Surgery for Pilonidal Disease

Background and Aims: Surgery for pilonidal disease carries a considerable risk of complications, recurrence, and cosmetic sequelae. The present study evaluates the four procedures performed in our institution. Material and Methods: Operations from 1999 through 2002 were retrospectively assessed. Cosmetic result and overall satisfaction were reported on visual analogue scales. Results: Seventy-three procedures were performed in 71 patients: excision with open granulation in nine; excision and primary suture in 25; rhomboid plasty in 23; and lay-open in 16 patients. Infections were as frequent after rhomboid plasty (40 %) as after excision and primary suture (43 %). Nineteen recurrences (26 %) were observed during a median follow-up of 20 months, and the estimated five-year actuarial recurrence rate was 44 %. Recurrence occurred in 1/9 (11 %) after excision with granulation, in 4/23 (17 %) after excision and suture, in 5/25 (20 %) after rhomboid plasty, and in 9/16 patients (56 %) after lay-open. The cosmetic result was satisfactory only in 22/53 (42 %) patients; the result was poor in 16/53 (30 %) patients. Conclusion: Results after surgery for pilonidal disease are modest and should be compared to conservative management in a randomised trial.