Long-term analysis of surgical treatment outcomes in chronic pilonidal sinus disease Huseyin Murat Mutus, Burhan Aksu, Ersan Uzun, Neslihan Gulcin, Gonca Gercel, Erdem Ozatman, Cigdem Ulukaya Durakbasa ⁎, Hamit Okur Department of Pediatric Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey abstract article info Article history: Received 3 November 2017 Accepted 8 November 2017 Available online xxxx Key words: Pilonidal sinus disease Surgery Complication Recurrence Local hygiene Adolescent Background/purpose: Chronic pilonidal sinus disease (PSD) is relatively common in adolescents and can be treat- ed by various surgical techniques. This study aimed to evaluate the outcome in adolescents surgically treated for PSD in a single clinic. Methods: PSD patients surgically treated over an 8-year period were retrospectively evaluated. Classical midline incision and excision with primary repair was performed in all. Regular follow up visits were scheduled. Evalua- tion of postoperative outpatient clinic records as well as telephone interviews for patients who were operated more than 6 months ago were done for the long-term results, including coherence to regional hair care. Results: There were 268 patients with a median age of 16 years; 146 (54%) were males, and 122 (46%) were females. Outpatient follow up records were available for 249 (92.9%) patients with a median of postoperative 3 months (7 days–49 months). Moreover, 114 (42.5% of total) patients were interviewed by telephone 6–63 (median 25) months after the surgery. In 36 (13.4%) patients, wound infection or dehiscence occurred within the first month of surgery and was treated by secondary healing. Recurrences were observed in 21 (7.8%) patients all having poor local hygiene. Laser epilation was employed in 32 (28%) patients, and none of these had recurrences. Conclusions: Classical midline incision and primary closure approach for surgical treatment of PSD in adolescents has similar results to adults. Postoperative hair removal seems to reduce recurrences. Type of study: Treatment study. Level of evidence: Level IV (Retrospective case series with no comparison group). © 2017 Elsevier Inc. All rights reserved. Pilonidal sinus disease (PSD) is a common chronic inflammatory condition caused by ingrown hair in natal cleft with an incidence of 26–700/100.000 population [1]. The etiology is not clearly identified, but it is commonly regarded as an acquired condition primarily affecting young males [2]. Painful chronic discharge from the infected area causes discomfort, embarrassment, and absence from work or school, therefore leading to impairment in life quality. PSD can be treated by a variety of surgical techniques by way of either midline or off-midline incisions [3–5]. Min- imal invasive methods such as using an endoscopic approach, tract de- epithelization and phenolization, and “pit pick” operations have also been described [6–8]. All have advantages and disadvantages on wound healing, complications, recurrence rates, and the final cosmetic appearance obtained. The aim of the present study is to assess short and long-term out- comes of a standard “traditional” surgical treatment modality in adoles- cent PSD patients in a single pediatric surgery unit. 1. Material and methods A retrospective chart review and telephone follow-up of patients op- erated on for PSD over an 8-year period (2008–2015) were performed. Preoperative systemic antibiotic treatment was prescribed for pa- tients applying with infection or abscess. The operation was undertaken after the infection subsided. Patients were instructed to remove the ex- cess hair surrounding the lesion area 24 to 48 h prior to surgery. The pa- tients were placed in prone position on the operating table, and sterile methylene blue was injected through the opening of sinus tracts to de- lineate the extension of lesions. The surgery was done through a classi- cal midline incision in all. A parallel incision was performed around intergluteal sulcus, including all tract openings in an elliptical fashion. Pilonidal sinus tract including the cystic cavity was excised, including a couple of millimeters of surrounding healthy tissue down to presacral fascia. The defect was repaired primarily by absorbable sutures. No Journal of Pediatric Surgery xxx (2017) xxx–xxx ⁎ Corresponding author at: Head of Department of Pediatric Surgery, Istanbul Medeniyet University, Goztepe Training and Research Hospital, 34722 Istanbul, Turkey. Tel.: +90 532 253 0569; fax: + 90 216 566 4023. E-mail address: cigdemulukaya@yahoo.com (C.U. Durakbasa). https://doi.org/10.1016/j.jpedsurg.2017.11.031 0022-3468/© 2017 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg Please cite this article as: Mutus HM, et al, Long-term analysis of surgical treatment outcomes in chronic pilonidal sinus disease, J Pediatr Surg (2017), https://doi.org/10.1016/j.jpedsurg.2017.11.031