Acute pilonidal abscess: Prospective nationwide audit in the Netherlands

Area of Science:

• Colorectal Surgery
• Surgical Outcomes
• Pilonidal Sinus Disease Management

Background:

• Pilonidal sinus disease (PSD) is a common condition requiring surgical intervention.
• Acute pilonidal abscesses represent a significant subset of PSD presentations.
• Understanding current Dutch surgical practices and outcomes for acute abscesses is crucial for improving patient care.

Purpose of the Study:

• To evaluate the surgical management and clinical outcomes of acute pilonidal abscesses in the Netherlands.
• To assess wound healing rates, complication incidence, and recurrence following incision and drainage (I&D).
• To determine the long-term impact on symptomatic chronic PSD and patient quality of life.

Main Methods:

• A prospective observational cohort study was conducted across 36 Dutch hospitals.
• Included patients underwent surgical treatment for pilonidal sinus disease between March 2020 and March 2021.
• Analysis focused on patients presenting with an acute pilonidal abscess, with 1-year follow-up assessing various outcomes.

Main Results:

• Of 681 PSD patients, 208 (30.5%) had an acute abscess, with 99% undergoing incision and drainage (I&D).
• Successful wound healing after I&D was observed in 42.2% of cases, with a median closure time of 43 days and a 4.4% complication rate.
• Within 1 year, 7.3% experienced recurrent abscesses, and 8.8% had symptomatic chronic PSD, though 91.2% did not require additional surgery.

Conclusions:

• Incision and drainage for acute pilonidal abscesses demonstrates a low complication rate but suboptimal wound healing rates.
• A significant proportion of patients with acute abscesses develop chronic PSD, necessitating further management strategies.
• The majority of patients managed with I&D for acute abscesses do not require further surgical intervention for chronic PSD within the first year.