Intra-operative ultrasound in the surgical treatment of complex and recurrent pilonidal disease: a retrospective, observational, single-center study

Background: Pilonidal disease (PD) is frequently associated with high recurrence rates and delayed healing, particularly in complex or recurrent cases. While Endoscopic Pilonidal Sinus Treatment (EPSiT) has improved postoperative recovery and patient satisfaction, its effectiveness can be limited by incomplete identification of fistulous tracts. Intraoperative ultrasound (IUS) offers real-time visualization of subcutaneous structures and may aid in detecting hidden tracts during surgery. This study evaluates the clinical outcomes of combining IUS with EPSiT in the treatment of complex and recurrent PD. Materials and methods: A retrospective cohort, single-center study was conducted on patients with recurrent and complex PD treated between 2018 and 2021 using IUS in conjunction with EPSiT. All patients had a minimum follow-up of 36 months. The study recorded the number of cases in which IUS identified additional fistulous tracts and led to a modification of the surgical strategy, as well as clinical outcomes including recurrence rate, time to wound healing, and incidence of incomplete wound healing. Results: Nineteen patients were included (14 males, 73.7%; mean age of 35.4 ± 6.4 years). The mean operative time was 42 min, with IUS requiring an additional 6 min. IUS identified previously undetected fistulous tracts in 6 patients (31.5%), leading to modifications in the surgical strategy. At 36-month follow-up, disease persistence (recurrence or incomplete healing) was observed in 5 patients (26.3%). Recurrent cases were successfully managed with additional procedures, achieving 100% healing after reintervention. Conclusions: Intraoperative IUS identified previously undetected secondary tracts in 31.5% of patients, leading to a modification of the surgical approach. Further comparative studies are needed to validate its effectiveness and assess its potential role as a standard adjunct in the surgical management of pilonidal disease.