Management of Pilonidal Disease

- Executive Summary

This guideline offers evidence-based recommendations on the targeted levels of Clinical practice guidelines and provide healthcare professionals with practical guidance on the diagnosis and treatment of pilonidal sinus.

·   We recommend the diagnosis of pilonidal disease clinically based on history and physical examination, with identification of midline pits, sinus tracts, and/or abscess formation in the sacrococcygeal region, (Strong Recommendation).

·  We recommend a thorough patient history including risk factors such as obesity, sedentary lifestyle, family history, and recurrent infections to guide management, (Conditional Recommendation).

·  Ultrasound or MRI may be recommended in recurrent or complex cases to assess the extent of sinus tracts and rule out other pathologies (e.g., perianal fistula, hidradenitis suppurativa), (Conditional Recommendation).

·   We recommend incision and drainage (I&D) for the treatment of acute pilonidal abscesses, (Strong Recommendation).

·       Routine postoperative antibiotics are not recommended unless there is evidence of cellulitis or systemic infection, (Conditional Recommendation).

·  In patients with acute or chronic pilonidal disease without abscess, phenol application may be recommended as an effective treatment that may result in rapid and durable healing, (Strong Recommendation).

·  In patients with chronic pilonidal disease without abscess, fibrin glue may be recommended as a primary or adjunctive treatment of pilonidal disease, (Conditional Recommendation).

·  Endoscopic pilonidal sinus treatment (EPSiT) or pit-picking (Bascom’s procedure) may be recommended for selected patients with limited disease, (Conditional Recommendation).

·  Laser surgery may be recommended to patients with PD, (Conditional Recommendation).

·  We recommend open healing, (secondary intention), in presence of infection as it has lower recurrence rate, (Conditional Recommendation).

·  We recommend closed techniques, (primary closure), in absence of infection as it offer faster healing, (Conditional Recommendation).

·  Off-midline closure techniques (e.g., Karydakis flap, Limberg flap) for Chronic/Recurrent Disease are recommended over midline closure due to lower recurrence rates, (Strong Recommendation).

·  We recommend proper wound hygiene and follow-up to monitor healing, (Good Practice Statement).

·  We recommend regular hair removal (laser or shaving) in the sacrococcygeal region to reduce recurrence, (Good Practice Statement).