Nationwide Outcomes of Surgical Treatment for Chronic Pilonidal Sinus Disease in the Netherlands
Overview
This nationwide prospective study evaluated 405 patients undergoing surgery for chronic pilonidal sinus disease (PSD) across 36 Dutch hospitals. Minimally invasive techniques were the most common surgical approach, with outcomes varying by PSD subtype and surgical method.
Background
Pilonidal sinus disease is an inflammatory condition primarily affecting young adults, with risk factors including male sex, deep natal cleft anatomy, and family history. While acute PSD is typically managed by incision and drainage, optimal surgical strategies for chronic PSD remain unclear due to heterogeneity in disease presentation and limited high-quality evidence. This study aimed to classify chronic PSD subtypes and assess practice variation and short-term surgical outcomes in the Netherlands.
Data Highlights
Characteristic
Value
Number of hospitals participating
36
Total patients included
681
Patients with chronic PSD undergoing surgery
405
Mean age (years)
28 ± 10
Male patients
82.7%
Patients with previous PSD surgery
48.6%
Median follow-up (days)
42 (IQR 29–49)
Surgical treatments performed
Excision with secondary wound healing (ESW)
25.9%
Excision with midline closure (EMC)
7.2%
Minimally invasive techniques (MIT)
61.2%
Excision with off-midline closure (OMC)
5.7%
Key Findings
Chronic PSD subtypes were evenly split between simple (type I) and complex (types III/IV), with symptom severity increasing with complexity.
Minimally invasive techniques were the predominant surgical approach, used in 61.2% of cases across both simple and complex PSD.
Excision with secondary wound healing was performed in approximately one-quarter of patients, while excision with midline closure and off-midline closure were less common.
Off-midline closure was mainly reserved for complex PSD cases.
Nearly half of patients had undergone previous PSD surgery, indicating a high rate of recurrent or persistent disease.
The median follow-up period was 42 days, allowing assessment of short-term postoperative outcomes.
Clinical Implications
The predominance of minimally invasive techniques reflects a shift towards less invasive management of chronic PSD in the Netherlands. Surgical choice appears influenced by PSD complexity, with off-midline closure favored for more complex disease. Awareness of patient history, including prior surgeries, is important for surgical planning. These findings support tailored surgical approaches based on PSD subtype to optimize short-term outcomes.
Conclusion
This nationwide audit highlights significant practice variation in surgical management of chronic PSD, with minimally invasive techniques being most common. Classification of PSD subtypes aids in guiding surgical strategy and may improve patient outcomes.
References
Dutch Classification System for Pilonidal Sinus Disease and Surgical Outcomes Study, 2021
STROBE Statement, 2007 -- Guidelines for Reporting Observational Studies
