Treatment of pilonidal sinuses in Denmark is not optimal

The standard treatments of chronic pilonidal sinuses (PS) were previously wide excision with primary midline closure or open treatment by non-specialist surgeons resulting in high rates of unhealed wounds and recurrences. An evidence-based shift from the now obsolete midline procedures towards off-line procedures seems to have occurred over the past 3-4 years. We decided to analyse the present state of PS treatment in Denmark.

A questionnaire was sent to all public hospitals and private clinics potentially treating PS. It included questions on the volume of procedures, experience of surgeons, and methods of anaesthesia and procedures in different cases.

The questionnaire was answered by 37 departments (response rate 95%) in public hospitals and by 92 private clinics (response rate 84%). Off-midline closure was performed in 75% of the public departments, but some of these are also still performing midline surgery in some case. A total of 54% of the public departments are still performing midline surgery in some cases. Local analgesia is used in only 41% of the departments, and in 58% of these departments, local analgesia is used in fewer than 10% of the cases. In 11 (39%) departments, elective PS is performed by one or two surgeons, and there is a significant relation (p = 0.033) between low experience and large number of PS surgeons per department. Midline surgery seems to be performed in departments with more PS surgeons.

Too many surgeons are still performing obsolete midline surgery. National guidelines are needed. The number of cases treated under local analgesia is unsatisfactorily low.