Surgical management of pilonidal sinus disease in pediatric population: An updated systematic review and meta-analysis.

Evidence synthesis in pilonidal disease surgery is limited by heterogeneity in outcome selection, definition, measurement and follow-up. This systematic review aimed to identify and describe outcomes reported in comparative studies of surgical management of pilonidal disease to inform development of a core outcome set. PubMed, Embase and CENTRAL were searched from inception to 28 November 2025. Randomised controlled trials and comparative observational studies evaluating surgical interventions for pilonidal disease were eligible. Two reviewers independently screened studies and extracted study characteristics and outcome data. Verbatim outcomes were standardised, grouped into domains and summarised descriptively. Because the objective was to map outcome reporting rather than estimate treatment effects, risk-of-bias assessment and GRADE appraisal were not undertaken. A total of 155 studies were included, comprising 93 randomised trials and 62 observational studies. Ten outcome domains were identified. Recurrence was reported most frequently (112 studies, 72.3%), followed by non-infective complications (103, 66.5%), pain (83, 53.5%), wound healing (82, 52.9%) and return to normal activities (63, 40.6%). Patient-important domains were less frequently reported, including health-related quality of life or satisfaction (50, 32.3%) and cosmesis (17, 11.0%). Among outcomes designated as primary, wound healing was most common (51 studies, 32.9%), followed by recurrence (35, 22.6%) and postoperative complications (25, 16.1%). Pain (6, 3.9%), return to normal activities/work (9, 5.8%), and psychological or quality-of-life outcomes (3, 1.9%) were rarely primary outcomes. Definitions, measurement instruments, assessment timepoints and overall follow-up duration varied substantially across studies. Comparative studies of pilonidal disease surgery predominantly prioritise recurrence, healing and complications, whereas patient-important outcomes are reported less consistently and are infrequently prioritised. Standardisation of outcome selection, definitions and measurement is needed. These findings support development of a core outcome set for future trials in pilonidal disease surgery. CRD420251128698.

Perianal itching is a common complaint associated with a variety of anorectal conditions such as fistulas, abscesses, hemorrhoids and pilonidal disease. Accurate diagnosis is essential for effective treatment and magnetic resonance imaging (MRI) plays a pivotal role due to its excellent soft-tissue resolution and multiplanar imaging. The objective of this study was to evaluate the diagnostic utility of MRI in patients with perianal itching, focusing on the identification and classification of perianal fistulas and their mimics, using St. James and Parks classification systems. This prospective observational study was conducted in the department of radiodiagnosis over 6 months (December 2023-May 2024) and included 59 patients aged ≥ 18 years with perianal itching. MRI (1.5T) pelvis scans were obtained using T1, T2, short tau inversion recovery, diffusion-weighted imaging, apparent diffusion coefficient and postcontrast sequences. Fistulas were classified using the St. James and Parks systems. Chi-square test assessed the correlation between the classifications. Among 59 cases, perianal fistula was most common (57.6%), followed by abscess (33.9%), pilonidal sinus (5.1%) and hemorrhoids (3.4%). The mean age was 45.8 ± 10.6 years with male predominance. Grade 2 fistulas ( 47.06%) and intersphincteric type (64.70%) were most frequent. A strong correlation ( P < 0.001) was observed between St. James and Parks classifications. Common complications included abscesses (70.6%) and horseshoe tracts (14.7%). MRI findings showed high concordance with clinical and surgical data. MRI is a sensitive, noninvasive tool for evaluating perianal itching. It effectively characterizes underlying pathology, guides treatment planning, shows strong classification correlation and enhancing clinical decision-making.

Pilonidal sinus disease (PSD) is a suppurative inflammatory condition characterized by a sinus tract in the sacrococcygeal gluteal cleft and surrounding skin. Surgical resection is an important treatment for PSD; however, postoperative recurrence occurs in some patients, severely affecting their quality of life. Due to the lack of objective clinical indicators for predicting recurrence, developing an artificial intelligence-based prediction model is an effective approach. In this study, postoperative hematoxylin and eosin (H&E) stained pathological sections from PSD patients were used. The horizontal and vertical distance network (HoVer-Net) deep learning model for automated nuclei segmentation and classification was employed to extract nuclear features from lesion regions. These features were then integrated with multidimensional clinical characteristics to select key features. And then a machine learning classifier was incorporated to construct a recursive feature elimination-balanced random forest (RFE-BalancedRF) ensemble model to predict PSD recurrence. Experimental results demonstrate that the proposed PSD recurrence prediction model achieves an area under the curve of receiver operating characteristic (ROC_AUC) of 0.751 ± 0.048 and an accuracy (Acc) of 0.715 ± 0.066. Furthermore, a correlation exists between multimodal features and the risk of PSD recurrence, confirming the effectiveness of the proposed model in predicting PSD recurrence. This study innovatively integrates radiomics features with clinical characteristics from the dual perspectives of pathological image analysis and multimodal feature fusion to construct a PSD recurrence risk prediction model, potentially providing a new pathway with considerable clinical translation potential for artificial intelligence assisted medicine.

The optimal treatment for complex Pilonidal Sinus Disease (PSD) is still debated. Despite great advances with the introduction of off-midline closure techniques, healing problems and recurrence remain challenges. We aimed to investigate whether choice of skin-suturing technique in Bascom's Cleft lift (BCL) procedure influenced risk of prolonged healing or recurrence. We analysed the data of 540 unique patients who underwent BCL surgery at Randers Regional Hospital between 2016 and 2022. During this period, a technical revision of technique caused a shift from extracutaneous to intracutaneous closure creating two groups for comparison. Prolonged healing was defined as lack of complete epithelialization at the second post-surgical follow-up (maximum 14weeks post-surgery). There was no difference in time-to-healing among the suture groups with a 76% rate of primary healing in both groups. At 5years post-surgery, the cumulative incidence proportion (CIP) of recurrence was 9.1% in the intracutaneous group and 5.7% in the extracutaneous group (p = 0.41). At 5years post-surgery, the CIP of recurrence was 14.0% among patients with prolonged healing and 7.0% among patients with primary healing (p < 0.05). In our study population, choice of skin-suturing technique did not affect risk of prolonged healing nor recurrence after BCL surgery. However, patients experiencing prolonged healing after surgery had significantly higher risk of recurrence, emphasizing the need for increased efforts to prevent post-surgical wound dehiscence.

Successful surgical management of pilonidal sinus disease (PSD) in young, active patients requires rapid restoration of daily functions, including driving and sexual activity. This study compared patient-reported recovery as regards sexual function and driving ability following the KF versus the LF for primary sacrococcygeal PSD. This multicenter retrospective cohort study (FLARE study) included employed, sexually active patients who underwent surgery for primary PSD (July 2017-July 2024). The primary outcome was time to sexual activity resumption; the secondary outcome was time to resumption of driving. Outcomes were assessed at 1year using a structured Likert-scale questionnaire. Kaplan-Meier curves and Cox regression analyses with adjustment were used. A total of 352 patients were divided into 176KF and 176 LF. KF patients resumed sexual activity earlier (2.88±0.7 vs. 4.58±1.1weeks; mean difference -1.7weeks, 95% CI -1.89 to -1.49, p<0.001). KF reported significantly less pain, less avoidance, and lower analgesic use during sex. LF reported lower sexual satisfaction (mean 3.94 vs. 2.15; mean difference -1.78, 95% CI -2.02 to -1.53). KF resumed driving earlier (median 9 vs. 19days; r=0.7, large effect, p<0.001) and had longer sitting tolerance (OR 0.3, 95% CI 0.2-0.4, p<0.001). LF had higher pain while sitting (mean Likert 4 vs. 2; mean difference of -1.94, 95% CI -2.19 to -1.68), higher VAS pain (median 4 vs. 2; r=0.5), greater need for cushions/analgesics, and more driving-related work/social limitations (all p<0.001). Time to resume sexual activity and driving was significantly shorter for KF. On multivariable analysis, LF was independently associated with delayed return to sexual activity (adjusted OR 4.02, 95% CI 2.1-7.5, p<0.001) and delayed return to driving (adjusted OR 2.8, 95% CI 1.5-5.2, p<0.001). In this retrospective cohort, KF may be associated with significantly faster return to sexual and driving activity compared with LF. These results underscore the importance of incorporating patient-centered functional outcomes into surgical decision-making for PSD. Number: NCT07271537.

Pilonidal sinus is a chronic inflammatory condition of the natal cleft that commonly affects young adults. Conventional surgical treatments, such as wide excision and flap reconstruction, are associated with large wounds and prolonged recovery. Phenol treatment has been reported as a minimally invasive alternative in several countries; however, clinical experience in Japan remains limited. We retrospectively reviewed patients with pilonidal sinus who underwent phenol treatment at our institution between 2020 and 2025. After excision of the midline pits and curettage of the sinus tract, undiluted phenol was injected into the cavity and subsequently neutralized with ethanol. Clinical data, including patient characteristics, number of pits, operative time, postoperative hospital stay, complications, and recurrence, were analyzed. A total of 11 patients were included in the study. The median age was 27 years (range, 13-50), and 10 patients were male. The median number of pits was 3 (range, 1-5). The median operative time was 32 min (range, 19-56), and the median postoperative hospital stay was 2 days (range, 1-6). Postoperative bleeding occurred in two patients and was successfully managed conservatively. No recurrence was observed during the follow-up period (median, 331 days; range, 100-979). Phenol treatment for pilonidal sinus appears to be a simple and minimally invasive procedure associated with short hospitalization and favorable short-term outcomes. This technique may represent a useful treatment option for pilonidal sinus in Japan.

Pilonidal sinus disease (PSD), which predominantly affects young adults, has increasingly been managed with minimally invasive techniques aimed at reducing postoperative pain, accelerating recovery, and minimizing work absenteeism. This study aimed to compare the early term outcomes of patients treated with crystallized phenol treatment (CPT) or sinus laser closure (SiLaC) for PSD. We retrospectively analyzed a prospectively maintained cohort at a tertiary center between January 2023 and August 2024. Patients with PSD undergoing SiLaC or CPT with scheduled 1-week and 1-month follow-up assessments were included. The primary outcomes were patient satisfaction, health-related quality of life (SF-36), symptom severity (itching, burning, purulent discharge), pain intensity (Visual Analogue Scale), and time to return to work, all assessed at 1week and 1month postoperatively. Secondary outcomes included pit orifice closure rates and perioperative complications. A total of 230 patients were analyzed (SiLaC n = 93; CPT n = 137), with comparable baseline characteristics. At 1week, itching (1 [1-1] versus 1 [1-2], p < 0.001), burning (1 [1-1] versus 1 [1-2], p = 0.001), and purulent discharge (1 [1-1] versus 1 [1-3], p < 0.001) were less frequent in the SiLaC group. Pain scores were also lower in the SiLaC group (VAS: 0 [0-1] versus 0 [0-5], p = 0.034). SF-36 scores were significantly higher in the SiLaC group for physical functioning (100 [90-100] versus 95 [85-100], p < 0.001), physical role limitation (100 [100-100] versus 100 [75-100], p = 0.005), social functioning (100 [87.5-100] versus 87.5 [62.5-100], p < 0.001), and pain (100 [67.5-100] versus 90 [67.5-100], p = 0.008). Return to daily activities was shorter in the SiLaC group (0 [0-0] versus 0 [0-1] days, p < 0.001). At 1month, most outcomes were comparable between groups, although purulent discharge remained higher in the CPT group (1 [1-2] versus 1 [1-1], p = 0.045). Complication rates were low and similar between groups (9.6% versus 12.4%, p = 0.489). The SiLaC method was associated with more favorable quality of life (QoL) outcomes compared with CPT during the first postoperative week. Subgroup analyses suggested that SiLaC may offer advantages in certain clinical scenarios. Further multicenter randomized controlled trials are warranted to better clarify and validate these findings.

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.

ABSTRACTObjective: To evaluate short‐term treatment outcomes and treatment burden in patients with presacral pilonidal sinus disease managed with crystallised phenol in a single‐centre clinical series, with particular emphasis on the relationship between pit burden and session requirement. Methods: Consecutive patients treated with crystallised phenol were analysed (n = 40). Demographic and clinical characteristics, symptom duration, pit count, number of phenol sessions (2 vs. 3), inter‐session intervals, and total treatment duration were recorded. All patients completed scheduled clinical reassessment at 5 weeks and 3 months. Treatment‐related abscess and recurrence during follow‐up were documented. Continuous variables are presented as mean ± standard deviation and median (minimum–maximum). Comparisons between the two‐session and three‐session groups were performed with the Mann–Whitney U test for continuous variables and Fisher's exact test for categorical variables. Results: The cohort was predominantly male (75%), with a mean age of 29.23 ± 9.85 years and a mean body mass index of 25.81 ± 3.85 kg/m2; 62.5% were smokers. Symptom duration was 6.80 ± 7.20 months, and mean pit count was 1.90 ± 0.93. Two sessions were sufficient in 42.5% (17/40), whereas 57.5% (23/40) required three sessions. The interval between the first and second sessions was 11.32 ± 3.30 days, and the interval between the second and third sessions was 11.96 ± 3.23 days in patients who underwent three sessions; overall treatment duration was 18.2 ± 7.58 days. No patient was lost to follow‐up. Pit burden was the strongest determinant of requiring a third session: pit count was significantly higher in the three‐session group than in the two‐session group (2.39 ± 0.89 vs. 1.24 ± 0.44, p < 0.001), and all patients with ≥ 3 pits required three sessions. Smoking status (p = 1.000) and body mass index (BMI) (p = 0.208) were not associated with session requirement. Treatment‐related abscess developed in 12.5% (5/40), and recurrence during the 3‐month follow‐up was observed in 12.5% (5/40); notably, all such events occurred in the three‐session group (0/17 vs. 5/23, p = 0.061 for both comparisons). Conclusion: In this single‐centre series, crystallised phenol provided acceptable short‐term outcomes and a relatively short treatment course in presacral pilonidal sinus disease. Pit count emerged as the main determinant of requiring a third session, whereas smoking status and BMI were not associated with session requirement. Larger studies with longer follow‐up are needed to clarify predictors of recurrence and to determine whether higher session requirements simply reflect disease complexity or also influence outcome.

Pilonidal sinus disease (PSD) is an acquired inflammatory condition of the gluteal cleft predominantly affecting teenagers. We report our 10-year experience adopting this minimally invasive approach, pediatric endoscopic pilonidal sinus treatment (PEPSiT). We retrospectively reviewed all patients, with primary or recurrent PSD, undergoing PEPSiT in the 2016-2025 period. We operated 507 patients (313 boys and 194 girls) with a median age of 15.5 years (IQR 12-18 years). All patients received our postoperative management. Data regarding success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10, IQR 1-2). Patient satisfaction was excellent (median score 4.8/5, IQR 4-5). Dressing after surgery was performed with ozone oil products in every patient and in the last 18 months Platelet-Rich Plasma (PRP) has been added to the intra and post-operative care too. Disease recurrence occurred in 53/507 patients (10.4%), mostly within 3 months (range 2 months-23 months), and all were successfully re-operated with PEPSiT with no further recurrence. This study demonstrates that a standardized perioperative protocol, including tailored pre- and post-operative management and structured long-term follow-up, is effective in ensuring favorable clinical outcomes, with negligible pain, high patient satisfaction and a low rate of recurrence.

Sinus laser-assisted closure (SiLaC) is gaining popularity as a minimally invasive surgical technique to treat chronic sacrococcygeal pilonidal sinus disease (SPSD). However, long-term outcomes on this technique are rarely reported in the literature. This multicenter study aimed to report the mid-term outcome of a cohort of patients who underwent SiLaC treatment for primary or recurrent SPSD. Patients with primary or recurrent SPSD were included in this retrospective cohort study. Data were collected from medical records, and a validated questionnaire was distributed to all patients at follow-up to assess symptoms, quality of life, and the need for additional surgery. A total of 231 patients were included, with a median follow-up of 33months (IQR 20-44): 128 patients underwent SiLaC for primary SPSD and 103 for recurrent SPSD. Additional interventions were required in 35 patients with primary SPSD (27.3%) and in 30 patients with recurrent SPSD (29.1%). Repeat SiLaC alone, i.e. no other surgical treatment than repeat SiLaC, was performed in 25 patients (19.6%) in the primary group and 22 patients (21.4%) in the recurrent group. Treatment failure, defined as persistent symptoms and/or the need for surgery other than SiLaC, occurred in 23 patients (18.0%) in the primary group and in 21 patients (20.4%) in the recurrent group. However, SPSD-related symptoms were low at follow-up, and quality of life measured by the SF-36 was reported to be even higher than in the general USA population, both in the primary and recurrent group. SiLaC for primary and recurrent SPSD appeared to be a safe procedure with excellent symptom control and quality of life, with only 7.8% of patients in both groups requiring other surgical treatment than SiLaC.

The optimal management of pilonidal sinus disease (PSD) remains controversial, with multiple treatment approaches available. Pit-picking is a minimally invasive technique, often enhanced with laser treatment (LT), but the long-term benefits of LT remain uncertain. The objective of this study is to compare pit-picking alone versus pit-picking combined with LT. This is a multicenter retrospective cohort study including seven centers across Turkey. Patients who underwent pit-picking surgery for PSD between June 2017 and March 2025 were included. Patients receiving adjunctive treatments beyond LT, undergoing excisional procedures, or with incomplete follow-up data were excluded. Pit-picking surgeries performed with or without LT were compared. The primary measure was the recurrence rate at 5 years. Secondary outcomes were postoperative pain, time to complete healing, complications, return to work, and costs. Of 306 patients, 109 (35.6%) underwent pit-picking alone, and 197 (64.4%) received pit-picking with LT. The complication rate was lower in the LT group (6.1% vs. 14.7%, p = 0.012). Patients treated with LT had shorter times to pain-free sitting (median 5 vs. 7days, p < 0.001) and return to work (3 vs. 6days, p < 0.001). Complete healing was achieved in 97.4% of patients, with a median time of 14days. Recurrence rates at 5 years were similar (pit-picking: 13.8%, pit-picking + LT: 12.7%, p = 0.460). Costs were higher for the LT group ($1212 ± 146 vs. $888 ± 148), although complicated pit-picking cases had comparable costs to the LT group ($1198 ± 370, p = 0.004). Risk factors for recurrence included high BMI, family history, advanced Tezel stage, and postoperative complications. While LT improves early postoperative outcomes, it does not impact long-term recurrence rates. The increased cost of LT should be weighed against its benefits in reducing complications, pain, and recovery time. Further randomized trials are needed to refine patient selection criteria and assess cost-effectiveness. NCT05569135, Registration date: 05.10.2022.

Endoscopic pilonidal sinus treatment (EPSiT) may reduce recovery burden, but comparative data against contemporary excisional practices in Australia are limited. We conducted a retrospective cohort study of consecutive elective pilonidal operations in patients aged ≥ 12 at a tertiary Australian hospital (January 2018-May 2025). Analyses were performed at the operative episode level, including repeat procedures. EPSiT was compared with excisional surgery (off-midline flap closure, lay-open excision or primary closure). The primary outcomes were primary healing and recurrence after healing. Secondary outcomes were same-day discharge and opioid prescription at discharge. The cohort included 180 elective operative episodes in 144 patients: 115 EPSiT (63.9%) and 65 excisional (36.1%). Primary healing occurred in 158 episodes (87.8%) and did not differ between EPSiT and excision (89.6% vs. 84.6%; p = 0.330). Recurrence occurred in 26.6% and was similar between groups (29.1% vs. 21.8%; p = 0.322). EPSiT was associated with higher same-day discharge (86.1% vs. 21.5%; p < 0.001) and lower opioid prescribing at discharge (2.6% vs. 63.1%; p < 0.001). In the subgroup with prior emergency I&D (n = 66), primary healing remained similar (89.5% vs. 85.7%; p = 0.644), but recurrence after healing was higher following EPSiT (47.1% vs. 20.8%; p = 0.041). EPSiT achieved similar primary healing and recurrence to excisional surgery while enabling ambulatory care and opioid-sparing discharge. Prior abscess I&D was associated with higher recurrence after EPSiT despite comparable primary healing, supporting tailored counselling and selective EPSiT use when long-term durability is prioritised.

Pilonidal sinus disease (PSD) is a chronic condition that mainly affects young adults impairing the quality of life. Among several surgical options, flap reconstruction offers faster healing and lower recurrence. This randomized comparative study evaluated the keystone perforator island flap (KSF) versus the Limberg flap (LF) in PSD repair, focusing primarily on patient satisfaction depending on the flap type, alongside perioperative outcomes following PS excision as secondary outcomes. A total of 50 patients with simple PSD were randomized equally to undergo KSF or LF reconstruction after sinus excision. Operative data, complications, and recovery metrics were recorded. Patient satisfaction, the primary endpoint, was assessed at 6 months using a validated 5-point scale. Statistical analysis employed the t-test, chi-squared test, and multivariate linear regression to identify independent predictors of satisfaction (p < 0.05 significant). The KSF group showed shorter operative time (54.9 ± 3.7 versus 73.4 ± 7.9min, p < 0.001), faster wound healing (13.5 ± 3.1 versus 17.1 ± 3.5days, p < 0.001), and earlier return to activity (6.8 ± 0.8 versus 8.5 ± 0.8days, p < 0.001). Complications were lower (24% versus 56%, p = 0.02). Satisfaction was significantly higher with KSF (96% versus 72%, p = 0.046). Regression analysis identified wound-healing time (p = 0.008) and return to activity (p < 0.001) as the independent predictors of satisfaction. The KSF provides faster recovery, better comfort, and higher patient satisfaction than the LF. Functional recovery parameters, rather than flap type alone, are the strongest determinants of postoperative satisfaction.

Endoscopic pilonidalsinus treatment (EPSiT) has emerged as a minimally invasive treatment option for pilonidal disease (PD) in adolescents, yet its adoption has been limited by the need for specialized equipment. We developed a modified EPSiT technique using standard urological instruments, saline irrigation, and lateral positioning, which was introduced in 2019. This study provides a technical description of the modified approach and evaluates the outcomes compared with conventional open excision in a pediatric cohort. We conducted a single-center retrospective cohort study of 113 pediatric patients treated surgically for PD between 2014 and 2023. Patients were divided into two cohorts: EPSiT (n = 48, 2019-2023) and open excision (n = 65, 2014-2018). Clinical data were collected from medical records for both groups and structured telephone interviews for patients undergoing EPSiT. Outcomes included operative time, hospital stay, recurrence, pain, and satisfaction. Gender distribution was identical in both cohorts (29.2% male, 70.8% female). Operative times were similar between groups (35.8 versus 31.7min; p = .307). EPSiT was associated with significantly shorter hospital stays (mean difference -2.55days; 95% CI -3.10 to -2.00; p < .001). Recurrence rates were comparable (16.7% versus 15.4%; p = .808). Patient-reported outcomes were available for the EPSiT cohort only and indicated high cosmetic satisfaction and minimal analgesic use. Among patients undergoing EPSiT, 41.7% returned to school immediately after discharge, and most resumed normal activities within a few days. This modified EPSiT approach is feasible and may increase accessibility in resource-limited settings, representing a less invasive treatment option for PD. Further prospective studies are needed to validate these findings and define the role of EPSiT in the treatment of pediatric PD.

Perianal fistula is a common, miserable, and often embarrassing condition that tends to recur. Most cases result from chronic infection of the anal glands (cryptoglandular), leading to an internal opening in the anal canal and an external opening that discharges fluid. Pelvic MRI has become essential for its management because it helps accurately classify the type and extent of the fistula, enabling optimized preoperative planning before surgery. It is particularly useful for perianal fistulas in patients with Crohn disease, in whom infections are often extensive. Examination involves imaging in three planes aligned with the anal canal axis, using T2-weighted sequences without fat saturation and at least one T2-weighted sequence with fat saturation; intravenous contrast material can also be used. Easy-to-use imaging criteria have been proposed to assess treatment response and healing in daily practice, while disease activity scores are primarily used for clinical research. Radiologists should be aware of mimics, such as pilonidal sinus and hidradenitis suppurativa, and recognize that cancers can rarely develop in fistulas. Reports should be tailored to the needs of the referring clinician rather than being merely descriptive.

Pilonidal sinus disease (PSD) is associated with substantial morbidity because of wound complications and recurrence after surgery. Adjunct laser hair removal (LHR) has been incorporated into postoperative management in some settings, but real-world outcomes in cohorts treated uniformly with LHR remain incompletely described. This study aimed to characterize postoperative outcomes after PSD surgery in a large integrated healthcare system in which adjunctive LHR was standard practice and to compare outcomes by surgical approach. We performed a retrospective descriptive cohort study of patients aged 14-89 years who underwent operative treatment of PSD with adjunctive LHR at Kaiser Permanente Northern California between 2012 and 2024. Outcomes included repeat procedures, 30-day surgical site infection (SSI), and unplanned clinic visits. Outcomes were summarized as proportions overall and by surgical approach. Exploratory bivariable logistic regression examined associations between sex or body mass index (BMI) and outcomes. Multivariable modeling was not performed because of low event counts and sparse covariate distributions, which resulted in unstable models. Among 168 patients, the overall repeat procedure rate was 16.7%, the 30-day SSI rate was 14.4%, and 39.3% had at least one unplanned clinic visit. Patients treated with Bascom flap closure had fewer repeat procedures (10.4% vs. 20.8%) and fewer unplanned visits (33.8% vs. 43.6%) than those undergoing pilocystectomy, with similar SSI rates (14.9% vs. 14.0%). In exploratory analyses, sex and BMI were not significantly associated with outcomes in either surgical group. In this real-world cohort managed uniformly with adjunctive LHR, postoperative outcomes appeared to vary more by surgical approach than by sex or BMI. These findings are descriptive and do not estimate the independent effect of LHR. Controlled comparative studies are needed to determine the contribution of LHR to PSD outcomes.

Comparing the treatment outcomes of Limberg versus Karydakis flap in sacrococcygeal pilonidal sinus: A systematic review and meta-analysis

BackgroundSpinal anesthesia (SA) is a safe and effective strategy for many procedures, providing several advantages over general anesthesia. SA is usually performed in a sitting or lateral position, followed by careful repositioning to achieve the final surgical position. This mobilization process may cause technical difficulties related to the patient, consume valuable time, and lead to an unpredictable spread of the local anesthetic agent. To overcome these challenges, some authors have successfully performed SA with the patient already in the prone position.MethodsIn this article, we present a case series of 81 patients who underwent pilonidal sinus surgery under SA in the prone position.ResultsThe technique achieved a 100% overall success rate, with 86.4% success on the first attempt. Adequate anesthetic block was obtained in all cases, without hemodynamic instability or respiratory complications during the procedure, and no complications related to the technique or patient positioning were observed.ConclusionsSA performed in the prone position appears to be a safe and effective approach for pilonidal sinus surgery, providing high success rates and a low incidence of complications.