Surgical preference and outcomes in pilonidal sinus disease: a national multicenter study evaluating complications, recurrence, and quality of life (PISI TURKEY)

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.

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.

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).

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.