. Giant epidermal inclusion cysts (GEICs), those exceeding 5 cm in diameter, are rare and may pose diagnostic challenges, especially in atypical locations. We report the case of a 29-year-old male with a 7-8 cm swelling in the natal cleft, diagnosed as a GEIC after imaging studies, including ultrasound, CT, and MRI. Surgical excision was performed with careful dissection to preserve surrounding structures. The patient had an uneventful recovery. This case highlights the diagnostic and surgical challenges of GEICs in the natal cleft and emphasizes the importance of pre-operative imaging and meticulous surgical technique to avoid complications.", "provenance": [ { "field": "n", "quote": "a 29-year-old male with a 7-8 cm swelling in the natal cleft" }, { "field": "population", "quote": "a 29-year-old male with a 7-8 cm swelling in the natal cleft" }, { "field": "intervention", "quote": "Surgical excision was performed with careful dissection to preserve surrounding structures." }, { "field": "comparator", "quote": "Surgical excision was performed with careful dissection to preserve surrounding structures." }, { "field": "primaryOutcome", "quote": "The patient had an uneventful recovery." }, { "field": "result", "quote": "The patient had an uneventful recovery." } ] }, { "id": "pmid:40100423", "pmid": "40100423", "doi": "10.1007/s10103-025-04409-8", "nctId": null, "pmcid": "PMC11920000", "title": "Is it beneficial to add laser ablation to curettage in the treatment of pilonidal sinus disease?", "firstAuthor": "Demir", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2025, "design": "rct", "n": 80, "nField": "reported", "population": "patients with pilonidal sinus disease (tailbone area infection)", "intervention": "laser ablation combined with curettage (scraping out the sinus tract)", "comparator": "curettage alone", "primaryOutcome": "postoperative complications, wound healing problems, and recurrence", "result": "no significant difference between laser plus curettage and curettage alone in pain, discharge, bleeding, wound healing, or recurrence", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "small randomized trial with no significant differences found, limiting confidence in any true benefit", "directness": "direct", "limitations": "small sample size; statistical significance not achieved for any outcome", "followUp": "6 months", "plainFinding": "No benefit from adding laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40100423/", "sourceText": "AIM: This study aimed to compare laser application with sinus curettage against only sinus curettage in the treatment of pilonidal sinus disease (PSD) in terms of postoperative complications, wound healing, and recurrence. Additionally, we aimed to investigate factors associated with wound healing and recurrence after PSD surgery. PATIENTS AND METHODS: This study included patients diagnosed with PSD between February 2019, and September 2022. The patients were randomly assigned to either the laser + curettage (L/C; n = 40) group or the curettage-only (C; n = 40) group. The following data were collected: demographic and anthropometric information, smoking status, comorbidities, number of PSD-related orifices, complicated or uncomplicated disease, prior recurrence, postoperative findings, wound healing problems within 30 days postoperatively, and recurrence within 6 months postoperatively. RESULTS: The L/C and C groups were similar in terms of age and sex distribution. The groups had similar results for postoperative pain, discharge, bleeding, wound healing problems at 30 days, and recurrence at 6 months. Multivariable logistic regression revealed that, high weight and higher orifice count were independently associated with wound healing problems. Additionally, high weight, higher orifice count and prior recurrence were independently associated with recurrence. CONCLUSION: Combined curettage and laser therapy showed non-significant but broad benefits over curettage alone, but statistical significance was not achieved in any of the adverse findings, as well as wound healing and recurrence. Higher body weight and higher orifice count were associated with both poor wound healing and recurrence, while prior recurrence was another factor associated with recurrence at 6 months.", "provenance": [ { "field": "n", "quote": "laser + curettage (L/C; n = 40) group or the curettage-only (C; n = 40) group" }, { "field": "population", "quote": "patients diagnosed with PSD" }, { "field": "intervention", "quote": "laser application with sinus curettage" }, { "field": "comparator", "quote": "only sinus curettage" }, { "field": "primaryOutcome", "quote": "postoperative complications, wound healing, and recurrence" }, { "field": "result", "quote": "The groups had similar results for postoperative pain, discharge, bleeding, wound healing problems at 30 days, and recurrence at 6 months." }, { "field": "followUp", "quote": "recurrence within 6 months postoperatively" } ] }, { "id": "pmid:40086161", "pmid": "40086161", "doi": "10.1016/j.jpedsurg.2025.162267", "nctId": null, "pmcid": null, "title": "Gender Differences in Adolescent Pilonidal Disease", "firstAuthor": "Stoeckel", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2025, "design": "retrospective", "n": 1356, "nField": "reported", "population": "adolescents with pilonidal disease (hair-containing cyst/abscess near top of buttock crease)", "intervention": "being female (gender comparison)", "comparator": "being male", "primaryOutcome": "disease severity, quality of life impact, and treatment outcomes", "result": "Females had earlier onset, lower disease severity, but worse quality-of-life impact including more pain, embarrassment, and disruption, compared to males", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Retrospective cohort study, level of evidence III, no control or randomization, and it compares genders rather than testing an intervention for symptom relief", "followUp": "", "plainFinding": "Girls report more pain, despite milder disease.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40086161/", "sourceText": "BACKGROUND: Pilonidal disease is a common, disruptive condition in adolescents. We studied the effects of pilonidal disease on adolescents by gender. STUDY DESIGN: Prospectively collected data on demographics, mental health comorbidities, disease severity, hirsutism, disease-related quality of life impact, interventions, and outcomes were retrieved from a Pilonidal Care Clinic REDCap database and were analyzed by gender. RESULTS: Of 1356 patients with pilonidal disease, 562 (41 %) were female and 794 male. Average age at disease onset was 14.8 years for females and 16.9 years for males (p-value <0.001). The incidence of mental health comorbidities was similar in females compared to males (17 % vs 16 %; p-value = 0.268) but females had a higher incidence of diagnosed anxiety (15 % vs 10 %; p-value = 0.005). Females were less likely to be hirsute than males (32 % vs 79 %; p-value <0.001), and were more likely to have fine hair in their gluteal crease (51 % vs 5 %; p-value <0.001). Females presented with lower disease severity than males (mild: 68 % vs 47 %, moderate: 22 % vs 33 %, and severe: 3 % vs 10 %; p-value <0.001), and were less likely to have undergone prior operation (3 % vs 8 %; p-value <0.001). However, disease-related quality of life impact was more severe for females than males in 5 of 6 domains examined including: pain (5 vs 3; p-value <0.001), embarrassment (4 vs 3; p-value = 0.021), ability to play sports (2 vs 1; p-value = 0.01), disruption of routine (4 vs 3; p-value = 0.024) and disturbance to school, work, or activities (3 vs 2; p-value = 0.004). More females underwent pit picking on their first clinic visit (33 % vs 27 %; p-value = 0.011) and incision and drainage (6 % vs 3 %; p-value = 0.01), with similar rates of laser follicle ablation (53 % vs 55 %; p-value = 0.45). CONCLUSION: The prevalence of pilonidal disease is much higher in females than previously reported. Pilonidal disease has different impacts on females than males including: earlier onset, higher incidence of anxiety, and greater disease-related impact on quality of life, despite lower disease severity on presentation. Tolerance of clinic treatments is comparable between genders. TYPE OF STUDY: Retrospective, cohort study. LEVEL OF EVIDENCE: III.", "provenance": [ { "field": "n", "quote": "Of 1356 patients with pilonidal disease, 562 (41 %) were female and 794 male." }, { "field": "population", "quote": "Pilonidal disease is a common, disruptive condition in adolescents." }, { "field": "intervention", "quote": "females had a higher incidence of diagnosed anxiety (15 % vs 10 %; p-value = 0.005)" }, { "field": "comparator", "quote": "562 (41 %) were female and 794 male" }, { "field": "primaryOutcome", "quote": "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)" }, { "field": "result", "quote": "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)" }, { "field": "result", "quote": "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)" } ] }, { "id": "pmid:40040301", "pmid": "40040301", "doi": "10.1111/codi.70041", "nctId": null, "pmcid": "PMC11880740", "title": "The validation of a simple and instrument-free technique to measure the depth of the natal cleft (a cohort study)", "firstAuthor": "Ojo", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2025, "design": "prospective-cohort", "n": 63, "nField": "reported", "population": "63 volunteers who had their natal cleft (top of the buttock crack) measured", "intervention": "a new instrument-free technique for measuring the depth of the natal cleft", "comparator": "repeated measurements taken by different clinicians and by the same clinician twice", "primaryOutcome": "how consistently the measurement technique gave the same result between different clinicians and by the same clinician", "result": "the technique showed very good agreement between different clinicians and moderate agreement when the same clinician repeated it", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a small, single-centre study testing a measuring tool, not testing why the area hurts or whether any treatment helps.", "directness": "indirect", "limitations": "Single centre, 63 participants, and intra-observer agreement was only moderate rather than strong.", "followUp": "", "plainFinding": "Tests a measuring tool, not pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40040301/", "sourceText": "AIM: Pilonidal disease is a benign condition mainly affecting the young population. In recent literature, the depth of the natal cleft is thought to impact postoperative outcomes including wound complications and rate of recurrence. Currently there is no agreed method for measuring the depth of the natal cleft; this study proposes a novel and instrument-free technique that can be used as a research tool to measure the depth. METHOD: This is a single centre study performed at St Mark's Hospital in London, with 63 participants volunteering to take part. Blinded repeated measurements of the natal cleft were taken by two separate clinicians to assess for inter-observer and intra-observer variation. RESULTS: Agreement was measured and assessed by the Bland-Altman limits of agreement method and intra-class correlation (ICC). The mean difference between repeat measurements for both inter-observer and intra-observer were close to zero (-0.06 and -0.11 respectively). 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. CONCLUSION: This study offers an alternative simple validated technique to measure the depth of the natal cleft, with good observer agreement. We propose that future studies aiming to analyse the depth of the natal cleft and its relationship with severity and postoperative outcomes use this technique.", "provenance": [ { "field": "n", "quote": "with 63 participants volunteering to take part" }, { "field": "population", "quote": "63 participants volunteering to take part" }, { "field": "intervention", "quote": "this study proposes a novel and instrument-free technique that can be used as a research tool to measure the depth" }, { "field": "comparator", "quote": "Blinded repeated measurements of the natal cleft were taken by two separate clinicians to assess for inter-observer and intra-observer variation" }, { "field": "primaryOutcome", "quote": "Agreement was measured and assessed by the Bland-Altman limits of agreement method and intra-class correlation (ICC)" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:39995244", "pmid": "39995244", "doi": "10.12659/MSM.947466", "nctId": null, "pmcid": "PMC11871746", "title": "Comparative Outcomes of Surgical Techniques for Pilonidal Sinus: A Turkish Retrospective Study", "firstAuthor": "Gojayev", "multipleAuthors": true, "journal": "Med Sci Monit", "year": 2025, "design": "retrospective", "n": 476, "nField": "reported", "population": "adults who had surgery for pilonidal sinus disease (a chronic infection near the tailbone/buttock crease)", "intervention": "different surgical techniques: primary midline closure, Karydakis flap, Limberg flap, and laser pilonidotomy", "comparator": "the four surgical techniques compared against each other", "primaryOutcome": "complication rates, recurrence, recovery time, and patient satisfaction", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "direct", "limitations": "Retrospective design; abstract itself calls for studies with larger samples and longer follow-up periods.", "followUp": "", "plainFinding": "Surgery choice affects healing speed, complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39995244/", "sourceText": "BACKGROUND Pilonidal sinus is a chronic or acute infectious disease in the intergluteal cleft. Various surgical treatments exist, but optimal management remains debated. This study compares outcomes of primary midline closure (PMC), Karydakis flap (KF), Limberg flap (LF), and laser pilonidotomy (LP) in adult patients with pilonidal sinus disease. MATERIAL AND METHODS The data of 476 patients who underwent surgery for pilonidal sinus disease in our clinic between January 2011 and September 2022 were retrospectively evaluated. After 54 patients were excluded, the remaining patients were divided into 4 groups: PMC (n=228), LF (n=82), KF (n=53), and LP (n=59). Patient characteristics, surgical findings, and quality of life outcomes were compared between the groups. RESULTS The operation time was significantly shorter in the LP group (P<0.001). Seroma (P=0.006), wound dehiscence (P<0.001), and postoperative recurrence (P=0.017) rates were significantly higher in the PMC group. Hospital stay was significantly shorter in the LP group (mean, 8 h; P<0.001). Pain-free toilet sitting time, pain-free walking time, and return to work time were statistically significantly shorter in the LP group (all P<0.001). According to the Likert scale, the satisfaction rate of the LP group was significantly higher (P<0.001). CONCLUSIONS The PMC method has a higher postoperative complication rate and a slower return to normal physical activity. The KF method appears to be more advantageous in terms of postoperative recurrence rate. Although the LP method seems to be more advantageous in terms of quality of life in selected patients, studies with larger samples and longer follow-up periods are needed.", "provenance": [ { "field": "population", "quote": "adult patients with pilonidal sinus disease" }, { "field": "n", "quote": "The data of 476 patients who underwent surgery for pilonidal sinus disease in our clinic between January 2011 and September 2022 were retrospectively evaluated." }, { "field": "intervention", "quote": "primary midline closure (PMC), Karydakis flap (KF), Limberg flap (LF), and laser pilonidotomy (LP)" }, { "field": "comparator", "quote": "compares outcomes of primary midline closure (PMC), Karydakis flap (KF), Limberg flap (LF), and laser pilonidotomy (LP) in adult patients with pilonidal sinus disease" }, { "field": "primaryOutcome", "quote": "Patient characteristics, surgical findings, and quality of life outcomes were compared between the groups." }, { "field": "result", "quote": "Seroma (P=0.006), wound dehiscence (P<0.001), and postoperative recurrence (P=0.017) rates were significantly higher in the PMC group." }, { "field": "result", "quote": "The KF method appears to be more advantageous in terms of postoperative recurrence rate." }, { "field": "result", "quote": "Pain-free toilet sitting time, pain-free walking time, and return to work time were statistically significantly shorter in the LP group (all P<0.001)." }, { "field": "limitations", "quote": "studies with larger samples and longer follow-up periods are needed" } ] }, { "id": "pmid:39982788", "pmid": "39982788", "doi": "10.1097/DCR.0000000000003688", "nctId": null, "pmcid": null, "title": "Outcome After Surgical Treatment for Chronic Pilonidal Sinus Disease: A Systematic Review of Common Surgical Techniques", "firstAuthor": "Wiinblad", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2025, "design": "meta-analysis", "n": 5762, "nField": "reported", "population": "adults and teenagers with chronic pilonidal sinus disease (a cyst/infection at the top of the buttock crease)", "intervention": "flap surgeries (Bascom, Limberg, or Karydakis flap operations)", "comparator": "primary midline closure or leaving the wound to heal on its own (secondary healing)", "primaryOutcome": "whether the pilonidal disease came back after surgery (recurrence)", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Most studies had a high or medium risk of bias, resulting in very low to low certainty of evidence. The trials generally had small numbers, short follow-ups, and no reported primary outcomes or power calculations.", "followUp": "", "plainFinding": "Flap surgery lowers pilonidal recurrence risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39982788/", "sourceText": "BACKGROUND: The choice of operation for chronic pilonidal sinus disease remains controversial. OBJECTIVE: To compare the outcomes of common operations for chronic pilonidal disease. DATA SOURCES: We searched PubMed, Embase, and the Cochrane Library. STUDY SELECTION: We included randomized trials in English or Danish language, published 2002 to 2024 that compared outcomes of operations to treat chronic pilonidal disease in adults and teenagers. INTERVENTIONS: We compared the outcomes of secondary healing, primary midline closure, Bascom, Limberg, and Karydakis flap operations. MAIN OUTCOME MEASURES: The primary outcome was recurrence; secondary outcomes were infection, healing time, and length of stay. We compared recurrence and infection rates in meta-analyses for all techniques. We assessed the risk of bias and the quality of all trials. RESULTS: Fifty trials included a total of 5762 participants. In a meta-analysis, the flap operations had fewer recurrences than primary midline closure (OR 0.31; 95% CI, 0.19-0.51; p < 0.01). The trials comparing flap operations with secondary healing were heterogeneous and did not reach significance (OR 0.38; 95% CI, 0.13-1.13; p = 0.08). Recurrence was similar between Limberg and Karydakis operations. Infection rates were lower for the flap operations compared with primary closure (OR 0.33; 95% CI, 0.23-0.48; p < 0.01) and with secondary healing (OR 0.48; 95% CI, 0.30-0.77; p < 0.01). Two trials tested Bascom procedure against Limberg operation without significant differences. All trials found secondary healing to have significantly longer healing times than any other operation. LIMITATIONS: Most studies had a high or medium risk of bias, resulting in very low to low certainty of evidence. The trials generally had small numbers, short follow-ups, and no reported primary outcomes or power calculations. CONCLUSIONS: Primary closure and secondary healing performed poorly compared with the flap techniques. Most trials tested Limberg operation; only 2 tested Bascom operation. The literature suggests the surgeon's expertise determines the choice of flap technique.", "provenance": [ { "field": "n", "quote": "Fifty trials included a total of 5762 participants." }, { "field": "population", "quote": "operations to treat chronic pilonidal disease in adults and teenagers" }, { "field": "intervention", "quote": "the flap operations had fewer recurrences than primary midline closure" }, { "field": "comparator", "quote": "compared the outcomes of secondary healing, primary midline closure, Bascom, Limberg, and Karydakis flap operations" }, { "field": "primaryOutcome", "quote": "The primary outcome was recurrence" }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:39969579", "pmid": "39969579", "doi": "10.1007/s00384-025-04832-x", "nctId": null, "pmcid": "PMC11839847", "title": "Efficacy and safety of laser ablation for recurrent pilonidal sinus: a systematic review and meta‑analysis", "firstAuthor": "Qin", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2025, "design": "meta-analysis", "n": 137, "nField": "reported", "population": "patients with recurrent pilonidal sinus (a skin condition at the top of the buttock crack)", "intervention": "laser ablation of the sinus tract", "comparator": "none (single-arm studies pooled; some with and without pit picking beforehand)", "primaryOutcome": "healing rate after treatment", "result": "about 82% of patients healed, with lower healing rates seen at longer follow-up", "resultDirection": "benefit", "quality": "low", "qualityWhy": "the pooled studies were mostly small, uncontrolled, and showed high variability between them, so confidence in the exact healing rate is limited", "directness": "direct", "limitations": "high statistical heterogeneity (I2 up to 79%), no randomized controlled trials included, wide confidence intervals, and declining healing rates with longer follow-up", "followUp": "12 months or less; some studies exceeding 12 months", "plainFinding": "Laser ablation healed most recurrent cases.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39969579/", "sourceText": "BACKGROUND: Recurrence remains a significant challenge following the surgical treatment of sacrococcygeal pilonidal sinus. Unlike patients with primary pilonidal sinus, those with recurrent cases often present with more complex sinus tracts, and scarring from previous surgeries increases the complexity of subsequent procedures. Therefore, selecting the appropriate surgical method for patients with recurrent pilonidal sinus requires greater caution. It is essential to reassess these patients to determine whether surgical techniques suitable for primary pilonidal sinus are equally effective for recurrent cases. Laser ablation, an innovative and minimally invasive technique, has emerged as a promising option for managing pilonidal sinus. This procedure uses a circular laser at the tip of a catheter to deliver energy, effectively destroying and ablating the sinus tract while promoting its closure. Previous studies have demonstrated the safety and efficacy of laser ablation in treating primary pilonidal sinus. The objective of this systematic review and meta-analysis is to assess the efficacy and safety of laser ablation in the management of recurrent pilonidal sinus. METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was carried out using PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov. Additionally, the references of all retrieved studies were screened to identify further eligible data. The search included studies published up to June 11, 2024. The primary outcome measure was the healing rate after laser ablation, which served as the metric for evaluating the efficacy of this technique in treating recurrent pilonidal sinus. Secondary outcome measures included the incidence of severe postoperative complications, which were assessed to determine the safety profile of laser ablation. According to the Clavien-Dindo classification of postoperative complications, we define severe complications as those classified as grade IIIb or higher. RESULT: A total of seven studies were included in this meta-analysis. With the exception of one study published in 2018, the remaining six were published within the past 3 years. Two studies originated from Middle Eastern countries, while the other five were from European countries. In total, 137 patients with recurrent pilonidal sinus were included, of whom 112 achieved healing following laser ablation treatment. The pooled healing rate across these studies was 81.9% (95% CI, 65.4-94.6%; I2 = 69.12%; p < 0.01). A subgroup analysis based on follow-up duration was also performed. The pooled healing rate for studies with a follow-up period of 12 months or less was 87.2% (95% CI, 63.2-100%; I2 = 78.57%; p < 0.01), while for studies with a follow-up duration exceeding 12 months, the pooled healing rate was 74.5% (95% CI, 51.5-92.7%; I2 = 47.48%; p = 0.15). In addition, five studies performed pit picking before laser ablation, while two studies did not. We conducted a subgroup analysis based on whether pit picking was performed before laser ablation. The results of the subgroup analysis indicated that the difference in efficacy between combined pit picking and laser ablation alone was not statistically significant (random effects model, p = 0.75). This suggests that both treatment methods may have similar effectiveness in the management of recurrent pilonidal sinus disease. CONCLUSIONS: This meta-analysis demonstrates that laser ablation is an effective and safe method for the treatment of recurrent sacrococcygeal pilonidal sinus in the short term. However, the findings indicate a trend toward a lower healing rate with extended follow-up periods. To better assess the long-term efficacy of laser ablation in managing recurrent pilonidal sinus, high-quality randomized controlled trials with extended follow-up durations are necessary.", "provenance": [ { "field": "population", "quote": "patients with recurrent pilonidal sinus" }, { "field": "intervention", "quote": "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." }, { "field": "comparator", "quote": "The results of the subgroup analysis indicated that the difference in efficacy between combined pit picking and laser ablation alone was not statistically significant" }, { "field": "primaryOutcome", "quote": "The primary outcome measure was the healing rate after laser ablation" }, { "field": "result", "quote": "The pooled healing rate across these studies was 81.9% (95% CI, 65.4-94.6%; I2 = 69.12%; p < 0.01)." }, { "field": "n", "quote": "In total, 137 patients with recurrent pilonidal sinus were included, of whom 112 achieved healing following laser ablation treatment." } ] }, { "id": "pmid:39953215", "pmid": "39953215", "doi": "10.1007/s10103-025-04341-x", "nctId": null, "pmcid": null, "title": "Laser versus rhomboid flap for sacrococcygeal pilonidal sinus: multi-centre comparative study", "firstAuthor": "Alwadees", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2025, "design": "retrospective", "n": 374, "nField": "reported", "population": "patients aged 16 to 70 with pilonidal sinus who had never had surgery before", "intervention": "laser ablation technique", "comparator": "open rhomboid flap surgery", "primaryOutcome": "rate of the condition coming back (recurrence)", "result": "the laser group had a significantly higher recurrence rate than the open rhomboid flap group", "resultDirection": "harm", "quality": "low", "qualityWhy": "This was a non-randomized comparison across hospitals, so differences in patient selection or surgeon practice could affect the results.", "directness": "direct", "limitations": "No randomization, government and private hospital settings may differ, and surgeon experience not controlled for.", "followUp": "4 weeks or 3 months", "plainFinding": "Laser had more recurrences than surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/39953215/", "sourceText": "Pilonidal sinus is a condition affecting young people. Several management methods are available. The two popular approaches are laser ablation and open techniques. This study aims to assess the recurrence rate after both techniques. This is a government and private hospital setting. Patients are included if they are diagnosed with pilonidal sinus, between the ages of 16 and 70, and have never had surgery before. Diabetic patients and patients with immune deficiency status who are younger than 16 or older than 70 are excluded. The operations are done by senior consultant surgeons. Patients are seen for 4 weeks or 3 months and discharged if there are no complications. 190 and 184 patients were selected for the laser and open groups, respectively. There are 142 men and 42 women in the open group compared to 140 men and 50 women in the laser group, with p-value: of 0.472. There was no significant difference in age, body mass index, or obesity between the two groups. There is a significantly higher recurrence rate in the laser group value: <0.00001. No significant difference in the recurrence rate for one or more than one opening disease within the open group. The laser technique is associated with a higher recurrence rate compared to the open rhomboid flap technique. One opening pilonidal sinus is significantly showing better results within the laser group but no significant difference in the open group.", "provenance": [ { "field": "n", "quote": "190 and 184 patients were selected for the laser and open groups, respectively." }, { "field": "population", "quote": "Patients are included if they are diagnosed with pilonidal sinus, between the ages of 16 and 70, and have never had surgery before." }, { "field": "intervention", "quote": "laser ablation" }, { "field": "comparator", "quote": "open rhomboid flap" }, { "field": "primaryOutcome", "quote": "This study aims to assess the recurrence rate after both techniques." }, { "field": "result", "quote": "There is a significantly higher recurrence rate in the laser group value: <0.00001." }, { "field": "followUp", "quote": "Patients are seen for 4 weeks or 3 months and discharged if there are no complications." } ] }, { "id": "pmid:39944926", "pmid": "39944926", "doi": "10.4174/astr.2025.108.2.124", "nctId": null, "pmcid": "PMC11813548", "title": "The power of platelet-rich plasma on operated pilonidal disease: a prospective randomized controlled trial", "firstAuthor": "Chousein", "multipleAuthors": true, "journal": "Ann Surg Treat Res", "year": 2025, "design": "rct", "n": 140, "nField": "reported", "population": "patients with pilonidal sinus disease (a chronic condition near the top of the buttock crack) who had surgery", "intervention": "platelet-rich plasma (PRP) added to standard wound dressing after surgery", "comparator": "standard wound dressing alone after surgery", "primaryOutcome": "how fast the surgical wound healed", "result": "wounds healed much faster with PRP (about 24 days) than without it (about 41 days)", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Faster healing after pilonidal surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39944926/", "sourceText": "PURPOSE: Pilonidal sinus disease is a chronic inflammatory disease that affects approximately 1% of the population. Although many treatment methods have been described, there is no consensus on the exact treatment method. This study was conducted to evaluate the wound healing-promoting effect of platelet-rich plasma (PRP) in patients treated using the unroofing and curettage technique. METHODS: A total of 140 patients diagnosed with pilonidal sinus disease were included in the study. The patients were randomized into 2 groups; one group was followed up with a standard dressing after the operation, and the patients in the other group were treated with PRP in addition to the standard dressing. In this study, the wound healing rate between the 2 groups was determined as the primary objective. RESULTS: In postoperative follow-up, a difference in wound healing rate was detected on postoperative day 10 (P = 0.007). While 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). It was determined that the wound closure time of patients in the PRP group was faster. CONCLUSION: In our prospective randomized study, we found that PRP significantly increased the wound healing rate and patient comfort, with recurrence rates below 1% and minimal pain. We think that it should be the first-choice method before operations that cause extensive tissue loss, such as flap surgery.", "provenance": [ { "field": "n", "quote": "A total of 140 patients diagnosed with pilonidal sinus disease were included in the study." }, { "field": "population", "quote": "patients treated using the unroofing and curettage technique" }, { "field": "intervention", "quote": "the patients in the other group were treated with PRP in addition to the standard dressing" }, { "field": "comparator", "quote": "one group was followed up with a standard dressing after the operation" }, { "field": "primaryOutcome", "quote": "the wound healing rate between the 2 groups was determined as the primary objective" }, { "field": "result", "quote": "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)" } ] }, { "id": "pmid:39926760", "pmid": "39926760", "doi": "10.4103/jpbs.jpbs_873_24", "nctId": null, "pmcid": "PMC11804983", "title": "Effective Ayurvedic Treatment of Pilonidal Sinus using Udumber Ksheer Sutra: A Case Study", "firstAuthor": "Prajapati", "multipleAuthors": true, "journal": "J Pharm Bioallied Sci", "year": 2024, "design": "case-series", "n": null, "nField": "not-reported", "population": "People with pilonidal sinus (a hair-related cyst/tunnel near the top of the buttock crease)", "intervention": "Udumber Ksheer Sutra (an Ayurvedic medicated thread treatment, a type of Kshara Sutra)", "comparator": "No comparator described (surgical techniques mentioned only as general background)", "primaryOutcome": "Whether the pilonidal sinus was cured", "result": "The treatment was described as beneficial and curative for the condition", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "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.", "directness": "direct", "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.", "followUp": "", "plainFinding": "Case report says thread treatment cured it.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39926760/", "sourceText": "Pilonidal sinus, also known as \"jeep bottom,\" is common among people who sit a lot, such as cab drivers. It mostly affects men and young adults and is associated with thick hair. Surgical techniques are available for treatment, but the condition has a relatively high recurrence rate. The Kshara Sutra method described in the Sushruta Samhita offers a minimally invasive treatment option. Pilonidal disease is estimated to affect about 26 out of every 100,000 persons, with around 0.7% of people affected. This study focuses on the diagnosis and treatment of patients who have Naadi Vrana (Pilonidal Sinus) using Udumber Ksheer Sutra. The Kshara Sutra is a minimally invasive, cost-effective technique with a low recurrence rate for treating pilonidal sinus. Udumber Ksheer Sutra management has also proven to be beneficial as a curative therapy for the pilonidal sinus.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus, also known as \"jeep bottom,\" is common among people who sit a lot, such as cab drivers." }, { "field": "intervention", "quote": "patients who have Naadi Vrana (Pilonidal Sinus) using Udumber Ksheer Sutra" }, { "field": "comparator", "quote": "Surgical techniques are available for treatment, but the condition has a relatively high recurrence rate." }, { "field": "primaryOutcome", "quote": "This study focuses on the diagnosis and treatment of patients who have Naadi Vrana (Pilonidal Sinus) using Udumber Ksheer Sutra." }, { "field": "result", "quote": "Udumber Ksheer Sutra management has also proven to be beneficial as a curative therapy for the pilonidal sinus." } ] }, { "id": "pmid:39900551", "pmid": "39900551", "doi": "10.1002/wjs.12492", "nctId": null, "pmcid": null, "title": "Evaluation of Outcomes for Karydakis Operation for Pilonidal Sinus Disease-Comparison of Original Reports With Later Results", "firstAuthor": "Doll", "multipleAuthors": true, "journal": "World J Surg", "year": 2025, "design": "systematic-review", "n": 9878, "nField": "reported", "population": "people with pilonidal sinus disease (a condition that causes pain and infection at the top of the buttock crack) who had a specific surgery", "intervention": "Karydakis advancement flap surgery for pilonidal sinus disease", "comparator": "the original 1992 Karydakis report's own outcomes", "primaryOutcome": "rate of the disease coming back (recurrence) at 5 and 10 years after surgery", "result": "recurrence rates in later global studies were far higher than in the original report", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "abstract does not describe how study quality or bias was assessed across the 113 included studies, and compares to a single historical report", "followUp": "10 years", "plainFinding": "Surgery recurs far more than first claimed.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39900551/", "sourceText": "BACKGROUND: Karydakis published his advancement flap technique to treat pilonidal sinus disease (PSD) in 1973 (GEK73) and reported a very low recurrence rate in 1992 (GEK92) in a large series of cases. Since then, the procedure has been widely adapted without replicating his results. AIM: To compare the outcomes of the Karydakis 1992 report to the global literature and evaluate reasons for the major discrepancy in recurrence rates. METHODS: From an international database including all PSD studies, we identified 113 other studies encompassing 9878 patients undergoing the Karydakis advancement flap surgery. Recurrence rates at 5- and 10-year follow-ups were compared to the data presented in the Karydakis 1992 paper. RESULTS: The Karydakis 1992 study reports a recurrence rate < 1% with a follow-up ranging between 2 and 20 years. In the global literature, the 10-year recurrence rate is 8.8% in RCTs and 14.6% in nonRCTs which is 11.6- and 19.2-fold higher. CONCLUSION: The standard for recurrence rates after the Karydakis advancement flap set by Karydakis has not since been replicated in the global literature. For surgeons and patients alike it is important to have realistic expectations of short- and long-term outcomes.", "provenance": [ { "field": "population", "quote": "pilonidal sinus disease (PSD)" }, { "field": "intervention", "quote": "Karydakis published his advancement flap technique to treat pilonidal sinus disease (PSD) in 1973" }, { "field": "comparator", "quote": "The Karydakis 1992 study reports a recurrence rate < 1% with a follow-up ranging between 2 and 20 years." }, { "field": "primaryOutcome", "quote": "Recurrence rates at 5- and 10-year follow-ups were compared to the data presented in the Karydakis 1992 paper." }, { "field": "result", "quote": "In the global literature, the 10-year recurrence rate is 8.8% in RCTs and 14.6% in nonRCTs which is 11.6- and 19.2-fold higher." }, { "field": "n", "quote": "113 other studies encompassing 9878 patients undergoing the Karydakis advancement flap surgery" } ] }, { "id": "pmid:39893840", "pmid": "39893840", "doi": "10.1016/j.jpedsurg.2025.162182", "nctId": null, "pmcid": "PMC11993338", "title": "Laser Hair Removal May Be a Primary Treatment of Pilonidal Disease: A Pilot Study", "firstAuthor": "Janek", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2025, "design": "prospective-cohort", "n": 22, "nField": "reported", "population": "patients ages 13-35 with moderate to severe pilonidal disease", "intervention": "laser hair removal (LHR) using a long-pulsed Alexandrite (755 nm) laser", "comparator": "no comparison group; patients followed before and after laser treatment, some proceeding to surgery if symptoms persisted", "primaryOutcome": "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; of those who had surgery, 6 of 9 (67%) resolved after one surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, single-center pilot study without a comparison group, so it can't prove the laser caused the improvement.", "directness": "direct", "limitations": "Small sample size, no control group, some patients withdrew (including due to COVID-19), single-center design.", "followUp": "18 months", "plainFinding": "Fewer needed surgery after laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39893840/", "sourceText": "INTRODUCTION: Pilonidal disease is a chronic skin disorder of the gluteal cleft in adolescents and young adults. No treatment is universally effective, and the heterogeneity of the disease and variability in treatment response frustrates patients and clinicians alike. Surgical treatment strategies focus on the removal of the sinus tracts. Post-operative laser hair removal (LHR) has demonstrated promise to reduce disease recurrence following surgery. LHR has yet to be investigated as a primary treatment strategy and may offer additional benefits. METHODS: A single-center prospective pilot study investigated laser hair removal as the primary treatment for moderate to severe pilonidal disease. Patients ages 13-35 with moderate to severe disease who were referred for surgical excision were recruited. Participants underwent 3-8 treatment sessions with the long-pulsed--Alexandrite (755 nm) laser by a dermatologist until hair removal endpoints were met. Patients with persistent symptoms after LHR underwent subsequent excision. Patients were subsequently followed in the pediatric surgery clinic at 6, 9, 12 and 18 months following LHR to evaluate for disease recurrence. Primary outcomes included resolution rates without surgical intervention and recurrence rates following surgical resection. Secondary outcomes included the number of episodes of infection and impact on quality of life, as assessed by the Dermatology Life Quality Index (DLQI) in patients ≥16 years of age, and the Children's Dermatology Life Quality Index (CDLQI) in patients <16 years of age. RESULTS: Twenty-two patients were enrolled, of which 18 were initiated and 15 completed the LHR sessions in the study, designed to the endpoint of the absence of terminal hair in the gluteal cleft. One patient withdrew prior to completion of the LHR sessions, and two withdrew from the study due to the COVID-19 pandemic. Of the 15 patients who completed the LHR sessions, all demonstrated significant improvement in hair follicle density in the treatment area, with no adverse events. Median number of laser treatments was 6. Six of 15 (40 %) who completed laser treatments had resolution without surgical intervention. Nine patients underwent surgery, of which 6 (67 %) resolved after one surgery, with 18 months of follow up to evaluate for recurrence. Quality of life scores improved after laser treatments (DLQI mean change -4.6, and Children's DLQI mean change -6.0) CONCLUSION: Laser hair removal was well tolerated, without adverse events and with improved quality of life, in a patient population with moderate to severe pilonidal disease. Nearly half of patients had disease resolution without the need for surgical intervention. These findings underscore the potential for laser hair removal to improve disease outcomes in pilonidal disease, reducing the need for surgical intervention. Based on these results, laser hair removal might provide an effective primary treatment strategy for some patients, and could improve outcomes for those who require surgical intervention. Further research is needed to determine which patients would most likely benefit from this treatment strategy. LEVEL OF EVIDENCE: Level III.", "provenance": [ { "field": "n", "quote": "Twenty-two patients were enrolled" }, { "field": "population", "quote": "Patients ages 13-35 with moderate to severe disease who were referred for surgical excision were recruited." }, { "field": "intervention", "quote": "Participants underwent 3-8 treatment sessions with the long-pulsed--Alexandrite (755 nm) laser by a dermatologist until hair removal endpoints were met." }, { "field": "comparator", "quote": "Patients with persistent symptoms after LHR underwent subsequent excision." }, { "field": "primaryOutcome", "quote": "Primary outcomes included resolution rates without surgical intervention and recurrence rates following surgical resection." }, { "field": "result", "quote": "Six of 15 (40 %) who completed laser treatments had resolution without surgical intervention. Nine patients underwent surgery, of which 6 (67 %) resolved after one surgery, with 18 months of follow up to evaluate for recurrence." } ] }, { "id": "pmid:39875233", "pmid": "39875233", "doi": "10.1016/j.jviscsurg.2024.12.005", "nctId": null, "pmcid": null, "title": "Management of pilonidal sinus and recurrences in 2025", "firstAuthor": "Darnis", "multipleAuthors": true, "journal": "J Visc Surg", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus (a condition at the top of the buttock crease)", "intervention": "surgical excision or minimally invasive treatments for pilonidal sinus", "comparator": "different surgical closure methods and minimally invasive techniques compared with each other", "primaryOutcome": "healing, recurrence, and complication rates", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a narrative review describing general management approaches and outcomes without presenting original controlled data or statistics.", "directness": "direct", "limitations": "No original data, no specific study designs, sample sizes, or statistical results given; general overview only.", "followUp": "", "plainFinding": "Different surgeries have trade-offs; recurrence common.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39875233/", "sourceText": "Pilonidal sinus is a common pathology of the intergluteal cleft that can develop into abscess or suppuration. This lesion corresponds histologically to a granuloma that organizes around foreign bodies, most often hairs, and fistulizes to the skin through partially epithelialized orifices. If suppuration and abscess develop, treatment is based either on medical treatment combining analgesics, local antiseptics and sometimes antibiotics, or on emergency incision and drainage in the operating room. This is performed in more than 10,000 patients per year in France. Outside of emergencies, elective surgery for pilonidal sinus is indicated to treat bothersome symptoms or to avoid the risk of recurrent abscess. The surgical indication must take into account the patient's risk factors, particularly active smoking, that increase the risk of postoperative complications and recurrence. Elective intervention is performed on more than 30,000 patients per year in France. Radical excision followed by secondary healing is the most commonly performed option. This strategy carries a risk of failure or recurrence for at least 10% of patients. Primary closure after excision can reduce the time for healing and convalescence, but at the cost of more frequent infectious complications. Midline closure should be avoided, in favor of paramedian or flap closure. Minimally invasive techniques are being developed that combine the extraction of foreign bodies and mechanical debridement or thermal or chemical cautery of the granulomatous walls. They avoid complex and unpleasant nursing care of secondarily healing wounds, at the cost of a recurrence rate equivalent to that from excision techniques. They have the merit of avoiding difficult situations of failure to heal or recurrence after radical excision that are associated with a clear deterioration in the quality of life. The treatment of surgical failures is complex, and combines comprehensive patient care (smoking cessation, anti-infectious treatments, treatment of excess weight, avoidance of a sedentary lifestyle) and often a repeat operation. Minimally invasive treatments, particularly laser treatments, have their place in these difficult situations.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus is a common pathology of the intergluteal cleft that can develop into abscess or suppuration." }, { "field": "intervention", "quote": "Radical excision followed by secondary healing is the most commonly performed option." }, { "field": "comparator", "quote": "Primary closure after excision can reduce the time for healing and convalescence, but at the cost of more frequent infectious complications." }, { "field": "primaryOutcome", "quote": "This strategy carries a risk of failure or recurrence for at least 10% of patients." }, { "field": "result", "quote": "They avoid complex and unpleasant nursing care of secondarily healing wounds, at the cost of a recurrence rate equivalent to that from excision techniques." } ] }, { "id": "pmid:39871414", "pmid": "39871414", "doi": "10.1111/codi.70003", "nctId": null, "pmcid": "PMC11772908", "title": "Gender-specific outcomes in pilonidal sinus disease: Female outcomes after cleft lift surgery in a large prospective Danish cohort", "firstAuthor": "Faurschou", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2025, "design": "prospective-cohort", "n": 560, "nField": "reported", "population": "women and men with pilonidal sinus disease who had cleft lift surgery", "intervention": "Bascom's cleft lift (BCL) surgery for pilonidal sinus disease", "comparator": "male patients undergoing the same surgery", "primaryOutcome": "risk of recurrence and prolonged wound healing after surgery", "result": "Women had a 30% higher risk of recurrence and a 46% higher risk of prolonged healing compared with men", "resultDirection": "harm", "quality": "moderate", "qualityWhy": "It is a large, prospective single-center cohort but not randomized, so the sex-based comparison could be influenced by other differences between patients.", "directness": "indirect", "limitations": "Observational design without randomization; wide confidence interval for recurrence risk (0.79-2.09) suggests uncertainty.", "followUp": "", "plainFinding": "Worse healing in women after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39871414/", "sourceText": "AIM: Pilonidal sinus disease (PSD) is a common condition particularly affecting young men. Females affected by the condition account for about 20% of patients and are rarely mentioned, much less studied specifically. In this study we evaluate the surgical outcomes in a female population following Bascom's cleft lift (BCL) surgery in primary extensive disease, non-healing wounds after previous surgery and recurrent disease in a large Danish cohort from a high-volume centre. METHOD: The study is based on a prospective database established at Randers Regional Hospital in 2016. All patients undergoing BCL surgery from June 2016 until October 2022 were included in this study. RESULTS: In all, 560 patients underwent BCL surgery at our centre during this period. Eighty-eight (15.7%) were women. Only 10 (11.3%) were operated due to primary extensive manifestations. The rest presented with either non-healing wounds after previous surgery (47.7%) or recurrent PSD (41%). Risk of recurrence in female patients was 30% higher than in male patients (risk ratio 1.30, 95% CI 0.79-2.09) and the risk of prolonged healing after BCL surgery was 46% higher in women compared to men (risk ratio 1.46, 95% CI 1.02-2.14). CONCLUSION: Female PSD patients may represent a subcategory of patients at higher risk of treatment failure and should be dealt with as such. Initially, few present with the need for extensive surgery. However, given the common occurrence of prolonged healing and recurrence, we recommend a minimal invasive approach when possible.", "provenance": [ { "field": "population", "quote": "Females affected by the condition account for about 20% of patients" }, { "field": "n", "quote": "In all, 560 patients underwent BCL surgery at our centre during this period." }, { "field": "intervention", "quote": "Bascom's cleft lift (BCL) surgery" }, { "field": "comparator", "quote": "Risk of recurrence in female patients was 30% higher than in male patients" }, { "field": "primaryOutcome", "quote": "risk of prolonged healing after BCL surgery" }, { "field": "result", "quote": "Risk of recurrence in female patients was 30% higher than in male patients (risk ratio 1.30, 95% CI 0.79-2.09) 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)." } ] }, { "id": "pmid:39842887", "pmid": "39842887", "doi": "10.1136/bcr-2024-261865", "nctId": null, "pmcid": null, "title": "Concurrent pilonidal sinus of the nape of the neck and sacrococcygeal region", "firstAuthor": "Hiremath", "multipleAuthors": true, "journal": "BMJ Case Rep", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "man in his mid-30s with recurring swelling and draining sinuses at the back of the neck and in the crack between the buttocks", "intervention": "surgical removal of the sinus tract in the neck plus wide excision with flap reconstruction (Limberg flap) in the tailbone area", "comparator": "none (single patient treated, no comparison group)", "primaryOutcome": "healing and recurrence after surgery", "result": "complete healing with no recurrence after one year of follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether surgery generally works or why the pain happens in other people.", "directness": "indirect", "limitations": "only one patient described, no comparison group, and this is an unusual double-site case rather than typical pilonidal disease", "followUp": "One year", "plainFinding": "Surgery healed pilonidal sinus fully.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39842887/", "sourceText": "The most common site for a pilonidal sinus is the sacrococcygeal region, typically affecting hirsute males. Hair entrapment beneath the skin triggers a granulomatous reaction, leading to the formation of a sinus tract. Here, we present a rare case of concurrent pilonidal abscess in both the nape of the neck and the natal cleft. To date, only five similar cases have been reported in the literature, making this presentation unique.The patient, in his mid-30s, presented with recurrent swelling and discharging sinuses in both the nape of the neck and the intergluteal region. The surgical intervention included excision of the sinus tract in the neck and wide local excision with Limberg flap reconstruction in the sacrococcygeal region.One year post-surgery, the patient showed complete healing with no recurrence observed during follow-up.", "provenance": [ { "field": "population", "quote": "The patient, in his mid-30s, presented with recurrent swelling and discharging sinuses in both the nape of the neck and the intergluteal region." }, { "field": "intervention", "quote": "The surgical intervention included excision of the sinus tract in the neck and wide local excision with Limberg flap reconstruction in the sacrococcygeal region." }, { "field": "comparator", "quote": "Here, we present a rare case of concurrent pilonidal abscess in both the nape of the neck and the natal cleft." }, { "field": "primaryOutcome", "quote": "One year post-surgery, the patient showed complete healing with no recurrence observed during follow-up." }, { "field": "result", "quote": "One year post-surgery, the patient showed complete healing with no recurrence observed during follow-up." }, { "field": "n", "quote": "The patient, in his mid-30s, presented with recurrent swelling and discharging sinuses" } ] }, { "id": "pmid:39842024", "pmid": "39842024", "doi": "10.1097/LGT.0000000000000871", "nctId": null, "pmcid": null, "title": "Cutaneous Intertriginous Langerhans Cell Histiocytosis in Adults: A Case Report and Systematic Review", "firstAuthor": "Mansfield", "multipleAuthors": true, "journal": "J Low Genit Tract Dis", "year": 2025, "design": "systematic-review", "n": 122, "nField": "reported", "population": "adults with biopsy-confirmed Langerhans cell histiocytosis affecting skin folds (including the area between the buttocks)", "intervention": "none (this is a review describing how the disease looks and behaves, not treating it)", "comparator": "none", "primaryOutcome": "the typical appearance, skin findings, and other conditions it can be mistaken for", "result": "the skin lesions commonly looked like eroded, ulcerated bumps and patches, and could be mistaken for hidradenitis suppurativa, fungal infection, or genital warts", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "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", "directness": "indirect", "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", "followUp": "", "plainFinding": "Describes a rare skin disease, not your pain's cause", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39842024/", "sourceText": "OBJECTIVE: Authors characterized all published adult cases of cutaneous, intertriginous Langerhans cell histiocytosis (LCH) to bring this clinical presentation to the attention of clinicians. The authors emphasize the morphology, histopathology, immunohistochemical profiles, and genetic mutations associated with these cases. MATERIALS AND METHODS: A systematic review of the National Center for Biotechnology Information's PubMed was conducted, utilizing the following specific key words to identify all adult LCH patients with cutaneous intertriginous involvement: \"Intertriginous Langerhans,\" \"Vulvar Langerhans,\" \"Genital Langerhans,\" \"Perineal Langerhans,\" \"Perianal Langerhans,\" \"Intergluteal Langerhans,\" \"Inguinal Langerhans,\" \"Axillary Langerhans,\" and \"Inframammary Langerhans.\" Reports were subjected to strict inclusion criteria: case reports, case series, or meta-analyses documenting case(s) of biopsy-proven LCH with cutaneous, intertriginous involvement in adult patients (>18 years of age at the time of diagnosis). RESULTS: This systematic review identified 1 original and 121 published cases of biopsy-proven, cutaneous, intertriginous LCH in adult patients. Morphology commonly included eroded, ulcerated papules and plaques, and rare presentations demonstrated potential mimickers (hidradenitis suppurativa, deep fungal mycosis, condyloma accuminata). CONCLUSIONS: This systematic review encompasses the largest compilation of adult cutaneous intertriginous LCH cases in the medical literature to the authors' knowledge to date. This study identifies an important clinical presentation of this rare, commonly pediatric diagnosis; highlights trends among these cases and important clinical mimickers; and serves as a reminder to clinicians to maintain suspicion for LCH in adult populations, particularly in the setting of intertriginous cutaneous involvement.", "provenance": [ { "field": "n", "quote": "This systematic review identified 1 original and 121 published cases of biopsy-proven, cutaneous, intertriginous LCH in adult patients." }, { "field": "population", "quote": "all published adult cases of cutaneous, intertriginous Langerhans cell histiocytosis (LCH)" }, { "field": "intervention", "quote": "The authors emphasize the morphology, histopathology, immunohistochemical profiles, and genetic mutations associated with these cases." }, { "field": "comparator", "quote": "A systematic review of the National Center for Biotechnology Information's PubMed was conducted" }, { "field": "primaryOutcome", "quote": "Morphology commonly included eroded, ulcerated papules and plaques, and rare presentations demonstrated potential mimickers (hidradenitis suppurativa, deep fungal mycosis, condyloma accuminata)." }, { "field": "result", "quote": "Morphology commonly included eroded, ulcerated papules and plaques, and rare presentations demonstrated potential mimickers (hidradenitis suppurativa, deep fungal mycosis, condyloma accuminata)." } ] }, { "id": "pmid:39837200", "pmid": "39837200", "doi": "10.1016/j.jaim.2024.101082", "nctId": null, "pmcid": "PMC11786198", "title": "Coexisting pilonidal sinus and anal fistula: Successful management with minimal invasive Kshara Karma Technique and Ksharasutra therapy- A case report", "firstAuthor": "Hemantha Kumar", "multipleAuthors": true, "journal": "J Ayurveda Integr Med", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "27 year old woman with a recurring pilonidal sinus (cyst at top of butt crack) also connected to an anal fistula", "intervention": "Ayurvedic Ksharasutra thread therapy combined with Minimal Invasive Kshara Karma Technique (medicated alkali treatment)", "comparator": "no comparison group; single patient case report", "primaryOutcome": "wound healing and prevention of recurrence", "result": "Thread treatment dissolved after five weeks, and the wound fully healed within six weeks with minimal scarring", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report with no comparison group, so it cannot show whether this treatment works better than standard care.", "directness": "direct", "limitations": "Only one patient was treated, there was no control group, and long-term recurrence was not tracked beyond the healing period.", "followUp": "six weeks", "plainFinding": "Wound healed in one case.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39837200/", "sourceText": "Pilonidal sinus (PNS) is a nest of hair which typically presents as pits, pus discharge, and an abscess at the natal cleft region. In rare conditions where pilonidal abscess is not drained properly, it progresses posteriorly and reaches anal canal, eventually coexisting with anal fistula. Both are associated with a high recurrence rate despite surgical management. 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. On local examination, a wound was seen at the natal cleft, secondary pit 3cm away with scar mark of the previous operation, and a digital rectal examination (DRE) revealed an internal opening at 6 o'clock position that was communicating with the previously operated PNS wound. The patient was diagnosed as a case of coexisting anal fistula and recurrent PNS. Patient was managed under spinal anaesthesia with interception of fistulous tract using Ksharasutra (Medicated alkaline thread), followed by Minimal Invasive Kshara Karma Technique (MIKKT) for PNS. Ksharasutra was sloughed out after the fifth week, and complete wound healing of PNS was achieved in six weeks. By interception of the fistulous tract, the length of the tract was reduced, which facilitated early wound healing and minimal scar mark formation. MIKKT also prevented bigger excision and wound formation, eventually reducing complete healing duration, and Kshara(a medicated alkali) applied caused chemical cauterization and hence prevented recurrence of pilonidal sinus.", "provenance": [ { "field": "population", "quote": "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" }, { "field": "n", "quote": "A 27 year old female patient presented" }, { "field": "intervention", "quote": "interception of fistulous tract using Ksharasutra (Medicated alkaline thread), followed by Minimal Invasive Kshara Karma Technique (MIKKT) for PNS" }, { "field": "comparator", "quote": "Patient was managed under spinal anaesthesia" }, { "field": "primaryOutcome", "quote": "Ksharasutra was sloughed out after the fifth week, and complete wound healing of PNS was achieved in six weeks" }, { "field": "result", "quote": "Ksharasutra was sloughed out after the fifth week, and complete wound healing of PNS was achieved in six weeks" } ] }, { "id": "pmid:39815683", "pmid": "39815683", "doi": "10.1093/ced/llaf035", "nctId": null, "pmcid": null, "title": "Laser hair depilation therapy for pilonidal sinus disease: a 5-year, retrospective experience in a university teaching hospital in the UK, 2017-2023", "firstAuthor": "Andrew", "multipleAuthors": true, "journal": "Clin Exp Dermatol", "year": 2025, "design": "retrospective", "n": 97, "nField": "reported", "population": "patients referred for pilonidal sinus disease treatment (mostly young men, median age 22)", "intervention": "laser hair removal therapy", "comparator": "number of laser sessions and surgery type compared among patients", "primaryOutcome": "healing or improvement of pilonidal sinus disease", "result": "more laser sessions linked to better symptom resolution; surgery type did not affect improvement; most non-surgical patients improved", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective chart review without a control group, so it can't prove laser treatment caused the improvement.", "directness": "direct", "limitations": "Retrospective design, no control group, single center, outcomes not independently verified.", "followUp": "", "plainFinding": "More laser sessions helped healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39815683/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a chronic, debilitating condition predominantly affecting young men. Laser hair depilation is an established adjunct to surgical treatment for PSD. It can lead to reduced rates of recurrence and postsurgical interventions. OBJECTIVES: To assess the outcome of laser hair depilation therapy on disease progression in patients with PSD at the Birmingham Skin Regional Laser Centre. METHODS: Patient demographics, PSD clinical stage, laser type, number of laser sessions, surgical intervention and treatment outcomes were extracted from electronic medical records of patients (n = 97) referred for laser hair depilation between 2017 and 2023. Statistical analysis was performed using Microsoft Excel and R. Treatment outcomes were categorized as improvement (healed, improved) or no improvement of underlying PSD. Disease severity was classified using the method of Guner et al. (BMC Surg 2016; 16:18). RESULTS: Most patients affected were male (77%). The median age was 22 years (interquartile range 20-28). The median number of laser hair removal sessions was 8 (interquartile range 5.5-10). The number of laser hair removal sessions was the only predictive factor for symptom resolution (P < 0.001). Neither surgical intervention nor the type of surgery (incision, excision, modified flap, or endoscopic surgical intervention) showed a significant association with improvement in PSD (P = 0.47 and P = 0.65, respectively). In the subgroup of patients who did not undergo surgery (n = 32, 33%), 25 patients (78%) had improvement or healing in their PSD. There were no statistically significant associations between age, type of laser, disease severity and benefit from laser hair removal. No complications were reported and there was only one case of recurrence. CONCLUSIONS: Laser hair depilation is a safe and effective postoperative adjunct treatment for treating sacrococcygeal PSD. For early-stage disease it may offer curative treatment.", "provenance": [ { "field": "population", "quote": "Patient demographics, PSD clinical stage, laser type, number of laser sessions, surgical intervention and treatment outcomes were extracted from electronic medical records of patients (n = 97) referred for laser hair depilation between 2017 and 2023." }, { "field": "intervention", "quote": "To assess the outcome of laser hair depilation therapy on disease progression in patients with PSD at the Birmingham Skin Regional Laser Centre." }, { "field": "comparator", "quote": "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)." }, { "field": "primaryOutcome", "quote": "Treatment outcomes were categorized as improvement (healed, improved) or no improvement of underlying PSD." }, { "field": "result", "quote": "The number of laser hair removal sessions was the only predictive factor for symptom resolution (P < 0.001)." }, { "field": "result", "quote": "In the subgroup of patients who did not undergo surgery (n = 32, 33%), 25 patients (78%) had improvement or healing in their PSD." }, { "field": "n", "quote": "Patient demographics, PSD clinical stage, laser type, number of laser sessions, surgical intervention and treatment outcomes were extracted from electronic medical records of patients (n = 97) referred for laser hair depilation between 2017 and 2023." } ] }, { "id": "pmid:39809548", "pmid": "39809548", "doi": "10.1111/codi.17295", "nctId": null, "pmcid": "PMC11732642", "title": "Lived experience of pilonidal sinus disease: Systematic review and meta-ethnography", "firstAuthor": "Aimar", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2025, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people living with pilonidal sinus disease", "intervention": "no treatment tested - qualitative exploration of patients' lived experience", "comparator": "none - no comparison group used", "primaryOutcome": "patients' lived experience of pilonidal sinus disease", "result": "three themes emerged: disruption to daily activities, impact on psychological well-being, and difficulties navigating healthcare", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Only four full texts covering three studies were included, and the abstract does not report participant numbers or address the cause of pain.", "followUp": "", "plainFinding": "Disease disrupts life, causes distress.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39809548/", "sourceText": "AIM: Pilonidal sinus disease (PSD) poses significant treatment challenges due to a lack of consensus on the diverse range of surgical approaches routinely employed, prompting a renewed focus on the patient experience. The aim of this study was to explore the lived experience of patients with PSD to better inform future person-centred treatment. METHOD: A systematic review was performed to identify papers reporting qualitative studies on the lived experience of PSD. The MEDLINE, EMBASE and CINAHL databases were searched, using a predefined search strategy. Studies were dual screened at each stage, with conflicts resolved by a third reviewer. Analytical frameworks were extracted, along with supporting quotes. A meta-ethnographic approach was used to systemically compare and synthesize frameworks in line with the eMERGe meta-ethnography protocol. The study was registered on PROSPERO (CRD42024495608). RESULTS: Four full texts covering three studies were included. Three key themes emerged: (1) disruption to activities of daily living; (2) impact on psychological well-being; (3) navigating healthcare. Reduction of physical activity was patient-led, owing to fears of exacerbating symptoms and wound complications. PSD had a complex influence on self-perception and emotional state, leading to changed relationships with others. This was largely driven by the forced reliance on others for wound care. The final theme highlighted concerns regarding unexpected disease course and outcomes stemming from a lack of patient awareness of PSD. CONCLUSION: This study informs a more sophisticated understanding of the experience of individuals living with PSD and has identified recommendations that should guide future clinical practice and research.", "provenance": [ { "field": "population", "quote": "patients with PSD" }, { "field": "intervention", "quote": "A systematic review was performed to identify papers reporting qualitative studies on the lived experience of PSD." }, { "field": "comparator", "quote": "A meta-ethnographic approach was used to systemically compare and synthesize frameworks" }, { "field": "primaryOutcome", "quote": "to explore the lived experience of patients with PSD to better inform future person-centred treatment" }, { "field": "result", "quote": "Three key themes emerged: (1) disruption to activities of daily living; (2) impact on psychological well-being; (3) navigating healthcare." } ] }, { "id": "pmid:39800555", "pmid": "39800555", "doi": "10.48095/ccachp2024120", "nctId": null, "pmcid": null, "title": "Limberg flap for previously recurrent complex sacrococcygeal pilonidal sinus surgeries", "firstAuthor": "Aljarrah", "multipleAuthors": true, "journal": "Acta Chir Plast", "year": 2024, "design": "case-series", "n": 10, "nField": "reported", "population": "Patients with complex or repeatedly recurring pilonidal sinus disease at the base of the spine", "intervention": "Limberg flap surgery (a rotational skin flap repair)", "comparator": "No control group studied; abstract compares results to open wound procedures based on general knowledge", "primaryOutcome": "Wound infection, seroma, pain, recurrence, return to work, cosmetic result, and patient satisfaction after surgery", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Only 10 patients were studied with no comparison group and just 3 months of follow-up, so the findings carry little weight.", "directness": "indirect", "limitations": "Very small number of patients, short follow-up time, no control group for comparison.", "followUp": "3 months", "plainFinding": "Flap surgery helped, no recurrence yet.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39800555/", "sourceText": "OBJECTIVE: Limberg flap, is a rotational rhomboid flap. A procedure done for people who have either complex or recurrent pilonidal disease. This study has been performed to determine effects of the Limberg flap for sacrococcygeal pilonidal sinus, regarding the wound infection rate, seroma formation, postoperative pain relief, recurrence rates, return to work, its cosmetic final result and patients' satisfaction. METHODS: A total of 10 patients were operated from January 2022 to March 2023. Patients were selected according to the disease complexity and recurrence, so that the patients selected were classified as complex and at least of a second recurrence of the disease. RESULTS: Patients successfully underwent surgery, with mild to moderate postoperative pain, stayed in hospital for 3 days in average, returned to work after 6 weeks, with 5 patients having flap oedema, 1 patient had wound infection, no one had flap necrosis, and there were no recurrences so far for an average follow-up time of about 3 months. Patients with flap oedema took 2-3 weeks to heal with regular dressing only. Patient satisfaction and final cosmetic result were well accepted. Limberg flap for sacrococcygeal pilonidal sinus was found very useful in terms of recurrences. CONCLUSION: Better patients' acceptance and satisfaction despite the increased risk in postoperative pain, infection rates, and longer return to work in comparison to the open procedures.", "provenance": [ { "field": "n", "quote": "A total of 10 patients were operated from January 2022 to March 2023." }, { "field": "population", "quote": "patients selected were classified as complex and at least of a second recurrence of the disease" }, { "field": "intervention", "quote": "Limberg flap, is a rotational rhomboid flap" }, { "field": "primaryOutcome", "quote": "regarding the wound infection rate, seroma formation, postoperative pain relief, recurrence rates, return to work, its cosmetic final result and patients' satisfaction" }, { "field": "result", "quote": "there were no recurrences so far for an average follow-up time of about 3 months" }, { "field": "result", "quote": "5 patients having flap oedema, 1 patient had wound infection, no one had flap necrosis" }, { "field": "followUp", "quote": "average follow-up time of about 3 months" }, { "field": "comparator", "quote": "in comparison to the open procedures" } ] }, { "id": "pmid:39792517", "pmid": "39792517", "doi": "10.1097/ASW.0000000000000220", "nctId": null, "pmcid": null, "title": "Evaluation of Clinical Outcomes and Quality of Life following the Karydakis Flap Procedure for Pilonidal Sinus Treatment", "firstAuthor": "Breidung", "multipleAuthors": true, "journal": "Adv Skin Wound Care", "year": 2024, "design": "retrospective", "n": 103, "nField": "reported", "population": "patients who had surgery for pilonidal sinus (a cyst near the top of the buttocks crease)", "intervention": "Karydakis flap surgical procedure to remove the pilonidal sinus", "comparator": "none - no comparison group reported", "primaryOutcome": "postoperative complications, recurrence rate, wound healing time, and return to daily life", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "direct", "limitations": "Retrospective data analysis; single surgeon; no control group; some follow-up done by telephone rather than in person.", "followUp": "59 months", "plainFinding": "Low complications, low recurrence after flap surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39792517/", "sourceText": "OBJECTIVE: To evaluate the clinical outcome of the Karydakis flap procedure performed by a single surgeon for the treatment of pilonidal sinus, focusing on postoperative complications, recurrence rate, wound healing time, and return to daily life. METHODS: Authors performed a retrospective data analysis of patients who underwent reconstruction of pilonidal sinus using the Karydakis technique at the Department of Plastic, Reconstructive and Hand Surgery, Center for Severe Burn Injuries of Paracelsus Medical University, Klinikum Nürnberg, Germany, between 2014 and 2021. All cases were performed by a single surgeon. Patients were requested to attend a follow-up appointment in person or, if this was not possible, by telephone. RESULTS: A total of 103 patients were enrolled in the study. The postoperative complication rate was 11.7%. Revision surgery was required in 4.9% of patients because of a complication. Wound healing time was on average 21.4 days postoperatively. A total of seven patients (6.8%) had a recurrence within 59 months postoperatively. CONCLUSIONS: The Karydakis flap is a robust reconstructive off-midline procedure for the treatment of pilonidal sinus. Relatively few postoperative complications and a low recurrence rate are advantages of the surgical procedure. Based on the results of quality-of-life factors, patients experience early functional return to daily life after the Karydakis flap procedure.", "provenance": [ { "field": "n", "quote": "A total of 103 patients were enrolled in the study." }, { "field": "population", "quote": "patients who underwent reconstruction of pilonidal sinus using the Karydakis technique" }, { "field": "intervention", "quote": "reconstruction of pilonidal sinus using the Karydakis technique" }, { "field": "comparator", "quote": "All cases were performed by a single surgeon." }, { "field": "primaryOutcome", "quote": "focusing on postoperative complications, recurrence rate, wound healing time, and return to daily life" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:39708093", "pmid": "39708093", "doi": "10.1007/s00383-024-05941-4", "nctId": null, "pmcid": null, "title": "Trephination for primary pediatric pilonidal sinus disease: medium term functional and recurrence outcome of a large cohort", "firstAuthor": "Iacob", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2024, "design": "retrospective", "n": 100, "nField": "reported", "population": "children with pilonidal sinus disease (a condition causing pain near the top of the buttock crack)", "intervention": "minimally invasive surgery called trephination", "comparator": "none (single group followed over time)", "primaryOutcome": "recovery time, pain, discharge, abscesses, and need for repeat surgery", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "direct", "limitations": "Retrospective design, no comparison group, relied partly on telephone follow-up interviews.", "followUp": "31.4 (16.2-52.8) months", "plainFinding": "Easy recovery, but sometimes comes back.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39708093/", "sourceText": "PURPOSE: Minimal incision procedures have been recommended for pediatric pilonidal sinus disease, based on small studies with short follow-up. We aimed to describe medium-term outcomes of trephination in a large cohort. METHODS: Retrospective chart review and additional concluding telephone interviews for all children who underwent primary trephination in our institution over 5.5 years, collecting demographic and clinical data, and updated functional and recurrence outcome data. RESULTS: 100 patients were included. Median follow-up time was 31.4 (16.2-52.8) months. 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, with 80-85% occurring within the first post-operative year. Reoperation rate was 18%, with 95% occurring within 2 years. No significant associations were found between demographic or clinical characteristics and either functional or recurrence medium-term outcomes. CONCLUSION: Trephination carries excellent functional outcome with less favorable medium-term efficacy for the treatment of primary pediatric pilonidal sinus disease. Most adverse outcomes, including reoperations, occur within the first two years.", "provenance": [ { "field": "population", "quote": "primary pediatric pilonidal sinus disease" }, { "field": "intervention", "quote": "primary trephination" }, { "field": "comparator", "quote": "Retrospective chart review and additional concluding telephone interviews for all children who underwent primary trephination" }, { "field": "primaryOutcome", "quote": "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" }, { "field": "result", "quote": "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." }, { "field": "n", "quote": "100 patients were included." }, { "field": "followUp", "quote": "Median follow-up time was 31.4 (16.2-52.8) months." } ] }, { "id": "pmid:39705452", "pmid": "39705452", "doi": "10.1097/MD.0000000000040998", "nctId": null, "pmcid": "PMC11666127", "title": "Subarachnoid anesthesia for sacrococcygeal pilonidal disease treatment: A case report", "firstAuthor": "Qin", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2024, "design": "case-series", "n": 1, "nField": "reported", "population": "48-year-old obese man with recurrent swelling, pain, and pus near the top of the buttock crack (pilonidal disease)", "intervention": "surgery to remove the pilonidal sinus, done under spinal (subarachnoid) anesthesia", "comparator": "none", "primaryOutcome": "safety and success of anesthesia and surgery", "result": "surgery completed successfully with stable vital signs; patient had brief breathing difficulty when repositioned, but no major anesthesia complications in the first 24 hours", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether this treatment generally works for this problem", "directness": "indirect", "limitations": "only one patient; focuses on anesthesia technique, not on long-term pain relief or explaining why the area hurts in general", "followUp": "24 hours", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39705452/", "sourceText": "RATIONALE: Sacrococcygeal pilonidal disease (SPD) is a chronic inflammatory condition primarily affecting young males. This case report details the perioperative anesthetic management of a patient undergoing SPD surgery under subarachnoid anesthesia. PATIENT CONCERNS: A 48-year-old obese male (body mass index 28 kg/m2) presented with recurrent sacrococcygeal swelling, pain, and purulent discharge for 2 months. Magnetic resonance imaging revealed a pilonidal sinus in the left subcutaneous sacrococcygeal region, with additional findings of degenerative vertebral changes and left paracentral disc protrusion at the fourth or fifth lumbar vertebrae. DIAGNOSES: SPD with abscess formation. INTERVENTIONS: Following comprehensive evaluation, the patient underwent SPD excision under subarachnoid anesthesia. Lumbar puncture was performed at the third and fourth lumbar vertebrae interspace, and 2 mL of 0.6% ropivacaine was administered, achieving a sensory block up to the eighth thoracic vertebra level. The patient experienced transient respiratory difficulty during positional change from supine to prone, necessitating immediate reassessment of the block level and appropriate management. Vital signs were closely monitored intraoperatively, with meticulous postoperative follow-up. OUTCOMES: The surgery was completed successful with stable hemodynamics. No significant anesthesia-related complications were observed within 24 hours postoperatively. LESSONS: Thorough preoperative assessment of local and systemic infection status is essential in SPD patients undergoing subarachnoid anesthesia. Intraoperative positional changes may affect the level of subarachnoid block, requiring vigilant monitoring of vital signs and respiratory function. Postoperative care should focus on potential anesthetic complications and wound care requirements. Individualized anesthetic management strategies are crucial for ensuring patient safety.", "provenance": [ { "field": "n", "quote": "A 48-year-old obese male" }, { "field": "population", "quote": "presented with recurrent sacrococcygeal swelling, pain, and purulent discharge for 2 months" }, { "field": "intervention", "quote": "the patient underwent SPD excision under subarachnoid anesthesia" }, { "field": "comparator", "quote": "INTERVENTIONS: Following comprehensive evaluation, the patient underwent SPD excision under subarachnoid anesthesia." }, { "field": "primaryOutcome", "quote": "The surgery was completed successful with stable hemodynamics. No significant anesthesia-related complications were observed within 24 hours postoperatively." }, { "field": "result", "quote": "The surgery was completed successful with stable hemodynamics. No significant anesthesia-related complications were observed within 24 hours postoperatively." }, { "field": "followUp", "quote": "No significant anesthesia-related complications were observed within 24 hours postoperatively." } ] }, { "id": "pmid:39699772", "pmid": "39699772", "doi": "10.1007/s10151-024-03058-3", "nctId": null, "pmcid": null, "title": "Sinus laser therapy versus Karydakis flap procedure in the management of pilonidal sinus disease: a comparative analysis of intraoperative parameters and postoperative outcome", "firstAuthor": "Akyol", "multipleAuthors": false, "journal": "Tech Coloproctol", "year": 2024, "design": "retrospective", "n": 106, "nField": "reported", "population": "patients with pilonidal sinus disease (average age 26, mostly male)", "intervention": "laser treatment of the sinus tract (SiLaT)", "comparator": "Karydakis flap surgery", "primaryOutcome": "operative time, pain after surgery, time to return to work, complications and recurrence", "result": "Laser treatment had shorter operation time, less pain, and quicker return to work, with similar complication and recurrence rates compared to flap surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective comparison of two surgical techniques without randomization, so differences between patient groups could affect results.", "directness": "direct", "limitations": "Retrospective design, not randomized, from a single comparative analysis; small number of complications/recurrences limits statistical power.", "followUp": "", "plainFinding": "Laser surgery meant less pain, faster recovery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39699772/", "sourceText": "BACKGROUND: This study aimed to investigate the utility of minimally invasive sinus laser therapy (SiLaT) versus flap surgery (Karydakis flap procedure) in terms of intraoperative parameters and postoperative outcome in patients with pilonidal sinus disease (PSD). METHODS: A total of 106 patients with PSD (mean ± SD age: 26.4 ± 7.0 years, 86.8% male) treated with Karydakis flap procedure (KF group; n = 63) or sinus laser therapy (SiLaT group; n = 43) were included in this retrospective study. Data on patient demographics, operative characteristics (number of openings, length of sinus tract, and operative time), and postoperative outcome including postoperative (day 1) pain intensity-visual analog scale (VAS) scores, time to return to work after surgery (days), complication rate, and recurrence rate were recorded in each patient and compared between KF and SiLaT groups. RESULTS: The SiLaT versus KF procedure was associated with significantly shorter operative time [median (min-max) 17 (12-28) versus 27 (20-44) min, p = 0.001], lower pain scores [3 (1-4) versus 5 (3-7), p = 0.001], and earlier return to work [1 (1-3) versus 10 (5-20) days, p = 0.001]. Although no significant difference was noted in complication and recurrence rates between the KF and SiLaT groups, 6.3% (wound infection only) and 3.2% of patients in the KF group but none of the patients in the SiLaT group developed complication and recurrence, respectively. CONCLUSIONS: SiLaT seems to be a promising minimally invasive technique for the management of PSD, being comparable to the KF procedure in terms of complications and recurrence, along with added advantages of shorter operative time, reduced postoperative pain, and earlier return to work.", "provenance": [ { "field": "population", "quote": "106 patients with PSD (mean ± SD age: 26.4 ± 7.0 years, 86.8% male)" }, { "field": "intervention", "quote": "sinus laser therapy (SiLaT group; n = 43)" }, { "field": "comparator", "quote": "Karydakis flap procedure (KF group; n = 63)" }, { "field": "primaryOutcome", "quote": "postoperative (day 1) pain intensity-visual analog scale (VAS) scores, time to return to work after surgery (days), complication rate, and recurrence rate" }, { "field": "result", "quote": "The SiLaT versus KF procedure was associated with significantly shorter operative time [median (min-max) 17 (12-28) versus 27 (20-44) min, p = 0.001], lower pain scores [3 (1-4) versus 5 (3-7), p = 0.001], and earlier return to work [1 (1-3) versus 10 (5-20) days, p = 0.001]." }, { "field": "n", "quote": "A total of 106 patients with PSD" } ] }, { "id": "pmid:39656288", "pmid": "39656288", "doi": "10.1007/s10151-024-03049-4", "nctId": null, "pmcid": null, "title": "Pediatric endoscopic pilonidal sinus treatment: lessons learned after 100 consecutive cases", "firstAuthor": "Pérez-Bertólez", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2024, "design": "prospective-cohort", "n": 149, "nField": "reported", "population": "Children having surgery for pilonidal sinus (a cyst near the top of the butt crack)", "intervention": "Endoscopic pilonidal sinus surgery (PEPSiT)", "comparator": "Standard surgery - either cutting out and leaving open to heal, or cutting out and stitching closed", "primaryOutcome": "How long healing took, how much pain patients had, complications, and whether the cyst came back", "result": "Endoscopic surgery healed faster, caused less pain, had far fewer complications, and was less likely to come back than the standard surgeries", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Patients were not randomly assigned to a surgery type - the surgeon chose the technique, which can bias the results.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Faster, less painful healing with endoscopic surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39656288/", "sourceText": "AIM: Pediatric endoscopic pilonidal sinus treatment (PEPSiT) has favorable short-term-outcomes, but there is a lack of reliable data on medium and long-term follow-up. The objective of our study was to evaluate the effectiveness and advantages of PEPSiT versus conventional surgery of pilonidal sinus in the pediatric population. METHODS: A quasi-experimental study was carried out in pediatric patients undergoing pilonidal sinus surgery at a single institution from 2019 to 2022. Excision and healing by secondary intention (EHSI), excision and primary closure (EPC), and PEPSiT were compared. The surgical technique chosen was surgeon-dependent. RESULTS: In total, 149 patients were studied-100 undergoing PEPSiT, 28 undergoing EHSI, and 21 undergoing EPC. Median full healing process was 4 weeks [interquartile range (IQR): 3-8] in PEPSiT, 16 weeks in EHSI (IQR: 12-26.5), and 7 weeks (IQR: 4-10) in ECP (p < 0.01). Pain on the visual analogue scale (VAS) and need for analgesics were lower in the PEPSiT group (p < 0.01). Mean time to return to normal life was shorter with PEPSiT-177 days earlier than EHSI (95% CI 124.7-230.2; p < 0,01) and 7.2 days earlier tan EPC (95% CI 20.2-138.6; p < 0,009). Complications with PEPSiT were 9.3 times lower tan EHSI [odds ratio (OR) 9.3; 95% confidence interval (CI) 3.5-24.7] and 8.5 times lower than ECP (OR = 8.5; 95% CI 2.9-24.4). EHSI had 5.3 times more probability of recurrence than PEPSiT (OR = 5.3; 95% CI 1.3-22.7), and ECP 15.2 times more (OR = 15.2; 95% CI 3.2-71.7). CONCLUSIONS: Endoscopic pilonidal sinus treatment is effective in medium-term follow-up, with fewer complications than classic techniques. It allows for an early return to normal life without restrictions.", "provenance": [ { "field": "n", "quote": "In total, 149 patients were studied-100 undergoing PEPSiT, 28 undergoing EHSI, and 21 undergoing EPC." }, { "field": "population", "quote": "A quasi-experimental study was carried out in pediatric patients undergoing pilonidal sinus surgery at a single institution from 2019 to 2022." }, { "field": "intervention", "quote": "Pediatric endoscopic pilonidal sinus treatment (PEPSiT)" }, { "field": "comparator", "quote": "Excision and healing by secondary intention (EHSI), excision and primary closure (EPC), and PEPSiT were compared." }, { "field": "primaryOutcome", "quote": "Median full healing process was 4 weeks [interquartile range (IQR): 3-8] in PEPSiT, 16 weeks in EHSI (IQR: 12-26.5), and 7 weeks (IQR: 4-10) in ECP (p < 0.01)." }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:39634483", "pmid": "39634483", "doi": "10.3389/fsurg.2024.1456846", "nctId": null, "pmcid": "PMC11614795", "title": "Unroofing and curettage for recurrent sacrococcygeal pilonidal disease", "firstAuthor": "Koc", "multipleAuthors": true, "journal": "Front Surg", "year": 2024, "design": "retrospective", "n": 74, "nField": "reported", "population": "patients over 16 with recurrent pilonidal disease at the top of the buttock crack, after at least one prior surgery", "intervention": "unroofing and curettage surgery", "comparator": "", "primaryOutcome": "recurrence rate, operation time, and recovery/return-to-work duration", "result": "recurrence occurred in only 1 of 74 patients (1.3%), with quick recovery and short operation time", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a retrospective study without a comparison group, so it cannot prove this surgery is better than other options.", "directness": "direct", "limitations": "retrospective design, no control group, single center/selected patient group with prior recurrence", "followUp": "81.6 ± 49 months", "plainFinding": "Low recurrence after repeat surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39634483/", "sourceText": "PURPOSE: Sacrococcygeal pilonidal disease (SPD) is a global concern, notably in Southeast Europe and the Middle East. Unroofing curettage (UC), which provides faster recovery, better cosmetic appearance, and lower recurrence rates in the primary cases, was evaluated with the results of recurrent disease. METHODS: This retrospective study included 74 patients with recurrent disease who were over 16 years of age, experienced recurrence after at least one surgical attempt, and underwent unroofing curettage between 2007 and 2019. Operation time, return to work duration, and recurrence rates were assessed. RESULTS: Mean age of patients was 29.8 ± 10.6 years, and 61 (82.4%) were male. Previous procedures included excision + flap reconstruction, excision + primary closure, and local excision + lay open. Mean operation time for unroofing curettage was 22 ± 5.3 min. Mean durations for return to work and recovery were 5.9 ± 3 days, and 6.5 ± 2.6 weeks, respectively. Mean follow-up duration was 81.6 ± 49 months. Recurrence was only observed in 1 (1.3%) patient. Unroofing curettage showed a mean recurrence-free period of 156.9 months (95% CI [, 152.9-160.9 months). CONCLUSION: Unroofing curettage stands out as a low-recurrence approach, likely to persist as a treatment method, especially for a selected group with recurrence.", "provenance": [ { "field": "population", "quote": "This retrospective study included 74 patients with recurrent disease who were over 16 years of age, experienced recurrence after at least one surgical attempt" }, { "field": "intervention", "quote": "underwent unroofing curettage between 2007 and 2019" }, { "field": "primaryOutcome", "quote": "Operation time, return to work duration, and recurrence rates were assessed." }, { "field": "result", "quote": "Recurrence was only observed in 1 (1.3%) patient." }, { "field": "n", "quote": "This retrospective study included 74 patients with recurrent disease" }, { "field": "followUp", "quote": "Mean follow-up duration was 81.6 ± 49 months." } ] }, { "id": "pmid:39578271", "pmid": "39578271", "doi": "10.1007/s10103-024-04239-0", "nctId": null, "pmcid": null, "title": "Does the holmium laser have a place in the treatment of pilonidal cysts? (Pilolas study)", "firstAuthor": "Darnis", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2024, "design": "retrospective", "n": null, "nField": "not-reported", "population": "people treated for pilonidal cysts (tailbone cysts)", "intervention": "holmium laser treatment of the cyst", "comparator": "SiLaT laser (the standard minimally invasive laser technique)", "primaryOutcome": "cure (healing) rate one month after treatment", "result": "Healing rate at one month was 90.7%, similar to SiLaT, but pain, infection and recurrence were more common", "resultDirection": "mixed", "quality": "low", "qualityWhy": "It is a retrospective study without a direct comparison group, so the comparison to SiLaT relies on indirect data.", "directness": "direct", "limitations": "Retrospective design, comparison to SiLaT laser not based on a head-to-head trial, and the cause of the pain is only inferred.", "followUp": "up to a year", "plainFinding": "Similar healing, more pain afterward.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39578271/", "sourceText": "Recently, a minimally invasive procedure based on a laser technique (SiLaT) has been developed for the treatment of pilonidal cysts. Although less invasive and less painful than surgery, this solution is nevertheless limited by its high cost. Other more affordable laser devices, such as the holmium laser, are also used in minimally invasive surgery. The objective of this study was to evaluate the possibility of using the holmium laser instead of the SiLaT laser in the treatment of pilonidal cysts. Retrospective cohort study with the primary endpoint being the cure rate one month after treatment. Median duration of local care was 21 days (mean = 22 ± 7.5) and healing rate at 1 month was 90.7%. During follow-up, 102 patients (44.9%) experienced pain in the coccygeal region often exacerbated by sitting and significantly more common in people with a small frame, overwhelmingly female. A surgical site infection was reported in 36 patients (15.9%). Recurrence, occurred in 39 patients (17.2%), was related to cyst type (type 1 do not recur, type 3 recur twice three time than type 2). Holmium laser does not differ from SiLaT laser in the healing rate of pilonidal cysts after treatment. However, it is characterised by a moderately higher incidence of complications, foremost of which is the occurrence of pain that can persist for up to a year after the procedure and which could be related to an increase in heat inherent to the use of holmium. As a result, this procedure does not seem to represent an alternative to SiLaT.", "provenance": [ { "field": "population", "quote": "treatment of pilonidal cysts" }, { "field": "intervention", "quote": "the holmium laser instead of the SiLaT laser in the treatment of pilonidal cysts" }, { "field": "comparator", "quote": "Holmium laser does not differ from SiLaT laser in the healing rate of pilonidal cysts after treatment" }, { "field": "primaryOutcome", "quote": "the primary endpoint being the cure rate one month after treatment" }, { "field": "result", "quote": "healing rate at 1 month was 90.7%" }, { "field": "result", "quote": "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" }, { "field": "followUp", "quote": "pain that can persist for up to a year after the procedure" } ] }, { "id": "pmid:39551964", "pmid": "39551964", "doi": "10.1111/codi.17238", "nctId": null, "pmcid": null, "title": "Distinct recurrence patterns according to disease manifestation in pilonidal sinus disease treated with cleft lift surgery at 5 years' follow-up in a large prospective Danish cohort", "firstAuthor": "Pedersen", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2025, "design": "prospective-cohort", "n": 392, "nField": "reported", "population": "adults with pilonidal sinus disease (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", "intervention": "Bascom's cleft lift surgery", "comparator": "compared outcomes between three disease subgroups (primary extensive disease, nonhealing wounds, recurrent disease) rather than against another treatment", "primaryOutcome": "wound healing and recurrence of the disease after surgery", "result": "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", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "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.", "directness": "direct", "limitations": "single high-volume center, no comparator treatment group, and the abstract does not report how missing follow-up data were handled", "followUp": "60 months (45-73 months)", "plainFinding": "Mostly healed, but recurrence varies by case", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39551964/", "sourceText": "AIM: Pilonidal sinus disease (PSD) is a common condition particularly affecting the young population. The disease is incompletely understood, and optimal treatment is still debated. However, off-midline closure techniques have become the standard of care in more advanced cases. The literature is, however, lacking disease stratification in evaluation of surgical results. The aim of this study was to evaluate the surgical outcomes in a prospective cohort following Bascom's cleft lift (BCL) in primary extensive disease, nonhealing wounds after previous surgery and recurrence on a large Danish cohort from a high-volume centre. METHOD: The study is based on a prospective database established at Randers Regional Hospital in 2016. All patients undergoing BCL surgery from June 2016 until June 2020 were included in this study. RESULTS: Three hundred and ninety two patients (326 men/66 women) underwent BCL surgery over a 4-year period. Of these, 127 (32.4%) presented with primary extensive PSD, 136 (34.7%) with nonhealing wounds and 129 (33.9%) with recurrent PSD. Overall, 87% healed uneventfully within the first 3 months, and 17% had recurrence at a median follow-up of 60 months (45-73 months). However, the risk of recurrence was higher among patients with nonhealing wounds (20%) and recurrence (17%) compared with primary extensive manifestation (13%). CONCLUSION: Treatment of advanced PSD remains challenging with a high rate of wound complications and recurrences, stressing the need for dedicated care. Patients with either failed surgery or recurrence need particular attention.", "provenance": [ { "field": "n", "quote": "Three hundred and ninety two patients (326 men/66 women) underwent BCL surgery over a 4-year period" }, { "field": "population", "quote": "Of these, 127 (32.4%) presented with primary extensive PSD, 136 (34.7%) with nonhealing wounds and 129 (33.9%) with recurrent PSD." }, { "field": "intervention", "quote": "Bascom's cleft lift (BCL)" }, { "field": "comparator", "quote": "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" }, { "field": "primaryOutcome", "quote": "Overall, 87% healed uneventfully within the first 3 months, and 17% had recurrence at a median follow-up of 60 months" }, { "field": "result", "quote": "the risk of recurrence was higher among patients with nonhealing wounds (20%) and recurrence (17%) compared with primary extensive manifestation (13%)" }, { "field": "followUp", "quote": "median follow-up of 60 months (45-73 months)" } ] }, { "id": "pmid:39507353", "pmid": "39507353", "doi": "10.1093/jscr/rjae683", "nctId": null, "pmcid": "PMC11539901", "title": "A novel, double Limberg flap repair for recurrent pilonidal sinus disease", "firstAuthor": "Leung", "multipleAuthors": true, "journal": "J Surg Case Rep", "year": 2024, "design": "case-series", "n": 1, "nField": "reported", "population": "18-year-old male with extensive recurrent pilonidal sinus disease", "intervention": "double Limberg flap surgery (two rotational skin flaps used together)", "comparator": "none (single case, no comparison group)", "primaryOutcome": "wound healing and recurrence after surgery", "result": "patient recovered well with no recurrence at 3 months", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether this works in general.", "directness": "direct", "limitations": "Only one patient was treated and followed for just 3 months, so long-term success and general safety are unknown.", "followUp": "3 months", "plainFinding": "New surgery healed one case", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39507353/", "sourceText": "Pilonidal sinuses are chronic inflammation and/or infection of the intergluteal region. Recurrent disease is common and is a source of significant morbidity for affected patients. We present a case of an eighteen-year-old male with extensive recurrent pilonidal disease. A novel technique of a double Limberg flap repair was used, with the vertical axes of each flap positioned to optimise wound tension. The cranio-caudal length of the disease in the natal cleft would have resulted in a large amount of excised normal tissue laterally if a single Limberg flap was considered. To avoid this, we used two Limberg flaps over the craniocaudal length to minimise the laterally excised tissue. The patient made an uneventful recovery with no recurrence at 3 months follow-up. This technique demonstrates the flexibility of the Limberg flap, and that a double flap may be successfully used in extensive disease.", "provenance": [ { "field": "n", "quote": "a case of an eighteen-year-old male with extensive recurrent pilonidal disease" }, { "field": "population", "quote": "an eighteen-year-old male with extensive recurrent pilonidal disease" }, { "field": "intervention", "quote": "A novel technique of a double Limberg flap repair was used" }, { "field": "comparator", "quote": "if a single Limberg flap was considered" }, { "field": "primaryOutcome", "quote": "The patient made an uneventful recovery with no recurrence at 3 months follow-up." }, { "field": "result", "quote": "The patient made an uneventful recovery with no recurrence at 3 months follow-up." } ] }, { "id": "pmid:39459497", "pmid": "39459497", "doi": "10.3390/medicina60101710", "nctId": null, "pmcid": "PMC11509449", "title": "A Comparative Analysis of Pain Assessment Methods in the Initial Postoperative Phase Following Different Pilonidal Cyst Surgeries", "firstAuthor": "Dainius", "multipleAuthors": true, "journal": "Medicina (Kaunas)", "year": 2024, "design": "rct", "n": 78, "nField": "reported", "population": "adults with symptomatic pilonidal cysts (a cyst/abscess near the top of the buttock crack) undergoing surgery", "intervention": "minimally invasive 'pit-picking' surgery for pilonidal cyst", "comparator": "radical excision surgery for pilonidal cyst", "primaryOutcome": "pain intensity after surgery, measured by visual analog scale and pressure algometry", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "Small sample size; abstract states further larger studies are needed; no correlation found between the two pain measurement methods.", "followUp": "the day after the operation", "plainFinding": "Similar pain scores; more pain on pressure testing", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39459497/", "sourceText": "Background and Objectives: In this study, we aimed to evaluate pain intensity in patients after pilonidal disease surgeries of varying extent using pressure algometry and the visual analog scale and to explore potential correlations between these methods. Materials and Methods: A total of 78 adult patients with symptomatic pilonidal cysts were enrolled in this study. The patients were divided into two groups based on the type of surgery assigned to each patient at the pre-hospital consultation: pit-picking surgery (n = 39) and radical excision (n = 39). The pain levels at the surgical site were assessed and compared using the visual analog scale (VAS) and pressure algometry the morning before surgery and the day after the operation. Results: 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. Notably, specific pressure algometry variables (pressure pain tolerance left 2.05 ± 1.46 compared to 1.42 ± 0.73 kg/cm2, p = 0.02; maximum pressure pain tolerance left 2.91 ± 1.33 compared to 2.32 ± 1.14 kg/cm2, p = 0.04; maximum pressure pain tolerance center 2.51 ± 1.07 compared to 1.91 ± 0.91 kg/cm2, p = 0.01; interval of pressure pain tolerance center 0.98 ± 0.62 compared to 0.59 ± 0.39 kg/cm2, p = 0.00) on the first postoperative day were significantly lower in the \"pit-picking\" group compared to the excision group. Furthermore, no statistically significant correlation was found between VAS and pressure algometry measurements either before surgery or on the first postoperative day. Conclusions: In the early postoperative period following pilonidal disease surgery of varying extents, pain measured with the VAS does not differ. In contrast, the pressure algometry method showed greater pain in the minimally invasive surgery cohort on the first postoperative day. However, further larger studies are needed to compare these pain assessment methods in reporting pain intensity experienced during patient movement.", "provenance": [ { "field": "population", "quote": "A total of 78 adult patients with symptomatic pilonidal cysts were enrolled in this study." }, { "field": "intervention", "quote": "pit-picking surgery (n = 39)" }, { "field": "comparator", "quote": "radical excision (n = 39)" }, { "field": "primaryOutcome", "quote": "to evaluate pain intensity in patients after pilonidal disease surgeries of varying extent using pressure algometry and the visual analog scale" }, { "field": "result", "quote": "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." }, { "field": "result", "quote": "significantly lower in the \"pit-picking\" group compared to the excision group" }, { "field": "result", "quote": "no statistically significant correlation was found between VAS and pressure algometry measurements either before surgery or on the first postoperative day" }, { "field": "n", "quote": "A total of 78 adult patients with symptomatic pilonidal cysts were enrolled in this study." }, { "field": "limitations", "quote": "further larger studies are needed to compare these pain assessment methods in reporting pain intensity experienced during patient movement" } ] }, { "id": "pmid:39427709", "pmid": "39427709", "doi": "10.1016/j.cireng.2024.10.002", "nctId": null, "pmcid": null, "title": "Short-term results of unroofing and marsupialization compared to the Karydakis technique in the treatment of pilonidal sinus. A randomized prospective study", "firstAuthor": "Baños", "multipleAuthors": true, "journal": "Cir Esp (Engl Ed)", "year": 2025, "design": "rct", "n": 122, "nField": "reported", "population": "adults having surgery for pilonidal sinus at the top of the buttock crack", "intervention": "unroofing and marsupialization surgery", "comparator": "Karydakis technique surgery", "primaryOutcome": "complications in the first 30 days after surgery", "result": "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", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "90-day follow-up", "plainFinding": "Simpler surgery, fewer early complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39427709/", "sourceText": "INTRODUCTION: The treatment of pilonidal sinus (PS) is usually surgical, but no procedure is considered the gold standard. The Karydakis (K) technique is widely used, and unroofing and marsupialization (UM) is a simple surgery with good results. PRIMARY OBJECTIVE: To evaluate early postoperative complications (EPC) 30 days after UM surgery compared to the K technique. SECONDARY OBJECTIVES: To evaluate surgical time, postoperative pain, patient satisfaction, return to daily activity and early recurrence within 3 months. METHOD: Prospective, single-center, randomized study in patients who underwent surgery for primary PS with no abscess between June 2016 and November 2017. They were randomized using a computer-generated block method. To analyze the main objective, a non-inferiority analysis was performed. RESULTS: 122 patients with symptomatic primary PS were randomized: 60 in the K group and 62 in the UM group. Both groups were homogeneous. There were statistically significant differences between surgery and postoperative complications at 15 and 30 days in favor of UM. There were also differences in favor of UM in surgical time and return to daily activity. During the 90-day follow-up, there were 3 recurrences in the UM group and 0 in the K group. CONCLUSIONS: UM is a simple, minimally invasive, easily reproducible technique that has a lower rate of early complications, with a shorter operative time and an earlier return to daily activity.", "provenance": [ { "field": "population", "quote": "122 patients with symptomatic primary PS were randomized" }, { "field": "intervention", "quote": "unroofing and marsupialization (UM) is a simple surgery with good results" }, { "field": "comparator", "quote": "The Karydakis (K) technique is widely used" }, { "field": "primaryOutcome", "quote": "To evaluate early postoperative complications (EPC) 30 days after UM surgery compared to the K technique" }, { "field": "result", "quote": "There were statistically significant differences between surgery and postoperative complications at 15 and 30 days in favor of UM. There were also differences in favor of UM in surgical time and return to daily activity. During the 90-day follow-up, there were 3 recurrences in the UM group and 0 in the K group." }, { "field": "n", "quote": "122 patients with symptomatic primary PS were randomized: 60 in the K group and 62 in the UM group." }, { "field": "followUp", "quote": "During the 90-day follow-up, there were 3 recurrences in the UM group and 0 in the K group." } ] }, { "id": "pmid:39422799", "pmid": "39422799", "doi": "10.1007/s00384-024-04742-4", "nctId": null, "pmcid": "PMC11489158", "title": "Phenolization of the sinus tract in recurrent sacrococcygeal pilonidal sinus disease: long-term results of a prospective cohort study", "firstAuthor": "de Kort", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2024, "design": "prospective-cohort", "n": 47, "nField": "reported", "population": "patients with recurrent sacrococcygeal pilonidal sinus disease", "intervention": "phenolization (a chemical treatment) of the sinus tract", "comparator": "no separate comparison group - outcomes compared to before treatment", "primaryOutcome": "whether the sinus came back and needed more surgery", "result": "about 15% of patients needed repeat surgery for recurrence, and pain, discharge and itching improved over the long term", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "small sample, no control group, based partly on patient questionnaires, and only looked at recurrent (not first-time) cases", "followUp": "76 (SD 21.7) months", "plainFinding": "Less pain, fewer recurrences long-term", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39422799/", "sourceText": "AIM: In recent years, the paradigm for the treatment of sacrococcygeal pilonidal sinus disease (SPSD) has shifted from surgical excision toward more minimally invasive techniques. Although extensive research has been conducted on the minimal invasive phenolization technique for primary SPSD, literature in recurrent SPSD is lacking. The purpose of this study was to report the long-term outcomes of the phenolization technique for recurrent SPSD. METHOD: This study included all 57 patients who were initially prospectively included in this study for short-term follow-up after phenolization for recurrent SPSD. A questionnaire was sent out to all patients to obtain long-term outcome. The primary endpoint was recurrence. Secondary endpoints included quality of life and symptoms related to SPSD. RESULTS: A total of 47 patients (82.5%) were available for long-term follow-up. Recurrence needing further surgery developed in 7 patients (14.9%) after a mean follow-up of 76 (SD 21.7) months. At follow-up, there was improvement in the quality of life compared to preoperative levels (82.0, IQR 75.0-90.0 versus 74.0 IQR 52.5-80.0, p = 0.024). Additionally, symptoms associated with SPSD, including pain, fluid discharge, and itching sensation, also showed significant improvement. A total of 42 patients (89.4%) would undergo the same treatment again. No significant association was found between known risk factors and recurrence. CONCLUSION: Phenolization for recurrent SPSD showed a recurrence rate of 14.9% with significant improvement of natal cleft symptoms and quality of life at long-term follow-up. Therefore, phenolization should be considered as a feasible option for patients with recurrent SPSD.", "provenance": [ { "field": "population", "quote": "phenolization for recurrent SPSD" }, { "field": "n", "quote": "A total of 47 patients (82.5%) were available for long-term follow-up." }, { "field": "intervention", "quote": "the phenolization technique for recurrent SPSD" }, { "field": "comparator", "quote": "there was improvement in the quality of life compared to preoperative levels" }, { "field": "primaryOutcome", "quote": "The primary endpoint was recurrence." }, { "field": "result", "quote": "Recurrence needing further surgery developed in 7 patients (14.9%) after a mean follow-up of 76 (SD 21.7) months." }, { "field": "result", "quote": "Additionally, symptoms associated with SPSD, including pain, fluid discharge, and itching sensation, also showed significant improvement." }, { "field": "followUp", "quote": "after a mean follow-up of 76 (SD 21.7) months" } ] }, { "id": "pmid:39370557", "pmid": "39370557", "doi": "10.1111/codi.17198", "nctId": null, "pmcid": "PMC11683170", "title": "Closed-incision negative-pressure wound therapy after Bascom's cleft lift surgery for pilonidal sinus disease: A randomized study comparing healing", "firstAuthor": "Faurschou", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2024, "design": "rct", "n": 118, "nField": "reported", "population": "patients undergoing surgery for complicated pilonidal sinus disease", "intervention": "negative-pressure wound therapy applied to the closed incision after surgery", "comparator": "standard drain and dry dressing after surgery", "primaryOutcome": "whether the surgical wound had healed at 2 and 12 weeks", "result": "no significant difference in healing rates between the two wound care methods at either time point", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "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.", "directness": "indirect", "limitations": "study stopped early after interim analysis before reaching the planned 200 patients", "followUp": "12 weeks", "plainFinding": "No difference in wound healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39370557/", "sourceText": "AIM: Despite favourable outcomes in recurrence after off-midline closure techniques in pilonidal surgery, between 18% and 40% of patients suffer from prolonged postoperative wound healing. The aim of this work was to investigate if closed-incision negative-pressure wound therapy (NPWT) promotes wound healing after Bascom's cleft lift (BCL) surgery for complicated pilonidal sinus disease compared with conventional drainage and dressing. METHOD: Patients were randomized to either NPWT for 4-7 days or loop-vessel drain for 24 h and a dry dressing postoperatively. Healing was evaluated by a wound care nurse blinded for randomization at 2 and 12 weeks postoperatively (primary endpoint). Healing was defined as one or no closing defects of ≤5 mm and with no undermining. RESULTS: Although we had wanted to recruit 200 patients, the study was terminated at 118 patients (NPWT group, n = 60; control group, n = 58) after interim analysis. Patients were comparable by age, sex, body mass index, previous smoking status and indication for BCL surgery. At 2 weeks 12% of patients were healed in both the NPWT and control groups [risk difference = 0.00(95% CI -0.12 to 0.11), p = 1.00]. 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]. There was no significant difference in pain experienced postsurgery. In a symptom-based questionnaire, the control group reported self-esteem to be less affected (p = 0.015). CONCLUSION: Closed-incision negative-pressure wound therapy did not significantly improve healing after BCL surgery for complicated pilonidal sinus disease.", "provenance": [ { "field": "n", "quote": "the study was terminated at 118 patients (NPWT group, n = 60; control group, n = 58)" }, { "field": "population", "quote": "complicated pilonidal sinus disease" }, { "field": "intervention", "quote": "closed-incision negative-pressure wound therapy (NPWT) promotes wound healing after Bascom's cleft lift (BCL) surgery" }, { "field": "comparator", "quote": "conventional drainage and dressing" }, { "field": "primaryOutcome", "quote": "Healing was evaluated by a wound care nurse blinded for randomization at 2 and 12 weeks postoperatively (primary endpoint)" }, { "field": "result", "quote": "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]" }, { "field": "followUp", "quote": "at 2 and 12 weeks postoperatively" } ] }, { "id": "pmid:39357489", "pmid": "39357489", "doi": "10.1016/j.ijscr.2024.110384", "nctId": null, "pmcid": "PMC11471657", "title": "Peri anal region is an overlooked location for pilonidal recurrence after surgical excision and closure - A case series", "firstAuthor": "Jo", "multipleAuthors": true, "journal": "Int J Surg Case Rep", "year": 2024, "design": "case-series", "n": 5, "nField": "reported", "population": "patients with pilonidal disease that came back after surgery", "intervention": "hair removal (manual and laser epilation), with one patient needing an additional procedure", "comparator": "none", "primaryOutcome": "whether the recurrent wounds healed", "result": "all five patients' wounds healed completely", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a tiny report of just five patients with no comparison group, so it cannot reliably show what works.", "directness": "indirect", "limitations": "Very small number of patients, no control group, and from a single specialty clinic, so results may not generalize.", "followUp": "", "plainFinding": "Hair removal healed recurrent pilonidal wounds.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39357489/", "sourceText": "INTRODUCTION AND IMPORTANCE: Patients with pilonidal disease (PD) often undergo wide excision of pilonidal sinuses and flap-based closures. Patients who failed these procedures can have recurrent perianal wounds obscured by hair and unrecognized even by the treating physicians. In this report, we describe a series of pilonidal patients with recurrent disease and perianal wounds. CASE PRESENTATION: Five pilonidal patients with recurrent disease after surgical excision and flap closure were referred to our Pilonidal Care Clinic. All five were found to have perianal wounds. Each patient was treated with regular manual and laser epilation and only one patient required a Gips procedure. All wounds were successfully healed. CLINICAL DISCUSSION: After removal of hair at the perianal region, patients with recurrent pilonidal disease can expose a pilonidal sinus that was previously unrecognized. Peri-anal wounds can have poor wound healing due to the close proximity of the wound to the anal verge, risk of contamination, difficulty of consistent observation of the wound, and moist environment of the anus that retains bacteria. Careful consideration of proper wound care post-excision of perianal pilonidal sinuses should be prioritized. CONCLUSIONS: Pilonidal perianal wounds after previous surgical excision and flap closure can be obscured by hair, resulting in recurrent pain and drainage. The perianal wounds can be successfully healed with regular manual and laser epilation and selectively excised using Gips procedure.", "provenance": [ { "field": "n", "quote": "Five pilonidal patients with recurrent disease after surgical excision and flap closure were referred to our Pilonidal Care Clinic." }, { "field": "population", "quote": "Five pilonidal patients with recurrent disease after surgical excision and flap closure were referred to our Pilonidal Care Clinic." }, { "field": "intervention", "quote": "Each patient was treated with regular manual and laser epilation and only one patient required a Gips procedure." }, { "field": "comparator", "quote": "All five were found to have perianal wounds." }, { "field": "primaryOutcome", "quote": "All wounds were successfully healed." }, { "field": "result", "quote": "All wounds were successfully healed." } ] }, { "id": "pmid:39323001", "pmid": "39323001", "doi": "10.1111/codi.17152", "nctId": null, "pmcid": "PMC11683164", "title": "Decision regret following surgical management of pilonidal disease", "firstAuthor": "Banks", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2024, "design": "prospective-cohort", "n": 677, "nField": "reported", "population": "patients with pilonidal disease who had surgery", "intervention": "surgical treatment of pilonidal disease (mostly major excisional surgery)", "comparator": "no direct comparator group; outcomes compared based on complications and recurrence", "primaryOutcome": "patient regret about their treatment decision 6 months after surgery", "result": "patients who had complications or disease come back were more likely to regret their treatment decision", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "6 months", "plainFinding": "Surgery complications linked to more regret.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39323001/", "sourceText": "AIM: Surgical decision making in the context of pilonidal disease (PD) can be challenging. Current evidence for the management of PD is inadequate and optimum treatment is not clear. This paper reports on patient experience of shared decision making (SDM) and decision regret following surgical management of PD. METHOD: The Pilonidal Trial. Studying the Treatment Options (PITSTOP) study (ISRCTN95551898) is a prospective cohort study of patients with PD treated between May 2019 and March 2022. This subanalysis reports the results of quantitative data capture between baseline and 6 months post-procedure. Baseline data consisted of patient and disease characteristics, surgical procedure and impression of SDM. Post-procedure data consisted of operative outcomes and decision regret. Multiple linear regression analysis was used to analyse the relationship between clinical outcomes and decision regret. RESULTS: Overall, 677 patients were included, and follow-up data to 6 months were available for 476 (71%). Most (59.5%) patients underwent major excisional surgery; 45.1% of patients experienced a postoperative complication. Participant impression of SDM was positive, with a median CollaboRATE mean-score response of 3 (interquartile range: 3-4). Of the patients who underwent a 'leave open' approach, 20.6% were dissatisfied or very dissatisfied with their treatment. 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. CONCLUSION: The clinical outcomes, postoperative complications and recurrence, were associated with higher levels of decision regret. Surgeons treating patients with PD should practice SDM and ensure that patient priorities inform treatment approach.", "provenance": [ { "field": "n", "quote": "Overall, 677 patients were included" }, { "field": "population", "quote": "patients with PD treated between May 2019 and March 2022" }, { "field": "intervention", "quote": "Most (59.5%) patients underwent major excisional surgery" }, { "field": "comparator", "quote": "Of the patients who underwent a 'leave open' approach, 20.6% were dissatisfied or very dissatisfied with their treatment." }, { "field": "primaryOutcome", "quote": "Post-procedure data consisted of operative outcomes and decision regret." }, { "field": "result", "quote": "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." }, { "field": "followUp", "quote": "quantitative data capture between baseline and 6 months post-procedure" } ] }, { "id": "pmid:39313437", "pmid": "39313437", "doi": "10.3760/cma.j.cn441530-20231017-00137", "nctId": null, "pmcid": null, "title": "[Clinical application of parasacral artery perforator flap in the treatment of Pilonidal Sinus Diseases]", "firstAuthor": "Lan", "multipleAuthors": true, "journal": "Zhonghua Wei Chang Wai Ke Za Zhi", "year": 2024, "design": "case-series", "n": 6, "nField": "reported", "population": "patients with pilonidal sinus disease (infected hair-containing cyst near the tailbone)", "intervention": "surgical removal of infected tissue plus a parasacral artery perforator flap (skin flap) to cover the wound", "comparator": "none (single-arm case series, no comparison group)", "primaryOutcome": "wound healing after surgery, including complications and recurrence", "result": "all six patients healed fully with no early or late complications and no recurrence during follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "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.", "directness": "direct", "limitations": "Very small sample size (6 patients), no control group, short case series design.", "followUp": "6-16 months", "plainFinding": "All healed well after flap surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39313437/", "sourceText": "Objective: To investigate clinical efficacy of parasacral perforator flap (PPF) on postoperative wound healing in pilonidal sinus diseases (PSDs). Methods: The surgery steps were as follows: (1) To preoperatively detect parasacral perforator arteries with the handhold Doppler probe and mark them; (2) To remove the infected and necrotic tissues of PSDs completely; (3) To design the PPF according to the wound size and the parasacral perforator arteries' localization; (4) To harvest the flap from the gluteus maximus muscle surface and transfer it to the wound without tension. Several data were documented, including surgical duration, flap length, flap width, drainage tube placement duration, hospital stay, duration from operation to stitch removal, postsurgical complications and recurrence. Results: There were six patients with PSDs whose postoperative wound healing was repaired by PPF, admitted in our department from March 2021 to March 2023. Of them, five were male and one was female. Their median age was 24 (range: 18-33) years old. Their median surgical duration was 165 (range: 134-207) minutes, median length of PPF was 8 (range: 7-11) cm, median width of PPF was 3 (range: 3-4) cm, mean duration of drainage tube placement was 8 (range: 4-17) days, mean hospital stay was 13 (range: 6-23) days, mean duration from operation to stitch removal was 14 (range: 14-17) days, median follow-up time was 6-16 months. Incisions of all six cases achieved first-intention healing without early- or late-stage complications. No recurrence occurred during follow-up. All patients involved were satisfied with their clinical efficacy. Conclusion: The utility of PPF in postoperative wound healing of PPDs was effective, safe and reliable.", "provenance": [ { "field": "n", "quote": "There were six patients with PSDs whose postoperative wound healing was repaired by PPF" }, { "field": "population", "quote": "patients with PSDs" }, { "field": "intervention", "quote": "To design the PPF according to the wound size and the parasacral perforator arteries' localization" }, { "field": "comparator", "quote": "Results: There were six patients with PSDs whose postoperative wound healing was repaired by PPF" }, { "field": "primaryOutcome", "quote": "To investigate clinical efficacy of parasacral perforator flap (PPF) on postoperative wound healing in pilonidal sinus diseases (PSDs)." }, { "field": "result", "quote": "Incisions of all six cases achieved first-intention healing without early- or late-stage complications. No recurrence occurred during follow-up." } ] }, { "id": "pmid:39310334", "pmid": "39310334", "doi": "10.1097/AS9.0000000000000488", "nctId": null, "pmcid": "PMC11415133", "title": "Heterogeneity of Treatment Effects of Laser Epilation on Pilonidal Disease Recurrence: A Randomized Clinical Trial", "firstAuthor": "Bergus", "multipleAuthors": true, "journal": "Ann Surg Open", "year": 2024, "design": "rct", "n": 302, "nField": "reported", "population": "patients aged 11 to 21 with pilonidal disease (the painful condition at the top of the buttock crack)", "intervention": "laser hair removal (laser epilation) of the gluteal cleft plus standard care", "comparator": "standard care alone (better hygiene and shaving or hair-removal cream)", "primaryOutcome": "pilonidal disease coming back (recurrence) within 1 year", "result": "Laser treatment lowered recurrence much more in non-Hispanic white and privately insured patients than in other racial/ethnic groups or publicly insured patients", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "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.", "directness": "direct", "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.", "followUp": "1-year follow-up", "plainFinding": "Laser benefit varied by race and insurance.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39310334/", "sourceText": "OBJECTIVE: To investigate the heterogeneity of treatment effects (HTE) of laser epilation in preventing pilonidal disease recurrence through analysis of prespecified clinical factors. BACKGROUND: Pilonidal disease is a common, painful disease affecting 1% of the population aged 15 to 30 years with postoperative recurrence rates as high as 30% to 40%. METHODS: Single-institution randomized controlled trial from September 2017 to September 2022 with 1-year follow-up, including patients aged 11 to 21 years with pilonidal disease undergoing gluteal cleft laser epilation and standard care (improved hygiene and mechanical or chemical depilation) or standard care alone. RESULTS: In total, 302 patients were enrolled with 151 randomized to each intervention. 1-year follow-up was available for 96 patients in the laser group and 134 in the standard care group. There were no significant differences in treatment effects based on sex, body mass index, previous disease, prior surgical excision, or annual household income (all P > 0.05). HTE was identified by race and ethnicity (P = 0.005) and health insurance type (P = 0.001). 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. Recurrence rates among privately insured patients were 4.0% (3/75) with laser treatment and 33.3% (29/87) with standard care versus 36.8% (7/19) with laser treatment and 29.7% (11/37) with standard care in patients with public insurance. CONCLUSIONS: The effectiveness of laser epilation to reduce pilonidal disease recurrence rates may vary based on race and ethnicity and insurance type. Additional studies are warranted to investigate this potential HTE.", "provenance": [ { "field": "population", "quote": "including patients aged 11 to 21 years with pilonidal disease undergoing gluteal cleft laser epilation and standard care" }, { "field": "intervention", "quote": "gluteal cleft laser epilation and standard care" }, { "field": "comparator", "quote": "standard care alone" }, { "field": "primaryOutcome", "quote": "preventing pilonidal disease recurrence" }, { "field": "n", "quote": "In total, 302 patients were enrolled with 151 randomized to each intervention." }, { "field": "result", "quote": "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." }, { "field": "followUp", "quote": "with 1-year follow-up" } ] }, { "id": "pmid:39307596", "pmid": "39307596", "doi": "10.1016/j.jpedsurg.2024.161934", "nctId": null, "pmcid": null, "title": "Platelet-rich Plasma as an Adjuvant Therapy to Crystallized Phenol in the Treatment of Pediatric Pilonidal Sinus Disease: A Prospective Randomized Controlled Trial", "firstAuthor": "Azizoglu", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2025, "design": "rct", "n": 87, "nField": "reported", "population": "children and teens (0-18) with pilonidal sinus disease near the tailbone", "intervention": "crystallized phenol treatment plus platelet-rich plasma (PRP) injection", "comparator": "crystallized phenol treatment alone", "primaryOutcome": "time to healing, cosmetic appearance, pain, complications, success and recurrence rates", "result": "PRP group healed faster, had better cosmetic scores, less pain, higher success rate, and lower recurrence, with similar complication rates", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but done at only one hospital with a modest number of patients, so results may not generalize.", "directness": "direct", "limitations": "single-center study", "followUp": "", "plainFinding": "Faster healing, less pain, fewer recurrences", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39307596/", "sourceText": "OBJECTIVE: This study aims to evaluate the safety and efficacy of platelet-rich plasma (PRP) as an adjuvant to crystallized phenol (CP) in treating pediatric pilonidal sinus disease (PSD). METHODS: A single-center randomized controlled trial was conducted at Istanbul Esenyurt Hospital. Eighty-seven patients aged 0-18 were randomly assigned to two groups: the CP group (n = 42) and the CP + PRP group (n = 45). Upon arrival at the clinic, patients began a regimen of manual shaving and, if necessary, laser epilation every 6-8 weeks. For those with pilonidal abscesses, incision, drainage, and antibiotics were given. The treatment area was sterilized and numbed with local anesthesia. Hair removal and curettage were performed, followed by the application of crystallized phenol. In CP + PRP group, PRP injections were also administered. The procedure concluded with wound dressing and thorough disinfection. The study was registered https://clinicaltrials.gov/ (NCT06324656). RESULTS: The CP + PRP group demonstrated significantly shorter healing times (19.4 ± 7.88 days) compared to the CP group (30.7 ± 12.9 days) (p < 0.001). The cosmetic score was higher in the CP + PRP group (7.42 ± 1.61) than in the CP group (6.11 ± 1.88, p = 0.001). CP + PRP group had lower VAS scores at measured all-time points after applications (p < 0.05 for each). Complications were comparable between the groups, with no significant differences in bleeding, infections, or skin burns (p > 0.05 for each comparison). No difference was found between groups in terms of total complication rate (p = 0.398). The success rate was higher in CP + PRP group (98%; n = 44) compared to CP group (86%; n = 36) (p = 0.039). Recurrence rates were lower in CP + PRP group (2%; n = 1) than CP group (14%; n = 6) (p = 0.039). CONCLUSION: The autologous PRP injection in pediatric PSD is safe. The addition of PRP to CP treatment for pediatric PSD significantly improves healing time, cosmetic outcomes, and overall success rates without increasing complication rates. This combined approach offers a promising alternative for effective and efficient treatment of PSD in children. TYPE OF THE STUDY: Randomized controlled trial. LEVEL OF EVIDENCE: Level I.", "provenance": [ { "field": "n", "quote": "Eighty-seven patients aged 0-18 were randomly assigned to two groups: the CP group (n = 42) and the CP + PRP group (n = 45)." }, { "field": "population", "quote": "pediatric pilonidal sinus disease (PSD)" }, { "field": "intervention", "quote": "In CP + PRP group, PRP injections were also administered." }, { "field": "comparator", "quote": "the CP group (n = 42)" }, { "field": "primaryOutcome", "quote": "evaluate the safety and efficacy of platelet-rich plasma (PRP) as an adjuvant to crystallized phenol (CP) in treating pediatric pilonidal sinus disease" }, { "field": "result", "quote": "The CP + PRP group demonstrated significantly shorter healing times (19.4 ± 7.88 days) compared to the CP group (30.7 ± 12.9 days) (p < 0.001)." }, { "field": "result", "quote": "The success rate was higher in CP + PRP group (98%; n = 44) compared to CP group (86%; n = 36) (p = 0.039)." }, { "field": "result", "quote": "Recurrence rates were lower in CP + PRP group (2%; n = 1) than CP group (14%; n = 6) (p = 0.039)." } ] }, { "id": "pmid:39301876", "pmid": "39301876", "doi": "10.1111/codi.17169", "nctId": null, "pmcid": "PMC11683166", "title": "Long-term outcomes after cleft lift surgery for pilonidal sinus disease in post-pubertal adolescents: data from a prospective Danish cohort", "firstAuthor": "Ankersen", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2024, "design": "prospective-cohort", "n": 79, "nField": "reported", "population": "post-pubertal teenagers (median age 17) with pilonidal sinus disease, compared to adult patients", "intervention": "Bascom's cleft lift surgery", "comparator": "same surgery in adult patients", "primaryOutcome": "wound healing and recurrence of the condition after surgery", "result": "69% healed without problems; 5-year recurrence was 19% in adolescents versus 17% in adults, not a significant difference", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "this is a single-center observational cohort without randomization, so differences between age groups could be due to other factors.", "directness": "direct", "limitations": "Observational study design, no control group outside of comparison to adult cohort, single hospital.", "followUp": "62 months", "plainFinding": "Similar recurrence as adults.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39301876/", "sourceText": "AIM: Pilonidal sinus disease (PSD) is a common condition. Despite a relatively large proportion of patients presenting as post-pubertal adolescents, only small cohorts focusing on this PSD subcategory have been published, and surgical treatment remains challenging. METHOD: The study is based on a prospective database established at Randers Regional Hospital in 2016. All patients undergoing Bascom's cleft lift (BCL) surgery from June 2016 until June 2020 were included in this study, focusing on patients ≤18 years of age comparing them to adult patients. Indications for BCL surgery were primary extensive manifestation, non-healing disease after previous elective surgery or disease recurrence. RESULTS: In total, n = 380 PSD patients were operated, of which n = 79 were post-pubertal adolescents with a median age at time of surgery of 17.2 years (interquartile range 16.3, 18.0). Sixty-six (84%) were boys. Twenty-seven (34%) presented with primary extensive manifestation, 34 (43%) due to non-healing wounds and 18 (23%) due to recurrence. Fifty-four patients (69%) healed uneventfully. There was no difference between the indications of surgery groups in terms of overall healing or time to healing if prolonged (P = 0.6). The median follow-up was 62 months (interquartile range 48, 73), with a 5-year recurrence rate of 19%, compared to 17% (P = 0.6) in the adult population. CONCLUSION: Our study is the first to investigate long-term clinical outcomes of BCL surgery for PSD in post-pubertal adolescent patients. Recurrences seem to occur more frequently compared to adults. However, we demonstrate that post-pubertal adolescent patients with advanced PSD can be treated with BCL surgery with acceptable outcomes.", "provenance": [ { "field": "n", "quote": "n = 79 were post-pubertal adolescents" }, { "field": "population", "quote": "post-pubertal adolescents with a median age at time of surgery of 17.2 years" }, { "field": "intervention", "quote": "Bascom's cleft lift (BCL) surgery" }, { "field": "comparator", "quote": "comparing them to adult patients" }, { "field": "primaryOutcome", "quote": "Fifty-four patients (69%) healed uneventfully" }, { "field": "result", "quote": "5-year recurrence rate of 19%, compared to 17% (P = 0.6) in the adult population" } ] }, { "id": "pmid:39279621", "pmid": "39279621", "doi": "10.4103/ajps.ajps_153_22", "nctId": null, "pmcid": "PMC11493232", "title": "Presacral Keratinous and Dermoid Cyst Masquerading as Meningocele - A Rare Case Report", "firstAuthor": "Gupta", "multipleAuthors": false, "journal": "Afr J Paediatr Surg", "year": 2024, "design": "case-series", "n": 1, "nField": "reported", "population": "a fifteen-month-old girl with a mass near the tailbone and buttock", "intervention": "surgical removal of the cyst and tailbone (coccygectomy)", "comparator": "none mentioned", "primaryOutcome": "successful removal of the cyst and diagnosis via tissue examination", "result": "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", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report with no comparison group, so it cannot show whether the treatment works better than any alternative.", "directness": "indirect", "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", "followUp": "", "plainFinding": "Rare cyst found and surgically removed.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39279621/", "sourceText": "Presacral tumours are rare developmental tumours associated with midline closure defects. A fifteen-month-old girl presented with pain in the lower abdomen and dysuria. After examination, the child underwent investigations and was diagnosed as a presacral mass with intergluteal extension and caudal mass in the subcutaneous tissue of the left gluteal region. Complete excision of mass along with coccygectomy was done. 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.", "provenance": [ { "field": "population", "quote": "A fifteen-month-old girl presented with pain in the lower abdomen and dysuria." }, { "field": "intervention", "quote": "Complete excision of mass along with coccygectomy was done." }, { "field": "comparator", "quote": "Complete excision of mass along with coccygectomy was done." }, { "field": "primaryOutcome", "quote": "Histopathology showed presacral as a keratinous cyst and gluteal as a dermoid cyst." }, { "field": "result", "quote": "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." }, { "field": "n", "quote": "A fifteen-month-old girl presented with pain in the lower abdomen and dysuria." } ] }, { "id": "pmid:39222673", "pmid": "39222673", "doi": "10.1016/j.clindermatol.2024.08.010", "nctId": null, "pmcid": null, "title": "Introducing the Bender sign for the diagnosis of intergluteal cleft skin disorders", "firstAuthor": "Hoenig", "multipleAuthors": false, "journal": "Clin Dermatol", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "People with skin conditions near the buttocks crease", "intervention": "Bending over and spreading the buttocks to examine the skin (the 'Bender sign')", "comparator": "No comparator described", "primaryOutcome": "Ability to detect skin disease in the gluteal cleft area", "result": "The abstract does not report a measured outcome; it describes and names a physical examination technique and its history", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a historical/educational note about a physical exam trick, not a study testing whether a treatment works.", "directness": "indirect", "limitations": "Not a clinical study; no data, no patients analyzed, no outcomes measured — purely historical/educational commentary.", "followUp": "", "plainFinding": "Describes exam technique, not treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39222673/", "sourceText": "Dr Benjamin Bender (1908-1996) was a longtime Clinical Professor of Dermatology at the State University of New York Downstate College of Medicine. Some 45 years ago, he coined the eponym Bender sign, which describes the discovery of cutaneous diseases that involve the gluteal cleft by having patients bend over and then manually separating the buttocks. Bender's eponym was created as a humorous pun involving his name \"Bender\" and the \"bending\" of the patient. This contribution formally introduces this delightful eponym into the dermatology literature and highly recommends its adoption as a teaching tool to remind students of the importance of examining the intergluteal cleft area, which can often harbor a variety of skin disorders, such as psoriasis. A second Bender sign, referred to as Bender sign #2, is also presented, which describes the sparing of the nose when the face is rubbed and inflamed from neurodermatitis. This contribution pays tribute to Dr Benjamin Bender, a beloved master teacher of dermatology.", "provenance": [ { "field": "population", "quote": "cutaneous diseases that involve the gluteal cleft" }, { "field": "intervention", "quote": "having patients bend over and then manually separating the buttocks" }, { "field": "comparator", "quote": "This contribution formally introduces this delightful eponym into the dermatology literature" }, { "field": "primaryOutcome", "quote": "the importance of examining the intergluteal cleft area, which can often harbor a variety of skin disorders, such as psoriasis" }, { "field": "result", "quote": "This contribution pays tribute to Dr Benjamin Bender, a beloved master teacher of dermatology." } ] }, { "id": "pmid:39212563", "pmid": "39212563", "doi": "10.12968/hmed.2024.0171", "nctId": null, "pmcid": null, "title": "Parathyroid Hormone Related Protein Mediated Hypercalcaemia Due to Metastatic Squamous Cell Carcinoma Originating from Pilonidal Disease: A Case Report", "firstAuthor": "Montebello", "multipleAuthors": true, "journal": "Br J Hosp Med (Lond)", "year": 2024, "design": "case-series", "n": 1, "nField": "reported", "population": "a 56-year-old man with a long-standing painful skin lesion at the top of the buttock crack", "intervention": "treatment for squamous cell carcinoma (radiotherapy, chemotherapy, immunotherapy) after the lesion turned out to be cancer, not a pilonidal abscess", "comparator": "none - single patient case report", "primaryOutcome": "disease control and survival", "result": "despite treatment the cancer spread widely, caused severe high blood calcium that did not respond to treatment, and he died within a year", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single patient's case report, so it cannot tell you how likely this is for anyone else.", "directness": "indirect", "limitations": "only one patient; describes a rare cancer misdiagnosed as a pilonidal abscess, not ordinary pilonidal disease pain", "followUp": "within a year of diagnosis", "plainFinding": "Rare cancer mimicked pilonidal disease, proved fatal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39212563/", "sourceText": "A 56-year-old male presented with a longstanding, gradually enlarging, painful, skin lesion over the natal cleft. This was initially thought to be a pilonidal abscess but, following multiple surgeries, he was diagnosed with Stage IVb squamous cell carcinoma of the natal cleft skin with bilateral inguinal lymph node metastases and subcutaneous metastatic deposits. Complete surgical cure was not possible. He underwent radiotherapy, cisplatin chemotherapy and cemiplimab immunotherapy to control his disease. His course was complicated by severe humoral hypercalcaemia of malignancy (HHM) resistant to medical therapy. His disease progressed, and he developed widespread metastases. He was thus transferred to palliative care with pain control being the major priority. He died within a year of diagnosis.", "provenance": [ { "field": "population", "quote": "A 56-year-old male presented with a longstanding, gradually enlarging, painful, skin lesion over the natal cleft." }, { "field": "intervention", "quote": "He underwent radiotherapy, cisplatin chemotherapy and cemiplimab immunotherapy to control his disease." }, { "field": "comparator", "quote": "Complete surgical cure was not possible." }, { "field": "primaryOutcome", "quote": "His disease progressed, and he developed widespread metastases." }, { "field": "result", "quote": "He died within a year of diagnosis." }, { "field": "n", "quote": "A 56-year-old male presented" } ] }, { "id": "pmid:39174833", "pmid": "39174833", "doi": "10.1007/s00423-024-03455-0", "nctId": null, "pmcid": "PMC11341738", "title": "Long-term follow-up of pilonidal sinus disease treated by radial laser surgery", "firstAuthor": "Karita", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2024, "design": "retrospective", "n": 83, "nField": "reported", "population": "patients with pilonidal sinus disease (a condition causing a cyst/infection at the top of the buttock crack)", "intervention": "radial laser surgery to close the sinus tract", "comparator": "", "primaryOutcome": "disease coming back (recurrence) and need for a repeat operation", "result": "14.5% recurrence and 27.7% needed a second operation over long-term follow-up", "resultDirection": "unclear", "quality": "low", "qualityWhy": "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.", "directness": "direct", "limitations": "Retrospective design, no comparator group, single center/study records only.", "followUp": "median of 5.2 years, range 1.5 to 7.4 years", "plainFinding": "Laser surgery, some recurrences later.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39174833/", "sourceText": "PURPOSE: Laser ablation is one of the newest and most advanced minimally invasive techniques in treating pilonidal sinus disease (PSD). Most studies on the subject have small sample sizes and relatively short follow-up times, making evaluation of long-term healing rates and recurrences difficult. Furthermore, long-term results for laser surgery of PSD are still lacking. The aim of this study was to retrospectively report long-term follow-up results for PSD treatment by radial laser surgery. METHODS: We retrospectively studied the medical records of 83 patients who underwent the radial laser procedure for PSD between January 2017 and September 2019. Our follow-up time was a median of 5.2 years, range 1.5 to 7.4 years. RESULTS: Twelve patients had a PSD recurrence after their laser procedure, which gives a recurrence rate of 14.5% (95% CI 8.2%-23.2%). These recurrences appeared at a median 12.2 months after the laser procedure, range 4.2 to 51 months. A total of 23 patients (27.7%; 95% CI 19.0-38.0) underwent a reoperation, 11 patients due to postoperative infection or prolonged recovery and 12 patients due to PSD recurrence. Recurrent PSD and spillage of pus during operation were statistically significantly associated with the need for a second operation. CONCLUSION: Radial laser surgery provides a minimally invasive treatment option with an acceptable recurrence rate in long-term follow-up.", "provenance": [ { "field": "n", "quote": "We retrospectively studied the medical records of 83 patients who underwent the radial laser procedure for PSD between January 2017 and September 2019." }, { "field": "population", "quote": "patients who underwent the radial laser procedure for PSD" }, { "field": "intervention", "quote": "radial laser procedure" }, { "field": "primaryOutcome", "quote": "Twelve patients had a PSD recurrence after their laser procedure, which gives a recurrence rate of 14.5% (95% CI 8.2%-23.2%)." }, { "field": "result", "quote": "Twelve patients had a PSD recurrence after their laser procedure, which gives a recurrence rate of 14.5% (95% CI 8.2%-23.2%)." }, { "field": "result", "quote": "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." }, { "field": "followUp", "quote": "Our follow-up time was a median of 5.2 years, range 1.5 to 7.4 years." } ] }, { "id": "pmid:39156280", "pmid": "39156280", "doi": "10.7759/cureus.64908", "nctId": null, "pmcid": "PMC11330625", "title": "Anogenital Erosive Lichen Sclerosus in a Male With Multiple Autoimmune Conditions", "firstAuthor": "Fardos", "multipleAuthors": true, "journal": "Cureus", "year": 2024, "design": "case-series", "n": 1, "nField": "reported", "population": "adult male with multiple autoimmune conditions (porphyria cutanea tarda, discoid lupus, Sjogren's syndrome)", "intervention": "intralesional corticosteroids and various topical treatments", "comparator": "none (no comparator, treatment-resistant case followed over time)", "primaryOutcome": "resolution or improvement of the skin lesion in the intergluteal cleft (butt crack area)", "result": "the lesion persisted despite numerous treatments over 11 years", "resultDirection": "no-benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether treatments generally work or what causes this problem.", "directness": "indirect", "limitations": "single case report with no control group, so findings may not apply to other people with similar pain or lesions.", "followUp": "11-year case", "plainFinding": "Rare skin disease, resisted all treatments.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39156280/", "sourceText": "Lichen sclerosus (LS) is a chronic inflammatory disorder primarily affecting the anogenital region, with a higher prevalence in females and often linked to autoimmunity. This association is not clearly elucidated in males, with LS commonly presenting in uncircumcised males. The most affected areas include the glans penis, prepuce, and coronal sulcus. In this report, we present 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. The patient had a complex autoimmune history, including porphyria cutanea tarda, discoid lupus, and Sjogren's syndrome. Histopathological analysis confirmed a diagnosis of erosive LS. Despite numerous treatments, including intralesional corticosteroids and various topicals, the lesion persisted. This case highlights the challenges in managing LS, particularly in uncommon sites and in patients with extensive autoimmune backgrounds. Treatment goals for LS focus on symptom relief, cosmetic improvement, and disease prevention. Although topical corticosteroids are commonly used, systemic options like hydroxychloroquine may be beneficial in resistant cases, although clear guidelines are lacking. Our case underscores the importance of a multidisciplinary approach in addressing LS and its associated autoimmune conditions.", "provenance": [ { "field": "population", "quote": "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" }, { "field": "intervention", "quote": "Despite numerous treatments, including intralesional corticosteroids and various topicals, the lesion persisted." }, { "field": "comparator", "quote": "Despite numerous treatments, including intralesional corticosteroids and various topicals, the lesion persisted." }, { "field": "primaryOutcome", "quote": "Treatment goals for LS focus on symptom relief, cosmetic improvement, and disease prevention." }, { "field": "result", "quote": "Despite numerous treatments, including intralesional corticosteroids and various topicals, the lesion persisted." }, { "field": "n", "quote": "we present an 11-year case of treatment-resistant LS in a male patient" }, { "field": "followUp", "quote": "an 11-year case of treatment-resistant LS" } ] }, { "id": "pmid:39145895", "pmid": "39145895", "doi": "10.1007/s00383-024-05821-x", "nctId": null, "pmcid": null, "title": "Management and outcomes of pilonidal patients with secondary sinuses-a cohort study", "firstAuthor": "Liang", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2024, "design": "prospective-cohort", "n": 105, "nField": "reported", "population": "young people (mostly teens) with pilonidal disease and an extra draining opening near the tailbone", "intervention": "surgical removal of the pilonidal sinus and the extra draining opening (Gips procedure)", "comparator": "none - all patients had the same surgery; some also used regular hair removal afterward", "primaryOutcome": "return of symptoms (pain/bleeding) or drainage after surgery", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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", "followUp": "367.0 days", "plainFinding": "Surgery mostly worked, some drainage recurred.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39145895/", "sourceText": "BACKGROUND: Patients with pilonidal disease (PD) can present with concurrent draining secondary sinus at the superior gluteal cleft. The natural disease course in the setting of this severe phenotype is poorly characterized. We present the largest cohort of patients with PD and concurrent secondary sinus. METHODS: Patients with PD and concurrent secondary sinus who underwent Gips procedure with secondary sinus excision from 2019 to 2023 were prospectively followed. Patient demographics, drainage recurrence, symptom resolution, treatment, and follow-up period were recorded. Recurrent drainage from previous secondary sinus site was defined as isolated painless serous drainage after the wound had closed for > 3 weeks; recurrent PD was characterized as recurrent pain and bloody drainage after excision. RESULTS: One hundred and five patients (seventy-one males) with a median age of 17.2 years [interquartile range (IQR):15.4-19.0] underwent excision of their disease and were followed for a median of 367.0 days (IQR: 173.2-658.8). Without regular epilation, six patients (5.7%, five males, one female) had recurrent PD. With regular epilation, three patients (2.8%, three males) had recurrent PD. Eight patients (7.5%, six males, two females) had recurrent secondary sinus site drainage. Median time to recurrent drainage was 75.5 days (IQR: 65.2-216.2) after excision and for recurrent drainage to resolve was 72 days (IQR: 49-81). Recurrent secondary sinus site drainage was treated with antibiotics, silver nitrate, debridement, or no treatment. CONCLUSION: Patients who present with PD in the setting of concurrent secondary sinus have a unique, more severe disease phenotype. Excision can be complicated by recurrent drainage from the secondary sinus site that can resolve without repeat surgical excision.", "provenance": [ { "field": "n", "quote": "One hundred and five patients (seventy-one males)" }, { "field": "population", "quote": "Patients with PD and concurrent secondary sinus who underwent Gips procedure with secondary sinus excision" }, { "field": "intervention", "quote": "underwent Gips procedure with secondary sinus excision" }, { "field": "comparator", "quote": "Without regular epilation, six patients (5.7%, five males, one female) had recurrent PD. With regular epilation, three patients (2.8%, three males) had recurrent PD." }, { "field": "primaryOutcome", "quote": "Patient demographics, drainage recurrence, symptom resolution, treatment, and follow-up period were recorded." }, { "field": "result", "quote": "Eight patients (7.5%, six males, two females) had recurrent secondary sinus site drainage." }, { "field": "result", "quote": "Excision can be complicated by recurrent drainage from the secondary sinus site that can resolve without repeat surgical excision." }, { "field": "followUp", "quote": "followed for a median of 367.0 days (IQR: 173.2-658.8)" } ] }, { "id": "pmid:39141158", "pmid": "39141158", "doi": "10.1007/s10151-024-02972-w", "nctId": null, "pmcid": "PMC11324676", "title": "Adolescent pilonidal disease laser treatment (a-PiLaT): a pilot study", "firstAuthor": "Romanova", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2024, "design": "case-series", "n": 17, "nField": "reported", "population": "adolescents aged 10-17 with pilonidal disease (abscess/sinus at top of buttock crack)", "intervention": "laser treatment for pilonidal disease (PiLaT)", "comparator": "no comparison group; outcomes compared to prior literature on adults", "primaryOutcome": "complications, recurrence, and scar appearance after treatment", "result": "complication rate 24% and recurrence rate 18%, with low scar scores indicating good cosmetic outcome", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "direct", "limitations": "Retrospective, small sample size, no control group, single-center experience", "followUp": "24.5 ± 16.8 months", "plainFinding": "Laser treatment showed promising, low-complication results.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39141158/", "sourceText": "BACKGROUND: Pilonidal disease (PD) is an acquired condition related to hair-induced mechanical forces on the skin surface of the intergluteal cleft, with subsequent abscess formation with or without a concomitant draining sinus (pit). While surgical management currently is the mainstay of treatment, pilonidal disease laser treatment (PiLaT) has recently been recognized as a promising treatment option for non-inflammatory diseases. Nonetheless, there is a paucity of available data on adolescent pilonidal disease laser treatment (a-PiLaT). METHODS: We describe our preliminary experience with PiLaT performed in adolescents aged 10-17 years at our tertiary paediatric surgical hospital from 2019 to 2023. Data on perioperative characteristics and clinical outcomes at follow-up were retrospectively analysed. RESULTS: A total of 17 consecutive patients (n = 12 female, 71%) underwent a-PiLaT. At the time of treatment, the patients' mean age and body mass index were 13.6 ± 1.6 years and 25.3 ± 5.6 kg m-2, respectively. The mean operative time was 21.5 ± 10.4 min, whereas the mean follow-up period was 24.5 ± 16.8 months, with a complication rate of 24% (n = 4) and recurrence rate of 18% (n = 3). With respect to postsurgical scar assessment, the mean Patient and Observer Scar Assessment Scale scores (score range 6-60, with higher scores indicating worse outcome) were 14.2 ± 6.5 (patients' evaluation) and 11.4 ± 4.7 (observers' evaluation). CONCLUSION: The a-PiLaT represents a novel approach for managing PD in adolescents. Our preliminary data on the outcomes of a small series of patients with pilonidal sinuses after a-PiLaT indicated complication and recurrence rates comparable to those reported in the literature for adults. This new minimally invasive technique has great potential and is therefore worthy of further research on a larger population.", "provenance": [ { "field": "population", "quote": "PiLaT performed in adolescents aged 10-17 years" }, { "field": "intervention", "quote": "pilonidal disease laser treatment (PiLaT)" }, { "field": "comparator", "quote": "complication and recurrence rates comparable to those reported in the literature for adults" }, { "field": "primaryOutcome", "quote": "Data on perioperative characteristics and clinical outcomes at follow-up were retrospectively analysed" }, { "field": "result", "quote": "complication rate of 24% (n = 4) and recurrence rate of 18% (n = 3)" }, { "field": "n", "quote": "A total of 17 consecutive patients (n = 12 female, 71%) underwent a-PiLaT" }, { "field": "followUp", "quote": "the mean follow-up period was 24.5 ± 16.8 months" } ] }, { "id": "pmid:39141128", "pmid": "39141128", "doi": "10.1007/s00383-024-05818-6", "nctId": null, "pmcid": null, "title": "Standardized pilonidal protocol as rescue therapy for excision-refractory pilonidal disease", "firstAuthor": "Emengo", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2024, "design": "prospective-cohort", "n": 34, "nField": "reported", "population": "patients with severe pilonidal disease that came back after at least one prior surgery", "intervention": "standardized minimally invasive protocol with wound care, regular hair removal, and selective debridement or small punch procedures", "comparator": "none - all patients received the same protocol, compared to their own prior surgical history", "primaryOutcome": "complete resolution of the pilonidal disease", "result": "All 34 patients achieved complete resolution after median 52 days; 5 (14.7%) later had recurrence", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, single-group study without a comparison group, so it can't rule out that patients would have improved anyway.", "directness": "indirect", "limitations": "No control group, single center, selected group of patients who already failed prior surgery", "followUp": "405 days", "plainFinding": "Non-surgical protocol healed stubborn pilonidal disease.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39141128/", "sourceText": "PURPOSE: Severe pilonidal diseases have refractory symptoms despite multiple surgeries and optimal therapy remains unclear. We hypothesized that standardized minimally invasive protocol could be an effective rescue treatment. METHODS: We prospectively collected data from symptomatic patients who underwent ≥ 1 pilonidal excision prior to presentation at our clinic 2019-2023. We treated these patients with standardized protocol incorporating local wound care, regular manual/laser epilation, and selective debridement/pit trephination. RESULTS: We treated 34 refractory patients (23 males) with median follow-up 405 days. Median age of first symptoms was 17.1 years; presentation to our clinic 20.0 years. Prior to our clinic, 27 received one surgery (cleft lift-2, excision no closure-1, excision primary closure-18, wound vac after excision-3, excision flap closure-3); 7 had two surgeries (excision without closure + cleft lift-1, primary closure after excision twice-3, flap closure after excision twice-2, excision primary closure + excision without closure-1). We treated all patients with regular epilation ± local wound care. 14 (41%) underwent trephination ± debridement. All patients achieved complete resolution after median 52 days. Five (14.7%) recurred and were treated with trephination + debridement-2 or wound care alone-3. Symptom length had no correlation with resolution time, skin type, hair amount. CONCLUSIONS: Standardized minimally invasive protocol requiring only selective surgical intervention can treat refractory pilonidal disease with low recurrence rate.", "provenance": [ { "field": "n", "quote": "We treated 34 refractory patients (23 males)" }, { "field": "population", "quote": "symptomatic patients who underwent ≥ 1 pilonidal excision prior to presentation at our clinic" }, { "field": "intervention", "quote": "standardized protocol incorporating local wound care, regular manual/laser epilation, and selective debridement/pit trephination" }, { "field": "comparator", "quote": "We prospectively collected data from symptomatic patients who underwent ≥ 1 pilonidal excision prior to presentation at our clinic" }, { "field": "primaryOutcome", "quote": "All patients achieved complete resolution after median 52 days." }, { "field": "result", "quote": "All patients achieved complete resolution after median 52 days. Five (14.7%) recurred" }, { "field": "followUp", "quote": "median follow-up 405 days" } ] }, { "id": "pmid:39140695", "pmid": "39140695", "doi": "10.1097/SLE.0000000000001316", "nctId": null, "pmcid": null, "title": "Results of Laser-assisted Closure (SiLaC) Surgery in Pilonidal Sinus Disease: Factors Associated With Success", "firstAuthor": "Yildirim", "multipleAuthors": true, "journal": "Surg Laparosc Endosc Percutan Tech", "year": 2024, "design": "retrospective", "n": 64, "nField": "reported", "population": "adults with pilonidal sinus disease (a pocket/tunnel near the top of the buttock crack)", "intervention": "laser treatment to close the sinus tract (SiLaC)", "comparator": "", "primaryOutcome": "whether the sinus healed without recurrence", "result": "85.9% recovered; higher body weight and more advanced disease were linked to treatment failure", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "direct", "limitations": "Retrospective design, no control group, single center, relatively small number of patients.", "followUp": "17.0±8.06 months (range: 3 to 36)", "plainFinding": "Laser closure healed most pilonidal sinuses.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39140695/", "sourceText": "BACKGROUND: Pilonidal sinus treatment with sinus laser-assisted closure (SiLaC) method has produced promising results in a limited number of studies conducted in recent years. We aimed to examine the efficacy and safety of this method in a tertiary care training hospital to reveal the factors affecting failure and to share our first experiences. METHODS: All adult patients treated with this procedure between March 2020 and December 2023 were included in the study. Demographic and clinical data, complications, and recurrence rates of the patients were compared. Univariate analysis was performed between recovered and non-recovered patients to find the factors influencing successful treatment. Logistic regression analysis was performed using significant factors in the single variable analysis. RESULTS: The study cohort consisted of 64 patients. The mean follow-up period was 17.0±8.06 months (range: 3 to 36), and the mean time for return to work was 2.4±2.78 days (range: 0 to 14). Our recovery rate was 85.9%. The complication rate was 14%, and the majority (50%) were wound infections. High BMI and advanced disease were significant factors for recurrence in the comparison of patients with successful and unsuccessful treatment ( P <0.01 and 0.013, respectively). The same situation persisted in multivariate analysis ( P =0.026, 95% CI: 1.36-7.81, and P =0.004, 95% CI: 1.36-1.78, respectively). In the ROC Curve analysis for BMI, the cutoff point was 29 (sensitivity: 66.9%, specificity: 77.4%, AUC 0.809). Other parameters were not significant ( P >0.05). CONCLUSIONS: The SiLaC procedure may be the treatment of choice for pilonidal sinus disease as a safe and effective method with mild complications and reasonable recurrence rates. The success rate decreased in obese patients and patients with advanced disease.", "provenance": [ { "field": "n", "quote": "The study cohort consisted of 64 patients." }, { "field": "population", "quote": "Pilonidal sinus treatment with sinus laser-assisted closure (SiLaC) method" }, { "field": "intervention", "quote": "sinus laser-assisted closure (SiLaC) method" }, { "field": "result", "quote": "Our recovery rate was 85.9%." }, { "field": "result", "quote": "High BMI and advanced disease were significant factors for recurrence in the comparison of patients with successful and unsuccessful treatment" }, { "field": "primaryOutcome", "quote": "recurrence rates of the patients were compared" }, { "field": "followUp", "quote": "The mean follow-up period was 17.0±8.06 months (range: 3 to 36)" } ] }, { "id": "pmid:39136828", "pmid": "39136828", "doi": "10.1007/s10151-024-02973-9", "nctId": null, "pmcid": null, "title": "Efficacy and safety of RD2 Ver.02, a whole blood clot therapy, coupled with a minimally invasive procedure in pilonidal sinus: a phase II study", "firstAuthor": "Ram", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2024, "design": "case-series", "n": 51, "nField": "reported", "population": "people with pilonidal sinus (an infected pocket of skin near the top of the buttock crease)", "intervention": "a minimally invasive trephine procedure plus instillation of RD2 Ver.02, a blood-clot gel made from the patient's own blood", "comparator": "none — all patients received the same treatment, no control group", "primaryOutcome": "whether the wound had fully healed at 3, 6, and 12 months", "result": "82.4% healed by 3 months, 90.2% by 6 months, and 82.4% by 12 months, with recurrence in 11.8% of patients", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, single-arm study with no comparison group, so it can't show whether this treatment works better than other options.", "directness": "direct", "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.", "followUp": "12 months", "plainFinding": "Most pilonidal sinuses healed with treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39136828/", "sourceText": "BACKGROUND: PNS is caused by an infection in the sacrococcygeal area triggered by hair particle accumulation in skin tunnels, resulting in infection. Surgical options range from simple excision to complex flap constructions. Primary wound healing failure and recurrence rates contribute to the burden of PNS. RD2 Ver.02, a novel autologous whole-blood clot product, demonstrated safety and efficacy in treating complex cutaneous wounds and was investigated for the management of PNS. METHODS: A Phase II open-label, pilot, single-arm prospective study was conducted from May 2021 to May 2023 (Ethics Committee approval #7952-20). Patients with PNS underwent a minimally invasive trephine procedure under local anesthesia followed by RD2 Ver.02 instillation into the cavity. Primary healing was assessed at 3, 6, and 12 months. Secondary outcomes included the collection of adverse events. RESULTS: Overall, 51 patients participated in the study. At 3 months, 42/51 healed (82.4%), 7/51 (13.7%) were granulating but not completely healed, and 2/51 (3.9%) failed to heal. At 6 and 12 months, 46/51 (90.2%) and 42/51 (82.4%) achieved complete healing, respectively. At 6 months, two PNSs recurred after initial healing and an additional four instances of PNS recurrence observed in 12 months, so a total of recurrence in six patients (11.8%). There were five adverse events (AEs) with no severe adverse events. CONCLUSION: RD2 Ver.02 is a safe and effective treatment of PNS when coupled with a minimally invasive trephine PNS procedure. Further comparative studies are needed to fully assess the role of this novel therapy for PNS.", "provenance": [ { "field": "n", "quote": "Overall, 51 patients participated in the study." }, { "field": "population", "quote": "Patients with PNS underwent a minimally invasive trephine procedure" }, { "field": "intervention", "quote": "a minimally invasive trephine procedure under local anesthesia followed by RD2 Ver.02 instillation into the cavity" }, { "field": "comparator", "quote": "Phase II open-label, pilot, single-arm prospective study" }, { "field": "primaryOutcome", "quote": "Primary healing was assessed at 3, 6, and 12 months." }, { "field": "result", "quote": "At 6 and 12 months, 46/51 (90.2%) and 42/51 (82.4%) achieved complete healing, respectively." }, { "field": "result", "quote": "a total of recurrence in six patients (11.8%)" } ] }, { "id": "pmid:39116170", "pmid": "39116170", "doi": "10.5281/zenodo.10278169", "nctId": null, "pmcid": "PMC12105863", "title": "[Hailey-Hailey disease: A case report]", "firstAuthor": "Rodríguez-Gutiérrez", "multipleAuthors": true, "journal": "Rev Med Inst Mex Seguro Soc", "year": 2024, "design": "case-series", "n": 1, "nField": "reported", "population": "a man with Hailey-Hailey disease, a rare inherited skin disorder", "intervention": "not specified as a treatment study — this is a case description", "comparator": "none reported", "primaryOutcome": "skin findings and diagnosis of Hailey-Hailey disease", "result": "patient had skin rash and blisters affecting neck, trunk, armpits, groin folds, and the area between the buttocks, with itching and chronic skin changes", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, which cannot show whether any treatment works or establish cause reliably", "directness": "indirect", "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", "followUp": "", "plainFinding": "Rare skin disease, not a treatment study", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39116170/", "sourceText": "BACKGROUND: Hailey-Hailey disease is a rare autosomal dominant genodermatosis whose cause is the ATP2C1 gene mutation. A prevalence of 1 in 50,000 cases is estimated and it manifests as grouped flaccid vesicles that break easily. The diagnosis is confirmed with the histopathological study creating an appearance called \"dilapidated brick wall\", identifying dyskeratosis in the form of round bodies and pimples. Treatment ranges from general measures to multiple pharmacological options, with topical corticosteroids being the most commonly used. CLINICAL CASE: Male patient diagnosed with Hailey-Hailey disease. On physical examination we observed a dermatosis disseminated to the neck, trunk, axillary and inguinal folds, and intergluteal region, 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. We also took the opportunity to review the most relevant information in the literature regarding Hailey-Hailey disease, especially focused on the therapeutic aspect. CONCLUSIONS: It is important to take into account that Hailey-Hailey disease is a rare pathology, in order to make a differential diagnosis in daily clinical practice.", "provenance": [ { "field": "population", "quote": "Male patient diagnosed with Hailey-Hailey disease." }, { "field": "primaryOutcome", "quote": "On physical examination we observed a dermatosis disseminated to the neck, trunk, axillary and inguinal folds, and intergluteal region" }, { "field": "result", "quote": "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" }, { "field": "n", "quote": "Male patient diagnosed with Hailey-Hailey disease." }, { "field": "intervention", "quote": "Treatment ranges from general measures to multiple pharmacological options, with topical corticosteroids being the most commonly used." }, { "field": "comparator", "quote": "CLINICAL CASE: Male patient diagnosed with Hailey-Hailey disease." } ] }, { "id": "pmid:39115207", "pmid": "39115207", "doi": "10.1097/DCR.0000000000003402", "nctId": null, "pmcid": "PMC11477847", "title": "Postoperative Outcomes of Bascom Cleft Lift Versus Excision With Secondary Wound Healing for Pilonidal Sinus Disease: A Multicenter Retrospective Analysis", "firstAuthor": "Huurman", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2024, "design": "retrospective", "n": 272, "nField": "reported", "population": "Patients with pilonidal sinus disease (a cyst/wound near the top of the buttock crack) needing surgery", "intervention": "Bascom cleft lift surgery", "comparator": "Excision with secondary wound healing (wound left open to heal)", "primaryOutcome": "Rate and time of successful wound healing", "result": "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)", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "direct", "limitations": "Retrospective design prone to selection bias and residual confounding; short follow-up period limits recurrence data; no patient satisfaction data collected.", "followUp": "12 months", "plainFinding": "Faster, more complete healing with cleft lift.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39115207/", "sourceText": "BACKGROUND: Pilonidal sinus disease impacts a patient's quality of life. In the Netherlands, it is often treated with excision and secondary wound healing, which is associated with high recurrence rates and poor wound healing. The Bascom cleft lift, an alternative technique, has shown favorable healing times and recurrence rates. OBJECTIVE: The present study compares successful wound healing, time to healing, complications, and recurrence rate between excision with secondary wound healing and Bascom cleft lift. DESIGN: This is a multicenter retrospective study. SETTINGS: Three institutions in the Rotterdam region of the Netherlands participated in the study. PATIENTS: Patients who underwent excision with secondary wound healing or Bascom cleft lift between July 2015 and August 2021 were included. MAIN OUTCOME MEASURES: Primary end points included the rate of successful wound healing and the time to achieve healing. Secondary end points included postoperative complications and the recurrence rate within 12 months after surgery. RESULTS: Of 272 patients, 128 underwent Bascom cleft lift and 144 patients underwent excision and secondary wound healing. Recurrent pilonidal sinus disease (47.7% vs 22.2%) and abscess history (53.1% vs 40.3%) were more common in the Bascom cleft lift group compared to excision with secondary wound healing. The median follow-up period at the outpatient clinic was 43 days. The wound healing rate was 84.4% after Bascom cleft lift versus 32.6% after excision and secondary wound healing ( p < 0.001), with a median time to wound healing of 55 and 101 days, respectively ( p < 0.001). Complications were 28.9% for Bascom cleft lift versus 13.2% for excision and secondary wound healing ( p = 0.003). The rate of recurrent disease was 6.3% after Bascom cleft lift and 11.8% after excision and secondary wound healing ( p = 0.113). LIMITATIONS: This study used a retrospective design, which makes it prone to selection bias and residual confounding. In addition, the short follow-up period adds to these limitations because a longer follow-up period may better identify true recurrence rates. The absence of collected patient satisfaction data, which is currently a common scientific issue, is also a deficiency. CONCLUSIONS: This retrospective study shows that Bascom cleft lift is superior to excision and secondary wound healing, given the higher percentage of patients with successful wound healing within a shorter time. See Video Abstract . RESULTADOS POSOPERATORIOS DE LA ELEVACIN DE LA HENDIDURA TIPO BASCOM VERSUS LA ESCISIN CON CICATRIZACIN DE LA HERIDA POR SEGUNDA INTENSIN PARA LA ENFERMEDAD DE SENO PILONIDAL UN ANLISIS RETROSPECTIVO MULTICNTRICO: ANTECEDENTES:La enfermedad de seno pilonidal afecta la calidad de vida del paciente. En los Países Bajos, a menudo se trata con escisión y cicatrización por segunda intensión, lo que se asocia con altas tasas de recurrencia y mala cicatrización de las heridas. La elevación de la hendidura de Bascom, una técnica alternativa, ha mostrado tiempos de curación y tasas de recurrencia favorables.OBJETIVO:El presente estudio tiene como objetivo comparar la cicatrización exitosa de la herida, el tiempo de cicatrización, las complicaciones y la tasa de recurrencia entre la escisión con cicatrización secundaria de la herida y la elevación de hendidura tipo Bascom.DISEÑO:Este es un estudio retrospectivo multicéntrico.AJUSTES:Tres instituciones en la región de Rotterdam de los Países Bajos participaron en el estudio.PACIENTES:Se incluyeron pacientes sometidos a escisión con cicatrización secundaria o elecación de la hendidura tipo Bascom entre julio de 2015 y agosto de 2021.PRINCIPALES MEDIDAS DE RESULTADO:Los resultados primarios incluyeron la tasa de curación exitosa de la herida y el tiempo para lograr la curación. Los resultados secundarios incluyeron complicaciones posoperatorias y tasa de recurrencia dentro de los doce meses posteriores a la cirugía.RESULTADOS:De 272 pacientes, 128 se sometieron a elevación de hendidura tipo Bascom y 144 pacientes a escisión y cicatrización secundaria. La ESP recurrente (47.7% frente a 22.2%) y los abscesos (53.1% frente a 40.3%) fueron más comunes en el grupo de elevación tipo Bascom en comparación con la escisión con cicatrización secundaria de la herida. La mediana del período de seguimiento en la consulta externa fue de 43 días. La cicatrización de la herida fue del 84.4 % después del lifting de Bascom frente al 32.6 % después de la escisión y la cicatrización secundaria (p < 0.001), con una mediana de tiempo hasta la cicatrización de la herida de 55 días y 101 días, respectivamente (p < 0.001). Las complicaciones fueron del 28.9% para el lifting tipo Bascom frente al 13.2% para la escisión y cicatrización secundaria (p = 0.003). La enfermedad recurrente fue del 6.3% después del lifting de hendidura tipo Bascom y del 11.8% después de la escisión y cicatrización secundaria (p = 0.113).LIMITACIONES:Diseño retrospectivo que lo hace propenso a sesgos de selección y confusión residual. Adicionalmente, el corto período de seguimiento del estudio aumenta aún más estas limitaciones, ya que un seguimiento más prolongado puede identificar mejor las verdaderas tasas de recurrencia. Por último, una deficiencia es la ausencia de datos recopilados sobre la satisfacción del paciente, lo que hoy en día es un problema científico común.CONCLUSIONES:Este estudio retrospectivo muestra que la elevación de hendidura tipo Bascom es superior a la escisión y cicatrización secundaria dado el mayor porcentaje de pacientes con curación exitosa de la herida en un tiempo más corto. (Traducción-Dr. Jorge Silva Velazco ).", "provenance": [ { "field": "population", "quote": "Patients who underwent excision with secondary wound healing or Bascom cleft lift" }, { "field": "intervention", "quote": "Bascom cleft lift" }, { "field": "comparator", "quote": "excision with secondary wound healing" }, { "field": "primaryOutcome", "quote": "Primary end points included the rate of successful wound healing and the time to achieve healing." }, { "field": "result", "quote": "The wound healing rate was 84.4% after Bascom cleft lift versus 32.6% after excision and secondary wound healing ( p < 0.001), with a median time to wound healing of 55 and 101 days, respectively ( p < 0.001). Complications were 28.9% for Bascom cleft lift versus 13.2% for excision and secondary wound healing ( p = 0.003). The rate of recurrent disease was 6.3% after Bascom cleft lift and 11.8% after excision and secondary wound healing ( p = 0.113)." }, { "field": "n", "quote": "Of 272 patients, 128 underwent Bascom cleft lift and 144 patients underwent excision and secondary wound healing." } ] }, { "id": "pmid:39045854", "pmid": "39045854", "doi": "10.3310/KFDQ2017", "nctId": null, "pmcid": "PMC11284621", "title": "Treatment options for patients with pilonidal sinus disease: PITSTOP, a mixed-methods evaluation", "firstAuthor": "Brown", "multipleAuthors": true, "journal": "Health Technol Assess", "year": 2024, "design": "prospective-cohort", "n": 667, "nField": "reported", "population": "adults referred for surgery to treat pilonidal sinus disease (a condition causing pain near the top of the buttock crack)", "intervention": "major surgical procedures for pilonidal disease", "comparator": "minor surgical procedures for pilonidal disease", "primaryOutcome": "pain after surgery, complications, time to heal, return to normal activities, and disease coming back", "result": "major surgery caused more pain and complications and took longer to heal, but had a lower chance of the disease returning", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it was a large multi-centre observational study with statistical adjustment for confounding, but not a randomized trial and had incomplete follow-up data", "directness": "indirect", "limitations": "Incomplete recruitment and follow-up data were an issue, particularly given the multiple interventions. Assumptions were made regarding risk adjustment.", "followUp": "", "plainFinding": "Major surgery: more pain, fewer recurrences", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39045854/", "sourceText": "BACKGROUND: There is no consensus on optimal management of pilonidal disease. Surgical practice is varied, and existing literature is mainly single-centre cohort studies of varied disease severity, interventions and outcome assessments. OBJECTIVES: A prospective cohort study to determine: • disease severity and intervention relationship • most valued outcomes and treatment preference by patients • recommendations for policy and future research. DESIGN: Observational cohort study with nested mixed-methods case study. Discrete choice experiment. Clinician survey. Three-stage Delphi survey for patients and clinicians. Inter-rater reliability of classification system. SETTING: Thirty-one National Health Service trusts. PARTICIPANTS: Patients aged > 16 years referred for elective surgical treatment of pilonidal disease. INTERVENTIONS: Surgery. MAIN OUTCOME MEASURES: Pain postoperative days 1 and 7, time to healing and return to normal activities, complications, recurrence. Outcomes compared between major and minor procedures using regression modelling, propensity score-based approaches and augmented inverse probability weighting to account for measured potential confounding features. RESULTS: Clinician survey: There was significant heterogeneity in surgeon practice preference. Limited training opportunities may impede efforts to improve practice. Cohort study: Over half of patients (60%; N = 667) had a major procedure. For these procedures, pain was greater on day 1 and day 7 (mean difference day 1 pain 1.58 points, 95% confidence interval 1.14 to 2.01 points, n = 536; mean difference day 7 pain 1.53 points, 95% confidence interval 1.12 to 1.95 points, n = 512). There were higher complication rates (adjusted risk difference 17.5%, 95% confidence interval 9.1 to 25.9%, n = 579), lower recurrence (adjusted risk difference -10.1%, 95% confidence interval -18.1 to -2.1%, n = 575), and longer time to healing (>34 days estimated difference) and time to return to normal activities (difference 25.9 days, 95% confidence interval 18.4 to 33.4 days). Mixed-methods analysis: Patient decision-making was influenced by prior experience of disease and anticipated recovery time. The burden involved in wound care and the gap between expected and actual time for recovery were the principal reasons given for decision regret. Discrete choice experiment: The strongest predictors of patient treatment choice were risk of infection/persistence (attribute importance 70%), and shorter recovery time (attribute importance 30%). Patients were willing to trade off these attributes. Those aged over 30 years had a higher risk tolerance (22.35-34.67%) for treatment failure if they could experience rapid recovery. There was no strong evidence that younger patients were willing to accept higher risk of treatment failure in exchange for a faster recovery. Patients were uniform in rejecting excision-and-leave-open because of the protracted nursing care it entailed. Wysocki classification analysis: There was acceptable inter-rater agreement (κ = 0.52, 95% confidence interval 0.42 to 0.61). Consensus exercise: Five research and practice priorities were identified. The top research priority was that a comparative trial should broadly group interventions. The top practice priority was that any interventions should be less disruptive than the disease itself. LIMITATIONS: Incomplete recruitment and follow-up data were an issue, particularly given the multiple interventions. Assumptions were made regarding risk adjustment. CONCLUSIONS AND FUTURE WORK: Results suggest the burden of pilonidal surgery is greater than reported previously. This can be mitigated with better selection of intervention according to disease type and patient desired goals. Results indicate a framework for future higher-quality trials that stratify disease and utilise broad groupings of common interventions with development of a patient-centred core outcome set. TRIAL REGISTRATION: This trial is registered as ISRCTN95551898. FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/17/02) and is published in full in Health Technology Assessment; Vol. 28, No. 33. See the NIHR Funding and Awards website for further award information.", "provenance": [ { "field": "population", "quote": "Patients aged > 16 years referred for elective surgical treatment of pilonidal disease." }, { "field": "intervention", "quote": "Over half of patients (60%; N = 667) had a major procedure." }, { "field": "comparator", "quote": "Outcomes compared between major and minor procedures using regression modelling" }, { "field": "primaryOutcome", "quote": "Pain postoperative days 1 and 7, time to healing and return to normal activities, complications, recurrence." }, { "field": "result", "quote": "For these procedures, pain was greater on day 1 and day 7" }, { "field": "result", "quote": "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" }, { "field": "n", "quote": "Over half of patients (60%; N = 667) had a major procedure." } ] }, { "id": "pmid:38967343", "pmid": "38967343", "doi": "10.12968/jowc.2021.0137", "nctId": null, "pmcid": null, "title": "Effectiveness and safety of an innovative silicone extender in suture reinforcement or dermatotraction: a retrospective study", "firstAuthor": "Yailian", "multipleAuthors": true, "journal": "J Wound Care", "year": 2024, "design": "retrospective", "n": 50, "nField": "reported", "population": "patients with large surgical wounds, mostly after skin cancer removal and a few after pilonidal disease surgery", "intervention": "a silicone tissue extender device to help close the wound (dermatotraction/suture reinforcement)", "comparator": "no comparison group", "primaryOutcome": "time for the wound to fully close", "result": "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", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Helped close surgical wounds after excision.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38967343/", "sourceText": "OBJECTIVE: Multiple techniques are available for closing skin defects, such as skin grafts, flaps and tissue expansion. The tissue extender MID SEW (MID, France) was developed to achieve dermatotraction or suture reinforcement. The aim of this study was to evaluate the effectiveness and safety of this innovative silicone extender for large surgical wounds. METHOD: A single-centre retrospective and observational study on an unselected consecutive cohort of patients treated with a tissue extender was conducted. Indications, initial and final wound surfaces, and adverse events (AEs) were retrieved from electronic medical records. The main outcome measure was the time to complete wound closure. RESULTS: We identified 50 patients from July 2017 to December 2018. Patients underwent cutaneous tumour-wide excision (n=44), or pilonidal disease surgical treatment (n=6). The average initial wound area was 53.3±42.4cm2. Healing was complete, without secondary dehiscence, within the first seven days after device withdrawal for 41 patients (82%). At least one AE was experienced by eight patients (16%) during the study period: five inflammation; five wound dehiscence; two skin necrosis; and one pain. CONCLUSION: This case series suggests that the tissue extender may be effective and safe in its dermatotraction and suture reinforcement indications in the treatment of large wounds after wide excision of skin cancer or treatment of pilonidal disease. DECLARATION OF INTEREST: This work was supported in part by the Hospices Civils de Lyon, France and in part by the University Claude Bernard Lyon 1, France. OB co-owns the patent on the MID SEW system. The authors have no other conflicts of interest to declare.", "provenance": [ { "field": "n", "quote": "We identified 50 patients from July 2017 to December 2018." }, { "field": "population", "quote": "Patients underwent cutaneous tumour-wide excision (n=44), or pilonidal disease surgical treatment (n=6)." }, { "field": "intervention", "quote": "The tissue extender MID SEW (MID, France) was developed to achieve dermatotraction or suture reinforcement." }, { "field": "comparator", "quote": "A single-centre retrospective and observational study on an unselected consecutive cohort of patients treated with a tissue extender was conducted." }, { "field": "primaryOutcome", "quote": "The main outcome measure was the time to complete wound closure." }, { "field": "result", "quote": "Healing was complete, without secondary dehiscence, within the first seven days after device withdrawal for 41 patients (82%)." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:38948976", "pmid": "38948976", "doi": "10.47391/JPMA.9948", "nctId": null, "pmcid": null, "title": "Endoscopic pilonidal sinus treatment (EPSiT) for sacrococcygeal pilonidal sinus disease: A prospective long-term study", "firstAuthor": "Amir", "multipleAuthors": true, "journal": "J Pak Med Assoc", "year": 2024, "design": "case-series", "n": 67, "nField": "reported", "population": "people with pilonidal sinus disease (cyst/infection at top of buttock crack)", "intervention": "minimally invasive endoscopic pilonidal sinus treatment (EPSiT)", "comparator": "none (single-group study, before/after surgery)", "primaryOutcome": "wound healing time, complications, and recurrence of the sinus", "result": "most patients healed completely with low recurrence and high satisfaction", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-group study without a comparison treatment, so it can't show this procedure is better than other options.", "directness": "direct", "limitations": "No control group for comparison; single surgical team; relies partly on telephone follow-up for recurrence.", "followUp": "1-7 years", "plainFinding": "Good healing, low recurrence rate.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38948976/", "sourceText": "OBJECTIVES: To assess short-term and long-term outcomes of endoscopic pilonidal sinus treatment for pilonidal sinus disease. METHODS: The prospective study was conducted at Shifa International Hospital, Islamabad, Pakistan, from July 2015 to July 2021, and comprised all pilonidal sinus cases undergoing minimal invasive endoscopic pilonidal sinus treatment who were treated by a single surgical team. The primary outcomes were duration of healing, post-operative morbidities, persistence of discharge and recurrence at 1-7 years. The secondary outcomes were operative time, return to work, cosmetic results and patient satisfaction. The patients were observed for wound healing and discharge on follow-up in the out-patient department at 1, 3, 6 and 24 weeks. They were further followed up every year through telephonic survey for persistence or recurrence of symptoms. Patient satisfaction was assessed using the 36-item Short Form Survey questionnaire filled at admission and then at 6 weeks post-surgery. Data was analysed using SPSS 23. RESULTS: Of the 67 patients, 55(82%) were males and 12(18%) were females. The overall mean age was 25.69±8.305 years. There were 13(19.4%) patients with a history of recurrent disease and previous procedures for pilonidal sinus, while 54(80.6%) had no previous surgery. The median operative time was 35 minutes (interquartile range: 20-45 minutes). Complete wound healing was achieved in 60(89.6%) patients, while recurrence was seen in 7(10.4%). The median time off work was 2.5 days (interquartile range: 1-3 days). Patient satisfaction with the procedure was significantly high (p<0.05). CONCLUSIONS: Endoscopic pilonidal sinus treatment appeared to be a good minimally invasive surgical technique for the treatment of pilonidal sinus disease in terms of both short-term and long-term outcomes.", "provenance": [ { "field": "n", "quote": "Of the 67 patients, 55(82%) were males and 12(18%) were females." }, { "field": "population", "quote": "comprised all pilonidal sinus cases undergoing minimal invasive endoscopic pilonidal sinus treatment" }, { "field": "intervention", "quote": "endoscopic pilonidal sinus treatment" }, { "field": "comparator", "quote": "treated by a single surgical team" }, { "field": "primaryOutcome", "quote": "The primary outcomes were duration of healing, post-operative morbidities, persistence of discharge and recurrence at 1-7 years." }, { "field": "result", "quote": "Complete wound healing was achieved in 60(89.6%) patients, while recurrence was seen in 7(10.4%)." }, { "field": "followUp", "quote": "recurrence at 1-7 years" } ] }, { "id": "pmid:38885167", "pmid": "38885167", "doi": "10.1097/SAP.0000000000003973", "nctId": null, "pmcid": null, "title": "Propeller Flap Reconstruction Following Pilonidal Cyst Excision: A Single-Center Experience With Same-Day Discharge", "firstAuthor": "Towfighi", "multipleAuthors": true, "journal": "Ann Plast Surg", "year": 2024, "design": "retrospective", "n": 26, "nField": "reported", "population": "patients having surgery to remove pilonidal cysts (small pockets at top of buttock crease)", "intervention": "propeller flap skin reconstruction after cyst removal, with same-day discharge", "comparator": "none (single-group case series)", "primaryOutcome": "flap survival, complications, and disease recurrence after surgery", "result": "all flaps survived, some minor wound problems, and about 1 in 9 patients had the cyst come back", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "retrospective chart review, small sample, short follow-up, no comparison group", "followUp": "4.1 ± 5.4 months", "plainFinding": "Surgical flap repair worked well, low recurrence", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38885167/", "sourceText": "INTRODUCTION: Reconstruction following pilonidal cyst resection must balance risk of recurrence, healing time, and resumption of functional routine. Propeller flaps provide a reliable and effective reconstructive option. This study highlights our experience with propeller flap reconstruction following pilonidal cyst resection and demonstrates the efficacy of same-day discharge. METHODS: A single-institution retrospective chart review was performed for propeller flap reconstructions completed from March 2018 to July 2022. Patient demographics, pilonidal cyst details, operative details, and postoperative outcomes were collected. Primary outcomes included flap survival, flap complications, and pilonidal disease recurrence. RESULTS: Twenty-eight outpatient propeller flap reconstructions following pilonidal cyst resections were identified in 26 patients, with two patients receiving a second propeller flap due to recurrence. Most patients were male (n = 15, 57.7%) with a mean age at time of index operation of 25.5 ± 5.8 years and mean body mass index of 26.5 ± 4.1 kg/m2. Mean symptom duration prior to index surgery was 39.3 months. Mean skin defect size following resection was 28.3 ± 15.3 cm2, with a mean flap size of 44.7 ± 35.5 cm2. Flap survival was 100% (n = 28), with five flaps (17.9%) experiencing minor wound complications and one patient (3.8%) requiring return to the operating room. Mean time to functional improvement was 24.0 ± 22.8 days. Pilonidal disease recurrence occurred in three patients (11.5%). Mean follow-up was 4.1 ± 5.4 months. CONCLUSIONS: Propeller flaps provide a successful and reliable reconstructive option for pilonidal disease defects. Because patients in our cohort experienced favorable outcomes and functional improvement, we advocate for same-day discharge in order to reduce hospital and patient burden.", "provenance": [ { "field": "n", "quote": "Twenty-eight outpatient propeller flap reconstructions following pilonidal cyst resections were identified in 26 patients" }, { "field": "population", "quote": "pilonidal cyst resection" }, { "field": "intervention", "quote": "Propeller flap reconstruction following pilonidal cyst resection and demonstrates the efficacy of same-day discharge" }, { "field": "comparator", "quote": "A single-institution retrospective chart review was performed for propeller flap reconstructions completed from March 2018 to July 2022." }, { "field": "primaryOutcome", "quote": "Primary outcomes included flap survival, flap complications, and pilonidal disease recurrence." }, { "field": "result", "quote": "Flap survival was 100% (n = 28), with five flaps (17.9%) experiencing minor wound complications and one patient (3.8%) requiring return to the operating room." }, { "field": "result", "quote": "Pilonidal disease recurrence occurred in three patients (11.5%)." } ] }, { "id": "pmid:38867278", "pmid": "38867278", "doi": "10.1186/s13019-024-02802-y", "nctId": null, "pmcid": "PMC11167765", "title": "Co-occurrence of posterior chest wall pilonidal sinus with melanocytic nevus: a challenging presentation: a case report", "firstAuthor": "Salih", "multipleAuthors": true, "journal": "J Cardiothorac Surg", "year": 2024, "design": "case-series", "n": 1, "nField": "reported", "population": "46-year-old woman with a painful dark skin lesion on her upper back", "intervention": "surgical removal of the lesion", "comparator": "none", "primaryOutcome": "diagnosis of the lesion after removal", "result": "the lesion was a mole combined with an inflamed pilonidal sinus in an unusual location on the back, not the buttock crack", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a single patient case report, which cannot show how common or treatable this condition is.", "directness": "indirect", "limitations": "Only one patient was studied, and the lesion was on the upper back, not the area between the buttocks.", "followUp": "", "plainFinding": "Rare mole plus sinus on back.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38867278/", "sourceText": "INTRODUCTION: To date, only a limited number of case reports have documented the co-occurrence of PNS and melanocytic nevus in the medical literature. This study aims to report an exceptionally rare case of posterior chest wall PNS in conjunction with a melanocytic nevus. CASE PRESENTATION: 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. There was a painful, dark blue, non-erythematous, and non-tender nodule on the left upper posterior chest wall. Based on the patient's desire for cosmetic purposes, the lesion was excised totally with primary closure under local anaesthesia. Histopathological examination revealed intradermal melanocytic nevus with inflamed pilonidal sinus. DISCUSSION: The rarity of posterior chest wall PNS associated with nevi poses unique diagnostic and therapeutic challenges for clinicians. The distinct anatomical location, different from the conventional region, and the rare association between the two conditions may delay accurate diagnosis and result in mismanagement or inappropriate interventions. CONCLUSION: The posterior chest wall PNS is another type of atypical PNS that is extremely rare. The association between PNS and blue nevus is a fascinating medical finding that deserves further investigation.", "provenance": [ { "field": "n", "quote": "A 46-year-old female presented" }, { "field": "population", "quote": "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." }, { "field": "intervention", "quote": "the lesion was excised totally with primary closure under local anaesthesia" }, { "field": "comparator", "quote": "the lesion was excised totally with primary closure under local anaesthesia" }, { "field": "primaryOutcome", "quote": "Histopathological examination revealed intradermal melanocytic nevus with inflamed pilonidal sinus." }, { "field": "result", "quote": "Histopathological examination revealed intradermal melanocytic nevus with inflamed pilonidal sinus." } ] }, { "id": "pmid:38859808", "pmid": "38859808", "doi": "10.1097/GOX.0000000000005887", "nctId": null, "pmcid": "PMC11164014", "title": "Partial Gluteus Muscle Flap for Treatment of Chronic, Recalcitrant Pilonidal Cyst Disease", "firstAuthor": "Farhat", "multipleAuthors": true, "journal": "Plast Reconstr Surg Glob Open", "year": 2024, "design": "case-series", "n": 11, "nField": "reported", "population": "young adults aged 14-31 with recurrent, chronic pilonidal cysts after prior surgeries", "intervention": "partial gluteus maximus muscle flap surgery to close the wound after cyst removal", "comparator": "none - all patients received the flap procedure, compared to their own prior failed treatments", "primaryOutcome": "wound healing and recurrence of infection after surgery", "result": "7 of 11 patients healed without problems; 3 had infection recur and 1 had the wound reopen", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "direct", "limitations": "Very small number of patients, no control group for comparison, and some patients still had complications like infection recurrence and wound dehiscence.", "followUp": "1.6-7 years", "plainFinding": "Mostly healed, some infections recurred.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38859808/", "sourceText": "BACKGROUND: Pilonidal cyst disease is a challenging condition requiring excision and wound management when it is chronic and symptomatic. Primary closure of the excision site can lead to high recurrence rates, necessitating flap-based reconstruction. This article discusses the use of a partial gluteus maximus muscle flap to address recurrent pilonidal disease and reduce its recurrence. METHODS: From 2014 to 2021, 11 patients aged 14-31 with recurrent pilonidal cysts underwent two-stage surgery involving excision and wound debridement by general surgery, followed by plastic surgery for wound closure using the partial gluteus muscle flap. RESULTS: Eleven patients were included in the study (four women and seven men). The mean age was 23 ± 5.2, and the average body mass index was 28.59 (±6.7). The mean number of previous procedures was 2.25 (range, 2-3). Operative time was 158.7 ± 37 minutes. The average length of stay when both procedures were done in the same admission was 8 ± 6 days (range 3-21 days) and when procedures were done separately, the length of hospital stay after the wound closure using a partial gluteus muscle flap was 3 days, and the range for reliable follow-up was 1.6-7 years postoperatively. In our study cohort of 11 patients, the majority, specifically seven individuals, experienced uneventful healing. However, a subset of patients encountered complications. 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. CONCLUSION: Partial gluteal muscle flap offers a promising approach for treating recalcitrant, difficult-to-treat pilonidal disease in young adults, enhancing wound healing and reducing the risk of recurrence.", "provenance": [ { "field": "n", "quote": "Eleven patients were included in the study (four women and seven men)." }, { "field": "population", "quote": "11 patients aged 14-31 with recurrent pilonidal cysts" }, { "field": "intervention", "quote": "wound closure using the partial gluteus muscle flap" }, { "field": "comparator", "quote": "The mean number of previous procedures was 2.25 (range, 2-3)." }, { "field": "primaryOutcome", "quote": "the majority, specifically seven individuals, experienced uneventful healing" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:38849230", "pmid": "38849230", "doi": "10.1016/j.jviscsurg.2024.03.007", "nctId": null, "pmcid": null, "title": "SiLaT: A paradigm shift in the treatment of pilonidal disease?", "firstAuthor": "Draullette", "multipleAuthors": true, "journal": "J Visc Surg", "year": 2024, "design": "case-series", "n": 111, "nField": "reported", "population": "adults with pilonidal disease (sinus) treated with laser therapy", "intervention": "sinus laser therapy (SiLaT) for pilonidal disease", "comparator": "none (single-arm study, no comparison group)", "primaryOutcome": "healing of the pilonidal sinus (closure of skin openings without drainage or abscess)", "result": "78.4% of patients healed, with a median healing time of 20 days", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a single-center retrospective case series without a comparison group, so it cannot prove the laser worked better than other treatments.", "directness": "direct", "limitations": "Retrospective design, no control group, and no predictive factors for healing were identified.", "followUp": "339.2 (± 221.4) days", "plainFinding": "High healing rate, patients very satisfied.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38849230/", "sourceText": "BACKGROUND: Pilonidal disease (PD) is a common condition for which the global incidence is increasing. Surgery is the currently preferred approach to treatment but there is a growing interest in new minimally invasive techniques, such as sinus laser therapy (SiLaT). AIM: Our primary objective was to assess the efficacy of SiLaT for the treatment of pilonidal disease. The secondary objectives were to evaluate morbidity and patient satisfaction and identify predictive factors of success. METHODS: All adult patients, who underwent SiLaT in our department for a primary or recurrent pilonidal sinus from June 1, 2018, to December 31, 2020, were included in the study. Healing was defined as the closure of cutaneous orifices and the absence of seepage or abscesses. RESULTS: In total, 111 consecutive patients, for whom the male/female sex ratio was 2.1 and the mean age 28.8 (± 9.4) years, were included in this study. Eighteen (16.2%) patients had already undergone prior surgery for PD. The mean follow-up was 339.2 (± 221.4) days. A healing rate of 78.4% was observed, with a median time to healing of 20.0 days (15.0-30.0). The median time to return to usual activities was three days (1-7). The only postoperative complication was bleeding, which occurred for two patients (1.8%). Eighty-two patients (88.2%) reported being \"very satisfied\" with the treatment. Multivariate analysis showed no predictive factors for healing among the studied variables. CONCLUSION: SiLaT is an efficient and safe procedure for the treatment of PD, with a high level of patient satisfaction. It will now be necessary to position it within the therapeutic algorithm.", "provenance": [ { "field": "n", "quote": "111 consecutive patients" }, { "field": "population", "quote": "All adult patients, who underwent SiLaT in our department for a primary or recurrent pilonidal sinus" }, { "field": "intervention", "quote": "sinus laser therapy (SiLaT)" }, { "field": "comparator", "quote": "All adult patients, who underwent SiLaT in our department" }, { "field": "primaryOutcome", "quote": "Healing was defined as the closure of cutaneous orifices and the absence of seepage or abscesses." }, { "field": "result", "quote": "A healing rate of 78.4% was observed, with a median time to healing of 20.0 days (15.0-30.0)." }, { "field": "followUp", "quote": "The mean follow-up was 339.2 (± 221.4) days." } ] }, { "id": "pmid:38845858", "pmid": "38845858", "doi": "10.1016/j.heliyon.2024.e31497", "nctId": null, "pmcid": "PMC11153105", "title": "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", "firstAuthor": "Dainius", "multipleAuthors": true, "journal": "Heliyon", "year": 2024, "design": "rct", "n": 100, "nField": "reported", "population": "adults with chronic symptomatic pilonidal disease at the top of the buttock crack", "intervention": "minimally invasive pit-picking surgery", "comparator": "radical excision surgery without stitching the wound closed", "primaryOutcome": "pain in the first week after surgery, failed surgery rate, and wound healing time", "result": "pit-picking surgery caused less pain in the first week, healed faster (17 days vs 60 days), with similar failure rates between groups", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but only looked at short-term results and some patients were lost to follow-up.", "directness": "direct", "limitations": "only short-term follow-up (6 months), 11% of patients lost to follow-up, recurrence not assessed long-term", "followUp": "6 months", "plainFinding": "Less pain, faster healing with pit-picking surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38845858/", "sourceText": "BACKGROUND: In this study we compared the potential benefits of surgical treatments for chronic symptomatic pilonidal disease (PD) - minimally invasive pit-picking surgery and radical excision without wound suturing. MATERIALS AND METHODS: A total of 100 adult patients with chronic symptomatic PD were enrolled in this study at the Kaunas Hospital of the Lithuanian University of Health Sciences. They were randomly divided into two groups: pit-picking surgery (n = 50) and radical excision with open healing (n = 50). Recurrent PD patients were not excluded. The comparison of the techniques was based on pain within the first postoperative week, failed surgery rates, and wound healing time. Additionally, pain levels at different time intervals following the treatment, analgesic consumption, and time off work, were assessed and compared. RESULTS: A total of 89 patients (89 %) were available for follow-up after 6 months. 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). 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). 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. CONCLUSION: Based on our short-term findings, minimally invasive pit-picking surgery is a better option regarding pain, wound healing time and failed surgery rate. In cases where this approach is not suitable, other alternatives should be contemplated, as radical surgery without wound suturing should not be employed as a treatment method for PD. Additionally, the relationship between PD and recurrence rates should be investigated further.", "provenance": [ { "field": "population", "quote": "100 adult patients with chronic symptomatic PD" }, { "field": "intervention", "quote": "minimally invasive pit-picking surgery" }, { "field": "comparator", "quote": "radical excision with open healing" }, { "field": "primaryOutcome", "quote": "pain within the first postoperative week, failed surgery rates, and wound healing time" }, { "field": "result", "quote": "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)." }, { "field": "result", "quote": "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)." }, { "field": "result", "quote": "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." }, { "field": "n", "quote": "A total of 100 adult patients with chronic symptomatic PD were enrolled in this study" }, { "field": "followUp", "quote": "A total of 89 patients (89 %) were available for follow-up after 6 months." } ] }, { "id": "pmid:38725367", "pmid": "38725367", "doi": "10.23938/ASSN.1073", "nctId": null, "pmcid": "PMC11102778", "title": "A new midline closure technique without skin sutures: Long-term outcomes of primary repair of pilonidal sinus disease", "firstAuthor": "Tas", "multipleAuthors": true, "journal": "An Sist Sanit Navar", "year": 2024, "design": "rct", "n": 160, "nField": "reported", "population": "men who had pilonidal sinus disease needing surgery", "intervention": "excision followed by midline wound closure without skin stitches", "comparator": "excision followed by standard primary closure with skin stitches", "primaryOutcome": "long-term wound complications and recurrence of the disease after surgery", "result": "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", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "five-year mean follow-up", "plainFinding": "Less recurrence with stitch-free closure.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38725367/", "sourceText": "BACKGROUND: Currently, the focus regarding pilonidal sinus disease is put on the treatment techniques. The aim of the study is to compare postoperative long-term complications and recurrence of two surgical techniques. MATERIAL AND METHODS: From February 2015 to December 2020, male patients with pilonidal sinus disease attended at two general surgery outpatient centers were randomly assigned to either Group 1 (n=80; excision and primary closure) or Group 2 (n=80; excision and midline closure without skin sutures). Patients with recurrent or complicated pilonidal sinus or with prior surgical procedures were excluded from the study. Intergroup postoperative results and recurrence throughout the follow-up period were analyzed. RESULTS: Significant decrease (p<0.001) in the duration of the surgical procedure (35 to 25 minutes), length of hospital stay (one day to the day of the surgery), and of the time required to return to work (15 to 12 days) was seen for Group 2 patients. The complication rate (wound infection and seroma) was lower in Group 2 compared to Group 1 (n = 3; 3.7% vs n = 10; 12.5%; p = 0.014). During the five-year mean follow-up, five patients (6.2%) in Group 1 had recurrence compared to none in Group 2 (p = 0.023). CONCLUSIONS: Midline primary closure method without skin sutures - easy to learn and implement and has no complication or recurrence in the long-term follow-up - may be an ideal method in cases where excision and primary repair is planned, especially in patients with sinus orifices located in the midline.", "provenance": [ { "field": "population", "quote": "male patients with pilonidal sinus disease" }, { "field": "intervention", "quote": "excision and midline closure without skin sutures" }, { "field": "comparator", "quote": "excision and primary closure" }, { "field": "primaryOutcome", "quote": "compare postoperative long-term complications and recurrence of two surgical techniques" }, { "field": "result", "quote": "five patients (6.2%) in Group 1 had recurrence compared to none in Group 2 (p = 0.023)" }, { "field": "n", "quote": "Group 1 (n=80; excision and primary closure) or Group 2 (n=80; excision and midline closure without skin sutures)" }, { "field": "followUp", "quote": "five-year mean follow-up" } ] }, { "id": "pmid:38704463", "pmid": "38704463", "doi": "10.1007/s13304-024-01848-w", "nctId": null, "pmcid": null, "title": "Minimum energy laser pilonidotomy (MELPi): a multicenter study of a novel method in pilonidal disease", "firstAuthor": "Paz Oliveira", "multipleAuthors": true, "journal": "Updates Surg", "year": 2024, "design": "retrospective", "n": 47, "nField": "reported", "population": "patients with pilonidal disease (hair-containing cyst/infection near the tailbone)", "intervention": "minimal energy laser pilonidotomy (MELPi), a laser procedure to treat the pilonidal tract", "comparator": "none (no comparison group; all patients received MELPi)", "primaryOutcome": "pain, complications, healing time, recurrence, and return to activities after the procedure", "result": "low pain, low complication rate, fast return to activities, 10% recurrence", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a small retrospective case series with no comparison group, so it can't show whether MELPi works better than other treatments.", "directness": "direct", "limitations": "Retrospective design, no control group, small number of patients, multiple centers may differ in technique.", "followUp": "12 months", "plainFinding": "Low pain, quick recovery, some recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38704463/", "sourceText": "Laser surgery, a minimally invasive procedure for the definitive approach to pilonidal disease (PD), has been frequently studied in recent years. This study aims to describe a new pilonidotomy method using minimal laser energy and evaluate its initial results. This is a retrospective multicenter study. We included 47 consecutive patients who underwent 50 \"minimal energy pilonidotomies (MELPi)\" between 2019 and 2023 in four centers in Brazil. Age, BMI, gender, smoking, diabetes, Guner classification, duration of illness, energy, hospitalization time, complications, recurrence, wound closure, pain, and return to activities were analyzed. The median age was 27; 61.7% were men, and 38.3% were women. The median BMI was 25.7. Smoking was evident in 14.9%, and diabetes in 2.1%. The average duration of the disease was 3 years. Most operations (36%) were performed on stage R disease. The median hospitalization time was 6 h, and the median healing time was 15 days. The average energy used in procedures was 433 J. The median postoperative pain was 2. Secretion occurred in 14% on the 60th day. Complications (cellulitis) occurred in 4% of cases. The median time to return to work was 7 days. The average following time was 12 months; recurrence occurred in 5 (10%)-in 3 patients, a second MELPi procedure was performed and was effective. MELPi shows promising initial results: low pain, low complication rates, and a fast activity return. It is a good option in recidivate cases and can be done more than once if necessary.", "provenance": [ { "field": "n", "quote": "We included 47 consecutive patients who underwent 50 \"minimal energy pilonidotomies (MELPi)\" between 2019 and 2023 in four centers in Brazil." }, { "field": "population", "quote": "pilonidal disease (PD)" }, { "field": "intervention", "quote": "\"minimal energy pilonidotomies (MELPi)\"" }, { "field": "comparator", "quote": "This is a retrospective multicenter study." }, { "field": "primaryOutcome", "quote": "Age, BMI, gender, smoking, diabetes, Guner classification, duration of illness, energy, hospitalization time, complications, recurrence, wound closure, pain, and return to activities were analyzed." }, { "field": "result", "quote": "MELPi shows promising initial results: low pain, low complication rates, and a fast activity return." }, { "field": "result", "quote": "recurrence occurred in 5 (10%)-in 3 patients, a second MELPi procedure was performed and was effective." }, { "field": "followUp", "quote": "The average following time was 12 months" } ] }, { "id": "pmid:38677816", "pmid": "38677816", "doi": "10.1016/j.suc.2023.11.003", "nctId": null, "pmcid": null, "title": "Management of Pilonidal Disease and Hidradenitis Suppurativa", "firstAuthor": "Singh", "multipleAuthors": true, "journal": "Surg Clin North Am", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "healthy young adults with pilonidal disease and hidradenitis suppurativa", "intervention": "hair removal and surgical treatment for pilonidal disease; topical agents, antibiotics, biologics, and wide excision for hidradenitis suppurativa", "comparator": "", "primaryOutcome": "approach to managing pilonidal disease and hidradenitis suppurativa", "result": "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", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general review describing treatment options without presenting study data or outcomes to judge effectiveness.", "directness": "direct", "limitations": "No specific patient numbers, outcomes, or comparative data are reported; it is a general management overview rather than a study of effectiveness.", "followUp": "", "plainFinding": "General treatment overview, no outcome data.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38677816/", "sourceText": "Pilonidal disease and hidradenitis suppurativa affect healthy young adults, causing discomfort and pain that leads to loss of work productivity and should be approached in a personalized manner. Patients with pilonidal disease should engage in hair removal to the sacrococcygeal region and surgical options considered. Hidradenitis suppurativa can be a morbid and challenging disease process. Medical management with topical agents, antibiotics, and biologics should be used initially but wide local excision should be considered in severe or refractory cases of the disease.", "provenance": [ { "field": "population", "quote": "Pilonidal disease and hidradenitis suppurativa affect healthy young adults" }, { "field": "intervention", "quote": "Patients with pilonidal disease should engage in hair removal to the sacrococcygeal region and surgical options considered." }, { "field": "intervention", "quote": "Medical management with topical agents, antibiotics, and biologics should be used initially but wide local excision should be considered in severe or refractory cases of the disease." }, { "field": "primaryOutcome", "quote": "causing discomfort and pain that leads to loss of work productivity and should be approached in a personalized manner" }, { "field": "result", "quote": "Patients with pilonidal disease should engage in hair removal to the sacrococcygeal region and surgical options considered." } ] }, { "id": "pmid:38644667", "pmid": "38644667", "doi": "10.1111/codi.16989", "nctId": null, "pmcid": "PMC11683182", "title": "Classification and stratification in pilonidal sinus disease: findings from the PITSTOP cohort", "firstAuthor": "Lee", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2024, "design": "prospective-cohort", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease in the PITSTOP cohort study", "intervention": "the International Pilonidal Society (IPS) four-part classification tool", "comparator": "other published pilonidal disease classification tools and agreement between different raters", "primaryOutcome": "how valid and reliable the IPS classification system is for describing pilonidal disease", "result": "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", "resultDirection": "mixed", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "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.", "followUp": "", "plainFinding": "Classification tool only moderately reliable.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38644667/", "sourceText": "AIM: Research in pilonidal disease faces several challenges, one of which is consistent and useful disease classification. The International Pilonidal Society (IPS) proposed a four-part classification in 2017. The aim of this work was to assess the validity and reliability of this tool using data from the PITSTOP cohort study. METHOD: Face validity was assessed by mapping the items/domains in the IPS tool against tools identified through a systematic review. Key concepts were defined as those appearing in more than two-thirds of published tools. Concurrent and predictive validity were assessed by comparing key patient-reported outcome measures between groups at baseline and at clinic visit. The outcomes of interest were health utility, Cardiff Wound Impact Questionnaire (CWIQ) and pain score between groups. Significance was set at p = 0.05 a priori. 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. Interrater reliability was assessed using the unweighted kappa and unweighted Gwet's AC1 statistics. RESULTS: For face validity items represented in the IPS were common to other classification systems. Concurrent and predictive validity assessment showed differences in health utility and pain between groups at baseline, and for some treatment groups at follow-up. 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)]. CONCLUSION: The IPS classification demonstrates key aspects of reliability and validity that would support its implementation.", "provenance": [ { "field": "population", "quote": "using data from the PITSTOP cohort study" }, { "field": "intervention", "quote": "The International Pilonidal Society (IPS) proposed a four-part classification in 2017." }, { "field": "comparator", "quote": "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." }, { "field": "primaryOutcome", "quote": "The aim of this work was to assess the validity and reliability of this tool using data from the PITSTOP cohort study." }, { "field": "result", "quote": "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)]." } ] }, { "id": "pmid:38554245", "pmid": "38554245", "doi": "10.1002/wjs.12167", "nctId": null, "pmcid": null, "title": "Recurrence rates of pilonidal sinus disease in the pediatric population following trephine surgery", "firstAuthor": "Dreznik", "multipleAuthors": true, "journal": "World J Surg", "year": 2024, "design": "retrospective", "n": 565, "nField": "reported", "population": "children and teens who had surgery for a pilonidal sinus (a cyst near the top of the buttock crease)", "intervention": "minimally invasive surgery (Gips procedure) for pilonidal sinus disease", "comparator": "none - all patients received the same procedure; repeat surgery used the same method", "primaryOutcome": "how often the problem came back after surgery", "result": "the problem came back in 8.1% of patients, and after a second surgery using the same method, only 1% had further recurrence", "resultDirection": "benefit", "quality": "low", "qualityWhy": "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.", "directness": "indirect", "limitations": "retrospective design, single center, no comparator group to other surgical methods", "followUp": "", "plainFinding": "Low recurrence after minimally invasive surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38554245/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a common surgical disease. Multiple surgical methods exist in the literature, without clear consensus regarding which should be the first-line treatment. Minimally invasive methods such as the Gips procedure are gaining popularity in recent years. The aim of our study was to assess recurrence rates following the Gips procedure and to determine whether using the same surgical approach during re-operation is efficient and successful. METHODS: This is a single-center retrospective observational study of pediatric patients that underwent Gips procedure due to PSD between the years 2012-2022. RESULTS: 565 pediatric patients underwent an elective surgery for PSD in the study period. Recurrence rate was 8.1% (n = 46). In all the patients with recurrence, re-operation took place on average 9 months following the first surgery and using the same surgical method. Following the second surgery, only 8 patients (1%) had multiple recurrences. CONCLUSIONS: We found a relatively low recurrence rate in the pediatric population using the Gips method, and nearly 100% success rate following the second operation. Our findings set a new benchmark for pediatric recurrence following PSD operation, with clear recommendation to use the same method of surgery upon further recurrences as well.", "provenance": [ { "field": "population", "quote": "pediatric patients that underwent Gips procedure due to PSD" }, { "field": "intervention", "quote": "Gips procedure" }, { "field": "comparator", "quote": "using the same surgical approach during re-operation" }, { "field": "primaryOutcome", "quote": "assess recurrence rates following the Gips procedure" }, { "field": "result", "quote": "Recurrence rate was 8.1% (n = 46)" }, { "field": "result", "quote": "Following the second surgery, only 8 patients (1%) had multiple recurrences." }, { "field": "n", "quote": "565 pediatric patients underwent an elective surgery for PSD in the study period" } ] }, { "id": "pmid:38530042", "pmid": "38530042", "doi": "10.1177/03000605241236057", "nctId": null, "pmcid": "PMC10967004", "title": "Efficacy of laser obliteration with limited excision of pilonidal sinus", "firstAuthor": "Gratiashvili", "multipleAuthors": true, "journal": "J Int Med Res", "year": 2024, "design": "prospective-cohort", "n": 152, "nField": "reported", "population": "patients with chronic pilonidal sinus disease", "intervention": "laser obliteration with limited excision (LOLE) of the pilonidal sinus", "comparator": "wide excision (WE) of the pilonidal sinus", "primaryOutcome": "complete wound healing, recurrence, and the complication rate", "result": "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.", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It compared two treatments in real patients but wasn't randomized, so differences could be due to other factors.", "directness": "direct", "limitations": "Observational, not randomized, which can bias comparisons between treatments.", "followUp": "", "plainFinding": "Laser treatment healed faster.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38530042/", "sourceText": "OBJECTIVE: This study was performed to compare the effectiveness of laser obliteration with limited excision (LOLE) versus wide excision (WE) of the pilonidal sinus. METHODS: A prospective, cross-sectional observational study of 152 patients with chronic pilonidal sinus disease was performed from September 2019 to September 2022. Of the 152 patients, 76 underwent LOLE and 76 underwent WE. The main evaluation criteria were complete wound healing, recurrence, and the complication rate. RESULTS: Complete healing was achieved in 74 (97.4%) patients in the LOLE group and 76 (100%) patients in the WE group. The duration of wound healing was significantly shorter in the LOLE group than in the WE group (6.5 ± 2.4 vs. 14.5 ± 2.6 weeks, respectively). Recurrence developed in six (7.9%) patients in the LOLE group and one (1.3%) patient in the WE group, with no significant difference. CONCLUSION: According to our study and the data available in the literature, laser surgery should be included in the guidelines for the treatment and management of pilonidal disease.", "provenance": [ { "field": "n", "quote": "A prospective, cross-sectional observational study of 152 patients with chronic pilonidal sinus disease" }, { "field": "population", "quote": "152 patients with chronic pilonidal sinus disease" }, { "field": "intervention", "quote": "laser obliteration with limited excision (LOLE)" }, { "field": "comparator", "quote": "wide excision (WE) of the pilonidal sinus" }, { "field": "primaryOutcome", "quote": "The main evaluation criteria were complete wound healing, recurrence, and the complication rate." }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:38512592", "pmid": "38512592", "doi": "10.1007/s00383-024-05668-2", "nctId": null, "pmcid": null, "title": "Pit excision with fibrin glue closure versus lateralizing flap procedures in the management of pilonidal sinus disease in adolescents: a 14-year cohort study", "firstAuthor": "Giles", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2024, "design": "retrospective", "n": 78, "nField": "reported", "population": "adolescents with chronic pilonidal sinus disease (hair follicle infection at the top of the butt crack)", "intervention": "pit excision with fibrin glue closure (a minimally invasive surgery)", "comparator": "traditional lateralizing flap surgery", "primaryOutcome": "recurrence of the condition and need for repeat surgery", "result": "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", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "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.", "directness": "direct", "limitations": "Retrospective design (not randomized), follow-up time differed between the two groups, single-center study.", "followUp": "2.21 and 2.52 years", "plainFinding": "Fewer repeat surgeries with simpler technique.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38512592/", "sourceText": "INTRODUCTION: Pilonidal sinus disease (PSD) arises in the hair follicles of the gluteal cleft with many cases occurring during adolescence. Early studies of pit excision with fibrin glue closure (PEF), a minimally invasive procedure for the management of chronic PSD, suggest it is safe and effective with similar results to traditional lateralizing flap procedures (LFP), without the need for extensive tissue excision and associated complications. However, these studies lack large sample sizes and prolonged follow-up. METHODOLOGY: All children undergoing primary operative procedures for chronic PSD from May 2009 to February 2022 received either a PEF or a LFP. Recurrence and complications rates alongside their demographic and disease severity data were compared using statistical and Kaplan-Meier analyses. RESULTS: Seventy-eight children had 33 primary PEF and 45 primary LFP procedures with a median follow-up of 2.21 and 2.52 years, respectively. Demographic and disease severity indicators were similar between groups (p > 0.05). The overall recurrence rate in each cohort was 3% for PEF and 11% for LFP, respectively (p = 0.2346). The all-cause repeat intervention rate was 12% and 49% in the PEF and LFP cohorts, respectively (p = 0.0007). Kaplan-Meier analysis showed a reduction in the requirement of re-operation in the PEF cohort (p = 0.0340). Operative time was significantly decreased in the PEF cohort compared to the LFP cohort (p < 0.0001). Wound dehiscence was significantly decreased in the PEF cohort compared to the LFP cohort (3% vs 31%; p = 0.0026). CONCLUSION: This 14-year study is the largest pediatric-focused cohort utilizing PEF to manage PSD and demonstrated clinically relevant decreases in symptom recurrence alongside significantly decreased rates of complications and further surgical intervention compared to traditional LFP techniques. We conclude that PEF is a viable minimally invasive technique in the management of pediatric PSD.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus disease (PSD) arises in the hair follicles of the gluteal cleft with many cases occurring during adolescence." }, { "field": "intervention", "quote": "pit excision with fibrin glue closure (PEF)" }, { "field": "comparator", "quote": "lateralizing flap procedures (LFP)" }, { "field": "n", "quote": "Seventy-eight children had 33 primary PEF and 45 primary LFP procedures" }, { "field": "primaryOutcome", "quote": "Recurrence and complications rates alongside their demographic and disease severity data were compared" }, { "field": "result", "quote": "The overall recurrence rate in each cohort was 3% for PEF and 11% for LFP, respectively (p = 0.2346). The all-cause repeat intervention rate was 12% and 49% in the PEF and LFP cohorts, respectively (p = 0.0007)." }, { "field": "result", "quote": "Wound dehiscence was significantly decreased in the PEF cohort compared to the LFP cohort (3% vs 31%; p = 0.0026)." }, { "field": "followUp", "quote": "median follow-up of 2.21 and 2.52 years, respectively" } ] }, { "id": "pmid:38507939", "pmid": "38507939", "doi": "10.1016/j.ijscr.2024.109539", "nctId": null, "pmcid": "PMC10963643", "title": "Pilonidal disease in the pregnant patient: A case report", "firstAuthor": "Liang", "multipleAuthors": true, "journal": "Int J Surg Case Rep", "year": 2024, "design": "case-series", "n": 1, "nField": "reported", "population": "a 22-year-old pregnant woman having her first baby", "intervention": "non-operative management during pregnancy, then minimally invasive surgery after birth", "comparator": "no comparison group, just her own course over time", "primaryOutcome": "whether her pilonidal disease symptoms went away and stayed away", "result": "symptoms came back more than once but resolved; after postpartum surgery there was no further recurrence", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient's case report, so it cannot show whether treatments generally work.", "directness": "direct", "limitations": "only one patient described, so findings may not apply to others; abstract notes the cause 'warrants further investigation'", "followUp": "", "plainFinding": "Symptoms recurred, resolved after postpartum surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38507939/", "sourceText": "INTRODUCTION: Pilonidal disease in the pregnant patient is underreported and may be instigated by significant shifts in hormone levels throughout pregnancy and the postpartum period. PRESENTATION OF CASE: An otherwise healthy primigravid 22-year-old woman developed pilonidal disease at the beginning of her pregnancy. While pregnant, her symptoms recurred once and resolved without treatment. She was managed non-operatively during pregnancy. Her symptoms recurred again in the postpartum period but they quickly resolved. Due to the recurrent symptoms, she underwent definitive management via minimally invasive Gips procedure in the postpartum period, without further recurrence. DISCUSSION: Pilonidal disease affects pregnant patients and can be managed non-operatively. The etiology of pilonidal disease in the setting of pregnancy may be related to hormonal shifts and warrants further investigation. CONCLUSION: We present the first report of pilonidal disease in a pregnant patient in the primary literature. The hormonal shifts associated with pregnancy may be associated with the development of pilonidal disease in the pregnant patient.", "provenance": [ { "field": "n", "quote": "An otherwise healthy primigravid 22-year-old woman developed pilonidal disease at the beginning of her pregnancy" }, { "field": "population", "quote": "An otherwise healthy primigravid 22-year-old woman developed pilonidal disease at the beginning of her pregnancy" }, { "field": "intervention", "quote": "She was managed non-operatively during pregnancy." }, { "field": "intervention", "quote": "she underwent definitive management via minimally invasive Gips procedure in the postpartum period, without further recurrence" }, { "field": "comparator", "quote": "Pilonidal disease affects pregnant patients and can be managed non-operatively." }, { "field": "primaryOutcome", "quote": "Her symptoms recurred again in the postpartum period but they quickly resolved." }, { "field": "result", "quote": "While pregnant, her symptoms recurred once and resolved without treatment." }, { "field": "result", "quote": "she underwent definitive management via minimally invasive Gips procedure in the postpartum period, without further recurrence" } ] } ], "faqs": [ { "q": "Why is there a bump at the top of my butt crack and it hurts?", "a": "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." }, { "q": "Why is the top of my bum crack split and sore?", "a": "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." }, { "q": "Why is my butt crack bleeding?", "a": "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." }, { "q": "Why does skin crack on top of butt?", "a": "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." }, { "q": "What should I do instead of waiting for it to go away on its own?", "a": "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." } ], "searchedAs": [ "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" ], "patientTakeaway": "Pain, a bump, or bleeding at the top of your butt crack is most often pilonidal disease — not something to pop, ignore, or treat yourself. See a doctor or nurse to get it looked at, especially if it's swollen, draining, or not settling down; most people who get treated do well, though the condition can come back and sometimes needs more than one procedure. If a sore in this spot won't heal over several weeks, get it checked rather than assuming it's 'just' a pilonidal cyst.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(\"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])" }, "pubmedQueryTranslation": "(\"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])", "searchedOn": "2026-10-13", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Why Does the Top of My Butt Crack Hurt?", "description": "Pain, bumps or bleeding at the top of the butt crack: what 179 studies show about pilonidal disease, recurrence and risks." }, "lastChecked": "2026-10-13", "lastChanged": "2026-10-13", "nextCheckDue": "2026-11-13", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-13" }, "status": "published" }