Management of Pilonidal Disease

Publication Date: February 1, 2019
Last Updated: March 14, 2022

Recommendations

INITIAL EVALUATION

A disease-specific history and physical examination should be performed, emphasizing symptoms, risk factors, and presence of secondary infection. (1C)
312133

TREATMENT

Nonoperative Therapy/ Nonoperative Adjuncts

Elimination of hair from the gluteal cleft and surrounding skin, by shaving or laser epilation, may be used for both acute and chronic pilonidal disease in the absence of abscess as a primary or adjunct treatment measure. (1C)
312133
In patients with acute or chronic pilonidal disease without abscess, phenol application is an effective treatment that may result in rapid and durable healing. (1B)
312133
In patients with chronic pilonidal disease without abscess, fibrin glue may be effective as a primary or adjunctive treatment of pilonidal disease. (2B)
312133
The value of prophylactic intravenous and topical prophylactic antibiotic in pilonidal disease surgery is not clear. Individualized consideration of their use is recommended. (2B)
312133

Operative Management

Patients with acute pilonidal disease characterized by the presence of an abscess should be treated with I&D regardless of whether it is a primary or recurring episode. (1B)
312133
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 based on surgeon and patient preference. Drain use should be individualized. (1B)
312133
Flap-based procedures may be performed, especially in the setting of complex and recurrent chronic pilonidal disease when other techniques have failed. (1B)
312133
Minimally invasive approaches to acute and chronic pilonidal disease that use endoscopic or video assistance may be used but require specialized equipment and expertise. (2B)
312133

Management of Recurrent Pilonidal Disease

Operative strategies for recurrent pilonidal disease should distinguish between the presence of an acute abscess (section B1) and chronic disease (section B2), considering the experience and expertise of the surgeon. (1C)
312133

Recommendation Grading

Overview

Title

Management of Pilonidal Disease

Authoring Organization

Publication Month/Year

February 1, 2019

Last Updated Month/Year

June 12, 2023

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Male, Female, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Outpatient, Operating and recovery room

Intended Users

Medical assistant, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Treatment, Management

Diseases/Conditions (MeSH)

D000038 - Abscess, D010864 - Pilonidal Sinus

Keywords

pilonidal sinus, Pilonidal cyst, abscess

Source Citation

Johnson, Eric K. M.D.1; Vogel, Jon D. M.D.2; Cowan, Michelle L. M.D.2; Feingold, Daniel L. M.D.3; Steele, Scott R. M.D., M.B.A.4; On Behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons The American Society of Colon and Rectal Surgeons’ Clinical Practice Guidelines for the Management of Pilonidal Disease, Diseases of the Colon & Rectum: February 2019 - Volume 62 - Issue 2 - p 146-157 doi: 10.1097/DCR.0000000000001237