Factors influencing surgical decisions in chronic pilonidal sinus disease

Background: Pilonidal sinus disease (PSD) may be present as chronic PSD, which may eventually exacerbate. Factors associated with the progression of chronic PSD to acute abscess-forming PSD were investigated. Methods: Records of 1962 patients admitted to the surgical departments of three hospitals of the German Armed Forces between 1980 and 1996 with PSD were analyzed. Results: Patients with chronic PSD showed higher sinus numbers (p < 0.001) and longer disease history (p < 0.001), while acute abscess-forming PSD was associated with smoking (p < 0.001). Surgeons were more likely to opt for primary wound closure when fewer sinus were present. Primary wound closure was similarly successful in chronic (67.2%) and acute (66.9%) PSD. Primary wound healing rate was negatively influenced by a high BMI in chronic PSD (p = 0.012). Conclusions: Early elective surgery in chronic PSD seems justified in patients presenting with a short duration of disease, low sinus number and smoking history.