Abstract Introduction: Minimally invasive surgery including endoscopic and laser-assisted techniques have gained popularity in the management of pilonidal sinus disease (PSD). Based on a series of 124 consecutive patients treated under a standardized protocol, we propose and evaluate a novel classification system incorporating endoscopic and laser modalities. Materials and Methods: This retrospective analysis of prospectively collected data was conducted at Singla Hospital, Bhiwani, Haryana, India. A total of 124 patients with sacrococcygeal PSD were included. Patients were classified according to the Singla–Mital classification based on midline wound size and recurrence status. P1/Pr1 cases (midline wound <1 cm) were treated with minimally invasive endoscopic or laser-assisted procedures, while P2/Pr2 cases (midline wound ≥1 cm) underwent Flap procedures with off-midline closure (Bascom 2). Follow-up ranged from 6 year and 4 months to 6 months postoperatively, with recurrence defined as reappearance of discharge or sinus at the operative site. Results: Of the 124 patients (106 males and 18 females), 106 were managed with LASER-Assisted Endoscopic Pilonidal Sinus Treatment (LEPSiT), seven underwent hybrid approaches (LEPSiT with small Flap), and nine were treated with Bascom 2 Flap. Two abscess cases treated by incision and drainage were excluded from analysis. Among 122 patients, three developed recurrence during follow-up. Most of the patients treated with endoscopic means started their day-to-day activities next day and returned to full activity within 2 weeks. Discussion: The proposed Singla–Mital classification is practical, treatment-oriented, and includes modern minimally invasive options. It differs from Tezel, Berlin and international pilonidal sinus classifications by emphasizing wound morphology and minimally invasive eligibility. In accordance with pIlonidal sinus treatment: studying the options recommendations, it provides a structured tool for clinical decision-making by dividing patients in to two broad categories, that is, where a minimally invasive procedure can be done (P1and Pr1) where a major excisional procedure is required (P2 and Pr2), while minimizing postoperative morbidity. However, the current classification is institutionally derived and requires external validation through larger multicentric studies. Conclusion: The new classification provides a simplified, management-guided approach for PSD. It helps surgeons identify when minimally invasive or Flap techniques are appropriate and further recommends the type of surgery in each category of patient. Although short-term outcomes are promising, broader validation and longer follow- up are essential to confirm its clinical utility. The system encourages individualized treatment with the guiding principle of minimizing surgical morbidity and no further harm.
Singla et al. (Mon,) studied this question.