Risk of re-operation after Bascom I for pilonidal sinus disease. A Danish population-based cohort study

The treatment of chronic pilonidal sinus disease (PSD) is controversial. Minor PSD can be treated minimally invasively. The preferred minimally invasive treatment in Denmark is the Bascom I procedure.

To evaluate re-operation rates following elective Bascom I and to identify potential risk factors.

Using nationwide Danish databases from 2010 to 2021, we identified patients diagnosed with PSD undergoing incident Bascom I. Based on previous surgery, patients were divided into four groups: (i) Bascom I with no previous PSD treatment; Bascom I with history of (ii) one or (iii) two incision & drainage (I&D) procedures; and (iv) Bascom I with history of other PSD procedures. Patients were followed until re-operation, death or emigration. Stratified by sex, 1-, 2- and 5-year risk of re-operation was examined. A subsequent analysis assessed the risk of re-operation after second Bascom I procedure.

Of 3555 (79% male) PSD patients undergoing Bascom I procedure, 2417 had the procedure without previous PSD surgery, 382 underwent Bascom I after one I&D procedure, 108 after two I&D procedures and 648 after other/more PSD procedures. The overall 5-year re-operation risk was 30%, highest in younger age groups. As much as 65% of re-operations occurred within the first 12 months. After a second Bascom I, the 5-year risk was 45%.

High rates of early failures seem to drive a high risk of re-operation after the Bascom I procedure. Patient selection, technique and training likely need improvements to ensure acceptable outcomes.