We systematically searched available databases. We reviewed 6,143 studies published from 1833 to 2017. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract. We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3-0.9%) 12 months and 1.8% (95%CI 1.1-2.4%) respectively 24 months postoperatively. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1-0.3%) 12 months and 0.6% (95%CI 0.5-0.8%) 24 months postoperatively. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3-82.4%) 240 months post-surgery. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure.

/pdf/common-surgical-procedures-in-pilonidal-sinus-disease-a-meta-3gr03m0tkn.pdf

Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence.

Background
Outpatient management is appropriate for chronic pilonidal sinuses. Even though there are different surgical treatments for pilonidal sinuses, the outcome may not be uniformly satisfactory. The aim of this paper was to examine the ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture.

http://canjsurg.ca/wp-content/uploads/2013/12/54-2-78.pdf

Ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture.

THE LARGE number of papers written on the surgical management of pilonidal sinus, each usually describing some new or different surgical technic, is eloquent testimony to the fact that results in many cases have been far from satisfactory. Inadequacies of follow-up studies often apparent in these reports, particularly those based on cases treated in the Armed Forces during World War II,1 2 3 have made evaluation of various operative procedures difficult. With Armed Forces personnel the follow-up lasted usually only until the patient returned to duty. Our experience has shown that a large percentage of recurrences develop at a later date, although . . .

https://www.nejm.org/doi/pdf/10.1056/NEJM195107262450403?listPDF=true

The marsupialization operation for pilonidal sinus; a comparison with other surgical methods in 359 cases.

Evaluating the effect of Histoacryl on the outcome and recurrence rate after excision and primary closure of sacrococcygeal pilonidal disease. Forty patients with sacrococcygeal pilonidal sinus were randomly divided into 2 equal groups through computer randomization program. Group I was operated by complete excision of sinus with wound closure using Histoacryl. Group II was operated with primary wound closure by interrupted inverting sutures. Mean operative time was 31.5 ± 5.6 minutes in group I and 35.9 ± 5.1 minutes in group II. Mean healing time was 13.4 ± 2.7 days in group I and 18.0 ± 8.9 days in group II. Wound infection occurred in 2 patients (10%) in Group II. Delayed wound healing occurred in 3 patients (15%) in group I and 4 patients (20%) in group II. Recurrence occurred in 1 patient (5%) in group I and 3 patients (15%) in group II. Histoacryl improves outcome (significantly decreases operative and healing times and increases patient satisfaction score, insignificantly decreases rates of complications and recurrence) after excision and primary closure of sacrococcygeal pilonidal disease.

/pdf/skin-glue-improves-outcome-after-excision-and-primary-13vfcr7e5n.pdf

Skin Glue Improves Outcome after Excision and Primary Closure of Sacrococcygeal Pilonidal Disease

Present status of the treatment of pilonidal sinus disease

THE ideal of all surgical treatment is to effect a cure, and in pilonidal cyst and sinus the basic aim is to prevent recurrence, lessen the period of disability and obtain a good mechanical result....

Pilonidal cyst and sinus.

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Pilonidal cyst and sinus.