The American Society of Colon and Rectal Surgeons’ Clinical Practice Guidelines for the Management of Pilonidal Disease

Johnson, Eric K.; Vogel, Jon D.; Cowan, Michelle L.; Feingold, Daniel L.; Steele, Scott R.

doi:10.1097/dcr.0000000000001237

Cited by 103 publications

(92 citation statements)

References 99 publications

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“…Currently there are three guidelines for the treatment of PD available, all made by relevant surgical societies, from Italy, USA and Germany [31][32][33]. In Germany despite the increasing number of novel procedures most surgeons still prefer traditional methods.…”

Section: Excisional Proceduresmentioning

confidence: 99%

“…Patient needs to be adequately informed about all aspects of treatment, from possible complications, cosmetic effects, postoperative course, to risk for recurrence [32]. Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons published the latest guideline for PD treatment in 2019 [33]. Based on low quality evidence there is weak recommendation for elimination of hair from the intergluteal cleft and surroundings in both, acute and chronic pilonidal disease, in the absence of abscess as a primary or adjunct treatment measure.…”

Section: Excisional Proceduresmentioning

confidence: 99%

“…Minimally invasive approaches to acute and chronic PD that use endoscopic or video assistance may be used but require specialized equipment and expertise (weak recommendation based on moderate-quality evidence). It is emphasized, that these guidelines should not be inclusive of all proper methods of care nor exclusive of other methods [33]. The final decision on treatment has to be individualized for every patient taking into consideration also surgeon experience and confidence in performing different techniques [32,33].…”

Section: Excisional Proceduresmentioning

confidence: 99%

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Pilonidal Disease

Nestorović

Pecić²,

Branković³

et al. 2019

FU Med Biol

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Pilonidal disease is a common and well-recognized medical condition. It affects people in reproductive age, especially men and in combination with in-patient and outpatient treatment and absence from work it causes a considerable socioeconomic loss. This fact led to a renewed interest in understanding of the disease and search for the ideal method of treatment. The purpose of this review was to provide update on therapeutic options for patients with pilonidal disease. In case of chronic or recurrent pilonidal disease various treatment options exist, addressing different measures of surgical outcome. Like for many conditions, there is increase in the use of minimally invasive techniques in the treatment, which could be alternative to surgical excisions for pilonidal disease. Procedures for treatment of pilonidal disease can be divided in two large groups: minimally invasive treatment and excisional procedures. Although various treatment options exist nowadays, surgery is still preferred as definitive treatment. The optimal closure of the wound following an excision is still under debate since outcome measures depend mostly on type of closure selected. Most of the procedures fail to achieve the goals altogether. The final decision on treatment should be made based on surgeon and the patient’ preference.

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Section: Excisional Proceduresmentioning

confidence: 99%

Section: Excisional Proceduresmentioning

confidence: 99%

Section: Excisional Proceduresmentioning

confidence: 99%

See 1 more Smart Citation

Pilonidal Disease

Nestorović

Pecić²,

Branković³

et al. 2019

FU Med Biol

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show abstract

“…Doll et al demonstrated that the hair found in the sinus originated from the head and entered the natal cleft after haircuts [ 3 ]. Therefore, risk factors are the quality of hair (strong and inflexible hair), sedentary occupation, obesity, repetitive trauma or irritation at the natal cleft, hirsute body habitus, and perspiration [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…The various treatment options can be categorized into those involving open wound treatment, those applying various forms of primary wound closure, and those involving newer, minimally invasive interventions [ 4 , 19 , 20 ]. Open wound treatments are associated with a low recurrence rate but are cumbersome.…”

Section: Introductionmentioning

confidence: 99%

Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

2020

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We aimed to compare the outcome of two different operative methods to correct pilonidal sinus disease (PSD) in children, i.e., excision and open wound care (OW) versus excision and primary transverse closure (PC) of the wound. In this retrospective, observational study, we extracted data from the medical records of 56 patients who underwent surgery for PSD at our institution between 1 January 2006 and 31 December 2016. To test whether the primary variable, i.e., rate of PSD recurrence, differed between the two surgical groups, a logistic regression model was fitted. Secondary explanatory variables were total length of stay (LOS) at the hospital, complications, sex and age of patients, seniority of the surgeon in charge, and volume of excised specimen. Overall, 32 (57%) children and young adults underwent OW, while 24 (43%) patients were treated by PC. Mean age at operation was 15.5 years in either group. PSD recurred in 12 of 32 (37.5%) children in the OW group and in 3 of 24 (12.5%) children in the PC group (ratio: 0.19, 95% confidence interval [95% CI] 0.03–1.07). Thus, treatment of primary PSD by PC proved superior with respect to PSD recurrence. Moreover, our study did not bring to light any high-grade complications in the PC group, and postoperative pain was minimal. Less invasive treatment approaches for chronic PSD are typically performed in an outpatient setting and offer reduced morbidity, low rates of PSD recurrence, and shortened periods of time to return to work or social activities. More radical operations of PSD should be reserved for recurrent PSD where less invasive approaches have failed several times.

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Management of Pilonidal Disease

2023

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ImportanceThe management of pilonidal disease continues to be a challenge due to high rates of recurrence and treatment-associated morbidity.ObservationsThere is a heterogeneous repertoire of treatment modalities used in the management of pilonidal disease and wide practice variation among clinicians. Available treatment options vary considerably in their level of invasiveness, associated morbidity and disability, risks of complications, and effectiveness at preventing disease recurrence. Conservative nonoperative management strategies, including persistent improved hygiene, depilation, and lifestyle modification, focus on disease prevention and minimization of disease activity. Epilation techniques using both laser and intense pulse light therapy are also used as primary and adjunct treatment modalities. Other nonoperative treatment modalities include phenol and fibrin injection to promote closure of pilonidal sinuses. The traditional operative management strategy for pilonidal disease involves excision of affected tissue paired with a variety of closure types including primary midline closure, primary off-midline closure techniques (ie, Karydakis flap, Limberg flap, Bascom cleft lift), and healing by secondary intention. There has been a recent shift toward more minimally invasive operative approaches including sinusectomy (ie, trephination or Gips procedure) and endoscopic approaches. Overall, the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies.Conclusions and RelevancePilonidal disease is associated with significant physical and psychosocial morbidity. Optimal treatments will minimize disease and treatment-associated morbidity. There is a need for standardization of definitions used to characterize pilonidal disease and its outcomes to develop evidence-based treatment algorithms.

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The American Society of Colon and Rectal Surgeons’ Clinical Practice Guidelines for the Management of Pilonidal Disease

Cited by 103 publications

References 99 publications

Pilonidal Disease

Pilonidal Disease

Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

Management of Pilonidal Disease

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