Pediatric Pilonidal Disease Surgical Approach (PPiDSA) Study

<b>Background:</b> Wide surgical excision is considered the traditional treatment for pilonidal sinus disease but is associated with prolonged wound healing and delayed recovery. This study aims to compare the outcomes of radical surgery versus a minimally invasive alternative in pediatric patients. <b>Methods:</b> A multicenter randomized comparative study was conducted on patients undergoing surgery for pilonidal sinus between January 2023 and December 2024 in four pediatric institutions. Patients were divided into two groups according to the surgical approach: Group 1 (en bloc excision) and Group 2 (endoscopic treatment). Demographic and clinical variables, postoperative complications, and recurrence rates were analyzed. <b>Results:</b> A total of 102 patients were included in this study (Group 1: n = 54; Group 2: n = 48). Baseline demographic and clinical characteristics were similar between groups. Postoperative complications occurred more frequently in Group 1 compared with Group 2 (53.7% vs. 20.8%; <i>p</i> < 0.001). Moreover, Group 1 presented a higher proportion of emergency department visits (44.4% vs. 8.36%; <i>p</i> < 0.001) and a longer median time to complete healing (100 vs. 45 days; <i>p</i> < 0.001). After a median follow-up of 19 months (interquartile range, 10-24 months), no significant differences were observed between groups in recurrence rates (14.8% vs. 16.7%; <i>p</i> = 0.797) or in median time from treatment to recurrence (198 vs. 184 days; <i>p</i> = 0.672). <b>Conclusions:</b> Endoscopic treatment of pilonidal sinus in pediatric patients is associated with fewer postoperative complications and faster recovery compared to radical surgery, with no observed differences in recurrence rates. Longer follow-up is needed to confirm these findings.