Pilonidal sinus disease (PSD) is a common condition associated with significant morbidity and healthcare costs. High recurrence rates still pose a considerable challenge in managing PSD, with no universally accepted guideline in place to guide management. Laser hair epilation offers a way to reduce recurrence rates with reports within the current literature demonstrating positive outcomes compared to alternative approaches. This review was conducted by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement standards. The primary outcome measure was the recurrence rate of PSD at a minimum of one year following laser hair epilation. The electronic databases of MEDLINE, EMBASE, CINAHL, Google Scholar, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched. OpenMeta Analyst (Brown University School of Public Health, Providence, RI) software was used for data synthesis. Three randomized controlled trials met the inclusion criteria with laser hair epilation treatments offering a significant reduction in PSD recurrence rates on odds ratio analysis: 0.319 ( 0.160, 0.636), P-value = 0.0001. Secondary outcomes involving patient disability days, caregiver disability days, health-related quality-of-life (HRQOL) scores, healthcare satisfaction scores, and perceived stigma were discussed qualitatively. The authors offer a decisive recommendation in favor of laser hair epilation in PSD; however, they recommend further high-quality trials to investigate the ideal timing and frequency of laser hair epilation sessions.

Pilonidal disease and hidradenitis suppurativa affect healthy young adults, causing discomfort and pain that leads to loss of work productivity and should be approached in a personalized manner. Patients with pilonidal disease should engage in hair removal to the sacrococcygeal region and surgical options considered. Hidradenitis suppurativa can be a morbid and challenging disease process. Medical management with topical agents, antibiotics, and biologics should be used initially but wide local excision should be considered in severe or refractory cases of the disease.

Basaloid squamous cell carcinoma (BSCC) is a rare and aggressive variant of squamous cell carcinoma. It is commonly seen in the oropharynx and strongly associated with p16-expressivity and high-risk human papilloma virus (HPV). We report the first case of primary cutaneous p16-positive BSCC in an elderly woman, with a background of chronic inverse psoriasis of the natal cleft. P16-expressivity is a common surrogate marker for oncogenic HPV16, routinely tested for oropharyngeal/anogenital squamous cell carcinoma. This is not routinely done for primary cutaneous disease. Pilonidal disease is uncommon in the elderly population, and malignant transformation is rarer still. Surgical resection is considered the mainstay of treatment for primary cutaneous BSCC, however due to this patient\'s broad distribution of cutaneous field change and p16-expressivity, she was effectively treated with primary radiotherapy. This is a unique case of malignant transformation of pilonidal disease in an atypical demographic, with a rare/aggressive disease variant.

The aim of this study was to evaluate the 5-year recurrence rate of pilonidal sinus disease (PSD) after endoscopic sinusectomy and identify risk factors for recurrence.
All consecutive patients from September 2011 through December 2017 who underwent endoscopic sinusectomy at seven referral centres for pilonidal sinus treatment were retrospectively analysed from a prospectively maintained database.
Out of 290 patients (185 males versus 105 female, with a mean age of 25.5±6.9), 73 presented recurrence at 5-year follow-up with a recurrence rate of 25.2%. The number of pilonidal sinus with pits off the midline (p = 0.001) and the mean (SD) distance from the most lateral orifice to the midline (p = 0.001) were higher in the group of patients with recurrence at 5-year follow-up. Multivariate analysis demonstrated that the position of the pits off the midline (p = 0.001) and the distance of the most lateral orifice from the midline (p = 0.001) were independent risk factors for recurrence at 5-year follow-up. Receiver operating characteristic (ROC) curve analysis showed that the distance of lateral orifice from midline predicted an 82.2% possibility of recurrence at 5-year follow-up and Youden\'s test identified the best cut-off as 2 cm for this variable. Out of 195 cases with the most lateral orifice less than 2 cm from the midline, 13 presented recurrence at 5-year follow-up with a recurrence rate of 6.7%. Out of 95 cases with the most lateral orifice more than 2 cm from midline, 60 showed recurrence at 5-year follow-up with a recurrence rate of 63.2%.
This data may help guide which disease characteristics predict the optimal use of an endoscopic pilonidal sinus technique.

UNASSIGNED: New surgical treatment methods are being investigated in sacrococcygeal pilonidal sinus disease. Minimal invasive methods such as endoscopic pilonidal sinus treatment (EPSIT) and sinus laser therapy (SiLaT) have promising results and advantages of laparoscopic surgery.
UNASSIGNED: To compare the efficiency and safety of EPSIT with SiLaT.
UNASSIGNED: Seventy-three patients with pilonidal sinus who had undergone EPSIT or SiLaT within 2 years were evaluated retrospectively. Data of patients\' demographics, complications and postoperative course were collected and compared between the two groups.
UNASSIGNED: We analyzed seventy-three patients who underwent EPSIT or SiLaT, with a mean age of 23.4 ±8.4 (12-46) years and body mass index (BMI) of 25.5 ±4.5 (18-38) kg/m2. Among them, 36 patients (26 males, ten females) underwent EPSIT and 37 patients (27 males, ten females) underwent SiLaT. Mean operative time was similar for both groups (32.3 ±14.8 vs. 31.0 ±14.8; p = 0.757). Early complications (minimal bleeding) were recorded in 2 patients in the SiLaT group. The duration of analgesic use was significantly lower in the EPSIT group compared to the SiLaT group (1.3 ±0.5 (1-3) vs. 1.9 ±1.1 (1-5); p = 0.005). The mean postoperative time of total wound healing was similar for both groups: 23.6 ±14.7 (12-90) vs. 25.2 ±14.5 (14-90) days (p = 0.385). There was no significant difference in the average time of return to total daily activity (3.4 ±0.9 (2-5) vs. 3.6 ±1.2 (2-7) days, p = 0.679). There were no significant differences between the groups regarding late postoperative complications (recurrence: 7).
UNASSIGNED: Both methods have similar early and late complications. The duration of need for analgesic usage was shorter in EPSIT patients.

Background: Pilonidal sinus disease (PSD) is a common inflammatory disease. PSD management in pediatric patients changed dramatically in the last few years especially when concerning the latest minimally invasive techniques. This article aims to identify clinical evidence about the reliability of the different techniques in managing PSD in children. Materials and Methods: We performed a PubMed search for articles published during the last 10 years, using the keywords \"pilonidal,\" \"sinus,\" \"disease,\" \"pediatric,\" \"surgery,\" and \"children.\" Results: We pooled 38 studies, 18 of these were excluded because they were either not relevant or concerned an adult population. Conclusions: Literature analysis shows that endoscopic techniques for PSD are superior to excision and primary closure (EPC) in terms of tolerance and postoperative conditions and, with the growing number of studies in the matter, important endpoints such as wound healing time and length of hospital stay will be proved to be superior. Pediatric Endoscopic pilonidal disease treatment showed to be a very promising alternative even from a statistical point of view, especially when considered that in this group, studies seemed to be more solid. Literature analysis showed that minimally invasive techniques were statistically superior to EPC in terms of recurrence and complications.

The cleft lift has been demonstrated to be one of the most successful operations for the treatment of pilonidal disease, however, there are times this procedure fails and further surgery is necessary. This article describes a reproducible and successful technique for the revision of a failed cleft lift. This procedure was performed on 76 consecutive patients who had previous cleft lift procedures. Failures were manifested by either a wound, sinus, abscess, dehiscence or fragile scar. The revision flattened the lower gluteal cleft with a rotation and advancement flap that placed the skin incision off-midline. Follow-up over the 10 years of this series was between six and 124 months with an average of 36 months. The revision was initially successful in 96.1% of patients; if the procedure was unsuccessful a repeat revision was subsequently curative. This procedure is proposed as an essential part of the treatment algorithm for patients with recurrent pilonidal disease after a cleft lift operation.

Pilonidal Sinus is a benign, chronic disease that affects the hair follicles of the natal cleft of the sacrococcygeal area. Its ideal treatment is controversial, especially in complex or recurrent cases. The aim of this study is to evaluate the use of minimally invasive endoscopic approach in this setting. We enrolled patients affected by complex or recurrent sacrococcygeal pilonidal sinus from January 2015 through December 2020 who underwent Video-Assisted Ablation of Pilonidal Sinus. All patients enrolled were re-evaluated once a year with a standard physical examination. The patients included were 38. Recurrence rate at 1-, 3- and 5-years follow-ups were 28.9%, 22.2% and 38.1% respectively. Of interest, the mean (SD) distance from the most lateral orifice to the midline was higher in group of patients with recurrence and the multivariate analysis demonstrated that it was the limiting factor, which influences the recurrence rate. In complex or recurrent pilonidal sinus disease with pits off the midline the endoscopic approach should not be the first choice. This makes us think that these cases should have their own classification to be identified and guide surgeons in choosing the appropriate approach.

BACKGROUND: Carcinoma secondary to pilonidal disease is very rare with fewer than 130 reported cases so far. It is presumed that underreporting and underpublishing contribute to the low reported incidence.
METHODS: A post was published on a closed Facebook group with about 30,000 Syrian doctors asking if anyone had ever seen a patient with pilonidal carcinoma before. The patients\' data were collected retrospectively from the treating physicians.
RESULTS: Between 2010 and 2019, we identified eight patients with pilonidal carcinoma. All patients were males with a mean age of 55.5 years. The mean interval between diagnosis of pilonidal disease and diagnosis of carcinoma was 6.9 years. A growing ulcer on the background of a pilonidal sinus disease was the presenting complaint in 50% of cases. Three patients were lost from follow-up after the diagnosis due to referral. All other five patients underwent surgical resection and three of them received postoperative chemoradiation. Four patients were followed for six months or longer: two died of metastases, one survived after recurrence and re-excision, and one survived with no recurrence.
CONCLUSIONS: This paper presents the largest cohort of pilonidal carcinoma so far and the first that describes the disease in the Syrian population. Due to underreporting, the real incidence of pilonidal carcinoma exceeds what is reported so far in the literature.

Introduction A pilonidal sinus (PNS) is a small passageway in the subcutaneous tissue which develops most frequently in the sacrococcygeal area. In terms of postoperative outcomes, the decision on the best surgical treatment for PNS is still a challenge for a surgeon. Prevention of the disease recurrence and improving quality of the life can be considered primary goals of the treatment. The current study intends to compare two commonly practiced surgical treatments for PNSes-Rhomboid excision with Limberg flap repair against wide-open excision with healing by secondary intention. Methods In a prospective randomized study, 50 patients with sacrococcygeal PNS were divided into two groups. Group A was operated by rhomboid excision with Limberg flap reconstruction and Group B was operated by wide-open excision and healing by secondary intention. Data were collected on a specially designed structured proforma and consisted of patient demographics, medical history, presentation, and postoperative complications assessed for a period of 6 months. Comparative outcomes of interest were postoperative pain, postoperative anxiety, duration of wound healing, duration of work loss, presence of wound infection, and recurrence. Results Mean age of 28 years was observed across the study with a male preponderance (76%). The mean visual analog scale (VAS) score for pain was greater in Group A during the early postoperative period, i.e., days 1, 3, and 7. However, patients in Group B reported a mean VAS score of 3 ± 0 and 1 ± 0 at one month and 2 months, respectively indicating a longer duration of postoperative pain overall. Patients in Group B also reported a significantly higher VAS for anxiety (VAS-A) score for postoperative anxiety/stress in all the follow-up visits. The mean healing time was 20 ± 2 days in Group A and 57 ± 11 days in Group B showing a significant difference. Duration of work loss was also significantly higher in Group B (31 days). Five patients in Group B developed wound infections. No recurrence was observed across both the groups in this study. Conclusion According to the findings of this study, the Limberg flap method outperforms the wide-open excision approach in terms of healing duration, work loss days, postoperative pain, anxiety, and wound infection. Both the techniques, however, are comparable in terms of recurrence.