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The following summarized guidelines for the evaluation and management of pilonidal disease are prepared by our editorial team based on guidelines from the American Society of Colon and Rectal Surgeons (ASCRS 2019), the German National Guideline (GNG 2016), and the Italian Society of Colorectal Surgery (SICCR 2015).
Clinical assessment: elicit a disease-specific history and perform physical examination, emphasizing symptoms, risk factors, and presence of secondary infection.
Antibiotic therapy: as per SICCR 2015 guidelines, administer antibiotics in patients with immunosuppression, severe cellulitis or important concomitant systemic diseases.
Gluteal cleft hair removal: as per ASCRS 2019 guidelines, consider offering elimination of hair from the gluteal cleft and surrounding skin by shaving or laser epilation as a primary or adjunct treatment measure in patients with both acute and chronic pilonidal cyst without abscess.
Phenol and fibrin glue injection
As per ASCRS 2019 guidelines:
Consider applying phenol in patients with acute or chronic pilonidal cyst without abscess.
Consider administering fibrin glue as a primary or adjunctive treatment in patients with chronic pilonidal cyst without abscess.
Perioperative antibiotic prophylaxis: as per ASCRS 2019 guidelines, insufficient evidence to support the use of IV or topical antibiotic prophylaxis for pilonidal cyst surgery. Consider administering antibiotic prophylaxis on an individualized basis.
As per GNG 2016 guidelines:
Perform surgery for the treatment of symptomatic patients with pilonidal disease.
Do not offer any treatment in asymptomatic patients with pilonidal disease.
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Incision and drainage
Excision and repair
Minimally invasive surgery
7.Follow-up and surveillance
Postoperative hair removal
Do not offer postoperative shaving.
Insufficient evidence to recommend postoperative laser hair removal.