Pilonidal Information - In short
Pilonidal pits along the natal cleft
What is the disease?
This is an inflammatory condition of the skin along the buttocks, during which pockets form under the skin, with small openings visible on the skin surface. The pockets usually contain loose hairs that have become embedded in them.
The disease is mainly common in young people in their teens and twenties.
It can manifest as pain, a bulge in the buttocks or on its sides, and local discharge, and can sometimes lead to the formation of an abscess that requires urgent surgical drainage.
What treatments are available?
Treatment depends on the patient's individual disease characteristics, the number of openings and inflammatory extensions, the presence of signs of inflammation or abscess, and previous treatments and surgeries. Options include conservative treatment (without surgery) in appropriate cases, abscess treatment, minimally invasive treatments, and excisional surgeries.
Minimal surgery with targeted removal of each pilonidal opening
Minimally invasive pilonidal surgery
Minimally invasive treatment is designed to treat the disease through small openings, while minimizing damage to surrounding tissues. There are several methods: targeted removal of each pilonidal opening individually with small perforators (trephines, punches), endoscopic treatments, laser treatments, and phenol treatment. These methods may be particularly suitable for mild to moderate disease, depending on the patient's individual disease characteristics.
Click for detailed information about minimally invasive treatments and the trephine technique.
Wide excision of pilonidal sinus
Wide excision surgeries
In cases of extensive, complex disease or in certain situations of recurrent disease, a wide excision of the diseased area may be considered. When a wide excision and closure of the surgical wound is performed, European guidelines favor closure outside the midline, with local tissue flaps being displaced to cover the excision area. Primary midline closure is not recommended (despite its common use as a treatment among surgeons).
After surgery
After surgery, it is important to clean the area with soap and water starting the day after surgery, apply a permanent local dressing, and monitor the wound's healing. Treatment instructions may vary depending on the type of surgery, the condition of the surgical wound, and the surgeon's recommendations.
What happens if the disease returns?
Pilonidal disease can recur after treatment, presenting with the appearance of new skin openings or a non-healing wound. In such a case, it is necessary to re-evaluate the condition of the disease and choose treatment based on the findings.
Click for information about recurring illness and a wound that does not heal.