Knowledge-based therapy of the pilonidal sinus

BACKGROUND: Controversy still exists concerning the surgical management of the pilonidal sinus. METHODS: Comparison of surgical treatment options with regard to recurrence based on review of randomized controlled trials (1960–2002). RESULTS: Four randomized studies were found that compared the recurrence following secondary vs. primary wound healing after excision. Recurrence after excision with primary closure is twofold when compared to secondary wound healing. Randomized controlled trials comparing primary suture and flap-plasty do not exist. CONCLUSIONS: Excision with secondary wound healing represents the optimal therapy for pilonidal sinus disease.