A Novel Scoring System for Pilonidal Disease: Predicting Complications and Guiding Surgical Management

TL;DR

A new scoring system called the Hazem-Talaat score is developed to predict complications and guide surgery for pilonidal disease, a chronic condition affecting the lower back.

Contribution

The study introduces a novel preoperative scoring system to assess severity and predict recurrence in pilonidal disease.

Findings

The Hazem-Talaat score effectively predicted recurrence with a cut-off value of 21.

Higher scores were significantly associated with male gender, higher BMI, diabetes, and other clinical factors.

The scoring system could improve surgical outcomes by tailoring techniques to disease severity.

Abstract

Background: Pilonidal disease is a chronic condition of the sacrococcygeal region, frequently affecting young adults and associated with high rates of recurrence and postoperative complications. Numerous surgical techniques have been described, yet there is no universally accepted classification or staging system to guide treatment decisions. This lack of standardization contributes to inconsistent outcomes and difficulty in predicting prognosis.

Objective: This study aimed to develop and validate a novel preoperative scoring system, the Hazem-Talaat score, to assess disease severity, predict recurrence, and facilitate surgical planning in pilonidal disease.

Methods: A prospective study was carried out on 156 patients (108 males, 48 females) aged 18-45 years admitted with primary or recurrent pilonidal disease to the General Surgery Department at Tanta University, Egypt, between June 2023 and June 2024. Patients with recurrent disease after flap repair or with hematological disorders were excluded, as the reason for this is to avoid anatomical distortions caused by flap surgeries. Preoperative variables, including BMI, sex, hair distribution, diabetes mellitus, number and location of pits, distance from the anus, history of abscess, and prior recurrence, were incorporated into the Hazem-Talaat score. All patients underwent standardized asymmetrical elliptical excision with off-midline closure and were followed for at least six months to assess wound complications and recurrence.

Results: The mean age of participants was 27.3 ± 6.5 years, and the mean BMI was 29.1 ± 4.6 kg/m². Recurrence occurred in 19 patients (12.2%), while wound dehiscence was noted in 26 patients (16.7%). Recurrence was significantly associated with male gender (p = 0.010), higher BMI (p < 0.001), diabetes mellitus (p < 0.001), prolonged operative time (p < 0.001), prior recurrence (p < 0.001), more than 10 midline pits (p < 0.001), lateral extension (p < 0.001), hairy back (p < 0.001), distance from anus < 5 cm (p < 0.001), and previous abscess formation (p < 0.001). Patients who developed recurrence had significantly higher Hazem-Talaat scores (mean 22.1 ± 4.5) compared with those without recurrence (mean 14.0 ± 3.1; p < 0.001). A cut-off value of 21 was determined using a receiver operating characteristic (ROC) curve.

Conclusion: The Hazem-Talaat score provides an objective, multifactorial tool that integrates clinical and anatomical factors to predict recurrence and stratify patients with pilonidal disease. Its application in surgical planning may improve outcomes by tailoring the choice of operative technique to disease severity. Further multicenter studies with longer follow-up are warranted to externally validate this system.

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