Pilonidal Disease Guidelines

Updated: Feb 14, 2017
  • Author: M Chance Spalding, DO, PhD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Guidelines Summary

In 2013, the American Society of Colon and Rectal Surgeons (ASCRS) published the following practice parameters for the management of pilonidal disease [39] :

  • A disease-specific history and physical examination should be performed, emphasizing symptoms, risk factors, and the presence of secondary infection (grade 1C recommendation)
  • In the absence of an abscess, a trial of gluteal cleft shaving may be used for both acute and chronic pilonidal disease as a primary or adjunct treatment measure (grade 1C recommendation)
  • Fibrin glue and phenol injection might be used in select patients with chronic pilonidal sinus disease (grade 2C recommendation)
  • Antibiotics have a limited role in the treatment of either acute or chronic pilonidal disease, though oral or intravenous agents may be considered in patients with significant cellulitis, underlying immunosuppression, or concomitant systemic illness (grade 1C recommendation)
  • Patients with acute pilonidal disease characterized by the presence of an abscess should be treated with incision and drainage regardless of whether it is a primary or recurring episode (grade 1B recommendation)
  • Patients who require surgery for chronic pilonidal disease may undergo excision and primary repair (with consideration for off-midline closure), excision with healing by secondary intention, or excision with marsupialization, depending on surgeon and patient preference; drain use should be individualized (grade 1B recommendation)
  • Flap-based procedures may be performed, especially in the setting of complex and multiple-recurrent chronic pilonidal disease when other techniques have failed (grade 1B recommendation)
  • Operative strategies for recurrent pilonidal disease should distinguish between the presence of an acute abscess and chronic disease, taking into account the surgeon's experience and expertise (grade 1C recommendation)