The Bascom Cleft Lift as a Solution for All Presentations of Pilonidal Disease

Abstract

Objective This study is a report on 700 consecutive patients treated with the Bascom cleft lift as treatment for both simple and complex pilonidal diseases between 1993 and 2020. Patients and methods The Bascom cleft lift was used in patients with primary disease, recurrent disease, perianal disease, and failed flap procedures. Some technical modifications had to be made to accommodate patients with perianal disease, and they are described. All patients were treated by the author in private practice clinics and hospitals between 1993 and 2020 and were entered into a database concomitantly with their treatment. Patients were subsequently surveyed in preparation for this study, by phone, email, or email survey to determine the current status. The procedure consisted of excision of the sinus tracts, cysts, and open wounds; raising a skin and subcutaneous tissue flap; and flattening the gluteal cleft. Failure of the procedure was defined as lack of complete healing or recurrent pilonidal disease requiring revisional surgery. Complications were recorded and are described. Results We found that of the 700 patients, 3.4% required revision of the cleft lift (confidence interval for proportion based on binomial distribution: 2.1%-4.8%). The median follow-up time for patients without recurrence was six months (IQR: 2-19.5). Once primary healing was obtained, there were no late recurrences in the 156 patients followed beyond 24 months. Factors that negatively impacted the success rate were having had previous failed pilonidal surgery (5.3% required revision) and open wounds on the edge of the anus (15.5% required revision). Conclusions The Bascom cleft lift had an overall success rate of 96.6%. There was no category of patients for which this was not a good option, but analysis of this data reveals that patients who have had previous failed surgery, and patients with wounds on the edge of the anus had a higher failure rate than the group as a whole.

Revision of the Failed Cleft Lift for Pilonidal Disease

“…The cleft lift procedure has several technical nuances and there are some slight differences between the techniques described by various experienced cleft lift surgeons [3,[9][10][11][12]. However, even with an experienced surgeon, failures, and recurrences occur.…”

“…The Bascom Cleft Lift has been proposed as a salvage procedure after the failure of most other pilonidal operations as well as an appropriate surgical strategy for the treatment of primary pilonidal disease [1][2][3]. Although in experienced hands the Bascom Cleft Lift and Karydakis Flaps have been shown to have the lowest long-term failure rates of any of the described procedures to treat pilonidal disease, failures do occasionally occur [4].…”

Patient Satisfaction After the Cleft-Lift Procedure

“…Some may view this approach as unusual, but it does give a unique view of the success of this procedure. We recently published a paper describing clinical parameters of success and failure with the cleft lift in a large group of patients [ 7 ], and in this paper, the overall success rate was 96.6%; but just because the surgeon views the operation as success does not mean the patient is in agreement. This paper helps to answer that question, with 98.8% of patients providing a response indicating satisfaction with the procedure.…”

Comparative analysis on the effect of the endoscopic versus conventional treatment for pilonidal sinus: A meta-analysis of controlled clinical trials

“…Recurrent disease with its concomitant morbidity remains a concern, and no single therapeutic option has acquired general acceptability. [5][6][7][8][9][10][11][12] In recent years, people are more and more inclined to minimally invasive surgery. Minero et al [13] introduced a more minimally invasive approach for sacrococcygeal pilonidal disease named Endoscopic Pilonidal Sinus Treatment in 2013 (EPSiT).…”

“…Recurrent disease with its concomitant morbidity remains a concern, and no single therapeutic option has acquired general acceptability. [5–12]…”