EP309 - Long term follow up comparing Gips procedure with wide excision of pilonidal disease

Purpose/Background: The surgical management of pilonidal disease remains variable, with no standardized approach. Despite the increasing number of surgical techniques, outcomes are often suboptimal, and the disease continues to cause significant morbidity in a predominantly young, working-age population. In recent years, there has been a shift from wide excision toward minimally invasive approaches such as sinusectomy (Gips procedure), which aim to reduce the prolonged and morbid recovery associated with traditional surgery. We hypothesize that the Gips procedure will decrease healing time and facilitate comparable long-term outcomes compared to wide excision.

Methods/Interventions: Charts were retrospectively reviewed for patients who received surgical treatment for pilonidal disease between 2018 and 2023 at two affiliated tertiary care centers. Patients were surveyed by phone for long term follow up data, such as recurrences or complications. Two attempts were made to contact each patient. Outcomes of patients who were treated via a minimally invasive approach (Gips) were compared to patients treated via wide excision with or without closure. Comparisons were analyzed by chi-square test, Fisher's exact test, and unpaired t-test.

Results/Outcomes: A total of 101 patients were included. Baseline demographics and comorbidities were comparable between groups, with no significant differences in age, race, BMI, diabetes, hypertension, or smoking status (Table 1). Patients undergoing the Gips procedure had more sinus pits identified intraoperatively (2.47 vs. 1.61, p< 0.001), shorter operative time (32.6 vs. 54.6 minutes, p=0.007), and required fewer postoperative opioid tablets (8.2 vs. 14.9, p=0.003) (Table 2). Overall complication rates were similar (34.8% vs. 20.5%, p=0.26). However, incomplete drainage (30.4% vs. 5.1%, p=0.003) and recurrence (26.1% vs. 3.8%, p=0.004) were significantly more frequent after Gips (Table 2). Rates of reoperation were comparable between groups. There were 26 surveys completed (8 Gips, 18 Non-Gips). Analysis suggested trends towards decreased time off work and/or school following GIPS, although this did not reach statistical significance (7.3 days vs. 17.2 days, p=0.06) (Table 2).

Conclusion/Discussion: The Gips procedure was associated with a near-significant reduction in healing time and return to work time. However, Gips resulted in significantly higher recurrence and incomplete drainage rates. These results are limited by small sample size and survey non-response bias. Future studies should involve prospective analysis.

Table 1: Patient Characteristics
Table 2: Postoperative Outcomes and Survey Data