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)
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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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Title
Management of Pilonidal Disease
Authoring Organization
American Society of Colon and Rectal Surgeons
Publication Month/Year
February 1, 2019
Last Updated Month/Year
June 12, 2023
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