Pilonidal disease: modern approaches in same-day surgery
DOI:
https://doi.org/10.11603/2414-4533.2026.2.16365Keywords:
pilonidal disease, surgical treatment, day surgeryAbstract
The aim of the work: to investigate the advantages and disadvantages of modern treatment methods for pilonidal disease.
Materials and Methods. The treatment outcomes of 298 patients with pilonidal disease who received outpatient and inpatient care were analyzed. Conservative treatment was performed in 24 patients with pilonidal disease. Non-excision surgical procedures were performed in 201 patients, including: incision, debridement, and drainage for acute pilonidal abscess; trepanation (Gips technique) and pit-picking (Bascom I method). Surgical excision procedures were performed in 73 patients, specifically: wide excision along the midline with or without skin closure and skin closure outside the midline, which involved lateralization of the postoperative wound (Karydakis flap).
Results. Conservative treatment is effective in most patients with stage I–IIa chronic pilonidal disease and/or an “asymptomatic course.” After incision, debridement, and drainage of an acute pilonidal abscess, 22.7 % of patients did not seek further medical care. Non-excision surgical techniques (Gips and Bascom I trepanation) can be performed on an outpatient basis under local anesthesia; the procedure takes 15–30 minutes, and the total time off work is only 2–3 days. However, according to our data, the probability of recurrence is 14–18 %. Surgical excisional techniques (wide excision along the midline with or without skin closure) require spinal or general anesthesia in an inpatient setting. The recurrence rate was 12.8–15.4 %, and the duration of disability ranged from 8–12 days to 30–42 days. Skin closure outside the midline, involving lateralization of the postoperative wound (Karydakis flap), was performed on inpatients with recurrent or chronic stage IV PH. The operation lasted an average of 70–110 minutes, total time off work was 9–14 days, and the recurrence rate was 8.3 %.
Conclusions. The ideal surgical procedure for pilonidal disease is one performed under local anesthesia, with few complications and a low recurrence rate, yielding good cosmetic results and minimizing the patient’s time off work. This is precisely why day surgery (day surgery / ambulatory surgery) is becoming increasingly important: the patient arrives, receives treatment, and goes home on the same day, which reduces the burden on the hospital and speeds up their return to an active life.
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