Adoption of a standardized treatment protocol for pilonidal disease leads to low recurrence

Background: Pilonidal disease may present as acute abscesses or chronic draining sinuses. There is no standardized treatment and recurrence rates can be as high as 30%. Within our five-hospital network we have established a standardized treatment protocol including minimally invasive surgical trephina-tion and aggressive epilation. We hypothesize that such a treatment protocol can be established across different hospital settings and lead to low overall recurrence. Methods: Patients with pilonidal disease were enrolled in the study on presentation to our hospital net-work. Those that underwent initial surgery outside our hospital system or were noncompliant with our treatment protocol were excluded. Patients were grouped based on surgeon and treating facility. Fre-quency of recurrence per surgeon and per hospital was calculated and compared. Results: Out of 132 patients, 80 patients were included (45 female, 35 male) while 52 were excluded because of initial surgery at a non-network hospital or for protocol noncompliance. Median age was 17 (16-19) years and median length of follow-up was 352 (261-496) days. There were 6 patients who ex-perienced at least one recurrence. There was an overall 8% recurrence rate with no significant difference noted between surgeons or hospitals (p = 0.15, p = 0.64, respectively). Conclusions: We have successfully implemented a standardized treatment protocol for pilonidal disease across different hospital settings and by different surgeons, with an overall low recurrence rate. Our find-ings suggest that adoption of a standardized protocol for treatment of pilonidal disease can lead to low recurrence. Level of evidence: Level IV. (c) 2022 Elsevier Inc. All rights reserved.