Pilonidal disease

Key points

Management steps

Abscess - avoid midline incision

Conservative - showering, hair removal - up to 80% resolution rate

Trephine + shower 24 hours later - 13% recurrence rate at 5 years - Gips 2008

Excision + asymmetric closure to flatten gluteal cleft - avoid midline closure as higher recurrence and slower healing - Cochrane review 2010

In all patients recommend hair removal program

Page edited by Mrs Charnjit Seehra BSc November 2024

References

Cevik M, Dorterler ME, Abbasoglu L. Is conservative treatment an effective option for pilonidal sinus disease in children? Int Wound J. 2018 Oct;15(5):840-844. doi: 10.1111/iwj.12936. Epub 2018 Jun 27. PMID: 29947121; PMCID: PMC7949598.

Gips M, Melki Y, Salem L, Weil R, Sulkes J. Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients. Dis Colon Rectum. 2008 Nov;51(11):1656-62; discussion 1662-3. doi: 10.1007/s10350-008-9329-x. Epub 2008 May 31. PMID: 18516645.

Al-Khamis A, McCallum I, King PM, Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev. 2010 Jan 20;2010(1):CD006213. doi: 10.1002/14651858.CD006213.pub3. PMID: 20091589; PMCID: PMC7055199.