A systematic review of classification systems for pilonidal sinus
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By
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E. M. Beal
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M. J. Lee
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D. Hind
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A. P. Wysocki
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F. Yang
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S. R. Brown
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May 16, 2019
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Clinical Scorecard: A Comprehensive Review of Classification Approaches for Pilonidal Sinus Disease
At a Glance
| Category | Detail |
|---|
| Condition | Pilonidal sinus disease (PSD) |
| Key Mechanisms | Spectrum of abnormalities from simple midline pits to complex chronically inflamed cavities with multiple fistulous tracks |
| Target Population | Predominantly young, employed males |
| Care Setting | Surgical treatment settings due to rarity of self-limiting cases |
Key Highlights
- PSD affects approximately 26 per 100,000 people, mainly young males.
- Surgery is the mainstay of treatment with various techniques but recurrence rates can be as high as 60.4% at 24 months.
- No universally adopted classification system exists to guide treatment; current systems lack routine clinical use and validated predictive properties.
Guideline-Based Recommendations
Diagnosis
- Classification systems should describe PSD presentation ranging from simple pits to complex fistulous disease.
- Diagnosis should consider disease stage to inform treatment strategy.
Management
- Surgical options include sinus/pit-based procedures, excision with open management, midline closure, and off-midline flap repairs.
- Adjuvant laser treatment and shaving may be used.
- Treatment choice is often based on clinician experience due to lack of standardized classification guidance.
Monitoring & Follow-up
- Monitor for early wound complications such as infection and dehiscence.
- Long-term follow-up is necessary due to high recurrence rates.
Risks
- High recurrence risk post-surgery (up to 60.4% at 24 months).
- Common early wound complications include infection and wound dehiscence.
Patient & Prescribing Data
Young, employed males with PSD ranging from simple to complex disease.
Surgical treatment is predominant; choice of procedure varies widely with no consensus classification to guide therapy.
Clinical Best Practices
- Use classification systems that assess disease severity and complexity to potentially stratify treatment.
- Evaluate classification tools for reliability, validity, and prognostic value before clinical application.
- Consider patient-specific factors and disease stage when selecting surgical technique.
- Monitor patients closely postoperatively for wound complications and recurrence.
References
