Abstract Objective: To assess whether routine histopathological examination of the pilonidal sinus is necessary. Background: Pilonidal sinus disease (PSD) is an acquired condition of the hair follicles and is thought to be an obstruction of the infundibulum of a hair follicle. The follicle enlarges and ruptures, causing secondary infection, the development of fistulae and abscesses, and other complications. Methods: This is a retrospective study including all patients who had pilonidal sinus excision from January 2015 to December 2021 at King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. A review of pathological slides took place in the Department of Pathology, and the chart review was conducted in the Department of Surgery through electronic patient’s medical records. Results: All of the excised sinuses (100%) were benign, and none of the patients in the study population had any cancerous lesions. Around 90% of the patients had no history of recurrence, and 84.8% had no history of surgical abscess drainage. With respect to the histopathological subtype of a benign sinus, the most common type was chronic inflammation, followed by granulation and fibrosis. Conclusions: This study’s findings reveal that none of the patients were diagnosed as having malignancy after excision of the pilonidal sinus. However, the findings reveal no need for performing an unnecessary histopathological examination unless someone is at risk of developing cancer based on whether they have palpable lymph nodes and a history of recurrence.

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