Treatment of pilonidal disease by minimal surgical excision under local anesthesia with healing by secondary intention: Results in over 500 patients.

Background: The surgical treatment of pilonidal disease is highly variable. The present study examines the long-term results in over 500 patients treated by minimal but complete surgical excision under local anesthesia with healing by secondary intention using moist dressings.

Methods: Records of all patients I treated for pilonidal disease from 1978 to 2015 with at least 1 year of follow-up were reviewed. Symptoms, prior surgical treatments, extent of disease, number of clinic visits, length of time until wound healed, compliance with wound care instructions, and length of follow-up were recorded.

Results: Records were found for 570 patients; mean follow-up was 4.7 years. Two hundred forty-eight patients (44%) had a prior abscess requiring drainage; 80 had from 1 to 6 prior operations. Ninety-two percent of operations were performed under local anesthesia. Men had more extensive disease than women (5.2 vs 3.5 cm, P < .001) and took longer to heal (median 46 days in women, 51 days in men, P < .001). Eighteen patients (3.2%) had persistent or recurrent disease requiring reoperation, most often because of poor compliance with wound care instructions, and later healed.

Conclusion: The majority of patients with pilonidal disease can be managed by simple, minimal excision of affected tissue under local anesthesia with healing by secondary intention. With careful attention to wound care, morbidity is minimal and the recurrence or failure rate is less than 5%.