Evolution of Surgical Management in Pilonidal Disease: A 25-Year Scoping Review and Bibliometric Analysis of Pediatric and Adult Literature

Background Pilonidal disease is a chronic inflammatory condition of the sacrococcygeal region that disproportionately affects adolescents and young adults. Although numerous treatment approaches exist, optimal management remains debated and practice patterns vary widely. How pediatric treatment strategies and research priorities have evolved relative to adult literature remains incompletely understood.Methods A scoping review and bibliometric analysis were conducted to evaluate trends in surgical management of pilonidal disease from 2000 to 2025. A systematic PubMed search identified studies reporting clinical data on pilonidal disease treatment. Extracted data included publication year, origin country, patient population, treatment modality, recurrence outcomes, and follow-up duration. Bibliometric analysis assessed publication trends, geographic distribution, and thematic evolution using keyword co-occurrence mapping.Results A total of 383 studies were included - 327 adult (85%) and 56 pediatric (15%) studies. Publication volume increased steadily over time, with pediatric literature expanding after 2015. Adult studies originated from 36 countries compared with 12 countries in pediatric literature, with no pediatric studies from low- or middle-income countries identified. Operative-only approaches predominated in adult literature (80% vs 61%, pConclusions Research on pilonidal disease surgery has increased but remains heterogeneous in treatment strategies and research focus. Pediatric literature represents a small but evolving portion of the evidence base and increasingly explores minimally invasive approaches. Greater standardization and broader international collaboration are needed to develop consistent evidence-based management strategies.