Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Viewpoint
  • Published:

The best surgical technique for chronic pilonidal disease—is this question still open, or closed?

Nature Clinical Practice Gastroenterology & Hepatology volume 6, pages 20–22 (2009)Cite this article

Over the years, surgery has experienced a transition from being a trial and error-based approach towards evidence-based practice. To no surgically treated ailment does this truism apply more than pilonidal disease.

Perceived risk factors for pilonidal disease include obesity, hirsutism, a family history of pilonidal disease, poor hygiene and a sedentary lifestyle. Once believed to be of congenital origin, pilonidal disease is now thought to involve small sinuses in the skin.4 A chronic inflammatory process is thought to be caused by the presence of a keratin 'plug' and debris within these sinuses that is observed clinically as a pit having penetrated the dermis.4 A pilonidal sinus develops when body hair grows or is pushed into a pilonidal pit located in the crease of the buttocks. As the hair grows inward the cavity can become irritated and inflamed and can get infected, developing into a pilonidal abscess (Figure 1). The symptoms of pilonidal disease can include abscess, pain, localized swelling, redness, fever and pus drainage. As a result, chronic pilonidal disease can be socially inhibiting because of the continuous drainage of pus that has a foul odor.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Pathogenesis of pilonidal disease.
Figure 2: The Bascom cleft-lift procedure with an off-midline skin closure.

References

  1. Chintapatla S et al. (2003) Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. Tech Coloproctol 7: 3–8

    Article  CAS  Google Scholar 

  2. Akinci OF et al. (1999) Incidence and aetiological factors in pilonidal sinus among Turkish soldiers. Eur J Surg 165: 339–342

    Article  CAS  Google Scholar 

  3. Sondenaa K et al. (1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 10: 39–42

    Article  CAS  Google Scholar 

  4. Bascom J (1980) Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 87: 567–572

    CAS  PubMed  Google Scholar 

  5. Holmebakk T and Nesbakken A (2005) Surgery for pilonidal disease. Scand J Surg 94: 43–46

    Article  CAS  Google Scholar 

  6. Bascom J and Bascom T (2007) Utility of the cleft lift procedure in refractory pilonidal disease. Am J Surg 193: 606–609

    Article  Google Scholar 

  7. Bascom JU (1987) Repeat pilonidal operations. Am J Surg 154: 118–122

    Article  CAS  Google Scholar 

  8. McCallum IJ et al. (2008) Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis. BMJ 336: 868–871

    Article  Google Scholar 

  9. Abdul-Ghani AK et al. (2006) Day-care surgery for pilonidal sinus. Ann R Coll Surg Engl 88: 656–658

    Article  CAS  Google Scholar 

  10. O'Meara SM et al. (2001) Systematic review of antimicrobial agents used for chronic wounds. Br J Surg 88: 4–21

    Article  CAS  Google Scholar 

  11. Chaudhuri A et al. (2006) Single-dose metronidazole vs 5-day multi-drug antibiotic regimen in excision of pilonidal sinuses with primary closure: a prospective, randomized, double-blinded pilot study. Int J Colorectal Dis 21: 688–692

    Article  CAS  Google Scholar 

Download references

Author information

Author notes

  1. Department of Surgery, Stavanger University Hospital, POB 8100, N-4068 Stavanger, Norway ksoreide@mac.com

Authors and Affiliations

  1. K Søreide is a Resident and Research Fellow in the Department of Surgery at Stavanger University Hospital, University of Stavanger, Stavanger, Norway.,

    Kjetil Søreide

Authors
  1. Kjetil Søreide
    View author publications

    You can also search for this author in PubMed Google Scholar

Ethics declarations

Competing interests

The author declares no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Søreide, K. The best surgical technique for chronic pilonidal disease—is this question still open, or closed?. Nat Rev Gastroenterol Hepatol 6, 20–22 (2009). https://doi.org/10.1038/ncpgasthep1316

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpgasthep1316

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing