Pilonidal disease is treated by eliminating the tracts and closure. Modern off-midline techniques (Karydakis, cleft-lift) and minimally invasive methods achieve faster healing and lower recurrence than classic midline closure.
What does it involve?
It treats a pilonidal sinus — a chronic inflammatory tract in the natal cleft, associated with trapped hair. The goal is definitive healing with the lowest possible recurrence.
A key principle is avoiding a healing scar exactly on the midline, which is associated with higher recurrence.
When is it needed?
It is indicated for a recurrent or chronic pilonidal sinus and persistent discharge. An acute abscess is first drained, and definitive surgery is planned at a second stage.
Preparation
The extent is assessed clinically; emphasis is placed on hygiene and hair control of the area, which is crucial for preventing recurrence.
How it's done
Off-midline techniques (e.g. Karydakis, cleft-lift/Bascom) are preferred, moving the scar away from the natal cleft and substantially reducing recurrence. In selected cases a minimally invasive endoscopic technique (EPSiT) or laying open to heal by secondary intention is used.
The choice is individualised to the extent, recurrences and patient priorities.
Minimally invasive
Pit picking / EPSiT: small incisions, minimal discomfort and rapid return in selected cases.
Off-midline
Karydakis / cleft-lift: moving the scar off the midline — low recurrence, good healing.
Excision & healing
For extensive or recurrent disease; the method of closure is individualised.
Recovery
Recovery depends on the technique: closed off-midline techniques heal faster, while laying open requires regular dressings. Local hygiene and hair removal are crucial to reduce recurrence.
Risks & outcomes
Main concerns: delayed wound healing and recurrence. Off-midline techniques and post-operative hair care substantially limit these.
Frequently asked questions
Which technique has the lowest recurrence?
Off-midline techniques (Karydakis, cleft-lift) have significantly lower recurrence than classic midline closure and are preferred.
How do I reduce the risk of recurrence?
Local hygiene and regular hair removal of the area are decisive, together with the right choice of technique.
Will I stay in hospital?
Many techniques are done as day cases. The healing time depends on the method.
What if I have an abscess?
An acute abscess is drained first for relief; the definitive operation is planned once the inflammation settles.