Clinical Report: Mapping Review of Sacrococcygeal Pilonidal Sinus Disease Management
Overview
This mapping review analyzed 983 studies on sacrococcygeal pilonidal sinus disease published between 1945 and 2020, highlighting a predominance of surgical technique research dominated by cohort studies. Non-surgical treatments and aftercare are less extensively studied, with limited randomized controlled trials available across categories.
Background
Pilonidal sinus disease, characterized by in-growing hair in the natal cleft, primarily affects younger, economically active men and often leads to pain and local sepsis. The condition is frequently recurrent and challenging to treat, with no universally accepted intervention ensuring long-term healing. The literature is largely composed of single-center case series and non-randomized studies, resulting in widespread variation in clinical practice and calls for higher-quality research. Mapping reviews provide a method to categorize and assess research activity, identifying gaps and guiding future investigations.
Data Highlights
Category
Systematic Reviews/Meta-analyses
Randomized Controlled Trials (RCTs)
Observational Studies
Non-surgical treatment
4
2
29
Hair removal (subcategory)
4
1
28
Conservative treatment (subcategory)
0
1
3
Surgical treatment
26
80
622
Flap (surgical technique)
14
38
222
Midline closure
10
30
163
Off-midline closure
12
21
116
Excision only
9
28
121
Minimal excision only
6
3
61
Marsupialisation
2
6
31
Endoscopic
4
1
47
Key Findings
The majority of pilonidal sinus literature focuses on surgical techniques, with 26 systematic reviews/meta-analyses, 80 RCTs, and 622 observational studies.
Within surgical techniques, flap procedures, midline and off-midline closures are the most studied subcategories.
Non-surgical treatments, including hair removal and conservative management, are less frequently studied, with only 4 systematic reviews and 2 RCTs identified.
Observational cohort studies dominate the literature, indicating a need for more high-quality randomized controlled trials.
Mapping reveals significant research gaps in aftercare and non-surgical management domains.
Systematic reviews often call for further research to address clinical uncertainties and improve evidence-based practice.
Clinical Implications
Clinicians should recognize that current evidence is heavily weighted towards surgical interventions, particularly flap and closure techniques, while non-surgical and aftercare strategies remain under-researched. Treatment decisions should consider the limited high-quality evidence available and the potential for recurrence and wound healing challenges. There is a critical need for well-designed randomized trials to establish optimal management protocols.
Conclusion
This comprehensive mapping review underscores the predominance of surgical research in pilonidal sinus disease and highlights significant gaps in non-surgical treatment and aftercare evidence. Enhanced focus on high-quality studies is essential to guide clinical practice and improve patient outcomes.
References
Mapping Review of Sacrococcygeal Pilonidal Sinus Disease Management, 2020
