Pilonidal Disease Guidelines

Updated: Jul 01, 2021
  • Author: M Chance Spalding, DO, PhD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Guidelines Summary

In 2019, the American Society of Colon and Rectal Surgeons (ASCRS) published the following practice parameters for the management of pilonidal disease [39] :

  • Perform a disease-specific history and physical examination, with particular attention paid to risk factors, symptoms, and presence of secondary infection
  • As a primary or adjunctive treatment, shaving or laser epilation may be used to eliminate hair from the gluteal cleft and surrounding skin in either acute or chronic pilonidal disease, unless an abscess is present
  • An effective treatment that can achieve rapid and durable healing in patients with acute or chronic pilonidal disease without abscess is phenol application
  • Fibrin glue can be efficacious as a primary or adjunctive treatment in patients with chronic pilonidal disease without abscess
  • It remains unclear if prophylactic intravenous and/or topical antibiotic treatment is of value in pilonidal disease surgery; individualized case-by-case consideration is recommended
  • In patients with acute pilonidal disease with an abscess, treat with incision and drainage in both primary episodes and recurrent episodes.
  • Based on surgeon and patient preference, recommended treatment options in patients who require surgery for chronic pilonidal disease include (1) excision and primary repair, with consideration for off-midline closure; (2) excision with healing by secondary intention; and (3) excision with marsupialization; drain use should be individualized on a case-by-case basis
  • Flap-based procedures remain an option, particularly in cases of complex and recurrent chronic pilonidal disease when other techniques have failed
  • Minimally invasive approaches, such as endoscopic techniques or video assistance, can be used in acute and chronic pilonidal disease; these require specialized equipment and expertise
  • When considering operative strategies for recurrent pilonidal disease, differentiate between the presence of an acute abscess and chronic disease, taking into consideration the expertise and experience of the surgeon