Last updated January 11, 2022

Management of Pilonidal Disease

Recommendations

INITIAL EVALUATION

A disease-specific history and physical examination should be performed, emphasizing symptoms, risk factors, and presence of secondary infection.  (1C)
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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)
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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)
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In patients with chronic pilonidal disease without abscess, fibrin glue may be effective as a primary or adjunctive treatment of pilonidal disease. (2B)
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The value of prophylactic intravenous and topical prophylactic antibiotic in pilonidal disease surgery is not clear. Individualized consideration of their use is recommended. (2B)
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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)
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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)
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Flap-based procedures may be performed, especially in the setting of complex and recurrent chronic pilonidal disease when other techniques have failed. (1B)
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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)
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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)
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Recommendation Grading

Overview

Title

Management of Pilonidal Disease

Authoring Organization

Publication Month/Year

February 1, 2019

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

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

Intended Users

Medical assistant

Scope

Assessment and screening, Management, Treatment

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