Abstract Purpose The authors aimed at comparing multiple operative methods for pilonidal disease (PD) and to determine the optimal treatment modality.Methods The authors assessed paediatric patients treated with PD between January 2008 and January 2021. Out of 276 patients, 255 met with the inclusion criteria. The total number of treatments were 340 for these 255 patients. Of these 340, the five modalities of therapy were incision only (INC n = 90), direct closure with drainage (DCW n = 172) and without drainage (DWO n = 19), paediatric endoscopic pilonidal sinus treatment (PEPSIT n = 37), and open wound treatment (OWT n = 22). Patients were categorized by age, sex, length of hospital stay (LOS), wound healing time, wound complications, use of antibiotics, and need for repeated hospitalization.Results Wound healing was the fastest after INC and the slowest in OWT. Females were treated less invasively than males. Use of antibiotics was the highest in DWO. Wound complications were lowest in INC and OWT; and the same in all other treatment modalities. Repeated hospitalization rate was the highest after INC. Length of stay (LOS) was lowest in PEPSIT and in INC, and by far the highest in OWT. Drainage time was the shortest after INC.Conclusion Multiple techniques are known for the treatment of PD. Neither technique proved to be significantly better. However, the authors recommend the use of PEPSIT because of its minimal invasiveness, shortest LOS, and consequent minimal patient discomfort.
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