A National Survey of Pilonidal Disease Treatment Preferences in Belgium

Abstract Background: Pilonidal sinus disease (PSD) is a chronic inflammatory condition of the sacrococcygeal region that primarily affects adolescents and young adults aged 15–24 years. Objectives: This survey aimed to capture perspectives on PSD management from general and colorectal surgeons in Belgium. Design: A cross-sectional, national web-based survey was developed by the PITCHER study group. Settings: The survey targeted Belgian surgeons treating PSD and was distributed via the Royal Belgian Society of Surgeons and promoted on LinkedIn. Methods: The 32-item survey, hosted on Qualtrics, collected data on surgeon demographics, clinical practices, surgical techniques, postoperative care, and adjunct treatments. Pilot testing was conducted to ensure clarity and validity. The survey remained open for 8 weeks, and participation required informed consent. Responses were anonymized unless participants waived anonymity, and data were securely stored. Main Outcome Measures: Primary outcomes included surgeons’ diagnostic and therapeutic strategies, preferred surgical approaches, and follow-up practices. Secondary outcomes assessed postoperative care and surgeon-perceived patient priorities. Sample Size: Of the 87 surgeons who accessed the survey, 68 completed it, resulting in a completion rate of 78.2%. Results: Respondents were predominantly male (75%) and practiced as general (52%) or colorectal surgeons (31%), with 6–20 years of experience. Nearly half (46%) treated 11–30 PSD cases annually (median 11-30 [IQR 11-50]) and worked primarily in nonacademic hospitals (68%). Preoperative imaging, primarily MRI, was used by 37% for recurrent or complex cases. Excision with secondary healing was the most frequently used technique (33%–75%), particularly for complex PSD (65%). For simple PSD, SiLaC was preferred (14%–33%), especially by colorectal surgeons (46%). However, the preference for SiLaC versus excision with secondary healing did not significantly differ between general and colorectal surgeons ( P = 1.00). Most surgeries were performed under general anesthesia (78%) in day hospitals (78%). Surgeons perceived that patients prioritized minimal recurrence risk (44%) over pain relief (18%) or short work disability (16%). Conclusion: PSD management in Belgium demonstrates variability, with traditional techniques remaining prevalent while minimally invasive methods are progressively gaining adoption. High-quality research and evidence-based guidelines are essential to standardize care and improve outcomes for PSD. Limitations: This study’s self-reported data and recruitment strategy may introduce recall and selection biases. Conflict of Interest: None.