Management of Pilonidal Disease

Abstract

ImportanceThe management of pilonidal disease continues to be a challenge due to high rates of recurrence and treatment-associated morbidity.ObservationsThere is a heterogeneous repertoire of treatment modalities used in the management of pilonidal disease and wide practice variation among clinicians. Available treatment options vary considerably in their level of invasiveness, associated morbidity and disability, risks of complications, and effectiveness at preventing disease recurrence. Conservative nonoperative management strategies, including persistent improved hygiene, depilation, and lifestyle modification, focus on disease prevention and minimization of disease activity. Epilation techniques using both laser and intense pulse light therapy are also used as primary and adjunct treatment modalities. Other nonoperative treatment modalities include phenol and fibrin injection to promote closure of pilonidal sinuses. The traditional operative management strategy for pilonidal disease involves excision of affected tissue paired with a variety of closure types including primary midline closure, primary off-midline closure techniques (ie, Karydakis flap, Limberg flap, Bascom cleft lift), and healing by secondary intention. There has been a recent shift toward more minimally invasive operative approaches including sinusectomy (ie, trephination or Gips procedure) and endoscopic approaches. Overall, the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies.Conclusions and RelevancePilonidal disease is associated with significant physical and psychosocial morbidity. Optimal treatments will minimize disease and treatment-associated morbidity. There is a need for standardization of definitions used to characterize pilonidal disease and its outcomes to develop evidence-based treatment algorithms.

Laser Epilation as an Adjunct to Standard Care in Reducing Pilonidal Disease Recurrence in Adolescents and Young Adults

“…This is likely reflective of both treatments being minimally invasive with minimal disruption to patients’ lives. This is in contrast to more invasive treatment modalities such as trephination, which has reported a time to return to activities of 2 to 16 days, and excisional procedures, which have reported a time to return to activities of anywhere from 1 to 8 weeks …”

“…This is in contrast to more invasive treatment modalities such as trephination, which has reported a time to return to activities of 2 to 16 days, and excisional procedures, which have reported a time to return to activities of anywhere from 1 to 8 weeks. 49 Pilonidal disease can impart significant psychosocial burden in a particularly vulnerable age group. In a qualitative study assessing the effect of pilonidal disease on activities of daily living, 3 emerging themes included difficulty adapting to life despite pilonidal wounds, perceived embarrassment and lack of understanding, and loss of control.…”

Moving Toward Minimally Invasive Treatments and Better Risk Characterization for Pilonidal Disease

“…To the Editor I read with interest the Review on pilonidal disease by Gil et al I wish to highlight the significant overlap between pilonidal disease and hidradenitis suppurativa that was not reviewed. The epidemiology of hidradenitis suppurativa has similarities to pilonidal disease: most patients report disease onset at puberty and prevalence peaks in early adulthood.…”

Moving Toward Minimally Invasive Treatments and Better Risk Characterization for Pilonidal Disease

“…To the Editor We read the excellent article by Gil et al in which they reviewed the management of pilonidal disease. However, they did not include laying open (unroofing) and curettage under local anesthesia (LOCULA) as an option in the management of pilonidal disease .…”

“…Among all the factors responsible for pilonidal disease, the only modifiable factors are hairs and excessive sweating in the intergluteal cleft . The flap procedures (Karydakis flap, Limberg flap, Bascom cleft lift, etc) flatten the contour of the buttocks and neutralize the impact of these 2 factors . However, the buttock-contour flattening is cosmetically inferior, irreversible, and not preferred by patients .…”