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Surgical Treatment Outcomes for Primary Pilonidal Sinus Disease: A Single-Centre Retrospective Study of 2222 Patients
Merve Tokocin1, Hakan Yigitbas1, Erkan Yavuz1
1Department of General Surgery, University of Health Sciences Türkiye, İstanbul Bağcılar Training and Research Hospital, Istanbul, Turkey.
Abstract:
Pilonidal sinus disease (PSD) is a common acquired condition of the sacrococcygeal region; despite numerous described surgical techniques, long-term outcomes remain highly variable. We compared long-term recurrence and postoperative infection among nine surgical techniques in a large single-centre cohort. We retrospectively analysed 2222 patients with primary PSD who underwent surgery between January 2006 and December 2020 at a single tertiary referral centre in Turkey and had a minimum follow-up of 5 years. Patients presenting with recurrent disease were excluded. Nine surgical techniques were evaluated. Recurrence was analysed as a time-to-event outcome using Kaplan-Meier estimates and multivariable Cox proportional hazards regression. The 5-year cumulative recurrence was 7.9% (175/2222) and postoperative infection 6.9% (154/2222); overall recurrence was 10.2% (226/2222). Recurrence and infection differed statistically significantly among surgical techniques (both p < 0.001). The lowest recurrence rates were observed with the Karydakis flap (1.5%), Bascom cleft lift (2.3%) and Dufourmentel flap (2.4%). Most recurrences occurred within the first 2 years, with a median time to recurrence of 20 months (IQR 12-36). Compared with lay-open treatment, the Karydakis flap (HR 0.19, 95% CI 0.12-0.30), Bascom cleft lift (HR 0.25, 95% CI 0.14-0.43), Limberg flap (HR 0.32, 95% CI 0.19-0.53) and Dufourmentel flap (HR 0.26, 95% CI 0.12-0.57) were independently associated with lower risk of recurrence, whereas a higher body mass index (HR 1.05 per 1 kg/m2, 95% CI 1.01-1.09) and current smoking (HR 1.98, 95% CI 1.54-2.55) were independently associated with an increased recurrence risk. Off-midline flap techniques were associated with superior long-term outcomes, with lower recurrence and infection than midline or secondary-healing approaches. Taken together, the findings of this study support the use of the Karydakis flap and Bascom cleft lift as first-line surgical options for PSD management.
