Pilonidal Sinus Disease — Deep Dossier

COL-PIL-COMP-01 · Surgical site infection

higher after midline closure: RR 3.72 (95% CI 1.86–7.42) · no significant SSI difference

SSI risk — Cochrane 2010 update, 26 trials, n=2,530. (Earlier Cochrane 2007 / BMJ 2008 analysis: RR 4.70, 95% CI 1.93–11.45.) Open vs closed overall:

SSI after excisional surgery

🟢 Verified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-COMP-02 · Seroma

Disputed — see D3.

🔴 CJS 2019 MA: seroma significantly higher with Karydakis (OR 0.36 [0.24–0.56] for Limberg vs Karydakis), losing significance in low-bias sensitivity analysis (OR 0.76 [0.31–1.85]). Surgeon 2019 MA (classical flaps, 5 RCTs, n=727): OR 0.47 (0.22–1.03), p=0.06 — not significant

Seroma formation after flap surgery

🔴 Disputed · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-COMP-03 · Wound infection & dehiscence

No significant difference

in either RCT meta-analysis: infection OR 0.59 (0.23–1.52); dehiscence OR 0.53 (0.09–2.85) (Sahebally 2019); CJS 2019 concurs (all other outcomes NS)

SSI / wound dehiscence after flap surgery

🟡 Qualified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-COMP-04 · Any complication

7% (95% CI 1–15)

Overall postoperative complication rate

🟡 Qualified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-PREV-01 · Annual incidence

~26 per 100,000 per year

New PSD cases per 100,000 population per year

🟢 Verified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-PREV-02 · Sex distribution

~4:1 male predominance

(reported ratios across sources range 2.2–4:1)

Male-to-female ratio of incident cases

🟡 Qualified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-REC-03 · Excision, left open (primary open healing)

1.5% @12 m · 4.2% @24 m · 13.1% @60 m · 19.9% @120 m

(1.2–1.7) · (3.7–4.7) · (11.9–14.4) · (17.9–21.9)

🟢 Verified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-REC-04 · Primary asymmetric (off-midline, non-flap) closure

1.0% @12 m · 1.6% @24 m · 3.2% @60 m · 6.7% @120 m

(0.6–1.4) · (1.1–2.1) · (2.3–4.0) · (5.2–8.2)

🟢 Verified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-REC-05 · Karydakis flap / Bascom cleft lift (grouped in the source)

0.2% @12 m · 0.6% @24 m · 1.9% @60 m · 2.7% @120 m

(0.1–0.3) · (0.5–0.8) · (1.6–2.2) · (2.4–3.1)

🔴 Disputed · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-REC-06 · Limberg / Dufourmentel flap

0.4% @12 m · 1.6% @24 m · 5.2% @60 m · 11.4% @120 m

(0.3–0.5) · (1.3–1.9) · (4.5–5.8) · (9.2–13.7)

🟢 Verified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-REC-07 · Phenol application (alone)

1.9% @12 m · 14.1% @24 m · 40.4% @60 m

(1.1–2.6) · (11.8–16.5) · (27.8–52.9)

🟡 Qualified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-REC-08 · EPSiT (endoscopic treatment)

9% (95% CI 5–12)

Pooled recurrence , mixed mostly short follow-up — Langenbecks SR/MA 2026, 10 EPSiT studies, single-arm pooling

🔴 Disputed · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-REC-09 · Pit picking (incl. Bascom pit picking)

2.7% @12 m · 6.5% @24 m · 15.6% @60 m

(2.2–3.1) · (5.7–7.3) · (13.8–17.4)

🟢 Verified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-REC-10 · Incision & drainage alone (no definitive procedure)

10.4% @12 m · 25.9% @24 m · 40.2% @60 m

(6.6–14.3) · (19.1–32.8) · (29.4–50.9)

🟡 Qualified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-RISK-01 · Family history

OR 4.31

(P<0.001; positive FH in 29.6% of cases vs 11.8% of controls)

Positive family history of PSD

🟢 Verified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-RISK-02 · Dense body hair

OR 3.29

(high-quality evidence per authors; no publication bias)

Dense/coarse body hair (hirsutism)

🟢 Verified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-RISK-03 · Infrequent bathing

OR 3.36

(high-quality evidence per authors)

Bathing ≤2 times per week (hygiene proxy)

🟢 Verified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-RISK-04 · Excess body weight

Overweight OR 1.89; Obesity OR 2.05

Overweight (BMI 25–29.9) / Obesity (BMI ≥30) vs normal weight

🟢 Verified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-RISK-05 · Prolonged sitting

No pooled OR published in the MA

consistent case–control signal: mean daily sitting 8.89 ± 2.14 h (cases) vs 7.41 ± 2.02 h (controls), Kanlioz et al.; drivers 66% of cases vs 34% of controls (Akinci et al.)

Sitting ≥6 h/day; occupational driving

🟡 Qualified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-RISK-06 · Smoking

No significant association

(pooled across 5 studies: 44.1% of cases vs 55.9% of controls smoked; NS)

Smoking history

⚪ Qualitative · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-SUC-01 · EPSiT — cure (success) rate

88% (95% CI 83–94)

Pooled cure , single-arm pooling of 10 studies; healing time mean 26.6 days (24.4–28.7)

🟡 Qualified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-TIME-01 · Return to work

10.48 days earlier after primary closure

Return to work (WMD 10.48, 95% CI 5.75–15.21)

Days to return to work after surgery

🟢 Verified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-TIME-02 · Complete healing time

EPSiT 26.6 days

(95% CI 24.4–28.7); SiLaC 30.1 days (25.9–38.2) — context

🟢 Verified · Registry audit 2026-11-06 · Pending triple review

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COL-PIL-TIME-03 · Healing time difference

5.4 days faster

Off-midline heals (MD 5.4, 95% CI 2.3–8.5)

Mean difference in days to healing

🟢 Verified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources

COL-PIL-TIME-04 · Open-wound healing duration

مؤقت (provisional): · 41–91 days · never headline this figure

trial-reported means in the BMJ 2008 SR/MA ranged roughly ; the authors explicitly judged healing-time data unsuitable for pooling. Commonly summarised as "several weeks to ~3 months" —

Time for an excision wound left open to heal fully

🟡 Qualified · Registry audit 2026-11-06 · Pending triple review

🔄Flip the card — population, dispute & sources