The Management of Pilonidal Sinus

Background: Pilonidal disease is an acute or chronic infection in the subcutaneous fatty tissue, mainly in the natal cleft. Its incidence in Germany in 2012 was 48 cases per 100 000 persons per year. Methods: This review is based on pertinent publications retrieved by a selective literature search. Results: The numerous minimally invasive techniques that are available for the treatment of pilonidal disease have the advantages of being relatively atraumatic and of enabling the patient to continue working almost without interruption. They are suitable for small lesions that have not been previously surgically treated. These techniques are associated with a higher recurrence rate than excisional methods (level of evidence [LoE]: Ib). It is not yet clear whether minimally invasive techniques employing laser or endoscopic technology can reduce the recurrence rate. In systematic meta-analyses, the duration of wound healing was shorter after off-midline techniques (the Karydakis procedure, the Limberg procedure, and others) than after excision with open wound treatment; the off-midline techniques should, therefore, be preferred for patients who have undergone previous surgery and for those with large lesions (LoE: Ia). Excision with midline suturing should not be performed (LoE: Ia). Postoperative permanent shaving cannot be recommended either (LoE: IV). Conclusion: Further randomized trials are needed to clarify the role of newer techniques in the treatment of pilonidal disease.