Recurrence Patterns in Pilonidal Sinus Disease Surgery: Navigating Misclassifications and Early Complications

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.

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.

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%).

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