Ten-Year Comparative Analysis of Surgical Strategies for Pilonidal Sinus Disease

Background: Pilonidal sinus disease (PSD) remains a common surgical challenge with persistent debate regarding the optimal operative technique. This study compared outcomes of three approaches—primary closure, rhomboid flap, and open excision—using ten-year data and comprehensive multivariate modeling. Methods: Records of 321 patients treated for PSD between 2015 and 2024 were retrospectively analyzed. Demographic, operative, and postoperative parameters were compared using multivariate linear, logistic, ordinal logistic, and Cox regression analyses. A 1:1 propensity-score–matched (PSM) subgroup analysis was performed for primary closure versus rhomboid flap groups. Results: Mean follow-up was 22 ± 6 months. Rhomboid flap was associated with faster healing (mean 30.4 ± 5.2 days), earlier return to work, and higher patient-reported satisfaction, whereas open excision had slower healing (mean 75.2 ± 8.9 days) but the lowest recurrence rate (3.4%). Primary closure showed intermediate results. On multivariate analysis, surgical technique, diabetes, and recurrent presentation were independent predictors of delayed healing and recurrence (all p < 0.05). Conclusion: Surgical technique plays a decisive role in determining both recovery and recurrence outcomes in pilonidal sinus disease. This retrospective analysis suggests that the rhomboid flap achieves the most balanced results, combining faster healing and high satisfaction with durable recurrence control, whereas open excision offers the lowest recurrence rates but slower rehabilitation. Future prospective multicenter studies should focus on standardized severity grading and patient-reported outcomes to refine surgical decision-making.