Fistula Research Articles

LIMBERG FLAP FOR SACROCOCCYGEAL PILONIDAL SINUS: A SAFE AND PROMISING SURGERY

Introduction:Sacrococcygeal pilonidal sinus is a common disease of the adult age group, especially male population, causing significant morbidity from both disease and surgery done for the same. It is essentially a cleavage between the buttocks (i.e., natal cleft), and diagnosis is made by identifying the epithelialized follicle opening (i.e., sinus). The name PILONIDAL is taken from Latin meaning nest of hairs. The estimated incidence is 26 per 1,00,000 people1. It generally presents as a cyst, abscess, or sinus tract with or without discharge2. Men affected more often than women1, rare both before puberty and after the age of 40 years3. The etiology of the pilonidal sinus is a matter of controversy. Aims & Objectives:Literature study showed that Limberg flap reconstruction following rhomboid excision of the sinus area was superior to primary closure and other flap procedures and a safe and reliable method in sacrococcygeal pilonidal sinus disease with low complication and recurrence rates. Hence, this study was performed in our setup to evaluate the usefulness of Limberg flap procedure in sacrococcygeal pilonidal sinus, patient compliance, complications and long-term recurrence rates following the procedure. Materials & Methods:The study involves 22 patients, from May 2022 to September 2023. Most of the patients were males of those 4 were females. Average age was 24 years—the oldest was 29 years and the youngest was 15 years. Results:In this study 22 patients were included. Among them 18 were males and 4 were females. Mean age was 24 years (range 15–29 years). Of the 22 patients, 14 had primary disease, 6 had recurrent disease, and 2 came up after having previous incision and drainage for abscess. All patients came with pilonidal sinus, from May 2022, were assessed for its severity and investigated, and then they underwent Limberg flap surgery under spinal anesthesia. Discussion:Sacrococcygeal pilonidal sinus is blind epithelial tract situated in the skin of the natal cleft, close to anal verge, generally containing hair. The etiology is matter of debate initially congenital origin was thought of which is now given up. Main causes for the formation of this sinus are hirsutism, sweating in the area, repeated maceration due to trauma, leading to breakage of the skin barrier, attracting hair inside which initiates a foreign body reaction leading to infection with abscess or sinus formation. Conclusion:Sacrococcygeal pilonidal sinus is headache to both the patient and the treating surgeon because of its repeated infection, persistent pain with discharge, and high recurrence rates with regular procedures.

“Limberg’s vs Modified Limberg’s”: Outcomes in Pilonidal Sinus Surgery

“Limberg’s vs Modified Limberg’s”: Outcomes in Pilonidal Sinus Surgery

Decision regret following surgical management of pilonidal disease.

Surgical decision making in the context of pilonidal disease (PD) can be challenging. Current evidence for the management of PD is inadequate and optimum treatment is not clear. This paper reports on patient experience of shared decision making (SDM) and decision regret following surgical management of PD. The Pilonidal Trial. Studying the Treatment Options (PITSTOP) study (ISRCTN95551898) is a prospective cohort study of patients with PD treated between May 2019 and March 2022. This subanalysis reports the results of quantitative data capture between baseline and 6 months post-procedure. Baseline data consisted of patient and disease characteristics, surgical procedure and impression of SDM. Post-procedure data consisted of operative outcomes and decision regret. Multiple linear regression analysis was used to analyse the relationship between clinical outcomes and decision regret. Overall, 677 patients were included, and follow-up data to 6 months were available for 476 (71%). Most (59.5%) patients underwent major excisional surgery; 45.1% of patients experienced a postoperative complication. Participant impression of SDM was positive, with a median CollaboRATE mean-score response of 3 (interquartile range: 3-4). Of the patients who underwent a 'leave open' approach, 20.6% were dissatisfied or very dissatisfied with their treatment. Postoperative complications (β = 3.21, 95% CI: -12.75 to 7.25, p < 0.001) and disease recurrence (β = 11.5, 95% CI: -10.6 to 9.4, p < 0.001) were both associated with higher rates of decision regret. The clinical outcomes, postoperative complications and recurrence, were associated with higher levels of decision regret. Surgeons treating patients with PD should practice SDM and ensure that patient priorities inform treatment approach.

Clinical application of parasacral artery perforator flap in the treatment of Pilonidal Sinus Diseases

Objective: To investigate clinical efficacy of parasacral perforator flap (PPF) on postoperative wound healing in pilonidal sinus diseases (PSDs). Methods: The surgery steps were as follows: (1) To preoperatively detect parasacral perforator arteries with the handhold Doppler probe and mark them; (2) To remove the infected and necrotic tissues of PSDs completely; (3) To design the PPF according to the wound size and the parasacral perforator arteries' localization; (4) To harvest the flap from the gluteus maximus muscle surface and transfer it to the wound without tension. Several data were documented, including surgical duration, flap length, flap width, drainage tube placement duration, hospital stay, duration from operation to stitch removal, postsurgical complications and recurrence. Results: There were six patients with PSDs whose postoperative wound healing was repaired by PPF, admitted in our department from March 2021 to March 2023. Of them, five were male and one was female. Their median age was 24 (range: 18-33) years old. Their median surgical duration was 165 (range: 134-207) minutes, median length of PPF was 8 (range: 7-11) cm, median width of PPF was 3 (range: 3-4) cm, mean duration of drainage tube placement was 8 (range: 4-17) days, mean hospital stay was 13 (range: 6-23) days, mean duration from operation to stitch removal was 14 (range: 14-17) days, median follow-up time was 6-16 months. Incisions of all six cases achieved first-intention healing without early- or late-stage complications. No recurrence occurred during follow-up. All patients involved were satisfied with their clinical efficacy. Conclusion: The utility of PPF in postoperative wound healing of PPDs was effective, safe and reliable.

Overview of Pilonidal Cyst Treatment Methods - Review Paper

Introduction and purpose A pilonidal cyst also known as a pilondial sinus, is an inflammatory condition that occurs in the intergluteal region, which can lead to serious infections. It most commonly affects young men, with risk factors including the presence of hair in this area, excessive sweating, obesity, and poor hygiene. Symptoms include a lump, pain, and purulent discharge from openings in the skin. Diagnosis involves taking a medical history, a physical examination, and often an ultrasound. The aim of this paper is to present and compare the available methods for treating pilonidal cysts. Materials and methods Literature available in PubMed databases were reviewed using the following keywords: ‘’Pilonidal cyst’’, ‘’Hair cyst’’, ‘’Abscess’’, ‘’Treatment of pilonidal cyst’’,’’ Bascom II method’’,’’ Limberg flap’’,’’ Suchorski technique’’, ‘’V-Y or Z skin flap reconstruction’’,’’ the Karadakis’’ Results The available treatment methods can be divided into conservative and invasive approaches. Conservative methods include hair removal and improved hygiene. Among the surgical methods, there are traditional excision techniques and modern methods such as excision using the Bascom II method, Limberg flap, Suchorski technique, or V-Y or Z skin flap reconstruction. The Karadakis method, which involves shifting a skin flap, is particularly effective for obese patients. Conclusion Treatment of pilonidal cysts depends on the stage and symptoms. Abscesses require urgent surgical intervention, while asymptomatic cysts can be treated conservatively or surgically.

Triangle Excision and Advancement Flap in Pilonidal Disease: A Single-Center Prospective Case Series

Triangle Excision and Advancement Flap in Pilonidal Disease: A Single-Center Prospective Case Series

Long‐term outcomes after cleft lift surgery for pilonidal sinus disease in post‐pubertal adolescents: data from a prospective Danish cohort

Long‐term outcomes after cleft lift surgery for pilonidal sinus disease in post‐pubertal adolescents: data from a prospective Danish cohort

Our Primary Closure Operative Technique for Pilonidal Sinus - A Recurrence-Free Procedure

Our Primary Closure Operative Technique for Pilonidal Sinus - A Recurrence-Free Procedure

Causal roles of skin and gut microbiota in skin appendage disorders suggested by genetic study.

There is evidence from observational studies that human microbiota is linked to skin appendage Disorders (SADs). Nevertheless, the causal association between microbiota and SADs is yet to be fully clarified. A comprehensive two-sample Mendelian randomization (MR) was first performed to determine the causal effect of skin and gut microbiota on SADs. A total of 294 skin taxa and 211 gut taxa based on phylum, class, order, family, genus, and ASV level information were identified. Summary data of SADs and eight subtypes (acne vulgaris, hidradenitis suppurativa, alopecia areata, rogenic alopecia, rosacea, rhinophyma, seborrhoeic dermatitis, and pilonidal cyst) were obtained from the FinnGen consortium. We performed bidirectional MR to determine whether the skin and gut microbiota are causally associated with multiple SADs. Furthermore, sensitivity analysis was conducted to examine horizontal pleiotropy and heterogeneity. A total of 65 and 161 causal relationships between genetic liability in the skin and gut microbiota with SADs were identified, respectively. Among these, we separately found 5 and 11 strong causal associations that passed Bonferroni correction in the skin and gut microbiota with SADs. Several skin bacteria, such as Staphylococcus, Streptococcus, and Propionibacterium, were considered associated with multiple SADs. As gut probiotics, Bifidobacteria and Lactobacilli were associated with a protective effect on SAD risk. There was no significant heterogeneity in instrumental variables or horizontal pleiotropy. Our MR analysis unveiled bidirectional causal relationships between SADs and the gut and skin microbiota, and had the potential to offer novel perspectives on the mechanistic of microbiota-facilitated dermatosis.

FP8.11 - Surgical Site Infection Post-operation (gowning vs not gowning): A District General Hospital Experience

Abstract Aims Increasing evidence shows that surgical site infection (SSI) does not differ significantly between main operation theatre and field sterility for many surgical procedures. This audit aimed to assess the rate of surgical site infection (comparing the operating surgeon using a disposable gown vs not using one) for emergency/elective skin procedures like uncomplicated incision and drainage of abscess, excision of lipoma, sebaceous cyst, and pilonidal sinus. Methods The electronic database was used to collect data (September-October 2023) on the type of surgery performed, number of theatre staff scrubbed in. Poster displays and informal education were used to raise awareness of theatre wastage (November 2023). All were advised to wear an apron, mask, sterile gloves, and field sterility only for uncomplicated cases. Data was recollected (December 2023-January 2024). Results 54 cases were performed in September and October 2023. All theatre staff scrubbed in and 160 gowns were used. 5/54 (9.3%) returned with wound infection and managed with antibiotics. The median of the number of days in which the patients returned post-operatively is 7 days. 24 cases were performed from December 2023-January 2024. Theatre staff in 5/24 cases did not scrub in and none of these patients returned with wound infection. Out of the other 17/24 cases, 5/17 (29.4%) returned with wound infection. Conclusions With the limitation of small sample size and multi-factorial aetiology of wound infection, surgeons who did not gown up had no increased risk of wound infection. The higher monetary and environmental costs of complete gowning without improvement of patients’ care are unjustifiable.

WP2.13 - Local Audit based on MAGIC study to improve abscess management at Royal Devon University Healthcare Trust

Abstract Aim To assess efficacy of current management approaches of subcutaneous abscess at the Royal Devon University Healthcare Trust (RD&amp;E). Methods Our audit is based on the MAGIC (Management of Acute surGIcal absCesses) national audit which involved anonymous retrospective analysis of patient records at the RD&amp;E during September – December 2022. We collected data on patient demographics, clinical characteristics and their management. Furthermore, we conducted a literature review to compare our results to the recommended practice. Results 31 patients records were analysed whereby 22 underwent surgical intervention (general anesthetic 17, local anesthetic 5) whereby the most common incision type was transverse (n=7). Nine patients were diabetic, two were immunosuppressed, 29 had hidradenitis suppurativa, while 19 had a past medical history of abscesses (n=31). The most common abscess type was pilonidal sinus (n=10). Eighteen patients received antibiotics prior to hospital admission, 12 of whom underwent surgery. Furthermore, 19 patients received antibiotics upon admission to hospital (n=31). Of the surgically treated cohort, 19 underwent packing and six were discharged with antibiotics. Conclusion Most subcutaneous abscess are approached surgically. However, postoperative care varies widely, with prolonged packing and frequent use of antibiotic postoperatively. Literature reviews have suggested no benefit of postoperative packing and specified certain circumstances of antibiotic use. Furthermore, clear communication with primary care providers detailing clear postoperative instructions is vital for patient safety and cost effectiveness.

SP1.9 - Management of cutaneous abscesses and infected sebaceous cysts using inhaled methoxyflurane Penthrox®: a 12 month prospective observational study

Abstract Aims Incision and drainage of abscesses contribute a significant burden upon emergency general surgical theatres. The purpose of this study was to look at the safety and effectiveness of incision and drainage using inhaled methoxyflurane (Penthrox®) to reduce reliance upon surgical theatres and provide an effective alternative to local anaesthetic. Methods After a successful pilot of 20 patients, adults with ‘simple’ abscesses were enrolled over a 12-month period and given inhaled methoxyflurane for ward-based incision and drainage. Pilonidal and perianal abscesses, patients with ASA ≥3 and abscesses greater than 5cm in size were excluded. Length of admission and outcomes at 1 week, 1 month and 3 months post procedure were compared to previously audited data on simple abscess drainage in theatre to determine safety, efficacy and cost-savings. Results 130 patients had an abscess drained using Penthrox® inhaled analgesia. 93.8% (122/130) had successful drainage with a mean admission time of 99 minutes. Eight patients reattended for further treatment (3&amp;lt;3 months, 3&amp;lt;1 month and 2&amp;lt;1 week); two patients required antibiotics and five required further drainage. Patients taken to theatre spent on average 34.5 hours in hospital compared to 1.65 hours for those performed using Penthrox®. A patient feedback tool captured very positive comments with no negative experiences recorded. Conclusion Penthrox® is a safe, effective analgesic for the incision and drainage of simple abscesses and patient experience is overwhelmingly positive. In addition, it significantly reduces the burden on emergency theatres and the hospital bed-base with an estimated minimum saving of £1704 per patient.

ThP6.19 - Surgical Management in Sacrococcygeal Pilonidal Sinus Disease Depending on The Suggested Staging System

Abstract Background The ideal management of the PNS has not been established yet. However; The optimal method should cover rapid recovery and return to normal daily activities, low recurrence rate, be technically applicable with reasonable cost. Aim to evaluate outcomes with the use of a stage-based treatment approach. Method A cohort prospective analytical study was conducted at Basrah Teaching Hospital-Iraq, a total of 71 patients were operated based on the proposed staging system in the period between December 2018 to April 2022, the staging system (Stage I–IV) was defined by using the morphological extent. the collected data includes demographic, perioperative data, short and long-term outcomes. Results Stage IV had the highest abscess drainage, drain insertion, and hospital stay. Concerning the short and long-term complications, the following frequencies were observed: Collection (9.85%), Infection (8.45%), and Dehiscence (4.22%), the collection and dehiscence were highest among stage R while the lowest rate of collection and infection was among stage III cases (6.67%, 6.67%) accordingly. Primary healing was recorded (91.5%) among the overall included patients with the higher rates of stage II-a (100.0%) with the lowest being among stage R (71.4%). Stage IV patients experienced the longest time for functional recovery and wound healing (14.25± 7.13, 13.25± 7.27) accordingly. The Recurrence rate was (2.81%) commonly observed among stage II-a (16.67%). Conclusion PNS is a recognizable condition in our locality and presents in different stages, thus this proposed staging system categorizes its extent and is a valuable tool in tailoring surgical approaches to each stage, Furthermore, it provides a common language for the surgeon to communicate about the disease.

FP8.5 - QR Coded Patient Leaflets – Transforming the Sustainability of Patient Information Delivery in the Surgical Outpatient Department

Abstract Introduction Quick Response (QR) codes are becoming ubiquitous in all aspects of life, including healthcare. In outpatient clinics, the benefits of convenience, cost effectiveness and environmental sustainability of QR codes has great potential. We identified that our trust was lacking in both electronic and hardcopy patient information leaflets for Bascom’s Procedure and Endoscopic Pilonidal Sinus Treatment (EPSIT). Our aim was to create information leaflets on our trust website and link them via a QR code for easy access. Methods We audited our hardcopy information leaflets for both procedures for quality and satisfaction of information and patients were given a feedback questionnaire which specifically included a response for their preference for electronic QR code access. Results The initial feedback from 20 patients showed 85% support for QR codes. 90% found the information clear, informative and easy to understand. There was a suggestion to include diagrams in our leaflets. Conclusion We had positive feedback regarding the following: quality of information, clarity of the leaflet, and accessibility (particularly the use of QR codes). The latter reflects the younger age demographic of patients that were surveyed. We plan to prospectively audit QR coded leaflets in our outpatients. We will evaluate success through both patient and clinician feedback forms. QR coded leaflets could be implemented trust wide and even nationally, to increase sustainability in outpatients and the wider NHS, without compromising patient understanding or satisfaction.

Heterogeneity of Treatment Effects of Laser Epilation on Pilonidal Disease Recurrence: A Randomized Clinical Trial.

To investigate the heterogeneity of treatment effects (HTE) of laser epilation in preventing pilonidal disease recurrence through analysis of prespecified clinical factors. Pilonidal disease is a common, painful disease affecting 1% of the population aged 15 to 30 years with postoperative recurrence rates as high as 30% to 40%. Single-institution randomized controlled trial from September 2017 to September 2022 with 1-year follow-up, including patients aged 11 to 21 years with pilonidal disease undergoing gluteal cleft laser epilation and standard care (improved hygiene and mechanical or chemical depilation) or standard care alone. In total, 302 patients were enrolled with 151 randomized to each intervention. 1-year follow-up was available for 96 patients in the laser group and 134 in the standard care group. There were no significant differences in treatment effects based on sex, body mass index, previous disease, prior surgical excision, or annual household income (all P > 0.05). HTE was identified by race and ethnicity (P = 0.005) and health insurance type (P = 0.001). Recurrence among non-Hispanic white patients was 4% (3/75) with laser treatment and 31.6% (31/98) with standard care versus 38.9% (7/18) with laser treatment and 38.2% (13/34) with standard care among all other racial/ethnic groups. Recurrence rates among privately insured patients were 4.0% (3/75) with laser treatment and 33.3% (29/87) with standard care versus 36.8% (7/19) with laser treatment and 29.7% (11/37) with standard care in patients with public insurance. The effectiveness of laser epilation to reduce pilonidal disease recurrence rates may vary based on race and ethnicity and insurance type. Additional studies are warranted to investigate this potential HTE.

Advancements in Surgical Approaches for Sacrococcygeal Pilonidal Sinus: A Comprehensive Review.

Sacrococcygeal pilonidal sinus (SPS) is a condition involving the formation of a cavity in the lower back region. It is more common among young adults and is influenced by factors such as sitting for long periods, body hair, and certain lifestyle habits. Surgical treatment is often necessary for recurring or severe cases, and various surgical techniques available, ranging from traditional surgical methods to newer, less invasive approaches. This comprehensive review examines the progress in surgical techniques for managing SPS, emphasizing the effectiveness, safety, and patient outcomes associated with different methods. It provides an overview of traditional procedures, such as excision with primary closure, and contrasts these with recent innovations like endoscopic and laser-assisted techniques. The review also considers advanced technologies, including the potential of robotic surgery and the use of specialized materials. By assessing clinical outcomes, recurrence rates, complications, and patient satisfaction, this review seeks to identify the most effective surgical strategies for SPS. Additionally, it discusses recent technological advancements and highlights areas needing further research to improve the management and treatment of this condition.

Platelet-rich Plasma as an Adjuvant Therapy to Crystallized Phenol in the Treatment of Pediatric Pilonidal Sinus Disease: A Prospective Randomized Controlled Trial

ObjectiveThis study aims to evaluate the safety and efficacy of platelet-rich plasma (PRP) as an adjuvant to crystallized phenol (CP) in treating pediatric pilonidal sinus disease (PSD). MethodsA single-center randomized controlled trial was conducted at Istanbul Esenyurt Hospital. Eighty-seven patients aged 0–18 were randomly assigned to two groups: the CP group (n = 42) and the CP + PRP group (n = 45). Upon arrival at the clinic, patients began a regimen of manual shaving and, if necessary, laser epilation every 6–8 weeks. For those with pilonidal abscesses, incision, drainage, and antibiotics were given. The treatment area was sterilized and numbed with local anesthesia. Hair removal and curettage were performed, followed by the application of crystallized phenol. In CP + PRP group, PRP injections were also administered. The procedure concluded with wound dressing and thorough disinfection. The study was registered https://clinicaltrials.gov/ (NCT06324656). ResultsThe CP + PRP group demonstrated significantly shorter healing times (19.4 ± 7.88 days) compared to the CP group (30.7 ± 12.9 days) (p < 0.001). The cosmetic score was higher in the CP + PRP group (7.42 ± 1.61) than in the CP group (6.11 ± 1.88, p = 0.001). CP + PRP group had lower VAS scores at measured all-time points after applications (p < 0.05 for each). Complications were comparable between the groups, with no significant differences in bleeding, infections, or skin burns (p > 0.05 for each comparison). No difference was found between groups in terms of total complication rate (p = 0.398). The success rate was higher in CP + PRP group (98%; n = 44) compared to CP group (86%; n = 36) (p = 0.039). Recurrence rates were lower in CP + PRP group (2%; n = 1) than CP group (14%; n = 6) (p = 0.039). ConclusionThe autologous PRP injection in pediatric PSD is safe. The addition of PRP to CP treatment for pediatric PSD significantly improves healing time, cosmetic outcomes, and overall success rates without increasing complication rates. This combined approach offers a promising alternative for effective and efficient treatment of PSD in children. Type of the studyRandomized controlled trial. Level of evidenceLevel I

Použitie Watanabeho spigotov v manažmente bronchoezofageálnych fi stúl

Summary: Bronchoesophageal and bronchogastric fistulas are rare complications of thoracic surgery as esophagectomy, malignancy or prolonged endotracheal intubation. Although uncommon, their morbidity and mortality is substantial. Treatment of these fi stulas is challenging and often lengthy with limited success rates. Endoscopic treatment may be the treatment of choice for some types of fi stulas, but despite a variety of methods available, the success rate is relatively low with little consistent data about its eff ectiveness. At the same time, new technologies and devices have become available with a potential to address these complicated conditions. One of them are Watanabe spigots, initially used in pneumology for the treatment of persistent pneumothorax and pyothorax with bronchial fi stula. In the presented case reports Watanabe spigots are used in combination with over-the-scope clips in two of our patients with bronchoesophageal fi stulas fol lowing esophagectomy with promising results. We also present an overview of endoscopic methods of therapy in the context of and separately discuss available evidence about the possibilities of the use of Watanabeho spigots in the treatment of bronchoesophageal fi stulas. Key words: bronchoesophageal fi stula – Watanabe spigot – esophagectomy – over-the-scope clip

Long-term follow-up of pilonidal sinus disease treated by radial laser surgery

PurposeLaser ablation is one of the newest and most advanced minimally invasive techniques in treating pilonidal sinus disease (PSD). Most studies on the subject have small sample sizes and relatively short follow-up times, making evaluation of long-term healing rates and recurrences difficult. Furthermore, long-term results for laser surgery of PSD are still lacking. The aim of this study was to retrospectively report long-term follow-up results for PSD treatment by radial laser surgery.MethodsWe retrospectively studied the medical records of 83 patients who underwent the radial laser procedure for PSD between January 2017 and September 2019. Our follow-up time was a median of 5.2 years, range 1.5 to 7.4 years.ResultsTwelve patients had a PSD recurrence after their laser procedure, which gives a recurrence rate of 14.5% (95% CI 8.2%-23.2%). These recurrences appeared at a median 12.2 months after the laser procedure, range 4.2 to 51 months. A total of 23 patients (27.7%; 95% CI 19.0–38.0) underwent a reoperation, 11 patients due to postoperative infection or prolonged recovery and 12 patients due to PSD recurrence. Recurrent PSD and spillage of pus during operation were statistically significantly associated with the need for a second operation.ConclusionRadial laser surgery provides a minimally invasive treatment option with an acceptable recurrence rate in long-term follow-up.

The effects of intraoperative use of blue dyes in pediatric pilonidal sinus disease—a retrospective exploratory cohort study

BackgroundIntraoperative use of methylene blue has been shown to reduce postoperative complications and recurrence rates in adults. It has however not been assessed if these beneficial effects would also apply to pediatric pilonidal sinus disease with its high recurrence rates. We, therefore, aimed to assess its effects on complications and recurrences in our retrospective exploratory cohort study.MethodsOf 55 consecutive children treated in our centre between January 2009 and December 2020, 48 were retrospectively included. We used logistic regression with a priori chosen predictors of intraoperative use of blue dyes, previous surgery for pilonidal sinus disease, and the presence of comorbidities on the composite outcome of complications and recurrence. Cramér’s V was used to explore associations between the use of blue dyes and the extent of resection.ResultsThe median age in our cohort was 15.3 years. Five patients were below 2 years of age, and 24 (50%) of them were males. Chronic diseases were present in 13 (27%) patients, eight had previously been operated on for pilonidal sinus disease, and blue dyes were used in 34 patients (71%). Their intraoperative use was linked to the composite outcome with an odds ratio of 5.41 (95% confidence interval (CI) 1.52–25.34, P = 0.017) as were comorbidities with an odds ratio of 1.86 (95% CI 1.18–3.25, P = 0.014), but not re-do surgery (odds ratio 2.94 (95% CI 0.37 23.42, P = 0.3)). The use of blue dyes was associated with larger resections (Cramér’s V 0.556 (95% CI 0.329–0.74)).ConclusionThe intraoperative use of blue dyes was negatively associated with complications and recurrences in pediatric pilonidal sinus disease. However, if blue dyes were used, the extent of resection was also larger. Larger resections had been shown before to be associated with complications and recurrences, too. This potential interaction requires further elucidation in future studies.