Prospective nationwide audit of short-term outcomes after surgery for chronic pilonidal sinus disease in the Netherlands.

BACKGROUND

The optimal surgical approach for chronic pilonidal sinus disease (PSD) remains unclear, resulting in variation in surgical practice. This study aimed to provide an overview of PSD subtypes and assess practice variation and short-term outcomes.

METHODS

A nationwide prospective observational cohort study was conducted. All patients with PSD and who underwent surgery were included during a 3-month inclusion period between March 1, 2020 and March 1, 2021. Primary endpoints were PSD classification and type and frequency of surgical approach. Secondary endpoints included symptoms, complications, recurrent open wounds, wound healing rate, time to wound healing, time to resume daily activities, reasons for selecting therapy, antibiotic prophylaxis, type of anesthesia, and hospital admission.

RESULTS

A total of 36 hospitals participated in the study, and 405 patients had chronic disease. The median follow-up period was 42 days. Mean age was 28 years and 335 (82.7%) patients were male. Simple (n = 213) and complex PSD (n = 192) was equally common. Twelve different treatment modalities were performed. Minimally invasive techniques were used the most (61.2%) and off-midline closure in only a small proportion of patients (5.7%). Minimally invasive techniques showed a significantly higher wound healing rate (41.1% vs 28.6%) and a shorter median time to closure (41 vs 78 days) compared to excision with secondary healing. They also had the shortest median time to resume daily activities (14 days).

CONCLUSIONS

Simple and complex PSD were equally common. Practice variation in surgery is substantial. Minimally invasive techniques were most frequently performed and showed good short-term outcomes.