Vol. 10, Issue 1, Part A (2026)

Background: Sacrococcygeal pilonidal sinus disease (SPSD) is a common condition affecting predominantly young adults, with varied clinical presentations ranging from asymptomatic sinuses to recurrent disease. Despite numerous surgical options, no universally accepted treatment strategy exists, and recurrence remains a major concern.
Aim: This study aimed to describe a morphology-based staging system for SPSD and to evaluate clinical outcomes of stage-specific surgical management using different operative techniques.
Methods: A prospective cohort analytical study was conducted at Basrah Teaching Hospital between December 2018 and April 2022. Seventy-one patients diagnosed with symptomatic SPSD were enrolled. Patients were staged according to a proposed system (Stage I-IV and recurrent stage) based on the number of midline pits and the presence of lateral extensions. Stage I and IIa disease were managed using pit-picking techniques, while Stage IIb and III disease were treated using the Bascom procedure. Preoperative, operative, and postoperative variables were recorded, including operative details, length of hospital stay, wound healing time, complications, functional recovery, and recurrence.
Results: Stage-adapted surgical management allowed tailored treatment according to disease extent, minimizing tissue excision in early stages and providing adequate drainage and off-midline healing in advanced stages. The approach demonstrated favorable primary healing rates, short hospital stays, rapid return to normal activities, and acceptable complication and recurrence rates.
Conclusion: A morphology-based staging system combined with stage-specific surgical techniques offers a rational and effective approach for managing SPSD. This strategy supports the “less is more” concept, potentially reducing overtreatment, complications, and disease recurrence while improving functional outcomes.