OBJECTIVE: Pilonidal sinus disease is a common condition treated by colorectal surgeons. There is a lack of literature in the field to guide optimal management of this condition. As part of the PITSTOP study, we aimed to identify policy and research priorities to provide direction to the field.
METHODS: Patients and surgeons were invited to participate. A \'So what, now what\' exercise was conducted, informed by data from PITSTOP. This generated statements for research and practice priorities. A three-round online Delphi study was conducted, ranking statements based on policy and research separately. Statements were rated 1 (not important) to 9 (important). Statements that were rated 7-9 by more than 70% of participants were entered into the consensus meeting. Personalized voting feedback was shown between rounds. A face-to-face meeting was held to discuss statements, and participants were asked to rank statements using a weighted choice vote.
RESULTS: Twenty-two people participated in the focus group, generating 14 research and 19 policy statements. Statements were voted on by 56 participants in round 1, 53 in round 2 and 51 in round 3. A total of 15 policy statements and 19 research statements were discussed in the consensus round. Key policy statements addressed treatment strategies and intensity, surgeon training opportunities, need for classification and the impact of treatment on return to work. Research recommendations included design of future trials, methodology considerations and research questions.
CONCLUSIONS: This study has identified research and policy priorities in pilonidal sinus disease which are relevant to patients and clinicians. These should inform practice and future research.

Sacrococcygeal pilonidal disease(SPD) is an acquired disease intimately related to the presence of hair in the gluteal groove. Although its pathogenesis is still controversial, numerous treatment options are available for SPD including gluteal groove and surrounding skin hair removal, sinusectomy, open healing by secondary intention, primary closure, and local excision with flap reconstruction. Lacking of standardized diagnosis and treatment processes of SPD in China, Chinese Medical Doctor Association Anorectal Branch and its Clinical Guidelines Committee jointly organized experts in this field to form expert consensus opinion on the basis of summarizing latest research progress in China and abroad, experts\' clinical experience and principles of evidence-based medicine. The expert group formed opinion in 12 terms of SPD diagnosis, risk factors, non-surgical treatment, surgical treatment, minimally invasive treatment, and wound management, and developed the \"Chinese expert consensus on the diagnosis and treatment of sacrococcygeal pilonidal disease (2023 edition)\" after rounds of discussion and revision, to improve the diagnosis and treatment of SPD.
骶尾部藏毛疾病（SPD）是一种与臀沟毛发密切相关的获得性疾病，其发病机制尚存在争议。SPD治疗方法很多，包括臀沟及周围皮肤脱毛、窦道切除、创面开放二期愈合、一期闭合、病灶切除加皮瓣技术。我国目前缺乏SPD诊治的规范化流程，中国医师协会肛肠医师分会及其临床指南工作委员会组织本研究领域专家，在总结国内外研究进展的基础上，结合专家的经验，经过多次研讨，依据循证医学原则，针对SPD的诊断评估、危险因素、非手术治疗、手术治疗、微创治疗和伤口管理等归纳了12个条目并形成专家共识意见，制定出台了《骶尾部藏毛疾病诊治中国专家共识（2023版）》，以提高我国SPD的诊治水平。.

Pilonidal disease is a common condition of the gluteal cleft region, but involvement of the anterior perineum is rarely reported. Surgical options for gluteal cleft disease include simple fistulotomy, excisional procedures with primary closure (ie, Bascom cleft lift, Karydakis and Limberg flaps), or excision with secondary healing. The Bascom cleft lift described here is an excisional procedure involving a rotational flap with an off-midline closure. Deep tissue is salvaged allowing for proper contouring of the gluteal cleft, resulting in a cosmetically pleasing result.
A 20-year-old man with recurrent pilonidal abscesses of the gluteal cleft underwent a Bascom cleft lift procedure for definitive care of his disease. During the procedure, involvement of the anterior perineum was found. Given the location of the pits relative to the flap, the anterior perineal disease was treated only with removal of hair from within the pits and clipping the hair of the perineum.
While this case highlights the current standard of care and surgical options for pilonidal disease, the ideal surgical options for rare cases of pilonidal disease of the anterior perineum remain to be determined.

Pilonidal disease (PD) is a relatively common, benign but challenging condition of the natal cleft. This consensus statement was drawn up by a panel of surgeons, identified by the Italian Society of Colorectal Surgery (SICCR) as having a \"special interest\" in PD, with the aim of recommending the best therapeutic options according to currently available scientific evidence. A three-step modified-Delphi process was adopted, implying: (1) choice of the panelists; (2) development of a discussion outline and of target issues; and (3) a detailed systematic review of the current literature. The agreement/disagreement level was scored on a five-point Likert scale as follows: \"A + : strongly agree; A-: agree; N: unsure/no opinion; D-: disagree; D + : strongly disagree. Each panelist contributed to the production of this manuscript, and the final recommendations were reviewed by the Clinical Practice Guidelines Committee.

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National or international guidelines can help surgeons and anesthesiologists make treatment decisions, but the existence of conflicting recommendations can hinder treatment rather than helping. A case in point is the treatment of pilonidal sinus disease, a chronic subcutaneous infection located in the sacrococcygeal area. Its incidence is rising, reaching almost 100/100,000 inhabitants. Three surgical societies have proposed guidelines for treating the disease, but these guidelines vary greatly in their approach to anesthesia. Who should provide input into guidelines? And how can medical disciplines successfully collaborate? Anesthesiologists must be involved in defining perioperative recommendations not only in patients with pilonidal sinus disease.

OBJECTIVE: The present national guideline aims to provide recommendations for physicians involved in the treatment of patients with pilonidal disease. It has been published previously as an extended version in German language.
METHODS: This is a systemic literature review. The present guideline was reviewed and accepted by an expert panel in a consensus conference.
RESULTS: Some of the present guideline conclusions were based on low- to moderate-quality trials. Therefore, an agreement was necessary in those cases to provide recommendations. However, recommendations regarding the most frequently used surgical procedures were based on numerous prospective randomized trials.
CONCLUSIONS: An asymptomatic pilonidal disease does not require treatment. A pilonidal abscess should be incised. After regression of the acute inflammation, a definitive treatment method should be applied. An excision is the standard treatment method for the chronic pilonidal disease. Open wound healing is associated with a low postoperative morbidity rate; however, it is complicated by a long healing time. The minimally invasive procedures (e.g., pit picking surgery) represent a potential treatment option for a limited chronic pilonidal disease. However, the recurrence rate is higher compared to open healing. Excision followed by a midline wound closure is associated with a considerable recurrence rate and increased incidence of wound complications and should therefore be abandoned. Off-midline procedures can be adopted as a primary treatment option in chronic pilonidal disease. At present, there is no evidence of any outcome differences between various off-midline procedures. The Limberg flap and the Karydakis flap are most thoroughly analyzed off-midline procedures.

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The Italian Society of Colorectal Surgery (SICCR.) has prepared clinical practice guidelines to help its members to optimize the treatment of pilonidal disease, a very common condition, especially among young people, and therefore of great importance on a socioeconomic level. The SICCR committee of experts on pilonidal disease analyzed the international literature and evaluated current evidence. Nonoperative management includes gluteal cleft shaving, laser epilation as well as fibrin glue and phenol injection: reported healing rates and recurrence incidence are satisfactory but the majority of studies are small series with low-quality evidence. Surgical therapy which can be divided into two categories: excision of diseased tissue with primary closure using different techniques or excision with healing by secondary intention. On the whole, no clear benefit is demonstrated for one technique over the other.