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Updated: Jul 17, 2026

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The Minimally Invasive Pilonidal Protocol (MIPP): Low Short-Term Recurrence After Completion in a Single-Center

Gheed Murtadi1, Anna Ghelfi1, Rachael Cohen1

  • 1Boston Children's Hospital, Department of Surgery, Massachusetts, United States, Boston.

European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [Et Al] = Zeitschrift Fur Kinderchirurgie
|July 15, 2026
PubMed
Summary

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The Minimally Invasive Pilonidal Protocol (MIPP) shows a 4.0% recurrence rate in pilonidal disease patients after graduation. Most recurrences were mild and successfully treated with further minimally invasive care.

Area of Science:

  • Surgery
  • Dermatology
  • Gastroenterology

Background:

  • Pilonidal disease treatment remains challenging with high recurrence rates (up to 30%) after traditional resection or sinusectomy.
  • The Pilonidal Care Clinic (PCC) developed the Minimally Invasive Pilonidal Protocol (MIPP) to address these limitations.

Purpose of the Study:

  • To evaluate the recurrence rate of pilonidal disease in patients who successfully completed the MIPP.
  • To assess the long-term outcomes and effectiveness of the MIPP for pilonidal disease management.

Main Methods:

  • A retrospective review of prospectively collected data from patients who completed the MIPP between January 2021 and December 2024.
  • Follow-up occurred every 6-8 weeks until disease resolution and laser ablation completion; recurrence was defined as disease presence upon examination after graduation.

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  • Graduated patients were contacted via text message to assess post-graduation symptoms; patients lost to follow-up or still in treatment were excluded.

    • Main Results:

    • Out of 884 initial patients, 297 completed the MIPP and graduated. The average treatment duration was 12.3 months.
    • A recurrence rate of 4.0% (12 out of 297 graduates) was observed, with recurrences occurring an average of 16.3 months post-graduation.
    • Of the 12 recurrent cases, 8 had new pits and 4 had both pits and a nidus; 9 of these patients were successfully re-graduated.
    • A text survey of 280 non-returning graduates revealed 5.6% reported recurrence, with 94.4% remaining disease-free.

    Conclusions:

    • Completion of the MIPP is associated with a low recurrence rate of 4.0% for pilonidal disease.
    • The majority of recurrences were mild and amenable to further minimally invasive treatment, suggesting MIPP's effectiveness.
    • The MIPP offers a promising approach for managing pilonidal disease with favorable long-term outcomes.