Sacrococcygeal Pilonidal Sinus Disease: Evaluation of a New Classification (Singla-Mital Classification) with Management Implications: A Retrospective Study

Abstract Introduction: Minimally invasive surgery including endoscopic and laser-assisted techniques have gained popularity in the management of pilonidal sinus disease (PSD). Based on a series of 124 consecutive patients treated under a standardized protocol, we propose and evaluate a novel classification system incorporating endoscopic and laser modalities. Materials and Methods: This retrospective analysis of prospectively collected data was conducted at Singla Hospital, Bhiwani, Haryana, India. A total of 124 patients with sacrococcygeal PSD were included. Patients were classified according to the Singla–Mital classification based on midline wound size and recurrence status. P1/Pr1 cases (midline wound <1 cm) were treated with minimally invasive endoscopic or laser-assisted procedures, while P2/Pr2 cases (midline wound ≥1 cm) underwent Flap procedures with off-midline closure (Bascom 2). Follow-up ranged from 6 year and 4 months to 6 months postoperatively, with recurrence defined as reappearance of discharge or sinus at the operative site. Results: Of the 124 patients (106 males and 18 females), 106 were managed with LASER-Assisted Endoscopic Pilonidal Sinus Treatment (LEPSiT), seven underwent hybrid approaches (LEPSiT with small Flap), and nine were treated with Bascom 2 Flap. Two abscess cases treated by incision and drainage were excluded from analysis. Among 122 patients, three developed recurrence during follow-up. Most of the patients treated with endoscopic means started their day-to-day activities next day and returned to full activity within 2 weeks. Discussion: The proposed Singla–Mital classification is practical, treatment-oriented, and includes modern minimally invasive options. It differs from Tezel, Berlin and international pilonidal sinus classifications by emphasizing wound morphology and minimally invasive eligibility. In accordance with pIlonidal sinus treatment: studying the options recommendations, it provides a structured tool for clinical decision-making by dividing patients in to two broad categories, that is, where a minimally invasive procedure can be done (P1and Pr1) where a major excisional procedure is required (P2 and Pr2), while minimizing postoperative morbidity. However, the current classification is institutionally derived and requires external validation through larger multicentric studies. Conclusion: The new classification provides a simplified, management-guided approach for PSD. It helps surgeons identify when minimally invasive or Flap techniques are appropriate and further recommends the type of surgery in each category of patient. Although short-term outcomes are promising, broader validation and longer follow- up are essential to confirm its clinical utility. The system encourages individualized treatment with the guiding principle of minimizing surgical morbidity and no further harm.