{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T03:10:06Z","timestamp":1793502606125,"version":"4.5.0"},"reference-count":73,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Pilonidal sinus disease (PSD) is a common condition affecting predominantly young adults and it is associated with a substantial impact on quality of life. Despite the wide range of available surgical options, optimal management remains controversial due to heterogeneous recurrence rates, wound complications and prolonged recovery. Over the last decade, a paradigm shift has occurred from midline excision toward off-midline closure techniques and minimally invasive procedures. This narrative review aims to critically appraise contemporary surgical strategies for PSD, comparing outcomes, indications and limitations, with particular emphasis on patient selection. Materials and Methods: A narrative review of the literature was conducted using PubMed, Scopus, and major guideline repositories. Relevant randomized controlled trials, systematic reviews, meta-analyses, observational studies and national and international guidelines were reviewed and synthesized, with a focus on healing time, recurrence, postoperative complications and patient-reported outcomes. Results: Midline primary closure is consistently associated with higher recurrence and complication rates and is no longer recommended. Off-midline flap techniques provide the most durable results in recurrent or complex disease. Minimally invasive approaches, including endoscopic and laser-assisted techniques, offer faster recovery and high short-term patient satisfaction in selected primary cases, but should not be considered equivalent to flap surgery in complex or recurrent PSD due to limited long-term evidence. Current guidelines uniformly advocate individualized, patient-tailored treatment strategies and discourage midline closure. Conclusions: Surgical management of PSD should be individualized according to disease complexity, prior interventions and patient expectations. While minimally invasive techniques represent an attractive option for selected primary disease, off-midline flap procedures remain the standard of care for extensive or recurrent cases. High-quality comparative studies with standardized outcome definitions and long-term follow-up are required to refine treatment algorithms.<\/jats:p>","DOI":"10.3390\/medicina62030518","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T10:43:27Z","timestamp":1773225807000},"page":"518","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The New Minimally Invasive Techniques for Pilonidal Sinus Disease Surgery: Choosing the Right Technique for the Right Patient\u2014A Narrative Review"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8724-2859","authenticated-orcid":false,"given":"Matteo","family":"Matteucci","sequence":"first","affiliation":[{"name":"Department of Medicine and General Surgery, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1985-0091","authenticated-orcid":false,"given":"Lorenza","family":"Zampino","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ospedale Giuseppe Fornaroli, ASST-Ovest Milanese, 20013 Magenta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gisella","family":"Barone","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ospedale Giuseppe Fornaroli, ASST-Ovest Milanese, 20013 Magenta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9117-4840","authenticated-orcid":false,"given":"Andrea","family":"Carnevali","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ospedale Giuseppe Fornaroli, ASST-Ovest Milanese, 20013 Magenta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1326-1862","authenticated-orcid":false,"given":"Luca","family":"Scaravilli","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ospedale Giuseppe Fornaroli, ASST-Ovest Milanese, 20013 Magenta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MiMi","family":"Yen","sequence":"additional","affiliation":[{"name":"Department of Medicine and General Surgery, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Costeri","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ospedale Giuseppe Fornaroli, ASST-Ovest Milanese, 20013 Magenta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5925-983X","authenticated-orcid":false,"given":"Camillo Leonardo","family":"Bertoglio","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ospedale Giuseppe Fornaroli, ASST-Ovest Milanese, 20013 Magenta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1056\/NEJM188011181032101","article-title":"Pilonidal sinus","volume":"103","author":"Hodges","year":"1880","journal-title":"Boston Med. Surg. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1016\/S0039-6109(02)00062-2","article-title":"Pilonidal disease","volume":"82","author":"Hull","year":"2002","journal-title":"Surg. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.suc.2025.08.005","article-title":"Pilonidal Disease","volume":"106","author":"Nguyen","year":"2026","journal-title":"Surg. Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1097\/01.ASW.0000725168.11099.92","article-title":"Pilonidal Sinus Disease: An Analysis of the Factors Affecting Recurrence","volume":"34","author":"Kanlioz","year":"2021","journal-title":"Adv. Skin Wound Care"},{"key":"ref_5","first-page":"62","article-title":"Risk factors for recurrence after pilonidal sinus surgery in children and adolescents","volume":"59","author":"Madenci","year":"2021","journal-title":"S. Afr. J. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"299","DOI":"10.3399\/bjgp23X733233","article-title":"Managing pilonidal sinus disease","volume":"73","author":"Forde","year":"2023","journal-title":"Br. J. Gen. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1097\/01.JAA.0000873828.43069.a1","article-title":"Pilonidal disease","volume":"35","author":"Murphy","year":"2022","journal-title":"JAAPA"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1007\/s10151-021-02432-9","article-title":"A mapping review of sacrococcygeal pilonidal sinus disease","volume":"25","author":"Kumar","year":"2021","journal-title":"Tech. Coloproctol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1111\/iwj.13042","article-title":"Management of sacrococcygeal pilonidal sinus disease","volume":"16","author":"Harries","year":"2019","journal-title":"Int. Wound J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"148","DOI":"10.14712\/23362936.2019.2","article-title":"Comparison of Three Surgical Techniques in Pilonidal Sinus Surgery","volume":"119","author":"Kartal","year":"2018","journal-title":"Prague Med. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1001\/jamasurg.2023.0373","article-title":"Management of Pilonidal Disease: A Review","volume":"158","author":"Gil","year":"2023","journal-title":"JAMA Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1097\/DCR.0000000000000240","article-title":"The use of negative-pressure wound therapy in pilonidal sinus disease: A randomized controlled trial comparing negative-pressure wound therapy versus standard open wound care after surgical excision","volume":"57","author":"Biter","year":"2014","journal-title":"Dis. Colon Rectum"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1097\/DCR.0000000000001237","article-title":"The American Society of Colon and Rectal Surgeons\u2019 Clinical Practice Guidelines for the Management of Pilonidal Disease","volume":"62","author":"Johnson","year":"2019","journal-title":"Dis. Colon Rectum"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1007\/s10151-015-1369-3","article-title":"The treatment of pilonidal disease: Guidelines of the Italian Society of Colorectal Surgery (SICCR)","volume":"19","author":"Segre","year":"2015","journal-title":"Tech. Coloproctol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1007\/s00423-016-1463-7","article-title":"German national guideline on the management of pilonidal disease","volume":"401","author":"Iesalnieks","year":"2016","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"znae237","DOI":"10.1093\/bjs\/znae237","article-title":"European Society of Coloproctology guidelines for the management of pilonidal disease","volume":"111","author":"Ojo","year":"2024","journal-title":"Br. J. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.jviscsurg.2013.05.006","article-title":"Pilonidal sinus disease","volume":"150","author":"Bouchard","year":"2013","journal-title":"J. Visc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"630","DOI":"10.12968\/jowc.2014.23.12.630","article-title":"How to repair the surgical defect after excision of sacrococcygeal pilonidal sinus: A dilemma","volume":"23","author":"Rashidian","year":"2014","journal-title":"J. Wound Care."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"13720","DOI":"10.1038\/s41598-020-70641-7","article-title":"Surgical procedures in the pilonidal sinus disease: A systematic review and network meta-analysis","volume":"10","author":"Bi","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1097\/MOP.0000000000000628","article-title":"Management of pilonidal disease","volume":"30","author":"Kallis","year":"2018","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_21","first-page":"325","article-title":"Pilonidal sinus. Excision--marsupialization--phenolization?","volume":"85","author":"Duchateau","year":"1985","journal-title":"Acta Chir. Belg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s101510200037","article-title":"Excision and marsupialization versus sinus excision for the treatment of limited chronic pilonidal disease: A prospective, randomized trial","volume":"6","author":"Oncel","year":"2002","journal-title":"Tech. Coloproctol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"307","DOI":"10.47717\/turkjsurg.2021.5002","article-title":"The comparison of short-term results of marsupialization method in operated patients with acute pilonidal abscess and chronic pilonidal sinus","volume":"37","year":"2021","journal-title":"Turk. J. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s10151-013-1016-9","article-title":"Endoscopic pilonidal sinus treatment (E.P.Si.T.)","volume":"18","author":"Meinero","year":"2014","journal-title":"Tech. Coloproctol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1007\/s00384-019-03256-8","article-title":"Endoscopic pilonidal sinus treatment (EPSiT) in recurrent pilonidal disease: A prospective international multicenter study","volume":"34","author":"Meinero","year":"2019","journal-title":"Int. J. Color. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"O164","DOI":"10.1111\/codi.13322","article-title":"Endoscopic pilonidal sinus treatment: A prospective multicentre trial","volume":"18","author":"Meinero","year":"2016","journal-title":"Color. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1007\/s00383-018-4262-0","article-title":"Preliminary report on endoscopic pilonidal sinus treatment in children: Results of a multicentric series","volume":"34","author":"Mazzola","year":"2018","journal-title":"Pediatr. Surg. Int."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s10151-025-03191-7","article-title":"The application of EPSiT in pilonidal sinus disease: An international Delphi consensus study endorsed by the Association of Laparoscopic Surgeons of Great Britain and Ireland (ALSGBI)","volume":"29","author":"Meinero","year":"2025","journal-title":"Tech. Coloproctol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.jpedsurg.2018.10.021","article-title":"Pit-picking resolves pilonidal disease in adolescents","volume":"54","author":"Delshad","year":"2019","journal-title":"J. Pediatr. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1007\/s00104-011-2077-9","article-title":"Pit-picking-Operation bei Patienten mit Sinus pilonidalis [Pit-picking surgery for pilonidal disease]","volume":"82","author":"Iesalnieks","year":"2011","journal-title":"Chirurg"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1016\/j.surg.2011.06.019","article-title":"Sinusectomy for primary pilonidal sinus: Less is more","volume":"150","author":"Soll","year":"2011","journal-title":"Surgery"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1111\/j.1445-2197.1992.tb07208.x","article-title":"Easy and successful treatment of pilonidal sinus after explanation of its causative process","volume":"62","author":"Karydakis","year":"1992","journal-title":"Aust. N. Z. J. Surg."},{"key":"ref_33","first-page":"78","article-title":"Limberg flap in management of pilonidal sinus disease: Systematic review and a local experience","volume":"118","author":"Boshnaq","year":"2018","journal-title":"Acta Chir. Belg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1097\/DCR.0b013e31828006f7","article-title":"Comparison of short-term results between the modified Karydakis flap and the modified Limberg flap in the management of pilonidal sinus disease: A randomized controlled study","volume":"56","author":"Bessa","year":"2013","journal-title":"Dis. Colon Rectum"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"870","DOI":"10.9738\/INTSURG-D-14-00213.1","article-title":"Comparison of modified Limberg flap and Karydakis flap operations in pilonidal sinus surgery: Prospective randomized study","volume":"100","author":"Tokac","year":"2015","journal-title":"Int. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"350","DOI":"10.6061\/clinics\/2015(05)08","article-title":"Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease","volume":"70","author":"Bali","year":"2015","journal-title":"Clinics"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1503\/cjs.003018","article-title":"Limberg flap versus Karydakis flap for treating pilonidal sinus disease: A systematic review and meta-analysis","volume":"62","author":"Gavriilidis","year":"2019","journal-title":"Can. J. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/j.amjsurg.2010.10.021","article-title":"Short and long-term results of the Karydakis flap versus the Limberg flap for treating pilonidal sinus disease: A prospective randomized study","volume":"202","author":"Ates","year":"2011","journal-title":"Am. J. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1111\/j.1463-1318.2008.01646.x","article-title":"Comparison of the short-term results after Limberg and Karydakis procedures for pilonidal disease: Randomized prospective analysis of 100 patients","volume":"11","author":"Ersoy","year":"2009","journal-title":"Color. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1007\/s00384-002-0407-6","article-title":"The effect of obesity on the results of Karydakis technique for the management of chronic pilonidal sinus","volume":"18","author":"Sakr","year":"2003","journal-title":"Int. J. Color. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.1007\/s10350-007-9049-7","article-title":"Results of the lateral advancing flap operation (modified Karydakis procedure) for the management of pilonidal sinus disease","volume":"50","author":"Bessa","year":"2007","journal-title":"Dis. Colon Rectum"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1111\/j.1445-2197.2006.04003.x","article-title":"Karydakis flap repair for sacrococcygeal pilonidal sinus disease: How important is technique?","volume":"77","author":"Keshava","year":"2007","journal-title":"ANZ J. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1111\/codi.16701","article-title":"Bascom\u2019s cleft lift procedure for pilonidal sinus disease\u2014A video vignette","volume":"25","author":"Leventoglu","year":"2023","journal-title":"Color. Dis."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1111\/codi.15023","article-title":"Limberg flap for pilonidal sinus disease\u2014A video vignette","volume":"22","author":"Cheng","year":"2020","journal-title":"Color. Dis."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1097\/DCR.0000000000000784","article-title":"Karydakis Flap with Compressing Tie-over Interrupted Sutures Without Drain versus Standard Karydakis for Treatment of Sacrococcygeal Pilonidal Sinus Disease","volume":"60","author":"Sewefy","year":"2017","journal-title":"Dis. Colon Rectum"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e17198","DOI":"10.1111\/codi.17198","article-title":"Closed-incision negative-pressure wound therapy after Bascom\u2019s cleft lift surgery for pilonidal sinus disease: A randomized study comparing healing","volume":"27","author":"Faurschou","year":"2024","journal-title":"Color. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1007\/s13304-023-01578-5","article-title":"Laser technology in proctological diseases: Is it really the wave of the future?","volume":"75","author":"Solari","year":"2023","journal-title":"Updates Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1089\/lap.2022.0567","article-title":"Outcomes of Laser-Assisted Closure (SiLaC) Surgery for Chronic Pilonidal Sinus Disease","volume":"33","author":"Horesh","year":"2023","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s10151-021-02550-4","article-title":"Sinus laser-assisted closure (SiLaC\u00ae) for pilonidal disease: Results of a multicentre cohort study","volume":"26","author":"Sluckin","year":"2022","journal-title":"Tech. Coloproctol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1097\/SLE.0000000000001316","article-title":"Results of Laser-assisted Closure (SiLaC) Surgery in Pilonidal Sinus Disease: Factors Associated with Success","volume":"34","author":"Yildirim","year":"2024","journal-title":"Surg. Laparosc. Endosc. Percutan. Tech."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1002\/lsm.70071","article-title":"International Society of Laser Proctology Position Paper on SiLaC and EPSiT\/SiLaC in the Management of Pilonidal Sinus Disease","volume":"57","author":"Ouali","year":"2025","journal-title":"Lasers Surg. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s10103-025-04525-5","article-title":"Evaluation of laser ablation for recurrent pilonidal sinus disease: Treatment success, recurrence rates, and patient outcomes","volume":"40","author":"Emral","year":"2025","journal-title":"Lasers Med. Sci."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1007\/s10103-023-03788-0","article-title":"Laser ablation: A unique and beneficial therapeutic option for pilonidal sinus? And the potential for further innovation-a review","volume":"38","author":"Ganduboina","year":"2023","journal-title":"Lasers Med. Sci."},{"key":"ref_54","first-page":"1141","article-title":"Radiofrequency sinus excision. A simple technique for sacro-coccygeal pilonidal sinus disease","volume":"26","author":"Gupta","year":"2005","journal-title":"Saudi Med. J."},{"key":"ref_55","first-page":"998","article-title":"Radiofrequency sinus excision: Better alternative to marsupialization technique in sacrococcygeal pilonidal sinus disease","volume":"97","author":"Gupta","year":"2005","journal-title":"J. Natl. Med. Assoc."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.cursur.2003.11.015","article-title":"A randomized study between excision and marsupialization and radiofrequency sinus excision in sacro-coccygeal pilonidal disease","volume":"61","author":"Gupta","year":"2004","journal-title":"Curr. Surg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e31","DOI":"10.1097\/DCR.0000000000001377","article-title":"Platelet-Rich Plasma as a Treatment Option in Pilonidal Disease","volume":"62","year":"2019","journal-title":"Dis. Colon Rectum"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Gohar, M.M., Ali, R.F., Ismail, K.A., Ismail, T.A., and Nosair, N.A. (2020). Assessment of the effect of platelet rich plasma on the healing of operated sacrococcygeal pilonidal sinus by lay-open technique: A randomized clinical trial. BMC Surg., 20.","DOI":"10.1186\/s12893-020-00865-x"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Boztug, C.Y., Karaagac Akyol, T., Benlice, C., Koc, M.A., Doganay Erdogan, B., Ozcebe, O.I., Kuzu, M.A., and Akyol, C. (2021). Platelet-rich plasma treatment improves postoperative recovery in patients with pilonidal sinus disease: A randomized controlled clinical trial. BMC Surg., 21.","DOI":"10.1186\/s12893-021-01370-5"},{"key":"ref_60","first-page":"e27777","article-title":"The Effect of Platelet-Rich Plasma on Healing Time in Patients Following Pilonidal Sinus Surgery: A Systematic Review","volume":"14","author":"Khan","year":"2022","journal-title":"Cureus"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"3058","DOI":"10.1038\/s41598-018-20143-4","article-title":"Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence","volume":"8","author":"Stauffer","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"3754","DOI":"10.1007\/s00464-018-6157-5","article-title":"Endoscopic pilonidal sinus treatment: A systematic review and meta-analysis","volume":"32","author":"Emile","year":"2018","journal-title":"Surg. Endosc."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1007\/s10151-014-1149-5","article-title":"Meta-analysis of randomized controlled trials comparing different techniques with primary closure for chronic pilonidal sinus","volume":"18","author":"Emparanza","year":"2014","journal-title":"Tech. Coloproctol."},{"key":"ref_64","first-page":"CD006213","article-title":"Healing by primary versus secondary intention after surgical treatment for pilonidal sinus","volume":"2010","author":"McCallum","year":"2010","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s00384-025-04832-x","article-title":"Efficacy and safety of laser ablation for recurrent pilonidal sinus: A systematic review and meta-analysis","volume":"40","author":"Qin","year":"2025","journal-title":"Int. J. Color. Dis."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1097\/DCR.0000000000003688","article-title":"Outcome After Surgical Treatment for Chronic Pilonidal Sinus Disease: A Systematic Review of Common Surgical Techniques","volume":"68","author":"Wiinblad","year":"2025","journal-title":"Dis. Colon Rectum"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1740","DOI":"10.1556\/650.2021.32246","article-title":"Sinus pilonidalis fisztuloszk\u00f3pos kezel\u00e9se gyermekekben [Fistuloscopy in the management of pediatric pilonidal sinus disease]","volume":"162","author":"Fadgyas","year":"2021","journal-title":"Orv. Hetil."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s10151-017-1722-9","article-title":"The effect of hair removal after surgery for sacrococcygeal pilonidal sinus disease: A systematic review of the literature","volume":"22","author":"Pronk","year":"2018","journal-title":"Tech. Coloproctol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1186\/s13063-018-2987-7","article-title":"Laser hair depilation for the prevention of disease recurrence in adolescents and young adults with pilonidal disease: Study protocol for a randomized controlled trial","volume":"19","author":"Minneci","year":"2018","journal-title":"Trials"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1001\/jamasurg.2023.5526","article-title":"Laser Epilation as an Adjunct to Standard Care in Reducing Pilonidal Disease Recurrence in Adolescents and Young Adults: A Randomized Clinical Trial","volume":"159","author":"Minneci","year":"2024","journal-title":"JAMA Surg."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1007\/s00268-004-7533-y","article-title":"High body mass index as a possible risk factor for pilonidal sinus disease in adolescents","volume":"29","author":"Arda","year":"2005","journal-title":"World J. Surg."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.jviscsurg.2024.12.005","article-title":"Management of pilonidal sinus and recurrences in 2025","volume":"162","author":"Darnis","year":"2025","journal-title":"J. Visc. Surg."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e1052","DOI":"10.1111\/jdv.20861","article-title":"Large language models in evaluating hidradenitis suppurativa from clinical images","volume":"39","author":"Boostani","year":"2025","journal-title":"J. Eur. Acad. Dermatol. 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