How to choose a treatment for pilonidal sinus

The choice of treatment type is influenced by three main factors:

The complexity of the pilonidal disease, patient preferences, and surgeon experience.

 

1. The complexity of pilonidal disease is defined by the surgeon after examining the patient and is influenced by the number of pilonidal openings along the gluteal fossa, the number of inflammatory extensions of the disease outside the fossa, types of treatment performed in the past, the presence of open wounds and deformities of the gluteal fossa tissue due to previous surgeries:

• Mild pilonidal disease: Single pilonidal openings without symptoms or with mild local disturbance.

• Moderate disease : multiple pilonidal openings and inflammatory extensions.

• Complex pilonidal disease : multiple openings and branches in different directions, condition after previous extensive excision surgeries, open wounds, distortion of the gluteal fossa tissue.

2. Patient preferences: The patient has the option of choosing treatment through minimal surgery , which is easier in terms of recovery time and activity limitation and without cosmetic damage but with a possibility of disease recurrence of about 20%, or, on the other hand, choosing wide excision surgery and local flap with prolonged recovery and activity limitation, significant cosmetic disturbance, but a smaller possibility of disease recurrence - below 10% (in experienced hands).

3. The surgeon's experience: As of today, most surgeons around the world have been educated and experienced in the traditional surgery of the wide median resection and recommend it as a default regardless of the complexity of the disease. It is important to consult with a surgeon who is also experienced in minimally invasive and flap surgeries and is qualified to recommend the most appropriate treatment, taking into account the complexity of the disease.