Comparative analysis of treatment modalities and contributing factors in recurrent pilonidal sinus disease

Pilonidal sinus disease (PSD) is a common and frequently recurring condition affecting young men. Despite the frequent recurrence of PSD, there is a lack of published literature addressing the management of recurrent disease. In the present retrospective study, data from 63 patients with recurrent pilonidal sinuses treated at the Plastic Surgery Department of Kuopio University Hospital (Kuopio, Finland) between 2010 and 2021 were analyzed. Patients were categorized into three groups based on the primary operation: Laser treatment (n=13), excision combined with direct closure (n=32) and flap reconstruction (n=18). The patient characteristics, complications, re-operative methods and follow-up times of these groups were compared. The minimum follow-up time was 18.3 months. Furthermore, ~1 in 5 patients required re-operation after the primary operation: 18.8% after laser treatment, 20.5% after direct closure and 19.2% after flap reconstruction. Residual disease or recurrence was more common as a reason for re-operation in the laser group compared with the other groups (direct closure group, P=0.003; flap group, P=0.010). Direct closure was the most common method for re-operation after primary direct closure and flap reconstruction (56.3 and 55.6%, respectively). However, patients treated primarily with laser were most likely re-operated with laser (61.5%), with only 15.4% operated using secondary direct closure and 23.1% with secondary flap reconstruction. In conclusion, the risk of recurrent PSD remains significant, yet most patients typically required only one re-operation. Laser treatment was a promising approach for both primary and recurrent cases. However, long-term outcomes are necessary to confirm this.