| Sumario: | Aim: This study aimed to identify key controversies in the management of pilonidal disease (PD) and to develop expert-based recommendations using a modified Delphi process, highlighting critical areas for future research. Method: A working group established by the Turkish Society of Colon and Rectal Surgery conducted a systematic literature review and invited national and international experts with relevant publication records to participate in a Delphi survey. A four-round Delphi process was conducted between July 2023 and February 2024. Statements that reached ≥70% consensus (agree/strongly agree) were accepted. Results: Of the 172 experts invited, 98 agreed to participate, and 52 completed at least two rounds. Expert opinions were evaluated across nine key aspects of PD management: classification, diagnosis, acute abscess, minimally invasive and excisional treatments, recurrence, hair removal, perioperative care, and postoperative management. Conclusion: This Delphi study presents expert consensus on unresolved clinical questions in the management of PD. The findings provide practical recommendations for surgeons and emphasize the need for prospective, high-quality studies to establish standardized treatment pathways.
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