Pilonidal Sinus Recurrence Rates in Young Adults—Similar to Children or Adults?

Background/Objectives: Treatment strategies in pilonidal sinus disease differ substantially between adults and children. While a single surgery with off-midline flap closure is recommended for adults, minimally invasive procedures are preferred in children due to their much higher recurrence rates. Recently, this strategy has been extended to young adults, but long-term recurrence rates in this age group are unknown. Methods: An established database of studies on pilonidal sinus disease was used for the present study. All entries providing information on age and recurrence over time were included. We compared recurrence rates between children (<18 years), young adults (18 to 21 years), and older adults (>21 years) using Kaplan–Meier curves. Between-groups testing employed the two-tailed log rank test. Results: We included 856 entries with 88,348 patients, of which 5635 were children and 3999 young adults. The 5-year recurrence rate in children was 45.1% (95% confidence interval: 40.2–49.7%). For older adults it was 11.5% (95% confidence interval: 11.1–11.8%) and 8.7% (95% confidence interval: 7.4–10%) in young adults. The recurrence rate in young adults was lower than in children (log rank p < 0.001) and comparable, albeit slightly lower, to older adults (log rank p < 0.001). Conclusions: Our results indicate that recurrence rates between young and older adults are similar. Consequently, treatment strategies for young adults could follow the recommendations for adults instead of those for children. Due to the limited quality of available evidence, this requires validation in primary studies with sufficiently long follow-up.