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?
The operation eliminates the sinus tracts containing hair and debris in the sacrococcygeal region. The method of closure is decisive for recurrence.
When is it needed?
It is indicated for symptomatic or recurrent disease (pain, discharge, inflammation). An acute abscess is drained first and the definitive operation is done at a second stage.
Preparation
A clinical assessment of the extent is made. For an active abscess, drainage comes first. Advice is given on local hygiene and hair removal of the area.
How it's done
Options are individualised: minimally invasive techniques (pit picking / EPSiT) for mild disease, or excision with off-midline closure (Karydakis, cleft-lift) that moves the scar away from the midline and reduces recurrence.
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
The timeline depends on the technique. Off-midline and minimally invasive methods heal faster. Important is local hygiene and hair removal to prevent recurrence.
Risks & outcomes
Recurrence is the key concern and is significantly lower with off-midline techniques than with classic midline closure. Others, usually mild: infection or delayed wound healing.
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.