Pilonidal disease management in young adults: A retrospective analysis of practices in a single tertiary center in Bahrain

Abstract Background Pilonidal disease is a prevalent skin condition that predominantly affects young males. This study, conducted at Salmaniya Medical Complex in Bahrain, aimed to analyze the demographics, treatment methodologies, and complications associated with pilonidal disease. Materials and Methods We analyzed the medical records of 56 patients, comparing our practices to the American Society of Colon and Rectal Surgeons guidelines. Variables collected included patient demographics (age and gender), details on preoperative and postoperative antibiotics, the type of surgical intervention performed, the closure technique used, and follow-up results at 2 months after discharge. Results Our findings confirmed the high prevalence of the disease in young males (75%), with a median age at presentation being 20.5 years. Our practices showed minimal compliance (≤69%) to key recommendations. We found no documented practices for hair removal, phenol application, fibrin glue, or minimally invasive approaches. The most common surgical approach was primary closure (60%), followed by flap reconstruction (16%) and leaving wounds open (7%). The commonest complications were wound dehiscence and surgical site infection (27% each). Postoperative complications were significant, with 67.6% in patients who received preoperative antibiotics and 63.6% in those who received postoperative antibiotics. However, no statistical link to closure type was found, likely due to our small sample size. Conclusions We recommend reassessing our management protocols to align with American Society of Colon and Rectal Surgeons guidelines and considering nonoperative treatments to reduce morbidity. This study underscores the need for guideline adherence and the potential benefits of nonoperative treatments in managing pilonidal disease.