Pilonidal sinus disease (PNS) is a chronic inflammatory condition of the sacrococcygeal region characterized by sinus tract formation containing hair and debris. It predominantly affects young adults, particularly males, and is strongly associated with risk factors such as hirsutism, sedentary occupation, obesity, and local trauma [1]. The condition is thought to arise from hair penetration into the skin, leading to a foreign body reaction and chronic infection [2].

The incidence of pilonidal sinus disease has increased in recent decades, particularly in populations with sedentary lifestyles, such as students and office workers. Studies have demonstrated that prolonged sitting and increased body hair density contribute significantly to disease development [3]. The disease commonly presents with pain, discharge, or recurrent abscess formation, significantly impacting quality of life and productivity.

Management of pilonidal sinus remains controversial, with multiple surgical techniques described, including wide local excision, flap procedures such as Limberg or Karydakis flap, and minimally invasive approaches like laser ablation [4]. The choice of surgical technique depends on disease extent, surgeon expertise, and patient factors. Traditional excision techniques are associated with prolonged healing times, whereas flap procedures and minimally invasive techniques aim to reduce recurrence and improve recovery [5].

Despite advances in surgical management, recurrence rates remain a concern, with reported rates ranging from 5% to 20% depending on the technique used [6]. Postoperative outcomes such as pain, hospital stay, return to normal activity, and patient satisfaction are increasingly recognized as important measures of treatment success [7-10].

There is limited real-world data from tertiary care settings in developing countries evaluating early postoperative outcomes and functional recovery in pilonidal sinus patients. The present study aims to describe the clinical profile, surgical techniques, and early outcomes of patients undergoing surgical management for pilonidal sinus.

Study Design and Setting This retrospective case series was conducted in the Department of General Surgery at a tertiary care teaching hospital. The study analyzed patients diagnosed with pilonidal sinus disease who underwent surgical management over a defined study period of January 2023 to December 2024. Institutional ethical clearance was obtained prior to data collection, and the study adhered to the principles outlined in the Declaration of Helsinki. Study Population A total of 10 consecutive patients (n = 10) with clinically diagnosed pilonidal sinus disease who underwent surgical intervention during the study period were included. Inclusion Criteria • Patients aged ≥18 years with a clinical diagnosis of pilonidal sinus • Patients who underwent definitive surgical management • Availability of complete clinical, operative, and follow-up records Exclusion Criteria • Patients managed conservatively or with incision and drainage alone • Patients with incomplete medical records • Patients lost to follow-up before 6 months Data Collection Data were retrospectively extracted from hospital medical records, operative notes, and follow-up registers using a structured data collection proforma. Demographic Variables • Age (years) • Gender • Occupation (categorized as sedentary vs non-sedentary) Clinical Variables • Hirsutism grading (categorized as low, moderate, high based on clinical assessment) • Duration of symptoms (days) • Type of disease (primary or recurrent) • Number of sinus openings Operative Variables • Type of surgical procedure (wide local excision, excision with modification, laser ablation) • Type of anesthesia (spinal or saddle block) • Operative duration (minutes) Postoperative Assessment Postoperative parameters were assessed using standardized definitions: Pain Assessment Postoperative pain was evaluated using the Visual Analog Scale (VAS), a validated 10-cm linear scale ranging from 0 (no pain) to 10 (worst imaginable pain), as originally described by Huskisson [11]. Pain scores were recorded on postoperative day 1. Recovery Parameters • Duration of hospital stay (days) • Time to resume sitting (days) • Time to return to work (days) • Drain usage and time of removal Outcome Variables • Postoperative complications: o Surgical site infection o Seroma formation o Wound dehiscence • Recurrence (defined as reappearance of sinus or discharge at the operative site within 6 months) • Patient satisfaction (categorized as very satisfied, satisfied, or dissatisfied based on follow-up assessment) Follow-up Protocol All patients were followed up at regular intervals in the outpatient department at: • 1 week • 2 weeks • 1 month • 3 months • 6 months Recurrence and complications were assessed clinically during these visits. Outcome Measures The primary outcome was recurrence rate at 6 months. Secondary outcomes included: • Postoperative pain (VAS score) • Complication rates • Functional recovery parameters (time to sitting and return to work) • Patient satisfaction Statistical Analysis Data were entered into Microsoft Excel and analyzed using Statistical Package for the Social Sciences (SPSS) version 26.0 (IBM Corp., Armonk, NY, USA). • Continuous variables were expressed as mean ± standard deviation (SD) or median with range where appropriate • Categorical variables were presented as frequencies (n) and percentages (%) Given the small sample size (n = 10), only descriptive statistical analysis was performed. No inferential statistical tests were applied. Results were summarized using tables and descriptive measures to reflect clinical trends and outcomes. Ethical Considerations Institutional Ethics Committee approval was obtained prior to commencement of the study. As this was a retrospective analysis of anonymized patient data, the requirement for individual informed consent was waived. Patient confidentiality was strictly maintained throughout the study.

A total of 10 patients (n = 10) were included in this retrospective case series. The cohort predominantly consisted of young adults, reflecting the known epidemiological profile of pilonidal sinus disease.

Demographic and Clinical Profile

The study population had a mean age of 23.4 years, with the majority being students (9/10, 90%), while 1 patient (10%) had a sedentary occupation. All patients presented with primary disease (10/10, 100%), and no recurrent cases were observed.

Hirsutism was moderate to high in most patients, with 5 patients (50%) having moderate and 3 patients (30%) having high hair density, indicating a strong association with disease occurrence. The mean duration of symptoms prior to presentation was 82 days.

Table 1. Demographic and Clinical Profile (n = 10)

Disease Characteristics

Most patients presented with single sinus openings (6/10, 60%), while 4 patients (40%) had multiple openings. The mean number of sinus openings was 1.8, suggesting relatively early-stage disease in the majority of cases.

Table 2. Disease Characteristics (n = 10)

Operative Details

Wide local excision was the most commonly performed procedure in 8 patients (80%), while 1 patient (10%) underwent laser ablation and 1 patient (10%) underwent excision with variation.

Spinal anesthesia was the preferred modality in 8 patients (80%), while 2 patients (20%) received saddle block anesthesia. The mean operative time was 42 minutes, reflecting relatively uncomplicated procedures.

Table 3. Operative Details (n = 10)

 Postoperative Outcomes

Postoperative recovery was favorable across the cohort. Pain levels were minimal, with a mean VAS score of 1.2 on postoperative day 1.

Drain placement was required in 2 patients (20%), while 8 patients (80%) did not require drainage. The mean hospital stay was 6.8 days, with early mobilization observed, as patients resumed sitting at a mean of 1.6 days and returned to work at 2.1 days.

Table 4. Postoperative Outcomes (n = 10)

Complications, Recurrence, and Satisfaction

No postoperative complications were observed in this study. Specifically, no cases of infection, seroma, or wound dehiscence (0/10, 0%) were reported.

At 6-month follow-up, no recurrence was noted (0/10, 0%).

Patient satisfaction was high, with 7 patients (70%) reporting being very satisfied and 3 patients (30%) reporting satisfaction, with no dissatisfaction reported.

Table 5. Complications, Recurrence, and Patient Satisfaction (n = 10)

Pilonidal sinus disease continues to be a common surgical condition affecting young individuals, particularly those with sedentary lifestyles. In the present case series, the majority of patients were young students, which is consistent with global epidemiological trends demonstrating higher prevalence among young males with prolonged sitting habits [11,12]. Sedentary occupation has been consistently identified as a major contributing factor due to increased friction and hair penetration in the natal cleft.

Hirsutism was observed in a significant proportion of patients in this study, reinforcing its role as an important etiological factor. Increased body hair density facilitates the insertion of loose hair into the skin, initiating a chronic inflammatory response [2]. Recent studies have emphasized the multifactorial etiology of pilonidal sinus disease, involving mechanical, hormonal, and hygienic factors [3].

All patients in this study presented with primary disease, with no recurrent cases. This likely contributed to the favorable outcomes observed. Recurrence remains one of the most significant challenges in the management of pilonidal sinus, with reported rates varying widely depending on the surgical technique used [4,13,14]. Studies have shown recurrence rates ranging from 5% to 25%, particularly in midline closure techniques [5]. The absence of recurrence in the present study may be attributed to early presentation and appropriate surgical selection.

Wide local excision was the most commonly performed procedure in this series, which continues to be a widely accepted treatment modality. However, recent literature has increasingly favored off-midline closure techniques and minimally invasive approaches due to improved healing and lower recurrence rates [6]. Minimally invasive procedures, including laser ablation and endoscopic techniques, have shown promising results in reducing postoperative morbidity [7].

Operative time in this study was relatively short, reflecting the limited disease extent and straightforward surgical approach. Comparable operative durations have been reported in recent studies evaluating excisional techniques [8,15]. Efficient surgical management is associated with reduced anesthesia exposure and improved perioperative outcomes.

Postoperative pain in this cohort was minimal, with low VAS scores observed. Pain control is a critical determinant of patient recovery, and modern surgical approaches aim to minimize tissue trauma and optimize postoperative comfort [16]. Reduced pain facilitates early mobilization, which is essential for preventing complications and improving overall recovery.

Hospital stay was short, and patients demonstrated early functional recovery, including rapid return to sitting and work. Early recovery is increasingly recognized as a key outcome measure, as it directly impacts quality of life and economic productivity [9]. The findings of this study are consistent with recent literature demonstrating improved recovery profiles with appropriate surgical techniques.

Complication rates in this study were negligible, with no cases of infection, seroma, or wound dehiscence observed. This is notable, as previous studies have reported complication rates ranging from 10% to 30% depending on the surgical method [10]. The absence of complications in this series may be attributed to careful operative technique and patient selection.

Patient satisfaction was high in this study, reflecting favorable clinical and functional outcomes. Satisfaction is influenced by multiple factors, including pain, cosmetic outcome, and time to recovery [12-15]. The results of this study support the effectiveness of surgical management in achieving high patient satisfaction.

Pilonidal sinus disease can be effectively managed with appropriate surgical intervention, resulting in low postoperative pain, minimal complications, and rapid recovery. This case series demonstrates excellent early outcomes and high patient satisfaction. Early diagnosis and individualized surgical approach are essential for optimizing results. Larger studies with longer follow-up are required to evaluate long-term recurrence and establish standardized management protocols. Acknowledgment of AI Assistance The authors acknowledge the use of artificial intelligence–based language tools to assist in improving the clarity, grammar, and overall readability of the manuscript. These tools were utilized solely for language refinement and sentence structuring. All scientific content, data analysis, interpretation, and conclusions are entirely the original work of the authors, who take full responsibility for the integrity and accuracy of the manuscript.

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