The current status of surgical pilonidal sinus disease therapy in Germany

Schneider, Ralph; Dettmer, Marius; Peters, Nora; Lamdark, Tenzin; Luedi, Markus M.; Adamina, Michel; Doll, Dietrich (2022). The current status of surgical pilonidal sinus disease therapy in Germany. European surgery, 54(2), pp. 117-125. Springer 10.1007/s10353-021-00715-x

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Purpose
Treatment of pilonidal sinus disease (PSD) requires a tailored approach. A national guideline was published in 2014. The current status of surgical PSD therapy in Germany is unknown. The present study aims at evaluating treatment strategies currently used for PSD in Germany. Additionally, changes in surgical practice over the past 20 years were reviewed.

Methods
A total of 1191 German hospitals treating patients with PSD were surveyed between September 2015 and September 2016 to identify treatment strategies used for asymptomatic, acute, and chronic PSD. Answers could be provided electronically or by mail. Analysis was performed following irreversible anonymization of the dataset.

Results
The return rate of the survey was 38%, with 454 of 1191 hospitals responding. Asymptomatic PSD was treated conservatively by a majority (52%) of participating institutions. Acute PSD was incised, and secondary definitive treatment followed in 42%. Chronic PSD was approached by primary excision and open wound healing in 60% of hospitals, with 33% using a flap technique and 15% an off-midline procedure to close the defect. Over the past 20 years, use of flap procedures and off-midline techniques has increased by 37% and 35%, respectively.

Conclusion
The present study reveals that primary excision and open wound healing is still preferred in Germany, in spite of the availability of better options. While the use of flap procedures and off-midline techniques has increased over the past decades, these minimally invasive approaches remained underused, and compliance with the 2014 national guidelines for treatment of PSD remains poor.

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