Abstract
<title>Abstract</title> <p> <bold>Purpose</bold> To compare clinical presentation and routinely available preoperative inflammatory markers between acute and chronic sacrococcygeal pilonidal disease (PD) in a large, single-center surgical cohort. <bold>Methods</bold> This retrospective, case-based study included adults treated surgically for PD at a single tertiary center. Demographic characteristics, primary versus recurrent disease, clinical symptoms, white blood cell (WBC) count, and C-reactive protein (CRP) level were extracted from hospital records. Cases with missing WBC or CRP values were excluded. Acute and chronic episodes were compared using the Mann-Whitney U test or Fisher exact test, as appropriate. <bold>Results</bold> Of 256 eligible treatment episodes in 217 patients, 10 episodes were excluded because of missing laboratory values, leaving 246 episodes for the principal analysis. Of these, 203 were classified as acute and 43 as chronic disease. Acute episodes had higher median WBC counts than chronic episodes (10.2 [7.8–12.4] vs 7.1 [6.2–8.2] x 10^9/L; p < 0.001) and higher median CRP levels (15.4 [4.3–32.2] vs 3.0 [2.0-6.1] mg/L; p < 0.001). Pain was documented in all acute episodes and in none of the chronic episodes, whereas secretion was more frequent in chronic disease (90.7% vs 30.0%; p < 0.001). Among acute episodes, recurrent disease was associated with lower WBC counts and CRP levels than primary disease. <bold>Conclusion</bold> Acute PD was associated with higher preoperative CRP levels and WBC counts than chronic PD. These markers can support clinical classification but should not be used as stand-alone criteria for treatment timing, because normal values do not exclude clinically significant acute disease. Local examination and symptom severity, particularly pain, remain central to decision-making. </p>