An analysis of a prospectively maintained database of 569 surgical excisions performed for sacrococcygeal pilonidal disease between 1988 and 2007 was performed.
The recurrence rate was lower in the asymmetric (n = 423) than in the symmetric (n = 101) group (9% vs 22.0%, P = .0001). After a median follow-up period of 11 years, 5-year 10-year, and 20-year disease-free survival rates were higher in the asymmetric group (94%, 92%, and 89% vs 84%, 79%, and 71%, respectively, P = .005).
D-shaped asymmetric excision is an effective treatment of sacrococcygeal pilonidal sinus. Better long-term recurrence rates are achieved compared with symmetric excision, when stratified for several features known to be related to recurrence.