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Pilonidal disease

Key sources
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).
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Guidelines

1.Diagnostic investigations

Clinical assessment: elicit a disease-specific history and perform physical examination, emphasizing symptoms, risk factors, and presence of secondary infection.
B
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2.Medical management

Antibiotic therapy: as per SICCR 2015 guidelines, administer antibiotics in patients with immunosuppression, severe cellulitis or important concomitant systemic diseases.
B

3.Nonpharmacologic interventions

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.
C

4.Therapeutic procedures

Phenol and fibrin glue injection
As per ASCRS 2019 guidelines:
Consider applying phenol in patients with acute or chronic pilonidal cyst without abscess.
B
Consider administering fibrin glue as a primary or adjunctive treatment in patients with chronic pilonidal cyst without abscess.
C

5.Perioperative care

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.
I

6.Surgical interventions

General principles
As per GNG 2016 guidelines:
Perform surgery for the treatment of symptomatic patients with pilonidal disease.
B
Do not offer any treatment in asymptomatic patients with pilonidal disease.
D

More topics in this section

  • Incision and drainage

  • Excision and repair

  • Minimally invasive surgery

7.Follow-up and surveillance

Postoperative hair removal
Do not offer postoperative shaving.
D
Insufficient evidence to recommend postoperative laser hair removal.
I