Quality of life after minimally invasive and radical pilonidal sinus surgery: Introducing a new assessment tool

Background. Pilonidal disease (PD) is a common acute or chronic condition, particularly affecting young adults, characterised by the presence of a sinus tract or cavity in the sacrococcygeal region. It often results in pain, recurrent infection, and reduced quality of life (QoL). Surgery is the primary treatment for PD. The optimal approach for managing chronic cases remains controversial due to the variety of techniques used worldwide. QoL tools are widely used to evaluate the impact of diseases and their treatments. Despite their importance, generic instruments may not adequately capture the unique challenges and symptoms of PD, limiting their reliability in guiding treatment decisions Aim. This study aimed to compare postoperative pain, QoL, and failed surgery rates between patients undergoing pit-picking (PP) surgery and radical excision (E) without wound closure. Methods. A total of 100 adult patients with chronic symptomatic PD were enrolled in study. They were randomly divided into two groups: PP group and E group. Follow-up period was 6 months. The pain and QoL were assessed at different time intervals after surgery using a newly developed disease-specific QoL (SQoL) questionnaire, evaluating four key areas: pain, physical activity, wound-related symptoms, and psychosocial well-being. The adapted SQoL questionnaire has been proven effective for use in clinical practice. Results. The two groups were homogeneous in terms of age, gender, BMI, harmful habits, duration of disease-related symptoms, pilonidal sinus size, and other baseline characteristics. Pain levels were significantly lower in the PP group compared to the E group during the first postoperative week (median: 10.0 and 20.0, respectively (p = 0.002)), at the two-week follow-up (median: 4.0 and 10.0, respectively (p = 0.013)) and 1-month intervals (median scores of 0.0 and 4.0, respectively (p < 0.05)). QoL scores were also significantly better in the PP group at both the two-week (mean: 21.1 ± 17.8 SD and 29.0 ± 15.9 SD, respectively (p = 0.033)) and one-month follow-ups (mean: 11.9 ± 14.4 SD and 20.8 ± 14.6 SD, respectively (p = 0.003)). No significant difference was found between the two groups in terms of failed surgery rates. Conclusion. Pit-picking surgery provides significant advantages, including reduced postoperative pain and faster improvement in quality of life, making it a favourable option for managing chronic pilonidal disease.