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Pilonidal Sinus Excision

Surgical Treatment of Sacrococcygeal Pilonidal Disease with Excision and Closure Techniques

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Pilonidal Sinus Excision?

Pilonidal disease is a chronic inflammatory condition of the natal cleft caused by ingrown hairs penetrating skin and creating sinus tracts with secondary infection, abscess formation, and chronic discharge.

Affects predominantly young men aged 15–30 years (male-to-female ratio approximately 3:1) with prevalence approximately 0.7–1% in the general population.

Surgical management is indicated for chronic or recurrent sinus, abscess (after drainage), and significant disability; numerous techniques exist with no single 'gold standard'.

Modern emphasis on flap-based off-midline closure techniques (Karydakis, Bascom cleft lift, Limberg flap) which have lower recurrence rates and faster healing compared to traditional midline closure or open healing.

Symptoms

Painful swelling, abscess, or fluctuant mass in the sacrococcygeal area
Chronic discharge: serous, purulent, or bloody from sinus openings (pits) in the natal cleft
Recurrent infection requiring repeated abscess drainage
Pain with sitting, prolonged sitting (driving, desk work), or activities that compress the area
Multiple visible pits in the midline of the natal cleft, sometimes with hair protruding
Foul-smelling discharge from sinus openings
Cellulitis around sinus openings during acute exacerbation

Risk Factors

Young men aged 15–30 years (post-pubertal, before fourth decade decline)
Hirsute body type with coarse, dark, abundant body hair
Obesity and deep natal cleft anatomy
Sedentary lifestyle, prolonged sitting (drivers, students, office workers, soldiers)
Poor hygiene of the natal cleft area
Mechanical trauma or friction in the area
Family history of pilonidal disease (suggesting genetic component)
Higher recurrence with midline closure compared to off-midline techniques

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Painful swelling, abscess, or chronic discharge in the natal cleft
  • Recurrent abscess despite multiple drainages, suggesting need for definitive surgical treatment
  • Persistent or recurrent symptoms after prior pilonidal surgery
  • Cellulitis or systemic signs of infection requiring urgent drainage and antibiotics
  • Chronic disability, work absenteeism, or impact on quality of life from pilonidal disease

Treatment Methods

01
Acute abscess management: incision and drainage under local anesthesia, lateral to midline if possible to facilitate later definitive surgery; antibiotics not routinely required unless cellulitis or systemic symptoms
02
Conservative measures: hair removal (depilation, laser), meticulous hygiene, weight loss, postural changes; can be sufficient for mild disease
03
Phenol injection: minimally invasive option for select cases with limited disease; chemical sclerosis of sinus tracts; multiple treatments may be needed
04
Pit-picking (Bascom-1) procedure: minimally invasive excision of midline pits and lateral incision for hair removal and granulation curettage; suitable for limited disease with low morbidity
05
Excision with open healing (laying open): wide excision of all sinuses and tracts with healing by secondary intention; longer healing (6–12 weeks) but lower infection risk
06
Excision with primary midline closure: simple but historically high recurrence rate (10–40%) and wound dehiscence; less commonly recommended now
07
Excision with marsupialization: edges of wound sutured to deeper tissues to flatten wound and accelerate healing while keeping wound open
08
Karydakis flap: off-midline flap reconstruction with lateral closure; excellent recurrence rates (1–5%) and rapid healing; technically demanding
09
Limberg flap (rhomboid flap): rotational flap from lateral gluteal area to flatten cleft; effective for recurrent or extensive disease; recurrence 1–5%
10
Bascom cleft lift: flattens the natal cleft by lifting and approximating off-midline flaps; very low recurrence rate (1–3%) and rapid return to activity
11
Postoperative care: hair removal in surrounding area, hygiene, dressing changes, smoking cessation, weight optimization; activity restriction depending on technique
12
Long-term follow-up: monitoring for recurrence (most occur within first 2 years), continued hair management, addressing risk factors

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.