Annals of Coloproctology

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Anorectal benign disease

Radiofrequency for the treatment of pilonidal disease: results of a French prospective pilot study: Nadia Fathallah, Amine Antonin Alam, Maria Skoufou, Marie Lazareth, Lucas Spindler, Manuel Aubert, Eric Safa Far, Elise Pommaret, Amélie Barré, Mathilde Wisniewski, Sinon Kurt, Dior Marone, Vincent de Parades; Ann Coloproctol. 2026;42(2):198-207. Published online April 23, 2026; DOI: https://doi.org/10.3393/ac.2025.00850.0121

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Graphical Abstract Abstract PDF: Purpose
Minimally invasive techniques are increasingly applied in the management of pilonidal disease. While laser therapy is well established, radiofrequency (RF) represents a newer alternative with theoretical advantages. However, no prospective data have yet been published on its use. This study aimed to assess the safety, efficacy, and patient satisfaction associated with RF treatment for infected pilonidal sinus.
Methods
We conducted a prospective, single-center pilot study including consecutive patients treated with RF between March and December 2023. The procedure was performed under spinal or general anesthesia in an outpatient setting using a radial RF probe (25 W, 4 MHz) following mechanical debridement. Patients were followed up at 15 days and at 1, 3, and 6 months. The primary endpoint was safety; secondary endpoints included healing rate, predictors of failure, postoperative pain, return to activities, and patient satisfaction.
Results
Forty-four patients were enrolled (median age, 25.5 years; 31 men, 70.5%), of whom 38.6% had undergone previous surgery. The median operative time was 12 minutes. No major complications occurred, and minor early events were reported in 6.8% of cases. Complete healing at 6 months was achieved in 77.3% of patients. Failure and recurrence rates were 13.6% and 9.1%, respectively. A history of prior surgery significantly increased the risk of failure (odds ratio, 0.2; P=0.005). The median peak pain score was 2 out of 10, with a median duration of 2 days. Overall, 33 patients (75.0%) were very satisfied, and 40 (90.9%) stated they would undergo the procedure again or recommend it to others.
Conclusion
RF appears to be a safe, minimally invasive outpatient treatment option for pilonidal disease, demonstrating promising efficacy, minimal postoperative pain, and high patient satisfaction. Trial registration: ClinicalTrials.gov identifier: NCT05855733.

Anorectal benign disease

Sinus laser-assisted closure for pilonidal sinus disease: a prospective single-center study: Francesco Esposito, Dorin Sacrieru, Alexandre Cortes; Ann Coloproctol. 2026;42(2):185-191. Published online April 20, 2026; DOI: https://doi.org/10.3393/ac.2025.00927.0132

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Abstract PDF Supplementary Material: Purpose
Pilonidal sinus disease (PSD) is a chronic condition that primarily affects young adults. Sinus laser-assisted closure (SiLaC) has recently emerged as a minimally invasive alternative to conventional surgery, offering potential benefits in postoperative recovery and recurrence rates. This study evaluates the clinical outcomes, safety, and patient satisfaction associated with SiLaC.
Methods
We conducted a retrospective analysis of prospectively collected data from 218 consecutive patients who underwent SiLaC for PSD between February 2023 and December 2024. Demographic characteristics, intraoperative parameters, postoperative complications, healing rates, and recurrence rates were examined. Pain and patient satisfaction were assessed using a standardized questionnaire.
Results
The study cohort included 142 male patients (65.1%), with a mean age of 25.3±8.1 years. The mean operative time was 13.4±4.4 minutes, and all patients were discharged the same day. The overall complication rate was 15.1%, with most complications being minor abscesses (84.8% managed conservatively). Healing rates at 15, 30, and 45 days were 13.8%, 80.2%, and 98.1%, respectively, with a mean healing time of 26.1±9.8 days. Recurrence was observed in 8.7% of patients after a median follow-up of 11 months (range, 3–25 months), decreasing to 6.5% following a second SiLaC procedure. The mean pain score on postoperative day 1 was 2.8±2.4, and patient satisfaction at 30 days was 9.2 out of 10.
Conclusion
SiLaC is a safe, effective, and well-tolerated minimally invasive treatment for PSD, associated with favorable short-term outcomes, rapid recovery, and low recurrence rates. Further research is needed to optimize treatment protocols and assess long-term outcomes.

Benign GI diease,Benign proctology,Surgical technique

Pilonidal Sinus Management; Bascom Flap Versus Pilonidal Pits Excision: A Single-Center Experience: Ashraf Imam, Harbi Khalayleh, Guy Pines, Deeb Khoury, Eli Mavor, Arie Pelta; Ann Coloproctol. 2021;37(2):109-114. Published online November 6, 2020; DOI: https://doi.org/10.3393/ac.2019.11.19.2

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Abstract PDF

Purpose
This study aimed to evaluate the outcomes of the Bascom cleft lift (flap) and the pilonidal pits excision (Gips procedure).
Methods
The records of all the patients who underwent pilonidal sinus excision between November 2013 and August 2017 were reviewed. Inclusion criteria included either pilonidal pits excision or the Bascom cleft lift procedure. All procedures were performed by a single surgeon. Perioperative complications and recurrence rates were reviewed.
Results
Fifty-three patients met the inclusion criteria. Male/female ratio was 36/17, with a mean age of 23.4 ± 7 years. In this study, 21 patients underwent the Bascom cleft lift (skin flap) procedure and 32 underwent the Gips-style operation. The mean follow-up was 3.5 months. Twenty-eight patients (52.8%) underwent prior drainage of pilonidal abscess. Eleven patients had a previous wide local excision with recurrent disease. A higher rate of recurrence was observed among patients who underwent pits picking following failure of a previous wide local excision (80% vs. 0%, P = 0.02). Minor wound dehiscence developed in 8 patients; all of which were in the Bascom flap group (40% vs. 0%, P < 0.005). All of these wounds healed completely between 3 and 6 weeks.
Conclusion
The Gips procedure is the recommended treatment for simple pilonidal disease. For recurrent pilonidal disease, the Bascom cleft lift (flap) procedure is an excellent option since it demonstrates a short wound healing time and a good success rate. This calls into question the continued use of the wide excision technique used by most surgeons in this country and abroad.

Citations

Citations to this article as recorded by

Outcomes of Pilonidal Surgery Performed in the Setting of Standard Adjunct Laser Hair Removal: A Retrospective Cohort Study
Alberto Jarrin Lopez, Kenneth Williams, Andrea Gochi, Brandon Cowan, Preston Carroway, Kristin Kanka, Akhil Wadhera
International Wound Journal.2026;[Epub] CrossRef
Efficiency of the new modified inverted Y cleft lift advancement flap in primary and recurrent sacrococcygeal pilonidal sinus disease with low-lying tracts near the anus
Walid G. Elshazly, Ahmed Radwan, Mohmed A. Elhalim, Ahmed Moaz
The Egyptian Journal of Surgery.2024; 43(2): 548. CrossRef
ЭФФЕКТИВНОСТЬ КОЛЛАГЕНОВОЙ ГУБКИ ПРОПИТАННОЙ ДОКСИЦИКЛИНОМ ПРИ ХИРУРГИЧЕСКОМ ЛЕЧЕНИИ ПИЛОНИДАЛЬНОГО СИНУСА
G.A. Kosayeva
Azerbaijan Medical Journal.2024; (2): 16. CrossRef
Pilonidal diseases in children
Yu. Yu. Koinov, Yu. V. Chikinev, P. V. Trushin, A. I. Shevela, V. V. Sytkov, A. I. Khavkin
Experimental and Clinical Gastroenterology.2024; (10): 206. CrossRef
The application of the Limberg flap repair technique in the surgical treatment of pilonidal sinus disease
Yaoyao Song, Yu Zang, Zequn Chen, Jianjun Li, Minhui Zhu, Hongjuan Zhu, Wanli Chu, Gang Liu, Chuan'an Shen
International Wound Journal.2023; 20(6): 2241. CrossRef
Minimally invasive surgery for pilonidal disease: Outcomes of the Gips technique—A systematic review and meta-analysis
Marta Amorim, José Estevão-Costa, Cristina Santos, Sara Fernandes, Ana Catarina Fragoso
Surgery.2023; 174(3): 480. CrossRef
Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review
Peiliang Wu, Yingyi Zhang, Yewei Zhang, Shuang Wang, Zhe Fan
International Journal of Surgery.2023; 109(8): 2388. CrossRef
Minimally invasive treatment of pilonidal sinus disease in a paediatric population: comparison of two techniques
Sara Fernandes, Carolina Soares‐Aquino, Inês Teixeira, Joana Mafalda Monteiro, Miguel Campos
ANZ Journal of Surgery.2022; 92(12): 3288. CrossRef

Comparison of Limberg Flap and Karydakis Flap Surgery for the Treatment of Patients With Pilonidal Sinus Disease: A Single-Blinded Parallel Randomized Study: Mina Alvandipour, Mohammad Sadegh Zamani, Mojtaba Ghorbani, Jamshid Yazdani Charati, Mohammad Yasin Karami; Ann Coloproctol. 2019;35(6):313-318. Published online May 22, 2019; DOI: https://doi.org/10.3393/ac.2018.09.27

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275 Download
19 Web of Science
29 Citations

Abstract PDF

Purpose
Pilonidal sinus disease is a common condition, which mostly affects young men. While various surgical techniques have been introduced for treating intergluteal pilonidal disease (IPD), controversies still exist regarding the best surgical approach. The purpose of this study was to compare the efficiency and the short-term outcomes of Limberg flap and Karydakis flap surgeries for the treatments of patients with IPD.
Methods
A total of 80 patients with IPD who had underwent either Karydakis flap (KF group: n = 37) or Limberg flap (LF group: n = 27) surgery between January 2015 and January 2016 at Imam Khomeini Hospital of Sari in the North of Iran were recruited for inclusion in this randomized, single-blind study.
Results
Compared to the KF group, the LF group showed faster complete wound healing, longer duration of surgery and hospital stay, larger wound size, and shorter period of incapacity for work. The overall patient satisfaction in the LF group was significantly higher than that in the KF group. The visual analogue scale score of pain was lower in the LF group than in the KF group. Also, the overall frequency of postoperative complications was higher in the KF group than in the LF group. Recurrence was reported in one patient from the KF group.
Conclusion
Given the lower rate of postoperative complications and greater cosmetic satisfaction of patients, the Limberg flap procedure should be selected, instead of the Karydakis flap procedure, as the standard technique for treating patients with IPD.

Citations

Citations to this article as recorded by

Light-based Epilation as an Adjunct to Surgery in the Management of Pilonidal Disease: A Meta-analysis
Mody Kutkut, Ibrahim Khansa
Plastic and Reconstructive Surgery - Global Open.2026; 14(1): e7364. CrossRef
Surgical Intervention and Outcome of Patients with Sacrococcygeal Pilonidal Sinus Disease
Tahir Ahmad Khan, Shams Ul Bari, Ajaz Ahmad Malik
Indian Journal of Colo-Rectal Surgery.2026; 9(2): 102. CrossRef
Comparing the treatment outcomes of Limberg versus Karydakis flap in sacrococcygeal pilonidal sinus: A systematic review and meta-analysis
Ze-Chao Hu, Jian-Te Li, Cheng-Li Jin, Xu-Dong Du, Min Lu
Asian Journal of Surgery.2026;[Epub] CrossRef
S3-Leitlinie: Sinus pilonidalis. Version 3.0 (2026)
A. Ommer, I. Iesalnieks, D. Doll, S. Petersen, V. Kahlke, J. Schneider, M.-Ch. Stefanescu, Ch. Oetzmann von Sochaczewski, J. Kirsch, C. Breitkopf, D. Bussen, A. Fürst, H. Krammer, F. Kühn, M. Stoll, T. Laubert, M. Sailer, O. Schwandner
coloproctology.2026;[Epub] CrossRef
Short-term results of unroofing and marsupialization compared to the Karydakis technique in the treatment of pilonidal sinus. A randomized prospective study
Pedro Antonio Parra Baños, Nuria Martínez Sanz, Francisco Miguel González Valverde, Jorge Alejandro Benavides Buleje, Miguel Ruiz Marín, Emilio Peña Ros, Carmen Martínez Sanz, Mari Fe Candel Arenas
Cirugía Española (English Edition).2025; 103(1): 25. CrossRef
Resultados a corto plazo de la puesta a plano, curetaje y marsupialización frente a la técnica de Karydakis en el tratamiento del seno pilonidal. Estudio prospectivo aleatorizado
Pedro Antonio Parra Baños, Nuria Martínez Sanz, Francisco Miguel González Valverde, Jorge Alejandro Benavides Buleje, Miguel Ruiz Marín, Emilio Peña Ros, Carmen Martínez Sanz, Mari Fe Candel Arenas
Cirugía Española.2025; 103(1): 25. CrossRef
Langzeitergebnisse einer Pilotstudie über das zweizeitige Verfahren mit primärer Exzision und Limberg-Plastik im Intervall zur Therapie einer sakrokokzygealen Pilonidalsinuserkrankung
Michael Ardelt, Falk Rauchfuss, Felix Dondorf, Aladdin Ali Deeb, Astrid Bauschke, Oliver Rohland, Laura Schwenk, Utz Settmacher
Die Chirurgie.2025; 96(8): 667. CrossRef
Outcome After Surgical Treatment for Chronic Pilonidal Sinus Disease: A Systematic Review of Common Surgical Techniques
Ida-Marie Myron Wiinblad, Johan Ulrichsen, Birgitte Brandstrup
Diseases of the Colon & Rectum.2025; 68(5): 515. CrossRef
Ovine Forestomach Matrix Graft Reduces Surgical Dehiscence in Fasciocutaneous Flap-Based Closure of Pilonidal Disease: A Comparative Study
Yosef Nasseri, Kimberly Oka, Kristina La, Rachel Ma, Christopher Frampton, Jessica Simon, Adam Young, Moshe Barnajian
Cureus.2025;[Epub] CrossRef
Midline and off-midline wound closure methods after surgical treatment for pilonidal sinus
Zhaolun Cai, Zhou Zhao, Qin Ma, Chaoyong Shen, Zhiyuan Jiang, Chunyu Liu, Chunjuan Liu, Bo Zhang
Cochrane Database of Systematic Reviews.2024;[Epub] CrossRef
A new method for wound defect closure after pilonidal sinus excision
E. N. Shubrov, A G. Baryshev, K. V. Triandafilov
Koloproktologia.2024; 23(1): 129. CrossRef
The application of ERAS in pilonidal sinus: comparison of postoperative recovery between primary suture and Limberg flap procedure in a multicenter prospective randomized trial
Wei Lu, Shujuan Huang, Hui Ye, Shang Xiang, Xiangsheng Zeng
Frontiers in Surgery.2024;[Epub] CrossRef
Management and outcomes of pilonidal patients with secondary sinuses—a cohort study
Norah E. Liang, Claire Abrajano, Kyla Santos Dalusag, Bill Chiu
Pediatric Surgery International.2024;[Epub] CrossRef
Dutch national guideline on the management of intergluteal pilonidal sinus disease
Eleonora A Huurman, Christel A L de Raaff, Pim C E J Sloots, Oren Lapid, Hessel H van der Zee, Wilfred Bötger, Sandra Janssen, Francine Das, Andrea L J Kortlever-van der Spek, Anja van der Hout, Bas P L Wijnhoven, Boudewijn R Toorenvliet, Robert M Smeenk
British Journal of Surgery.2024;[Epub] CrossRef
Comparison of Outcome between Limberg Flap and Karydakis Flap in Pilonidal Sinus Disease
Madeeha Shahid, Muhammad Khalid, Nazia Qamar, Salman Zafar, Sadia Sundus, Abdul Rehman
Pakistan Journal of Health Sciences.2024; : 174. CrossRef
The application of the Limberg flap repair technique in the surgical treatment of pilonidal sinus disease
Yaoyao Song, Yu Zang, Zequn Chen, Jianjun Li, Minhui Zhu, Hongjuan Zhu, Wanli Chu, Gang Liu, Chuan'an Shen
International Wound Journal.2023; 20(6): 2241. CrossRef
Management of Pilonidal Disease
Lindsay A. Gil, Katherine J. Deans, Peter C. Minneci
JAMA Surgery.2023; 158(8): 875. CrossRef
Bilaterally parallel elliptic flap versus Karydakis flap in primary pilonidal sinus disease: a randomized controlled trial
Umut Fırat Turan, Serdar Coban, Tezcan Akin, Huseyin Berkem, Bulent Cavit Yuksel, Sadettin Er
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Evaluation of single center clinical experience in patients undergoing modified Limberg flap technique in pilonidal sinus disease
Burak UÇANER, Şebnem ÇİMEN, Mehmet Zeki BULDANLI
Journal of Medicine and Palliative Care.2023; 4(6): 694. CrossRef
Comparative Study on Short-Term Outcome in Patients Undergoing Pilonidal Sinus Surgery in Tertiary Care
Dakshay A. Chordia, A. P. Prem, Jameel Akhter, M. Muralidharan, A. Sathishkumar
Indian Journal of Colo-Rectal Surgery.2023; 6(1): 4. CrossRef
Analysis of the Outcomes of a New Method for Plastic Surgery for Postoperative Wound Of Sacrococcygeal Region after Excision of the Pilonidal Cyst: Randomized Trial.
E. N. Shubrov, A. G. Baryshev, K. V. Triandafilov, V. A. Aladina, V. V. Fedyushkin, R. K. Amirova
Kuban Scientific Medical Bulletin.2022; 29(5): 80. CrossRef
Effectiveness and Feasibility of Limberg and Karydakis Flap in Recurrent and Complicated Pilonidal Sinus Disease
Amr Abdel Hameed Elhiny, Doaa Ali Saad, Mohamed Sadek Farahat
Indian Journal of Surgery.2021; 83(1): 55. CrossRef
S3-Leitlinie: Sinus pilonidalis. 2. revidierte Fassung 2020
A. Ommer, I. Iesalnieks, D. Doll
coloproctology.2021; 43(S1): 25. CrossRef
Pilonoidal Sinüs Tedavisinde Modifiye Limberg Flep Uygulaması Sonuçları
Nizamettin KUTLUER, Nurullah AKSOY
Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi.2021; 16(1): 68. CrossRef
Pilonidal Sinus Disease: An Analysis of the Factors Affecting Recurrence
Murat Kanlioz, Uğur Ekici, Faik Tatli, Turgay Karatas
Advances in Skin & Wound Care.2021; 34(2): 81. CrossRef
Karydakis procedure versus Limberg flap for treatment of pilonidal sinus: an updated meta-analysis of randomized controlled trials
Sameh Hany Emile, Sualeh Muslim Khan, Samer Hani Barsom, Steven D Wexner
International Journal of Colorectal Disease.2021; 36(7): 1421. CrossRef
Evaluation of comma-shaped incision with a sacral flap in surgical treatment of pilonidal sinus
MinaR.A.R. El Nahal, MohammedY.F. Aly, RagaiS Hanna, GamalA Makhlouf, GamalA Hameed Ahmed
Journal of Current Medical Research and Practice.2020; 5(1): 46. CrossRef
Surgical procedures in the pilonidal sinus disease: a systematic review and network meta-analysis
Siwei Bi, Kaibo Sun, Shanshan Chen, Jun Gu
Scientific Reports.2020;[Epub] CrossRef
An effective minimal invasive method in pilonidal sinus surgery: Sinusotomy
Önder KARABAY
Archives of Clinical and Experimental Medicine.2019; 4(3): 138. CrossRef

Case Report

Pilonidal Abscess Associated With Primary Actinomycosis: Han Boon Oh, Mohamad Hashir Abdul Malik, Chris Hang Liang Keh; Ann Coloproctol. 2015;31(6):243-245. Published online December 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.6.243

9,463 View
37 Download
7 Web of Science
7 Citations

Abstract PDF

Pilonidal disease in the sacrococcygeal region usually presents as abscesses, recurrent inflammation, cellulitis or fistula tracks. However, few reports on actinomycosis affecting pilonidal sinuses have been published. We report a case of a 25-year-old woman who presented with a pilonidal abscess who underwent surgical drainage and debridement. Pus from the pilonidal abscess was sent for microbiology, which grew actinomyces turicensis associated with prevotella bivia and peptostreptococci. She was treated with oral amoxicillin-clavulanate after surgical drainage for one week and recovered well. Actinomycosis associated with pilonidal abscesses, though uncommon, should be recognized and can be satisfactorily treated with a combination of surgical drainage and antibiotics.

Citations

Citations to this article as recorded by

Pilonidal sinus disease prevalence and risk factors in Saudi Arabia: A cross-sectional study
Hadi A. Alabbas, Mohammed A. Balhareth, Basmah F. Nawawi, Jood E. Alzohari, Maryam A. AlQarni, Abdullah Y. Asiri, Omar H. Alahmadi, Khames T. Alzahran
Journal of Family Medicine and Primary Care.2026; 15(1): 252. CrossRef
Brain abscess caused by Actinomyces turicensis in a non-immunocompromised adult patient: a case report and systematic review of the literature
Alessandra Imeneo, Lorenzo Vittorio Rindi, Andrea Di Lorenzo, Rosario Alessandro Cavasio, Pietro Vitale, Ilaria Spalliera, Mario Dauri, Daniele Guerino Biasucci, Ilaria Giuliano, Cartesio D’Agostini, Silvia Minelli, Maria Cristina Bossa, Anna Altieri, Mas
BMC Infectious Diseases.2024;[Epub] CrossRef
Skin and Soft Tissue Actinomycosis in Children and Adolescents
Salih Demirhan, Erika Orner, Wendy Szymczak, Philip J. Lee, Margaret Aldrich
Pediatric Infectious Disease Journal.2024; 43(8): 743. CrossRef
Cutaneous Actinomycosis of the Perineum in an Immunocompetent Man
Jeffrey A. Sanford, Walter L. Rush, Mary K. Klassen-Fischer, Jill I. Allbritton
The American Journal of Dermatopathology.2022; 44(4): 272. CrossRef
Pleural empyema caused by Actinomyces turicensis
Apostolos C. Agrafiotis, Ines Lardinois
New Microbes and New Infections.2021; 41: 100892. CrossRef
Actinomycosis of the Appendix Mimicking Cecal Tumor Treated by Single-Port Laparoscopic Approach
In Soo Cho, Sung Uk Bae, Hye Ra Jung, Kyung Sik Park, Woon Kyung Jeong, Seong Kyu Baek
Annals of Coloproctology.2021; 37(2): 125. CrossRef
Actinomyces turicensis parapharyngeal space infection in an immunocompetent host: first case report and review of literature
Ayla Tabaksert, Ravi Kumar, Veena Raviprakash, Rajeev Srinivasan
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