Effectiveness and safety of elliptical midline excision and rectangular flap reconstruction in the treatment of pilonidal sinus disease: a retrospective study

Abstract Objective This study aimed to evaluate the clinical outcomes, effectiveness, and safety of elliptical midline excision combined with rectangular advancement flap reconstruction for the treatment of pilonidal sinus disease (PSD). Methods A retrospective analysis was performed on 102 patients who underwent elliptical midline excision with tension-free rectangular advancement flap reconstruction between February 2019 and February 2024 at a single tertiary referral center. Diagnosis was confirmed clinically and by routine preoperative ultrasonography. Patients with acute abscess requiring drainage, uncontrolled comorbidities, or incomplete one-year follow-up were excluded. Results A total of 102 patients (95 males [93.1%] and 7 females [6.9%]; mean age, 28.1 ± 5.8 years) were included. The mean wound healing time was 9.1 ± 2.3 days. The overall complication rate was 7.8% (8/102; 95% CI, 3.4–14.9%), and the 1-year recurrence rate was 4.9% (5/102; 95% CI, 1.6–11.1%). No flap necrosis or major complication requiring reoperation occurred. Patients resumed normal daily activities after a mean of 11.6 ± 3.2 days. Conclusion This study indicates that elliptical midline excision with rectangular advancement flap reconstruction is a safe and effective surgical option for pilonidal sinus disease, providing low complication and recurrence rates together with rapid postoperative recovery. These findings should be confirmed by prospective comparative studies with longer follow-up.