Management of pilonidal sinus and recurrences in 2025

Area of Science:

• Surgical Pathology
• Dermatology
• Wound Healing

Background:

• Pilonidal sinus is a frequent intergluteal cleft pathology characterized by foreign body granuloma formation, often around hairs.
• Complications include abscess and suppuration, necessitating medical or surgical treatment, with over 10,000 emergency procedures annually in France.
• Elective surgery is common for persistent symptoms or recurrent abscess risk, with over 30,000 procedures yearly in France.

Purpose of the Study:

• To review current treatment strategies for pilonidal sinus.
• To compare the efficacy and outcomes of radical excision versus minimally invasive techniques.
• To discuss management of surgical failures and the role of patient risk factors.

Main Methods:

• Review of existing literature on pilonidal sinus treatment modalities.
• Analysis of outcomes associated with radical excision, primary closure, and minimally invasive approaches.
• Discussion of patient risk factors, such as smoking, and their impact on surgical success.

Main Results:

• Radical excision with secondary healing has a recurrence rate of at least 10%.
• Primary closure reduces healing time but increases infectious complications; midline closure is discouraged.
• Minimally invasive techniques, including laser treatment, avoid complex wound care and offer comparable recurrence rates to excision, with improved quality of life in failure cases.

Conclusions:

• Minimally invasive techniques provide a valuable alternative to traditional excision for pilonidal sinus, particularly in managing recurrent or complex cases.
• Patient-centered care, including addressing risk factors like smoking and obesity, is crucial for successful pilonidal sinus management.
• Further research into minimally invasive methods may optimize treatment outcomes and patient recovery.