Controversies in the Management of Pilonidal Disease: Expert Recommendations from a Modified Delphi Survey and Review of the Literature

Aim: This study aimed to identify key controversies in the management of pilonidal disease (PD) and to develop expert-based recommendations using a modified Delphi process, highlighting critical areas for future research.Method: A working group established by the Turkish Society of Colon and Rectal Surgery conducted a systematic literature review and invited national and international experts with relevant publication records to participate in a Delphi survey.A four-round Delphi process was conducted between July 2023 and February 2024.Statements that reached 70% consensus (agree/strongly agree) were accepted.Results: Of the 172 experts invited, 98 agreed to participate, and 52 completed at least two rounds.Expert opinions were evaluated across nine key aspects of PD management: classification, diagnosis, acute abscess, minimally invasive and excisional treatments, recurrence, hair removal, perioperative care, and postoperative management. Conclusion:This Delphi study presents expert consensus on unresolved clinical questions in the management of PD.The findings provide practical recommendations for surgeons and emphasize the need for prospective, high-quality studies to establish standardized treatment pathways.