Minimal incision procedures have been recommended for pediatric pilonidal sinus disease, based on small studies with short follow-up. We aimed to describe medium-term outcomes of trephination in a large cohort.

Retrospective chart review and additional concluding telephone interviews for all children who underwent primary trephination in our institution over 5.5 years, collecting demographic and clinical data, and updated functional and recurrence outcome data.

100 patients were included. Median follow-up time was 31.4 (16.2–52.8) months. Post-operative analgesics were used for 1.25 (0–4) days, sick days were 7 (3–11), and time to full activity was 14 (14–30) days. Recurrent pain, discharge, and abscess/es were reported by 37%, 35%, and 15% of patients, with 80–85% occurring within the first post-operative year. Reoperation rate was 18%, with 95% occurring within 2 years. No significant associations were found between demographic or clinical characteristics and either functional or recurrence medium-term outcomes.

Trephination carries excellent functional outcome with less favorable medium-term efficacy for the treatment of primary pediatric pilonidal sinus disease. Most adverse outcomes, including reoperations, occur within the first two years.