EP1080 - A Bibliometric and Science-Mapping Analysis of the Surgical Management of Pilonidal Disease (1992–2025)

Purpose/Background: Pilonidal disease is a common benign condition of the natal cleft, presenting with acute abscess or chronic sinus. The optimal operation remains debated, with controversies around extent of excision, midline versus off-midline closure, choice of flap, and the role of minimally invasive approaches. Clinical practice often favors limited excision with primary closure for non-infected disease, and incision-and-drainage with staged excision for abscesses. Despite diverse techniques, morbidity and variable recurrence persist (≈5%-40%), negatively impacting recovery and return to work. We conducted a bibliometric and science-mapping study to delineate the research landscape, hotspots, and frontiers in the surgical management of pilonidal disease, and to compare strategic approaches to inform innovation and clinical decision-making.

Methods/Interventions: Literature on surgical management of pilonidal disease published from January 1, 1992 to October 1, 2025 was retrieved from the Web of Science Core Collection. Analyses were performed with VOSviewer, CiteSpace, and Scimago Graphica. We constructed co-authorship, co-citation, and keyword co-occurrence networks, generated timeline (timezone) views and thematic clusters, and summarized outputs by country/region, institution, author, journal, highly cited papers, and keywords. Comparative academic impact included total citations, citation impact, H-index, and journal impact factor, interpreted alongside the maps. Studies unrelated to surgical management and clear duplicates were excluded; network features (e.g., betweenness centrality) and burst detection were used to highlight pivotal nodes and emerging topics.

Results/Outcomes: A total of 1,378 publications from 65 countries/regions and 231 institutions were included. Over the last decade, annual output showed sustained growth, with the United States and Turkey emerging as the most prolific contributors. The University of Naples Federico II produced the highest international output, followed by St. Marien Hospital. The journal with the greatest number of publications was Diseases of the Colon & Rectum. Dietrich Doll (Germany) was identified as the most prolific author. High-frequency and frontier terms included 'pilonidal sinus,' 'pilonidal disease,' and 'surgery,' with sustained attention to minimally invasive strategies. Thematic clustering highlighted interconnected domains spanning off-midline flap reconstruction, minimally invasive/endoscopic and energy-based techniques, wound care/sepsis control, and recurrence prevention-indicating a gradual shift from wide excision toward tissue-sparing, standardized pathways.

Conclusion/Discussion: This bibliometric synthesis charts more than three decades of research in surgical management of pilonidal disease, showing increasing output and diversification of techniques. Off-midline closure and flap-based reconstruction remain foundational for selected phenotypes, while minimally invasive approaches are rapidly expanding and warrant prospective validation. Future work should prioritize high-quality comparative trials and standardized outcome sets (healing, time to wound closure, recurrence, continence where relevant, pain, return-to-work, and cost-effectiveness) with adequate follow-up, to define durable, patient-centered care pathways and guide precision procedure selection.

Figure1
(A)Publication volume from 2019 to 2025, (B)Aggregation graph of keywords, (C)Network map of state distribution, (D)Network map of author distribution