Authors’ reply to: “The long-term recurrence rate of minimally invasive methods in pilonidal sinus disease therapy is still unclear”

The authors wish to thank Dettmer and colleagues for their interesting comments on our consensus paper on pilonidal disease (PD) [1, 2]. Just a few years ago, the same authors acknowledged the difficulty of developing PD guidelines that could cover and solve all issues [3]. However, the real challenge is the quest for new scientifc evidence, such as prospective trials with acceptably extended follow-ups and/or systematic reviews and meta-analyses producing “top of the pyramid” results [4]. All guidelines should be based on the best available scientifc evidence and represent a summary and synthetic indications of good clinical practice. Indeed, the outcomes of minimally invasive procedures to treat PD are good, even when compared to time honored wide excisions, these positive results being operator dependent and closely related to the surgeon’s experience with minimally invasive procedures for PD.