Recurrence Rates after Uncommon Surgical Procedures for Pilonidal Sinus Disease

Background. Pilonidal sinus disease is a frequent disorder in young men. Recurrence depends greatly on both the surgical procedure selected and the follow-up time. We systematically searched the literature and analyzed available data for recurrence rates after uncommon therapy techniques, specifically endoscopic approaches, the seton technique, and conservative treatment. We then compared recurrence rates with those of well-established techniques and determined the relationship between recurrence and follow-up time for uncommon therapies. Methods. We analyzed 13 studies published between 1949 and 2017 for uncommon surgical procedures and found one randomized controlled trial (RCT) and 12 non-RCTs including 566 patients. As there was only one RCT, we conducted a merged data analysis including both the RCT and the non-RCTs. Results. Recurrence rates following endoscopic approaches were 8.5% after 12 months in the merged data and 3.9% after 12 months when considering only the available RCT. The seton technique was associated with a mean recurrence rate of 6.9% at 12 months after initial treatment. Recurrence rates following conservative treatment were 1.0% after 18 months, 4.7% after 24 months, 8.8% after 60 months, and 15.3% after 112 months. Conclusion. Recurrence rates following uncommon techniques fall within the range of well-established surgical approaches. However, data are sparse, with long-term results missing, and future studies may reveal a more differentiated picture for newer techniques such as endoscopic procedures.