Surgical Management of Pilonidal Sinus Disease: A Single-Center Experience with a Focus on Aesthetic Outcomes

Abstract: Background: Pilonidal sinus disease (PSD) primarily affects young adults and is associated with a high recurrence rate and notable aesthetic consequences. Objective: To present our surgical experience in managing PSD, with a particular focus on minimizing aesthetic sequelae. Methods: We conducted a retrospective review of 30 patients operated on between 2021 and 2024. Two main techniques were used: midline primary closure and off-midline flap reconstruction (Limberg or Karydakis) for complex or recurrent cases. Obesity and perianal hair density were noted as potential risk factors. Results: Midline closure was performed in 22 patients and flap procedures in 8. The recurrence rate was 13.3%, exclusively observed in the midline group. Obesity was associated with increased wound complications. Dense perianal hair correlated with recurrence in the absence of definitive hair removal. Flap procedures yielded shorter healing times and superior cosmetic results. Conclusion: Off-midline flaps significantly reduce recurrence and improve aesthetic outcomes. Risk factor management, including obesity control and laser hair removal, should be an integral part of PSD treatment.