{ "slug": "pilonidal-cyst-pop", "question": "Is it safe to pop a pilonidal cyst yourself, or should you let it drain on its own?", "shortTitle": "Popping a Pilonidal Cyst Yourself", "clinicalQuestion": "In patients with a pilonidal cyst/abscess, does self-drainage (spontaneous rupture or manual popping/lancing at home) versus formal incision and drainage or surgical management affect resolution of infection, recurrence, and complication rates?", "pico": { "population": "People with a pilonidal cyst or abscess at the natal cleft", "intervention": "Self-popping or allowing spontaneous rupture/drainage at home", "comparator": "Formal clinical incision and drainage or surgical excision", "outcomes": [ "Time to symptom resolution", "Recurrence rate", "Rate of secondary infection or abscess formation", "Need for subsequent surgical intervention", "Pain scores", "Wound healing time" ] }, "category": "anorectal", "relatedConditions": [ "pilonidal-cyst", "pilonidal-sinus", "skin-abscess" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "No study has tested whether it's safe to pop a pilonidal cyst yourself — the research only compares different ways doctors drain or treat these cysts.", "detail": "One study found that abscesses which burst open on their own, without a clinician draining them, were linked to a higher chance of the cyst coming back over 20 years (35%) than when a doctor drained it first (24%). But that study wasn't randomised, and it compared spontaneous rupture to clinician drainage before a planned surgery — not a patient squeezing or lancing a cyst at home. No study has actually done that comparison.", "studyIds": [ "pmid:23078365" ] }, "strength": { "level": "very-low", "why": "The only direct evidence is 1 small or uncontrolled study.", "override": null }, "direction": { "level": "unclear", "why": "The studies point in different directions.", "override": null }, "counts": { "recordsRetrieved": 329, "recordsScreened": 200, "included": 60, "rcts": 1, "systematicReviews": 2, "observational": 26, "participants": 16916, "yearFrom": 2008, "yearTo": 2026, "registeredTrialsWithoutResults": 5 }, "excluded": [], "outcomes": [ { "name": "Time to symptom resolution", "status": "not-studied", "note": "No study timed how quickly symptoms go away after self-popping compared with seeing a clinician or doing nothing. Healing-time data only exists for clinician-performed drainage or surgery.", "studyIds": [ "pmid:39635960" ] }, { "name": "Recurrence rate", "status": "possible-harm", "note": "One non-randomised study found that an abscess bursting open on its own (not popped by the patient, just unaided rupture) before surgery was linked to more recurrences over 20 years than when a clinician drained it first. This is the closest evidence to the question, but it isn't the same as a patient manually popping a cyst, and it can't prove cause and effect.", "studyIds": [ "pmid:23078365" ] }, { "name": "Rate of secondary infection or abscess formation", "status": "not-studied", "note": "No study measured infection rates after self-popping. Case reports describe hair left inside the wound after a clinician opened an abscess forming a lingering, draining lump needing more surgery — but that was after professional drainage, not self-popping.", "studyIds": [ "pmid:39461136" ] }, { "name": "Need for subsequent surgical intervention", "status": "not-studied", "note": "Large registry studies show many patients need another procedure after a clinician drains or operates on a pilonidal abscess — roughly 30% within 5 years in one study and about a third in another — but none of these studies tracked what happens after a patient pops the cyst at home.", "studyIds": [ "pmid:42227065", "pmid:41239746" ] }, { "name": "Pain scores", "status": "not-studied", "note": "No study compared pain scores for people who pop their own cyst against those who have it drained by a clinician or leave it alone.", "studyIds": [] }, { "name": "Wound healing time", "status": "not-studied", "note": "Healing-time data only comes from clinician-performed drainage — for example, a median of 43 days to wound closure in one cohort. No study has timed healing after a cyst is popped at home.", "studyIds": [ "pmid:39635960" ] } ], "benefits": [], "limitations": [ { "text": "Only one study even comes close to this question, and it didn't actually study a patient popping their own cyst — it compared an abscess bursting open on its own with a clinician draining it, both followed by the same planned surgery.", "studyIds": [ "pmid:23078365" ] }, { "text": "That one study wasn't randomised. It was a retrospective look back at records from a single military hospital, so other differences between the two groups of patients could explain the result, not just how the abscess opened.", "studyIds": [ "pmid:23078365" ] }, { "text": "Many of the other studies here are case series or retrospective reviews describing a single clinician-performed treatment — such as laser ablation, pit excision, phenol injection, or pit-picking — usually without a comparison group. None of these studies mention self-popping or draining a cyst at home; they describe outcomes of professionally performed treatment only, and say nothing about self-drainage.", "studyIds": [ "pmid:42560577", "pmid:41461191", "pmid:36102566", "pmid:30661599", "pmid:30064734", "pmid:29947121", "pmid:23559647", "pmid:22343201", "pmid:21982072", "pmid:20357505" ] } ], "risks": [ { "text": "Case reports show that when hair is left trapped inside an opened abscess, it can cause a lingering, draining lump (a granuloma) that needs further surgery to remove. This was reported after a clinician opened the wound, not after self-popping, but it's a reminder that what's left behind inside matters however the cyst is opened.", "studyIds": [ "pmid:39461136" ], "severity": "serious" }, { "text": "Even with professional drainage, complications and early return of the abscess still happened in some patients in one study — about 1 in 20 had a complication and roughly 1 in 14 had it come back within a year. Opening a pilonidal abscess, by any method, doesn't reliably prevent further problems.", "studyIds": [ "pmid:39635960" ], "severity": "minor" }, { "text": "Letting an abscess burst open on its own, rather than having a clinician drain it, was linked to a higher chance of the cyst returning over many years in one non-randomised study. This doesn't prove self-popping causes recurrence, but it's a reason for caution about skipping medical care.", "studyIds": [ "pmid:23078365" ], "severity": "minor" } ], "whyPeopleTryIt": [ { "text": "It hurts, and squeezing or lancing it can feel like it will bring instant relief." }, { "text": "The area is private and embarrassing, so some people would rather deal with it alone than show a doctor." }, { "text": "It looks like a large pimple, which makes popping feel like an obvious, familiar thing to do." }, { "text": "Getting a doctor's appointment or going to urgent care takes time and money that a quick squeeze at home doesn't." } ], "keyStudies": [ "pmid:23078365", "pmid:42227065", "pmid:41239746", "pmid:39635960", "pmid:39461136", "pmid:41058826", "pmid:18565338" ], "studies": [ { "id": "pmid:42560577", "pmid": "42560577", "doi": "10.1007/s00383-026-06553-w", "nctId": null, "pmcid": null, "title": "Laser-assisted endoscopic treatment of pilonidal sinus disease in children: a first pediatric series", "firstAuthor": "Türker Çolak", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2026, "design": "retrospective", "n": 45, "nField": "reported", "population": "children under 18 with pilonidal sinus disease", "intervention": "laser-assisted endoscopic pilonidal sinus treatment (LEPSIT)", "comparator": "none - single group before/after single procedure", "primaryOutcome": "successful treatment (no recurrence) and pain scores after surgery", "result": "91.1% of patients were cured after one procedure, with low pain scores and all patients improved by final follow-up", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a retrospective case series without a comparison group, so it can't show whether the laser method is better than other options, only that most patients did well.", "directness": "indirect", "limitations": "Retrospective design, no control group, small sample size, single-center experience.", "followUp": "32.4 ± 11.3 months", "plainFinding": "Laser surgery worked well, low pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42560577/", "sourceText": "BACKGROUND: This study aims to describe the technical details of laser-assisted endoscopic pilonidal sinus treatment (LEPSIT), a method used for the first time in pediatric pilonidal sinus disease (PSD), and to report early-stage clinical outcomes in a pediatric cohort. METHODS: Clinical data of children under 18 years of age who underwent LEPSIT for PSD between November 2021 and July 2023 were retrospectively analyzed. RESULTS: Of the 45 patients included, 19 (42.2%) were female, and 26 (57.8%) were male; the mean age at surgery was 15.2 ± 3.1 years, and the mean body mass index was 25.1 ± 3.2. Of the 45 patients, 35 presented with an acute pilonidal abscess at initial evaluation and had undergone abscess drainage prior to LEPSIT. Six patients had been previously operated on for pilonidal sinus disease at an external center prior to LEPSIT. Mean procedure duration was 30 ± 7.2 min. The mean visual analog scale (VAS) score at 6 h was 1.8, 24 h was 1,1 and the mean analgesic use was 1 ± 0.3 days. Successful treatment was achieved in 41 patients (91.1%) after a single procedure; 4 patients (8.9%) had recurrence, all of whom achieved cure after a second LEPSIT. Improvement was ultimately achieved in all 45 patients. Mean follow-up was 32.4 ± 11.3 months. CONCLUSION: LEPSIT is an easy-to-administer, minimally painful (mean VAS score: 1.1), and minimally invasive treatment that shortens hospital stay and enables rapid return to daily activities. It is also a safe and well-tolerated option for recurrent PSD.", "provenance": [ { "field": "n", "quote": "Of the 45 patients included" }, { "field": "population", "quote": "Clinical data of children under 18 years of age who underwent LEPSIT for PSD" }, { "field": "intervention", "quote": "laser-assisted endoscopic pilonidal sinus treatment (LEPSIT)" }, { "field": "comparator", "quote": "Clinical data of children under 18 years of age who underwent LEPSIT for PSD between November 2021 and July 2023 were retrospectively analyzed." }, { "field": "primaryOutcome", "quote": "Successful treatment was achieved in 41 patients (91.1%) after a single procedure" }, { "field": "result", "quote": "Successful treatment was achieved in 41 patients (91.1%) after a single procedure; 4 patients (8.9%) had recurrence, all of whom achieved cure after a second LEPSIT. Improvement was ultimately achieved in all 45 patients." } ] }, { "id": "pmid:42227065", "pmid": "42227065", "doi": "10.1111/codi.70509", "nctId": null, "pmcid": null, "title": "Risk of re-operation after Bascom I for pilonidal sinus disease. A Danish population-based cohort study", "firstAuthor": "Faurschou", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2026, "design": "registry", "n": 3555, "nField": "reported", "population": "patients with chronic pilonidal sinus disease having elective Bascom I surgery in Denmark", "intervention": "Bascom I minimally invasive surgical procedure for pilonidal sinus disease", "comparator": "patients grouped by prior treatment: no previous treatment, one or two prior incision & drainage procedures, or other prior PSD procedures", "primaryOutcome": "risk of needing a repeat (re-operation) procedure after Bascom I surgery", "result": "Overall 5-year risk of re-operation was 30%, with 65% of re-operations happening within the first 12 months; after a second Bascom I the 5-year risk rose to 45%", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "It is a large nationwide registry study, which gives solid numbers, but it is retrospective and does not address the question of self-popping versus natural drainage at all.", "directness": "indirect", "limitations": "Retrospective registry-based cohort without comparison to non-surgical draining or home treatment; study only covers surgically treated patients.", "followUp": "5-year", "plainFinding": "High re-operation rate after cyst surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42227065/", "sourceText": "BACKGROUND: The treatment of chronic pilonidal sinus disease (PSD) is controversial. Minor PSD can be treated minimally invasively. The preferred minimally invasive treatment in Denmark is the Bascom I procedure. AIM: To evaluate re-operation rates following elective Bascom I and to identify potential risk factors. METHODS: Using nationwide Danish databases from 2010 to 2021, we identified patients diagnosed with PSD undergoing incident Bascom I. Based on previous surgery, patients were divided into four groups: (i) Bascom I with no previous PSD treatment; Bascom I with history of (ii) one or (iii) two incision & drainage (I&D) procedures; and (iv) Bascom I with history of other PSD procedures. Patients were followed until re-operation, death or emigration. Stratified by sex, 1-, 2- and 5-year risk of re-operation was examined. A subsequent analysis assessed the risk of re-operation after second Bascom I procedure. RESULTS: Of 3555 (79% male) PSD patients undergoing Bascom I procedure, 2417 had the procedure without previous PSD surgery, 382 underwent Bascom I after one I&D procedure, 108 after two I&D procedures and 648 after other/more PSD procedures. The overall 5-year re-operation risk was 30%, highest in younger age groups. As much as 65% of re-operations occurred within the first 12 months. After a second Bascom I, the 5-year risk was 45%. CONCLUSION: High rates of early failures seem to drive a high risk of re-operation after the Bascom I procedure. Patient selection, technique and training likely need improvements to ensure acceptable outcomes.", "provenance": [ { "field": "n", "quote": "Of 3555 (79% male) PSD patients undergoing Bascom I procedure" }, { "field": "population", "quote": "patients diagnosed with PSD undergoing incident Bascom I" }, { "field": "intervention", "quote": "The preferred minimally invasive treatment in Denmark is the Bascom I procedure." }, { "field": "comparator", "quote": "Based on previous surgery, patients were divided into four groups: (i) Bascom I with no previous PSD treatment; Bascom I with history of (ii) one or (iii) two incision & drainage (I&D) procedures; and (iv) Bascom I with history of other PSD procedures." }, { "field": "primaryOutcome", "quote": "To evaluate re-operation rates following elective Bascom I and to identify potential risk factors." }, { "field": "result", "quote": "The overall 5-year re-operation risk was 30%, highest in younger age groups. As much as 65% of re-operations occurred within the first 12 months. After a second Bascom I, the 5-year risk was 45%." } ] }, { "id": "pmid:41461191", "pmid": "41461191", "doi": "10.1055/a-2773-3657", "nctId": null, "pmcid": null, "title": "In-Office Pit Excision for Pilonidal Disease Using Needle-Free Local Anesthesia: A Minimally Invasive, Non-Operative Treatment Approach", "firstAuthor": "Stoeckel", "multipleAuthors": true, "journal": "Eur J Pediatr Surg", "year": 2026, "design": "case-series", "n": 100, "nField": "reported", "population": "patients with pilonidal disease (gluteal crease pits), mean age 18 years", "intervention": "in-office minimally invasive pit excision using needle-free pneumatic lidocaine anesthesia, laser follicle ablation, and punch excision", "comparator": "none reported; no comparison group", "primaryOutcome": "healing of pilonidal pits at follow-up", "result": "60% of patients had all pits healed at first follow-up, and ultimately 88% healed all of their pits", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-arm study with no comparison group and 25 of 125 eligible patients lost to follow-up, so it can't say whether this approach is better or safer than alternatives.", "directness": "indirect", "limitations": "No control group, 25 patients lost to follow-up, patients requiring incision and drainage were excluded from the study.", "followUp": "6 to 8 weeks", "plainFinding": "In-clinic procedure healed most pits.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41461191/", "sourceText": "INTRODUCTION: Treatment of pilonidal disease traditionally involves an operation under general anesthesia, which may have a period of postoperative disability and a significant recurrence rate. We report a novel treatment for pilonidal disease performed in-office using a pneumatic lidocaine injection device, requiring no pain medication or activity restrictions-supporting a non-operative standard of care. METHODS: Patients with gluteal crease pits at our Pilonidal Care Clinic were offered pit excision as standard care. Prospective data on demographics, pain scores (0-10), and outcomes were collected in REDCap. Under sterile conditions, patients received 1% buffered lidocaine via pneumatic injection. Laser follicle ablation was followed by punch excision (1.5 or 2 mm) of full-thickness pit epithelium. Sinus tracts were probed but not excised. Patients were asked to wash the area twice daily, maintain normal activities, and return in 6 to 8 weeks. Patients requiring nidus incision and drainage (I&D) were excluded. RESULTS: About 130 patients underwent this technique between February and June 2024; 100 were included in the analysis (5 excluded for concurrent I&D, 25 lost to follow-up). Mean age was 18.1 years; 50% were male. At subsequent follow-up, 60% patients healed all pits, resolving their condition, with 64% (144/224) of all pits healed. Patients with three or more pits were more likely to need an additional pit excision. Mean procedure pain score was 1.6/10 (SD 1.21); no patient used pain medication or experienced disability. Ultimately, 88% of patients healed all of their pits. CONCLUSION: Pilonidal disease may be resolved non-operatively in a single outpatient clinic visit, without even a shot.", "provenance": [ { "field": "population", "quote": "Patients with gluteal crease pits at our Pilonidal Care Clinic" }, { "field": "intervention", "quote": "Under sterile conditions, patients received 1% buffered lidocaine via pneumatic injection. Laser follicle ablation was followed by punch excision (1.5 or 2 mm) of full-thickness pit epithelium." }, { "field": "comparator", "quote": "Patients requiring nidus incision and drainage (I&D) were excluded." }, { "field": "primaryOutcome", "quote": "60% patients healed all pits, resolving their condition, with 64% (144/224) of all pits healed" }, { "field": "result", "quote": "Ultimately, 88% of patients healed all of their pits." }, { "field": "n", "quote": "100 were included in the analysis (5 excluded for concurrent I&D, 25 lost to follow-up)" } ] }, { "id": "pmid:41454773", "pmid": "41454773", "doi": "10.1093/jpids/piaf115", "nctId": null, "pmcid": null, "title": "Patient characteristics and microbiology in pilonidal abscesses in children", "firstAuthor": "Garcia", "multipleAuthors": true, "journal": "J Pediatric Infect Dis Soc", "year": 2026, "design": "retrospective", "n": 154, "nField": "reported", "population": "children with pilonidal abscesses treated at a children's hospital", "intervention": "surgical treatment of pilonidal abscess (cultures taken during care)", "comparator": "none described", "primaryOutcome": "types of bacteria found and factors linked to the abscess coming back", "result": "no factors were found that predicted recurrence; bacteria without oxygen and a strep species were most common", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a retrospective chart review of children treated surgically, and it does not study or compare self-draining versus professional drainage at all.", "directness": "indirect", "limitations": "Retrospective design; abstract does not address self-drainage versus medical drainage, only microbiology and recurrence risk in surgically managed abscesses.", "followUp": "", "plainFinding": "Doesn't answer self-popping safety question.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41454773/", "sourceText": "We described the microbiology of 216 pilonidal abscess episodes among 154 children over a 10-year period at a tertiary pediatric center and assessed patient characteristics associated with recurrence. Anaerobes and Streptococcus anginosus group were the most common organisms isolated from surgical cultures. No risk factors for recurrence were identified.", "provenance": [ { "field": "population", "quote": "216 pilonidal abscess episodes among 154 children" }, { "field": "n", "quote": "154 children" }, { "field": "primaryOutcome", "quote": "described the microbiology of 216 pilonidal abscess episodes among 154 children over a 10-year period at a tertiary pediatric center and assessed patient characteristics associated with recurrence" }, { "field": "result", "quote": "Anaerobes and Streptococcus anginosus group were the most common organisms isolated from surgical cultures. No risk factors for recurrence were identified." }, { "field": "intervention", "quote": "surgical cultures" }, { "field": "comparator", "quote": "No risk factors for recurrence were identified." } ] }, { "id": "pmid:41397831", "pmid": "41397831", "doi": "10.3760/cma.j.cn441530-20251104-00417", "nctId": null, "pmcid": null, "title": "[Treatment options for different types of sacrococcygeal pilonidal disease]", "firstAuthor": "Chen", "multipleAuthors": true, "journal": "Zhonghua Wei Chang Wai Ke Za Zhi", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with sacrococcygeal pilonidal disease, including acute abscess and recurrent cases", "intervention": "different surgical and non-surgical treatment approaches for pilonidal disease, including drainage during acute abscess", "comparator": "different treatment strategies compared to each other (minimally invasive procedures, excision, flap techniques)", "primaryOutcome": "recurrence rate, complications, and recovery time across treatment approaches", "result": "the abstract summarizes treatment strategies rather than reporting a specific comparative result; it states drainage is the primary goal in the acute abscess phase, avoiding midline incisions", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative summary of clinical experience and literature rather than a study with original data or a defined comparison.", "directness": "indirect", "limitations": "This is an expert narrative review without original patient data, control groups, or statistical results, and does not specifically address self-drainage versus professional drainage.", "followUp": "", "plainFinding": "Review recommends drainage, not self-popping.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41397831/", "sourceText": "The treatment of sacrococcygeal pilonidal disease (SPD) remains challenging due to its high recurrence rate and treatment-related complications. An ideal treatment plan for SPD should be simple to perform, reduce recurrence rates, enable patients to quickly return to normal daily activities, and be associated with a low incidence of complications. Various surgical techniques have been employed for the treatment of SPD, but discrepancies and controversies persist in current clinical practice. Non-surgical treatment is suitable for asymptomatic SPD patients. For patients in the acute abscess phase, drainage is the primary therapeutic goal, with avoidance of midline incisions. Minimally invasive procedures may be considered for patients with localized lesions after weighing the recurrence risk, aiming for faster recovery and better cosmetic outcomes. For recurrent SPD or cases with extensive lesions, excision followed by secondary healing or combined with flap techniques is required to pursue a lower recurrence risk. Based on clinical experience and literature review, this article summarizes the treatment strategies for different types of SPD, providing a reference for clinicians in formulating diagnosis and treatment plans.", "provenance": [ { "field": "population", "quote": "The treatment of sacrococcygeal pilonidal disease (SPD) remains challenging due to its high recurrence rate and treatment-related complications." }, { "field": "intervention", "quote": "Various surgical techniques have been employed for the treatment of SPD" }, { "field": "comparator", "quote": "For recurrent SPD or cases with extensive lesions, excision followed by secondary healing or combined with flap techniques is required to pursue a lower recurrence risk." }, { "field": "result", "quote": "For patients in the acute abscess phase, drainage is the primary therapeutic goal, with avoidance of midline incisions." }, { "field": "primaryOutcome", "quote": "An ideal treatment plan for SPD should be simple to perform, reduce recurrence rates, enable patients to quickly return to normal daily activities, and be associated with a low incidence of complications." } ] }, { "id": "pmid:41340801", "pmid": "41340801", "doi": "10.20471/acc.2025.64.01.17", "nctId": null, "pmcid": "PMC12671715", "title": "LASER SURGERY FOR PILONIDAL DISEASE - A NOVEL MINIMALLY INVASIVE PROCEDURE", "firstAuthor": "Grgić", "multipleAuthors": true, "journal": "Acta Clin Croat", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal disease (a skin condition near the tailbone), mostly young men aged 15-30", "intervention": "laser treatment for pilonidal sinus disease", "comparator": "various other surgical and conservative treatments (e.g., incision and drainage, phenol, excision, flap surgeries)", "primaryOutcome": "not stated", "result": "not stated", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general review describing treatment options and the authors' experience without presenting any outcome data or numbers, so it can't show whether a specific treatment works.", "directness": "indirect", "limitations": "No patient numbers, outcomes, or comparison data are reported; it is a general overview of pilonidal disease treatments rather than a study answering a specific question about self-draining versus popping a cyst.", "followUp": "", "plainFinding": "No outcome data reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41340801/", "sourceText": "Pilonidal disease (PD) is a common inflammatory disease of the gluteal region with an incidence of 26/100000 and usually occurs in young males (15-30 years old). The etiology of pilonidal disease is unclear, but literature describes a wide range of factors such as keratin plugs, foreign substance reaction related to hairs, as well as dermatopathy and debris in hair follicles in the natal cleft. PD and also its classic treatment can cause discomfort and very much deteriorate the patient's quality of life. There are many possibilities (conservative or surgical) in the treatment of pilonidal disease, but there is no gold standard. In the acute phase (abscess), surgical incision with pus evacuation and antibiotic therapy is enough. In the chronic phase, there are many possibilities like phenol treatment, surgical excision with lay open and secondary wound healing. There are many reconstructive techniques such as Karydakis, V-Y flap or Limberg flap. A recently minimally invasive technique such as endoscopic surgical procedure or filling pilonidal tract with fibrin glue or phenol have been introduced. We present our experience with laser treatment (Biolitec, Germany) of pilonidal sinus disease.", "provenance": [ { "field": "population", "quote": "Pilonidal disease (PD) is a common inflammatory disease of the gluteal region with an incidence of 26/100000 and usually occurs in young males (15-30 years old)." }, { "field": "intervention", "quote": "We present our experience with laser treatment (Biolitec, Germany) of pilonidal sinus disease." }, { "field": "comparator", "quote": "There are many reconstructive techniques such as Karydakis, V-Y flap or Limberg flap." }, { "field": "primaryOutcome", "quote": "We present our experience with laser treatment (Biolitec, Germany) of pilonidal sinus disease." }, { "field": "result", "quote": "We present our experience with laser treatment (Biolitec, Germany) of pilonidal sinus disease." } ] }, { "id": "pmid:41241452", "pmid": "41241452", "doi": "10.1016/j.suc.2025.08.005", "nctId": null, "pmcid": null, "title": "Pilonidal Disease", "firstAuthor": "O'Guinn", "multipleAuthors": true, "journal": "Surg Clin North Am", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal disease, especially adolescents and young adults", "intervention": "incision and drainage, with or without deroofing of pits, and various surgical closure techniques", "comparator": "different management approaches to each other (non-operative management, drainage alone vs with deroofing, marsupialization, primary closure, flap-based closures)", "primaryOutcome": "recurrence and complications of pilonidal disease treatment", "result": "the abstract discusses recurrence and complication trade-offs between different drainage and closure techniques but does not address self-popping or spontaneous drainage at home", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a general narrative review of treatment approaches, not a study testing whether self-draining a cyst is safe, so it cannot answer the specific question.", "directness": "indirect", "limitations": "abstract does not mention home or self-drainage at all, and no study design, sample size, or comparative data are given for this question", "followUp": "", "plainFinding": "Doesn't address self-popping cysts", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41241452/", "sourceText": "Pilonidal disease, common in adolescents and young adults, is linked to hair insertion, friction, and bacterial colonization. Risk factors including obesity, sedentary lifestyle, and hirsutism should be addressed with initial non-operative management. Acute disease is primarily managed by incision and drainage; the addition of deroofing identified pits at the time of drainage can reduce recurrence. Management of chronic pilonidal disease is focused on removal of pits with the possible addition of marsupialization or primary closure. Closures with flap-based techniques, such as Karydakis and Bascom's cleft lift, offer a lower recurrence rate but higher complication risks.", "provenance": [ { "field": "population", "quote": "Pilonidal disease, common in adolescents and young adults, is linked to hair insertion, friction, and bacterial colonization." }, { "field": "intervention", "quote": "Acute disease is primarily managed by incision and drainage; the addition of deroofing identified pits at the time of drainage can reduce recurrence." }, { "field": "comparator", "quote": "Closures with flap-based techniques, such as Karydakis and Bascom's cleft lift, offer a lower recurrence rate but higher complication risks." }, { "field": "primaryOutcome", "quote": "the addition of deroofing identified pits at the time of drainage can reduce recurrence" }, { "field": "result", "quote": "Closures with flap-based techniques, such as Karydakis and Bascom's cleft lift, offer a lower recurrence rate but higher complication risks." } ] }, { "id": "pmid:41239746", "pmid": "41239746", "doi": "10.1111/codi.70307", "nctId": null, "pmcid": null, "title": "Risk of re-operation after incision and drainage for acute, abscess-forming pilonidal sinus disease: A Danish population-based cohort study", "firstAuthor": "Faurschou", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2025, "design": "retrospective", "n": 8251, "nField": "reported", "population": "patients diagnosed with an abscess from pilonidal sinus disease who had surgical drainage", "intervention": "lateral incision and drainage performed by a surgeon", "comparator": "none; the study tracked outcomes after this one treatment rather than comparing it to another approach", "primaryOutcome": "need for another operation (re-operation) over time", "result": "about one third of patients needed another operation within five years; risk was higher in younger patients and after repeat procedures", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "it is a large national registry study, which gives reliable numbers, but it only looks at surgical drainage by doctors and does not compare it to any other method, so it can't say what works better.", "directness": "indirect", "limitations": "the abstract does not compare surgical incision and drainage to self-draining or no treatment, so it cannot answer whether popping a cyst yourself is safe", "followUp": "five-year", "plainFinding": "Most avoided further surgery after drainage.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41239746/", "sourceText": "BACKGROUND: Acute abscess-forming pilonidal sinus disease (PSD) is treated surgically, with lateral incision and drainage (I&D) considered the gold standard; however, the risk of re-operation is unknown. AIM: To evaluate re-operation rates following abscess-forming PSD treatment with lateral I&D, and to identify factors influencing re-operation rates. METHODS: Using data from nationwide Danish databases covering 2010-2021, we identified patients diagnosed with abscess-forming PSD undergoing lateral I&D as the initial treatment for PSD. Patients were followed up until re-operation, death, emigration, or the end of the study period. Stratified by sex, the risk of re-operation was reported as a cumulative incidence function (CIF). To explore risks, we used Cox regression analysis to calculate crude and age-adjusted hazard ratios (aHR). RESULTS: Of 8251 (62% male) patients included, 2455 underwent re-operation for PSD. The overall five-year CIF was 32% for males and 33% for females. In males, the five-year CIF decreased from 47% among 0- to 16-year-olds to 14% among 50+ year-olds. In females, the corresponding numbers were 37% and 13%, respectively. A family history of PSD was found to increase re-operation risk, especially among female patients (aHR: 1.64 (95% confidence interval [95% CI]: 1.39-1.93)). The risk increases following the second and third consecutive I&D procedures to 52% and 69% in males, and to 57% and 64% in females, respectively. CONCLUSION: As roughly two-thirds of patients do not require additional surgery, our findings do not support mandatory follow-up with definitive surgery for all PSD patients undergoing I&D. For certain high-risk subgroups, however, subsequent definitive surgery may be appropriate.", "provenance": [ { "field": "population", "quote": "patients diagnosed with abscess-forming PSD undergoing lateral I&D as the initial treatment for PSD" }, { "field": "intervention", "quote": "lateral incision and drainage (I&D) considered the gold standard" }, { "field": "comparator", "quote": "Patients were followed up until re-operation, death, emigration, or the end of the study period." }, { "field": "primaryOutcome", "quote": "To evaluate re-operation rates following abscess-forming PSD treatment with lateral I&D" }, { "field": "result", "quote": "The overall five-year CIF was 32% for males and 33% for females." }, { "field": "result", "quote": "As roughly two-thirds of patients do not require additional surgery, our findings do not support mandatory follow-up with definitive surgery for all PSD patients undergoing I&D." }, { "field": "n", "quote": "Of 8251 (62% male) patients included, 2455 underwent re-operation for PSD." }, { "field": "followUp", "quote": "The overall five-year CIF was 32% for males and 33% for females." } ] }, { "id": "pmid:41058826", "pmid": "41058826", "doi": "10.7759/cureus.91699", "nctId": null, "pmcid": "PMC12498115", "title": "Comparison of Simple Drainage Versus Drainage With Tract Destruction in the Management of Pilonidal Abscess", "firstAuthor": "Hawezy", "multipleAuthors": false, "journal": "Cureus", "year": 2025, "design": "retrospective", "n": 480, "nField": "reported", "population": "patients with acute pilonidal abscesses", "intervention": "surgical drainage combined with destruction of the sinus tract", "comparator": "surgical drainage alone (simple drainage)", "primaryOutcome": "recurrence of the abscess after at least nine months of follow-up", "result": "recurrence was much lower when the sinus tract was destroyed along with drainage (11.8%) compared to drainage alone (55.7%)", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "Large patient numbers make the comparison informative, but the study does not describe random assignment, so bias between groups cannot be ruled out.", "directness": "indirect", "limitations": "The abstract does not mention randomization, blinding, or how patients were assigned to each group, and it does not address at-home self-drainage versus natural drainage, only two surgical techniques.", "followUp": "nine months", "plainFinding": "Destroying tract cuts recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41058826/", "sourceText": "INTRODUCTION: Pilonidal disease is an acquired condition primarily affecting the gluteal cleft and sacrococcygeal area, often complicated by the formation of sinuses and abscesses. Despite multiple surgical options, there is no universally accepted standard treatment. This study aimed to compare the outcomes of simple drainage alone versus drainage combined with sinus destruction using the same incision technique. METHODS: Between February 2019 and March 2024, a total of 480 patients with acute pilonidal abscesses received treatment. Of these, 235 underwent simple drainage (Group A), while 245 had drainage with sinus damage (Group B). All participants were followed for at least nine months, with recurrence rates recorded throughout. Statistical analysis was performed using SPSS version 28 (IBM Corp., Armonk, NY, USA). RESULTS: In Group A, 131 patients (55.7%) experienced a recurrence, compared to only 29 patients (11.8%) in Group B. This difference is statistically significant (p < 0.001). The majority of recurrences occurred in younger, male, and overweight individuals. CONCLUSION: Removing the sinus tract during the same procedure as abscess drainage greatly lowers the chance of the abscess recurring, compared to drainage alone. Incorporating sinus destruction into the initial surgery might eliminate the need for subsequent operations for people with pilonidal abscesses.", "provenance": [ { "field": "population", "quote": "a total of 480 patients with acute pilonidal abscesses received treatment" }, { "field": "intervention", "quote": "245 had drainage with sinus damage (Group B)" }, { "field": "comparator", "quote": "235 underwent simple drainage (Group A)" }, { "field": "primaryOutcome", "quote": "recurrence rates recorded throughout" }, { "field": "result", "quote": "In Group A, 131 patients (55.7%) experienced a recurrence, compared to only 29 patients (11.8%) in Group B." }, { "field": "n", "quote": "a total of 480 patients with acute pilonidal abscesses received treatment" } ] }, { "id": "pmid:39875233", "pmid": "39875233", "doi": "10.1016/j.jviscsurg.2024.12.005", "nctId": null, "pmcid": null, "title": "Management of pilonidal sinus and recurrences in 2025", "firstAuthor": "Darnis", "multipleAuthors": true, "journal": "J Visc Surg", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus/cyst, including those with abscess or suppuration", "intervention": "emergency incision and drainage in the operating room, or elective surgery (excision, flap closure, minimally invasive techniques)", "comparator": "medical treatment with analgesics, local antiseptics and sometimes antibiotics", "primaryOutcome": "management approach, healing, recurrence and complications", "result": "abstract describes treatment options and their complication/recurrence rates but does not address self-popping or spontaneous drainage at home", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a narrative overview of surgical management, not a study testing self-drainage versus letting a cyst drain on its own, so it cannot answer the specific question.", "directness": "indirect", "limitations": "abstract does not report study methodology, numbers, or compare self-drainage to spontaneous drainage; it is a general review of surgical and medical management of pilonidal disease and its recurrence", "followUp": "", "plainFinding": "Doesn't address popping cysts yourself.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39875233/", "sourceText": "Pilonidal sinus is a common pathology of the intergluteal cleft that can develop into abscess or suppuration. This lesion corresponds histologically to a granuloma that organizes around foreign bodies, most often hairs, and fistulizes to the skin through partially epithelialized orifices. If suppuration and abscess develop, treatment is based either on medical treatment combining analgesics, local antiseptics and sometimes antibiotics, or on emergency incision and drainage in the operating room. This is performed in more than 10,000 patients per year in France. Outside of emergencies, elective surgery for pilonidal sinus is indicated to treat bothersome symptoms or to avoid the risk of recurrent abscess. The surgical indication must take into account the patient's risk factors, particularly active smoking, that increase the risk of postoperative complications and recurrence. Elective intervention is performed on more than 30,000 patients per year in France. Radical excision followed by secondary healing is the most commonly performed option. This strategy carries a risk of failure or recurrence for at least 10% of patients. Primary closure after excision can reduce the time for healing and convalescence, but at the cost of more frequent infectious complications. Midline closure should be avoided, in favor of paramedian or flap closure. Minimally invasive techniques are being developed that combine the extraction of foreign bodies and mechanical debridement or thermal or chemical cautery of the granulomatous walls. They avoid complex and unpleasant nursing care of secondarily healing wounds, at the cost of a recurrence rate equivalent to that from excision techniques. They have the merit of avoiding difficult situations of failure to heal or recurrence after radical excision that are associated with a clear deterioration in the quality of life. The treatment of surgical failures is complex, and combines comprehensive patient care (smoking cessation, anti-infectious treatments, treatment of excess weight, avoidance of a sedentary lifestyle) and often a repeat operation. Minimally invasive treatments, particularly laser treatments, have their place in these difficult situations.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus is a common pathology of the intergluteal cleft that can develop into abscess or suppuration." }, { "field": "intervention", "quote": "treatment is based either on medical treatment combining analgesics, local antiseptics and sometimes antibiotics, or on emergency incision and drainage in the operating room" }, { "field": "comparator", "quote": "medical treatment combining analgesics, local antiseptics and sometimes antibiotics" }, { "field": "primaryOutcome", "quote": "This strategy carries a risk of failure or recurrence for at least 10% of patients." }, { "field": "result", "quote": "Primary closure after excision can reduce the time for healing and convalescence, but at the cost of more frequent infectious complications." } ] }, { "id": "pmid:39635960", "pmid": "39635960", "doi": "10.1111/codi.17254", "nctId": null, "pmcid": "PMC11683315", "title": "Acute pilonidal abscess: Prospective nationwide audit in the Netherlands", "firstAuthor": "Huurman", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2024, "design": "prospective-cohort", "n": 208, "nField": "reported", "population": "patients who had surgery for a pilonidal abscess (a pus pocket near the tailbone)", "intervention": "doctors cutting open and draining the abscess (incision and drainage)", "comparator": "no comparison group was studied", "primaryOutcome": "how well the wound healed, time to heal, and complications after drainage", "result": "only 42.2% of wounds had fully healed at follow-up, with a median of 43 days to closure, and 4.4% had complications; 7.3% had the abscess come back within a year", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is an observational study of surgical drainage by doctors with no comparison group, so it cannot tell you whether self-popping or letting it drain on its own is safe or effective.", "directness": "indirect", "limitations": "no control group, only measured surgeon-performed drainage in hospitals, not self-treatment or spontaneous drainage at home", "followUp": "1 year", "plainFinding": "Surgical drainage healed less than half.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39635960/", "sourceText": "AIM: The aim of this study was to assess Dutch surgical practice and outcomes for acute pilonidal abscess. METHOD: Patients with pilonidal sinus disease (PSD) who underwent surgical treatment between 1 March 2020 and 1 March 2021 at 36 participating hospitals were included in a prospective observational cohort study. For the present study, only patients with an acute abscess were included for analysis. Outcomes included symptoms, wound healing, time to resume daily activities and complications. Follow-up was 1 year and included questionnaires on recurrent abscesses, symptomatic chronic PSD, quality of life and patient-reported experience measures. RESULTS: Of 681 included patients, 208 presented with an acute pilonidal abscess. Incision and drainage (I&D) was performed in 205 of these patients (99%). The wound healing rate after I&D was 42.2% at the outpatient clinic, with a median time to closure of 43 days. The complication rate was 4.4%. One-year questionnaires were completed by 158 out of 205 patients (77.1%). Fifteen patients (7.3%) had a recurrent abscess within 1 year. The symptomatic chronic PSD rate was 8.8%. CONCLUSION: Of all the patients presenting with PSD in this prospective national study cohort, 30% had a pilonidal abscess. Incision and drainage showed a low complication rate but successful wound healing in less than half of the patients. The study showed that 91.2% of patients did not undergo additional surgical treatment for symptomatic chronic PSD within 1 year of follow-up.", "provenance": [ { "field": "population", "quote": "Patients with pilonidal sinus disease (PSD) who underwent surgical treatment" }, { "field": "intervention", "quote": "Incision and drainage (I&D) was performed in 205 of these patients (99%)" }, { "field": "comparator", "quote": "Of 681 included patients, 208 presented with an acute pilonidal abscess." }, { "field": "primaryOutcome", "quote": "Outcomes included symptoms, wound healing, time to resume daily activities and complications." }, { "field": "result", "quote": "The wound healing rate after I&D was 42.2% at the outpatient clinic, with a median time to closure of 43 days. The complication rate was 4.4%." }, { "field": "n", "quote": "Of 681 included patients, 208 presented with an acute pilonidal abscess." }, { "field": "followUp", "quote": "Follow-up was 1 year" } ] }, { "id": "pmid:39461136", "pmid": "39461136", "doi": "10.1016/j.ijscr.2024.110500", "nctId": null, "pmcid": "PMC11541939", "title": "Pilonidal granuloma formation after an incision and drainage procedure is associated with retained hair within the sinus - A case series", "firstAuthor": "Nepomuceno", "multipleAuthors": true, "journal": "Int J Surg Case Rep", "year": 2024, "design": "case-series", "n": 2, "nField": "reported", "population": "two adolescent males with pilonidal disease (gluteal cleft abscess)", "intervention": "incision and drainage of pilonidal abscess", "comparator": "none (natural course after incision and drainage)", "primaryOutcome": "formation of granuloma with recurring drainage at the incision site", "result": "Both patients developed a draining granuloma after incision and drainage, caused by hair retained in the sinus, requiring further surgery to remove the hair and granuloma", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is just two patient stories, not a controlled study, so it can't prove what causes problems or how common they are.", "directness": "direct", "limitations": "Only two cases reported; no comparison group; does not describe outcomes of self-popping versus other drainage methods.", "followUp": "", "plainFinding": "Draining after incision can recur with hair.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39461136/", "sourceText": "INTRODUCTION AND IMPORTANCE: Pilonidal disease may present with a draining secondary sinus or granuloma, but the development of these findings is not well-characterized. CASE PRESENTATION: Two adolescent males presented with pilonidal disease. The first patient had a gluteal cleft abscess, and an incision and drainage procedure was performed. Although the abscess resolved, the incision site formed a granuloma with intermittent draining wound with granulation tissue. He underwent a pit-picking procedure along with excision of the granuloma. A large amount of hair was also removed from within the pilonidal sinus. The second patient underwent an incision and drainage procedure to treat the pilonidal abscess. The incision site evolved into a granuloma with recurring drainage. A pit-picking procedure was performed, and the granuloma was excised. During the excision, a moderate amount of hair was evacuated from the pilonidal sinus. CLINICAL DISCUSSION: Many pilonidal patients present with a granuloma or secondary sinus at the gluteal cleft, but there has been no documentation of the natural history of this development. The role of hair is central to pilonidal disease pathophysiology and is a known factor in foreign body granuloma formation - a cutaneous inflammatory response to endogenous or exogenous material in the dermis that is not broken down readily by macrophages. CONCLUSION: Even though the pilonidal abscess was drained with an incision, a granuloma was able to form with recurrent drainage when hair was retained within the pilonidal sinus.", "provenance": [ { "field": "n", "quote": "Two adolescent males presented with pilonidal disease." }, { "field": "population", "quote": "Two adolescent males presented with pilonidal disease." }, { "field": "intervention", "quote": "an incision and drainage procedure was performed" }, { "field": "comparator", "quote": "Although the abscess resolved, the incision site formed a granuloma with intermittent draining wound with granulation tissue." }, { "field": "primaryOutcome", "quote": "the incision site formed a granuloma with intermittent draining wound with granulation tissue" }, { "field": "result", "quote": "Even though the pilonidal abscess was drained with an incision, a granuloma was able to form with recurrent drainage when hair was retained within the pilonidal sinus." } ] }, { "id": "pmid:38478417", "pmid": "38478417", "doi": "10.12968/bjcn.2024.29.Sup3.S26", "nctId": null, "pmcid": null, "title": "Commentary on packing vs non-packing of pilonidal sinus cavities after incision and drainage", "firstAuthor": "King", "multipleAuthors": true, "journal": "Br J Community Nurs", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease (a skin condition near the tailbone) who have had surgical incision and drainage", "intervention": "packing the wound cavity after incision and drainage", "comparator": "leaving the wound cavity unpacked (non-packing) after incision and drainage", "primaryOutcome": "not clearly stated; the commentary discusses outcomes from a prior systematic review rather than reporting its own", "result": "The abstract does not report a specific result; it describes critiquing and expanding on another review's findings", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a commentary critiquing another review's methods rather than new research, so it carries little weight on its own.", "directness": "indirect", "limitations": "The abstract does not report study limitations of its own; it is a critique of another paper's methodology.", "followUp": "", "plainFinding": "Commentary discusses debate, no clear result.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38478417/", "sourceText": "Pilonidal sinus disease (PSD) manifests as an inflammatory skin condition typically emerging within the anal cleft. The prevalence of this disease varies in high income countries. This disease is associated with significant physical and psychosocial distress. Surgery is an option for managing PSD; yet, surgical methods vary, and a universally accepted gold standard approach is lacking, leading to current practices that are diverse and subject to ongoing debate. One such point of contention revolves around the decision to use packing or opt for a non-packing approach following surgery. Mohamedahmed et al (2021) conducted a systematic review to evaluate the comparative outcomes of packing versus non-packing of an abscess cavity following incision and drainage of cutaneous abscess on any part of the body. This commentary aims to critically appraise the methods used within the review by Mohamedahmed et al (2021) and expand upon the findings in the context of treatment and management of PSD.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus disease (PSD) manifests as an inflammatory skin condition typically emerging within the anal cleft." }, { "field": "intervention", "quote": "packing or opt for a non-packing approach following surgery" }, { "field": "comparator", "quote": "packing versus non-packing of an abscess cavity following incision and drainage of cutaneous abscess on any part of the body" }, { "field": "primaryOutcome", "quote": "to evaluate the comparative outcomes of packing versus non-packing of an abscess cavity following incision and drainage of cutaneous abscess" }, { "field": "result", "quote": "This commentary aims to critically appraise the methods used within the review by Mohamedahmed et al (2021) and expand upon the findings in the context of treatment and management of PSD." } ] }, { "id": "pmid:36542008", "pmid": "36542008", "doi": "10.1590/0102-672020220002e1713", "nctId": null, "pmcid": "PMC9767422", "title": "RADICAL VERSUS CONSERVATIVE METHODS IN ONE-STAGE PILONIDAL ABSCESS SURGERY: THE EXPERIENCE OF A TUNISIAN CENTER", "firstAuthor": "Mahjoubi", "multipleAuthors": true, "journal": "Arq Bras Cir Dig", "year": 2022, "design": "retrospective", "n": 57, "nField": "reported", "population": "patients who had surgery for a pilonidal abscess", "intervention": "radical excision surgery of the abscess", "comparator": "conservative incision (with drainage or curettage) of the abscess", "primaryOutcome": "recurrence of the pilonidal disease after surgery", "result": "excision had lower recurrence than incision (19% vs 54%) but slower return to activity, while incision healed the wound faster", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a small, non-randomized comparison of surgeon-performed techniques based on medical records and patient interviews, which is weak evidence.", "directness": "indirect", "limitations": "Not randomized, small sample, retrospective record review and patient interviews, both treatments performed surgically by doctors rather than self-management.", "followUp": "", "plainFinding": "Surgical excision cuts recurrence, but heals slower.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36542008/", "sourceText": "BACKGROUND: Surgical treatment for pilonidal abscess is the gold standard, but not yet well codified. Different techniques proposed can be conservative or radical. AIMS: The aim of our study was to compare postoperative outcomes of both methods in one-stage treatment strategy. METHODS: This is a comparative study including patients operated on for pilonidal abscess, with a satisfactory postoperative follow-up, over a period of 4 years. We looked for the occurrence of postoperative recurrence in the medical records or by interviewing reachable patients. RESULTS: We analyzed 57 patients: 33 males and 24 females. The mean age was 26.9±10 years. The type of operation was excision in 46 (81%) cases and incision in 11 (19%) cases associated with curettage in three cases and drainage in 1 case. There was no statistically significant relationship between the type of surgery and the occurrence of postoperative surgical complications (p=1) and hospital stay (p=0.4). Excision of pilonidal abscess was significantly associated with a longer time to return to activity (p=0.04). Conservative surgery was significantly associated with faster healing of the surgical wound (p<0.001). The recurrence rate was 19% in radical surgery and 54% in conservative surgery. Radical surgery was significantly associated with a lower recurrence rate than incision procedure (p=0.02). CONCLUSIONS: Excision of pilonidal abscess was the common technique in our series, with a significantly lower rate of recurrence of the disease than after incision. However, the long convalescence following excision and the longer operating time, particularly in an emergency context, may sometimes lead to choosing conservative surgery.", "provenance": [ { "field": "n", "quote": "We analyzed 57 patients" }, { "field": "population", "quote": "patients operated on for pilonidal abscess, with a satisfactory postoperative follow-up" }, { "field": "intervention", "quote": "The type of operation was excision in 46 (81%) cases" }, { "field": "comparator", "quote": "incision in 11 (19%) cases associated with curettage in three cases and drainage in 1 case" }, { "field": "primaryOutcome", "quote": "We looked for the occurrence of postoperative recurrence in the medical records or by interviewing reachable patients" }, { "field": "result", "quote": "The recurrence rate was 19% in radical surgery and 54% in conservative surgery. Radical surgery was significantly associated with a lower recurrence rate than incision procedure (p=0.02)." }, { "field": "result", "quote": "Conservative surgery was significantly associated with faster healing of the surgical wound (p<0.001)." }, { "field": "result", "quote": "Excision of pilonidal abscess was significantly associated with a longer time to return to activity (p=0.04)." } ] }, { "id": "pmid:36102566", "pmid": "36102566", "doi": "10.1097/XCS.0000000000000356", "nctId": null, "pmcid": null, "title": "Resolution of Mild Pilonidal Disease in Adolescents Without Resection", "firstAuthor": "Check", "multipleAuthors": true, "journal": "J Am Coll Surg", "year": 2022, "design": "case-series", "n": 102, "nField": "reported", "population": "Adolescents and young adults with mild pilonidal disease", "intervention": "Improved hygiene, excision of midline pits under local anesthesia, and laser ablation of hair follicles", "comparator": "No comparison group; outcomes tracked over time in a single treatment pathway", "primaryOutcome": "Resolution of pilonidal disease", "result": "77 of 78 patients who continued care had resolution of their pilonidal disease after an average of 3 laser treatments and about 1 pit excision over roughly 30 weeks", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, uncontrolled case series with nearly a quarter of patients lost to follow-up, so it can't prove the approach works better than other options.", "directness": "indirect", "limitations": "No control group, 24 of 102 patients lost to follow-up, single clinic experience", "followUp": "30 ± 19 weeks", "plainFinding": "Minor in-office procedure resolved most cases.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36102566/", "sourceText": "BACKGROUND: Pilonidal disease is a common condition of the gluteal crease, affecting around 1 in 2,000 adolescents and young adults. 1 Traditional options for management of pilonidal disease include improved hygiene with or without hair removal or resection of the nidus. Given a high recurrence rate associated with hygiene alone, nidus resection is often recommended, even for patients with mild pilonidal disease, despite significant postoperative morbidity. We present a consecutive series of patients with mild pilonidal disease managed in a dedicated Pilonidal Care Clinic using an alternate approach directed toward source control: improved hygiene to limit debris in the gluteal crease, excision of midline pilonidal pits under local anesthesia to prevent intrusion of debris with drainage of any nidus present, and laser ablation of midline follicles to prevent new pits from forming. 2. STUDY DESIGN: Data on demographics, disease severity, symptom scoring, treatments provided, and outcome for consecutive new patients presenting to an outpatient pilonidal care clinic with mild disease between August 2017 and September 2020 were analyzed. RESULTS: One hundred two patients presented; their mean age was 16.3 years, 56 (55%) were female, and 42 (41%) had undergone prior nidus incision and drainage. Twenty-four were lost to follow up, and 77 of the 78 who continued care had resolution of their pilonidal disease after a mean of 3 ± 2.5 laser epilations and 1.3 ± 1 pit excisions during 4 ± 2 clinic visits over a treatment duration of 30 ± 19 weeks. CONCLUSION: Mild pilonidal disease may be resolved with improved hygiene, pit excision, and laser epilation with minimal morbidity and no activity restrictions. Adoption of this approach may keep a large number of patients with pilonidal disease from undergoing unindicated resection.", "provenance": [ { "field": "population", "quote": "consecutive new patients presenting to an outpatient pilonidal care clinic with mild disease" }, { "field": "intervention", "quote": "improved hygiene to limit debris in the gluteal crease, excision of midline pilonidal pits under local anesthesia to prevent intrusion of debris with drainage of any nidus present, and laser ablation of midline follicles to prevent new pits from forming" }, { "field": "comparator", "quote": "Traditional options for management of pilonidal disease include improved hygiene with or without hair removal or resection of the nidus." }, { "field": "primaryOutcome", "quote": "outcome for consecutive new patients" }, { "field": "result", "quote": "Twenty-four were lost to follow up, and 77 of the 78 who continued care had resolution of their pilonidal disease after a mean of 3 ± 2.5 laser epilations and 1.3 ± 1 pit excisions during 4 ± 2 clinic visits over a treatment duration of 30 ± 19 weeks." }, { "field": "n", "quote": "One hundred two patients presented" } ] }, { "id": "pmid:35677490", "pmid": "35677490", "doi": "10.47717/turkjsurg.2021.5002", "nctId": null, "pmcid": "PMC9130949", "title": "The comparison of short-term results of marsupialization method in operated patients with acute pilonidal abscess and chronic pilonidal sinus", "firstAuthor": "Öztürk", "multipleAuthors": false, "journal": "Turk J Surg", "year": 2021, "design": "retrospective", "n": 58, "nField": "reported", "population": "patients with acute pilonidal abscess or chronic pilonidal sinus disease who had surgery", "intervention": "marsupialization surgery (excision and stitching the wound edges open)", "comparator": "comparison between patients with acute abscess versus chronic sinus disease, both treated the same surgical way", "primaryOutcome": "time for the wound to heal, wound length, operation time, and hospital stay", "result": "no significant difference in healing time between the two groups, though wound length was shorter in the chronic sinus group", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a small, single-center study comparing two surgically treated patient groups without randomization or a true control group, so it carries limited weight.", "directness": "indirect", "limitations": "Small sample size, no randomization, no comparison to leaving the cyst to drain on its own or to self-draining at home, all patients underwent surgery performed by clinicians.", "followUp": "", "plainFinding": "Surgery works similarly for both.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35677490/", "sourceText": "OBJECTIVES: This study aimed to compare the short term results of the marsupialization method for the treatment of patients with acute pilonidal abscess and chronic pilonidal sinus disease treated in single step and to investigate the feasibility of final pilonidal sinus treatment in single step in patients with pilonidal abscess. MATERIAL AND METHODS: A total of 58 patients who were operated on using the marsupialization method were included in this study. Patients with acute pilonidal abscess were included in Group 1 (23 patients) and those with chronic pilonidal sinus disease were included in Group 2 (35 patients). Pilonidal sinus was excised as a whole by a vertical elliptic incision, with some surrounding intact tissue. After excision, the wound edges were sutured to the postsacral fascia. Daily dressings were performed by relatives at home. The patients were instructed to visit the hospital for follow-up 1-2 times a week. Student's t-test was used to compare the parameters between the groups. RESULTS: The mean wound length was 73.4 and 61.7 mm in Group 1 and Group 2, respectively. The mean duration of wound closure was 59.3 and 54.1 days in Group 1 and Group 2, respectively. There was no significant difference between the groups in terms of age, operation time, hospital stay, and duration of wound closure; however, wound length was significantly shorter in Group 2 than in Group 1. CONCLUSION: The definitive treatment of acute pilonidal abscess can be achieved in single step by using marsupialization method as well as in patients with chronic pilonidal disease.", "provenance": [ { "field": "n", "quote": "A total of 58 patients who were operated on using the marsupialization method were included in this study." }, { "field": "population", "quote": "Patients with acute pilonidal abscess were included in Group 1 (23 patients) and those with chronic pilonidal sinus disease were included in Group 2 (35 patients)." }, { "field": "intervention", "quote": "Pilonidal sinus was excised as a whole by a vertical elliptic incision, with some surrounding intact tissue. After excision, the wound edges were sutured to the postsacral fascia." }, { "field": "comparator", "quote": "This study aimed to compare the short term results of the marsupialization method for the treatment of patients with acute pilonidal abscess and chronic pilonidal sinus disease treated in single step" }, { "field": "primaryOutcome", "quote": "There was no significant difference between the groups in terms of age, operation time, hospital stay, and duration of wound closure; however, wound length was significantly shorter in Group 2 than in Group 1." }, { "field": "result", "quote": "There was no significant difference between the groups in terms of age, operation time, hospital stay, and duration of wound closure; however, wound length was significantly shorter in Group 2 than in Group 1." } ] }, { "id": "pmid:34216557", "pmid": "34216557", "doi": "10.1016/j.nwh.2021.06.004", "nctId": null, "pmcid": null, "title": "Presentation, Management, and Women's Health Implications of Pilonidal Disease", "firstAuthor": "Rudd", "multipleAuthors": true, "journal": "Nurs Womens Health", "year": 2021, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal disease, including women who are often misdiagnosed", "intervention": "clinical assessment, treatment, and patient education for pilonidal disease", "comparator": "", "primaryOutcome": "accurate diagnosis and quality of life impact", "result": "Abstract does not report comparison of self-draining versus spontaneous drainage; it discusses diagnosis, treatment, and education broadly.", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general review article with no data, comparison, or specific findings about self-popping versus natural drainage.", "directness": "indirect", "limitations": "Abstract does not mention any limitations; it does not address the specific question of self-draining versus spontaneous drainage.", "followUp": "", "plainFinding": "Does not address self-popping question.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34216557/", "sourceText": "Many people think of pilonidal disease (PD) in its acute presentation, which is an abscess at the gluteal cleft that is warm and tender with purulent drainage. In this article, we describe how PD is an acute, chronic, and recurring disease that requires clinicians to be vigilant in assessments, treatments, therapies, referrals, and patient education. Because PD is more common in men than women, it is often misdiagnosed and undertreated in female patients. Its impact on an individual's life, work, and health, however, cannot be underestimated. Obtaining an accurate diagnosis and appropriate care can positively impact quality of life for people with PD.", "provenance": [ { "field": "population", "quote": "Because PD is more common in men than women, it is often misdiagnosed and undertreated in female patients." }, { "field": "intervention", "quote": "requires clinicians to be vigilant in assessments, treatments, therapies, referrals, and patient education" }, { "field": "primaryOutcome", "quote": "Obtaining an accurate diagnosis and appropriate care can positively impact quality of life for people with PD." }, { "field": "result", "quote": "In this article, we describe how PD is an acute, chronic, and recurring disease that requires clinicians to be vigilant in assessments, treatments, therapies, referrals, and patient education." } ] }, { "id": "pmid:33298356", "pmid": "33298356", "doi": "10.1016/j.jemermed.2020.10.043", "nctId": null, "pmcid": null, "title": "Abscess Management: An Evidence-Based Review for Emergency Medicine Clinicians", "firstAuthor": "Menegas", "multipleAuthors": true, "journal": "J Emerg Med", "year": 2021, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with abscesses treated in the emergency department, including pilonidal abscesses", "intervention": "needle aspiration with antibiotics for draining the abscess", "comparator": "traditional incision and drainage", "primaryOutcome": "effectiveness of abscess management approach", "result": "needle aspiration with antibiotics may be a suitable alternative to incision and drainage for pilonidal abscesses", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review summarizing other studies without describing its own methods or giving numbers, so it can't be weighed as new evidence.", "directness": "indirect", "limitations": "This is a general review for ER doctors on professionally draining abscesses, not about whether someone should pop a cyst themselves at home.", "followUp": "", "plainFinding": "Doctor-performed drainage, not self-popping, discussed", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33298356/", "sourceText": "BACKGROUND: Abscesses are commonly evaluated and managed in the emergency department. Recent research has evaluated the use of ultrasonography, packing, incision and drainage (I&D), and antibiotics. There are evidence-based nuances to the management of specific types of abscesses, such as Bartholin, breast, dental, hidradenitis suppurativa, peritonsillar, and pilonidal abscesses. OBJECTIVE: This review provides emergency medicine clinicians with a summary of the current literature regarding abscess management in the emergency department. DISCUSSION: Ultrasound is valuable in diagnosing abscesses that are not clinically evident and in guiding I&D procedures. Although I&D is traditionally followed by packing, this practice may be unnecessary for small abscesses. Antibiotics, needle aspiration, and loop drainage are suitable alternatives to I&D of abscesses with certain characteristics. Oral antibiotics can improve outcomes after I&D, although this improvement must be weighed against potential risks. Many strategies are useful in managing Bartholin abscesses, with the Word catheter proving consistently effective. Needle aspiration is the recommended first-line therapy for small breast abscesses. Dental abscesses are often diagnosed with clinical examination alone, but ultrasound may be a useful adjunct. Acute abscess formation caused by hidradenitis suppurativa should be managed surgically by excision when possible, because I&D has a high rate of abscess recurrence. Peritonsillar abscesses can be diagnosed with either intraoral or transcervical ultrasound if clinical examination is inconclusive. Needle aspiration and I&D are both suitable for the management of peritonsillar abscesses. Pilonidal abscesses have traditionally been managed with I&D, but needle aspiration with antibiotics may be a suitable alternative. CONCLUSIONS: This review evaluates the recent literature surrounding abscess management for emergency medicine clinicians.", "provenance": [ { "field": "population", "quote": "Abscesses are commonly evaluated and managed in the emergency department" }, { "field": "intervention", "quote": "needle aspiration with antibiotics may be a suitable alternative" }, { "field": "comparator", "quote": "Pilonidal abscesses have traditionally been managed with I&D" }, { "field": "primaryOutcome", "quote": "This review provides emergency medicine clinicians with a summary of the current literature regarding abscess management in the emergency department." }, { "field": "result", "quote": "Pilonidal abscesses have traditionally been managed with I&D, but needle aspiration with antibiotics may be a suitable alternative." } ] }, { "id": "pmid:32660027", "pmid": "32660027", "doi": "10.3390/medicina56070341", "nctId": null, "pmcid": "PMC7404453", "title": "Treatment Strategies for Pilonidal Sinus Disease in Switzerland and Austria", "firstAuthor": "Lamdark", "multipleAuthors": true, "journal": "Medicina (Kaunas)", "year": 2020, "design": "registry", "n": 92, "nField": "reported", "population": "patients with pilonidal sinus disease treated at hospitals in Switzerland and Austria", "intervention": "various surgical treatment strategies for pilonidal disease (including incision and drainage, primary resection, tissue flaps, minimally invasive techniques)", "comparator": "treatment practices compared between Switzerland and Austria, and over time", "primaryOutcome": "type of treatment strategy used, length of stay, and recurrence rate", "result": "Treatment approaches varied widely between countries; recurrence rate was similar (20%) in both, with Austria using more inpatient care, longer hospital stays, and more flap procedures, while Switzerland used more minimally invasive techniques", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a survey of hospital practices, not a controlled study of outcomes, so it cannot show whether one treatment approach is better or safer.", "directness": "indirect", "limitations": "Survey-based data from participating hospitals only (47% response rate), compares practice patterns rather than testing outcomes of self-drainage versus medical drainage", "followUp": "", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32660027/", "sourceText": "Background and objective: No current nationwide consensus exists on pilonidal disease (PD) treatment in Switzerland and Austria. The objective of this study was to assess and compare the spectrum of PD treatment strategies in Switzerland and Austria. Materials and Methods: A survey including 196 certified institutions (Switzerland, N = 99 and Austria, N = 97) was performed. Treatment strategies for both chronic and acute pilonidal disease were investigated, as well as evolution of treatment over the last 20 years. Results: In total, 92 of 196 (47%) hospitals participated in the survey. Recurrence rate (20%) was similar between the two countries. In acute pilonidal disease, a two-stage approach with incision and drainage as the first step was preferred over a one-stage procedure in both countries. In Austria, all patients with chronic pilonidal disease were treated as inpatients, whereas 28% of patients in Switzerland were treated on an outpatient basis (p = 0.0019). Median length of hospital stay was double in Austria (four days) compared to Switzerland (two days; p < 0.001). Primary resection and off-midline closure (p = 0.017) and the use of tissue flaps (p = 0.023) were performed more commonly in Austria than in Switzerland. Minimally invasive techniques were performed more often in Switzerland than in Austria (52% vs. 4%, p < 0.001). Overall, wide excision with secondary wound healing or midline closures declined over the last 20 years. Conclusion: Treatment strategies for chronic PD differ between Austria and Switzerland with more and longer inpatient care in Austria, increasingly minimally invasive approaches in Switzerland, and outdated procedures still being performed in both countries. Overall, heterogeneity of practice dominates in both countries.", "provenance": [ { "field": "population", "quote": "Treatment strategies for both chronic and acute pilonidal disease were investigated" }, { "field": "n", "quote": "In total, 92 of 196 (47%) hospitals participated in the survey." }, { "field": "intervention", "quote": "In acute pilonidal disease, a two-stage approach with incision and drainage as the first step was preferred over a one-stage procedure in both countries." }, { "field": "comparator", "quote": "Treatment strategies for chronic PD differ between Austria and Switzerland" }, { "field": "primaryOutcome", "quote": "Recurrence rate (20%) was similar between the two countries." }, { "field": "result", "quote": "Minimally invasive techniques were performed more often in Switzerland than in Austria (52% vs. 4%, p < 0.001)." } ] }, { "id": "pmid:30661599", "pmid": "30661599", "doi": "10.1016/j.jpedsurg.2018.10.021", "nctId": null, "pmcid": null, "title": "Pit-picking resolves pilonidal disease in adolescents", "firstAuthor": "Delshad", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2019, "design": "case-series", "n": 58, "nField": "reported", "population": "adolescents with pilonidal disease", "intervention": "a minor office procedure called pit-picking done under local anesthesia, with cleaning and hair removal", "comparator": "none; outcomes compared before and after the procedure", "primaryOutcome": "whether patients became symptom-free after the procedure", "result": "92% of patients with follow-up were symptom-free an average of 5 months later", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small case series with no comparison group and short follow-up, so it only shows what happened after a doctor-performed procedure, not what happens with self-popping or natural drainage.", "directness": "indirect", "limitations": "No control group, 12% lost to follow-up, and short average follow-up of 5 months; authors say longer follow-up is needed to know recurrence rates.", "followUp": "5.0 months", "plainFinding": "Doctor-done pit-picking helped, not self-popping", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30661599/", "sourceText": "PURPOSE: The purpose of the study was to evaluate the outcome of pit-picking on adolescents with pilonidal disease. METHODS: Patients presenting to a Pilonidal Clinic were managed by evacuation of any un-drained collections, soaking, and as needed, hair removal. Once active inflammation resolved, they underwent pit-picking under local anesthesia. Those with >3 pits underwent sequential pit-pickings 2 months apart. Hirsute patients also underwent laser hair epilation. Pilonidal disease was stratified by severity. Patient symptoms were collected prospectively and reviewed. RESULTS: Fifty-eight patients underwent at least one pit-picking from February 2016 to September 2017. There were 40 (69%) males with a mean age of 17.7 years (range 13-24). Thirty-seven hirsute patients (64%) underwent a series of laser epilation treatments. Patients required from 0 to 3 days of non-narcotic analgesia, and all returned promptly to pre-procedure activities. Seven patients (12%) were lost to follow-up. Of the 51 patients with follow-up data, 47 (92%) were symptom-free an average of 5.0 months (range 1-20) post-procedure. Four patients (8%) had persistent intermittent drainage. CONCLUSION: Pit-picking is a simple office procedure that may resolve pilonidal disease in many adolescents. A longer follow-up interval is needed to determine the long-term recurrence rate. TYPE OF STUDY: Case Series. LEVEL OF EVIDENCE: Level IV.", "provenance": [ { "field": "population", "quote": "Patients presenting to a Pilonidal Clinic" }, { "field": "population", "quote": "adolescents with pilonidal disease" }, { "field": "intervention", "quote": "they underwent pit-picking under local anesthesia" }, { "field": "intervention", "quote": "managed by evacuation of any un-drained collections, soaking, and as needed, hair removal" }, { "field": "comparator", "quote": "TYPE OF STUDY: Case Series." }, { "field": "primaryOutcome", "quote": "Patient symptoms were collected prospectively and reviewed." }, { "field": "result", "quote": "47 (92%) were symptom-free an average of 5.0 months (range 1-20) post-procedure" }, { "field": "n", "quote": "Fifty-eight patients underwent at least one pit-picking from February 2016 to September 2017." }, { "field": "followUp", "quote": "an average of 5.0 months (range 1-20) post-procedure" } ] }, { "id": "pmid:30463753", "pmid": "30463753", "doi": "10.1016/j.jss.2018.06.071", "nctId": null, "pmcid": null, "title": "Recurrence of Pilonidal Disease: Our Best is Not Good Enough", "firstAuthor": "Halleran", "multipleAuthors": true, "journal": "J Surg Res", "year": 2018, "design": "retrospective", "n": 307, "nField": "reported", "population": "young patients with pilonidal disease treated by pediatric surgeons at one hospital", "intervention": "surgical excision or incision-and-drainage with antibiotics for pilonidal disease", "comparator": "the two initial treatment types compared with each other (surgical excision vs. incision and drainage/antibiotics)", "primaryOutcome": "disease recurrence needing another treatment after the initial one", "result": "About a third of patients had their pilonidal disease come back, usually within a year, and being obese raised that risk", "resultDirection": "unclear", "quality": "low", "qualityWhy": "It is a single-center retrospective chart review of surgical treatments and recurrence, not a study of whether popping a cyst yourself is safe.", "directness": "indirect", "limitations": "Retrospective design from one center; looks at recurrence after medical or surgical care, not at self-popping or spontaneous drainage at home.", "followUp": "", "plainFinding": "About a third relapsed after treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30463753/", "sourceText": "BACKGROUND: Recurrence rates of pilonidal disease have been reported to be high as 30%. Patients with recurrent pilonidal disease often develop chronic wounds and draining sinuses that incur long-term morbidity, disability, and decreased quality of life. The aim of this study was to characterize rates of recurrence in patients with pilonidal disease treated by pediatric surgeons. METHODS: A single center retrospective review of patients with pilonidal disease evaluated by pediatric surgeons from 2010 to 2015 was performed. Recurrence of pilonidal disease was defined as an episode of active pilonidal disease that required medical or surgical intervention >30 days from the preceding treatment. Repeated events proportional hazards regression modeling was performed to identify factors associated with time to recurrence. RESULTS: Among 307 patients treated for pilonidal disease, nearly 50% were male, and the median age at initial evaluation was 16 years (IQR 15-17). Approximately 45% were obese (BMI ≥ 95th percentile). The initial treatment during the study period was surgical excision in two-thirds and incision and drainage and/or antibiotics in one-third. The overall recurrence rate was 33%, with the majority of recurrences (80%) occurring within the first year. On multivariable analysis, obese BMI was the only factor independently associated with time to disease recurrence. CONCLUSIONS: Pilonidal disease has a substantial recurrence rate even after surgical excision. Future studies investigating treatments that can prevent disease recurrence are needed.", "provenance": [ { "field": "n", "quote": "Among 307 patients treated for pilonidal disease" }, { "field": "population", "quote": "patients with pilonidal disease evaluated by pediatric surgeons from 2010 to 2015" }, { "field": "intervention", "quote": "surgical excision in two-thirds and incision and drainage and/or antibiotics in one-third" }, { "field": "comparator", "quote": "surgical excision in two-thirds and incision and drainage and/or antibiotics in one-third" }, { "field": "primaryOutcome", "quote": "Recurrence of pilonidal disease was defined as an episode of active pilonidal disease that required medical or surgical intervention >30 days from the preceding treatment." }, { "field": "result", "quote": "The overall recurrence rate was 33%, with the majority of recurrences (80%) occurring within the first year." } ] }, { "id": "pmid:30064734", "pmid": "30064734", "doi": "10.1016/j.surg.2018.05.046", "nctId": null, "pmcid": null, "title": "Treatment of pilonidal disease by minimal surgical excision under local anesthesia with healing by secondary intention: Results in over 500 patients", "firstAuthor": "Burney", "multipleAuthors": false, "journal": "Surgery", "year": 2018, "design": "case-series", "n": 570, "nField": "reported", "population": "people with pilonidal disease treated by one surgeon", "intervention": "minimal surgical excision under local anesthesia with wound left open to heal on its own", "comparator": "", "primaryOutcome": "how long the wound took to heal and whether the disease came back", "result": "3.2% needed repeat surgery for recurrence, and most wounds healed within about 6-7 weeks", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is one surgeon's retrospective review of their own patients with no comparison group, so it can't show whether this approach is better than other options.", "directness": "indirect", "limitations": "Retrospective, single-surgeon case series with no control group and reliance on patient compliance with wound care.", "followUp": "4.7 years", "plainFinding": "Surgical excision heals well, low recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30064734/", "sourceText": "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%.", "provenance": [ { "field": "n", "quote": "Records were found for 570 patients" }, { "field": "population", "quote": "over 500 patients treated by minimal but complete surgical excision" }, { "field": "intervention", "quote": "minimal but complete surgical excision under local anesthesia with healing by secondary intention using moist dressings" }, { "field": "primaryOutcome", "quote": "length of time until wound healed" }, { "field": "result", "quote": "Eighteen patients (3.2%) had persistent or recurrent disease requiring reoperation" }, { "field": "result", "quote": "median 46 days in women, 51 days in men" }, { "field": "followUp", "quote": "mean follow-up was 4.7 years" } ] }, { "id": "pmid:29947121", "pmid": "29947121", "doi": "10.1111/iwj.12936", "nctId": null, "pmcid": "PMC7949598", "title": "Is conservative treatment an effective option for pilonidal sinus disease in children?", "firstAuthor": "Cevik", "multipleAuthors": true, "journal": "Int Wound J", "year": 2018, "design": "retrospective", "n": 29, "nField": "reported", "population": "children aged 12-16 diagnosed with pilonidal sinus disease", "intervention": "conservative treatment (hair removal, hygiene, warm sitz baths, and drainage for abscess)", "comparator": "", "primaryOutcome": "complete healing and recurrence rates", "result": "79.3% of patients healed completely; 12% had recurrence; 4 patients needed surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small retrospective study without a comparison group, so it can't prove conservative treatment is better than other options.", "directness": "indirect", "limitations": "Retrospective design, small sample size, no control group, telephone follow-up, and short/variable follow-up length.", "followUp": "8.34 ± 6.36 (range: 1-25) months", "plainFinding": "Most healed without surgery conservatively.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29947121/", "sourceText": "Pilonidal sinus disease (PSD) is associated with a complex disease process in children, and its management remains controversial. There are a few published studies on PSD in the paediatric literature; therefore, we present our experience of conservatively treating PSD in children. This study involved a retrospective review with telephone follow up. All children diagnosed with PSD in 2012 to 2017 were identified at the outpatient clinic of the Department of Paediatric Surgery. All patients initially underwent conservative treatment (meticulous hair removal, improved perianal hygiene, warm sitz baths, and drainage for abscess). Data collection included demographics, type of management, recurrence, presence of infection, and total healing time. In the study period, 29 children were identified. Their mean age was 14.94 ± 1.09 (range: 12-16) years, and 51.7% were girls. The mean length of follow up was 8.34 ± 6.36 (range: 1-25) months. Complete healing occurred in 79.3% of patients. Recurrence was evident in 12% of patients. Four patients underwent surgery. PSD is being seen in children more frequently in recent years. Conservative treatment may be the recommended initial approach for PSD in children.", "provenance": [ { "field": "n", "quote": "29 children were identified" }, { "field": "population", "quote": "Their mean age was 14.94 ± 1.09 (range: 12-16) years" }, { "field": "intervention", "quote": "meticulous hair removal, improved perianal hygiene, warm sitz baths, and drainage for abscess" }, { "field": "primaryOutcome", "quote": "Data collection included demographics, type of management, recurrence, presence of infection, and total healing time." }, { "field": "result", "quote": "Complete healing occurred in 79.3% of patients. Recurrence was evident in 12% of patients. Four patients underwent surgery." }, { "field": "followUp", "quote": "The mean length of follow up was 8.34 ± 6.36 (range: 1-25) months." } ] }, { "id": "pmid:29433863", "pmid": "29433863", "doi": "10.1016/j.jss.2017.09.051", "nctId": null, "pmcid": null, "title": "Aspiration for acute pilonidal abscess-a cohort study", "firstAuthor": "Lasithiotakis", "multipleAuthors": true, "journal": "J Surg Res", "year": 2018, "design": "retrospective", "n": 100, "nField": "reported", "population": "adults and teens with a sudden pilonidal abscess (average age 24)", "intervention": "doctor draining the abscess with a needle (aspiration) under local anesthetic plus a week of antibiotics", "comparator": "no comparison group studied (traditional open incision and drainage mentioned only as background)", "primaryOutcome": "whether the abscess resolved without needing surgical incision and drainage, and patient satisfaction", "result": "83% did not need incision and drainage, and patients reported high satisfaction", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-group study of selected patients with no comparison group and only about half returned satisfaction surveys, so it can't prove aspiration is better or safer than other options.", "directness": "indirect", "limitations": "No control group, exclusion of higher-risk patients (diabetes, immunosuppression, skin necrosis), and only 56 of 100 patients returned satisfaction questionnaires.", "followUp": "29 (47) months", "plainFinding": "Clinician needle-draining mostly avoided surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29433863/", "sourceText": "BACKGROUND: The traditional open incision and drainage of a pilonidal abscess is associated with slow healing and delayed return to normal daily activities. The aim of this study is to assess safety, effectiveness, and patient satisfaction of aspiration followed by antibiotics for a pilonidal abscess. MATERIAL AND METHODS: All patients presenting with an acute pilonidal abscess during the period December 2010 and December 2014 in York Hospital, UK, were treated with bedside aspiration under local anesthetic, followed by oral cefalexin and metronidazole for 7 days. Patients with immunosuppression, diabetes, overlying skin necrosis, and perforation were excluded. Complications of the procedure were prospectively recorded. Long-term outcomes and overall patients' satisfaction were assessed with the use of mailed questionnaires and Visual Analogue Scales (VAS) (0 = not satisfied at all, 10 = very satisfied). RESULTS: One hundred sixty-nine patients presented with an acute pilonidal abscess and a total of 100 patients were treated with aspiration and antibiotics. There were 50 women (50%) and the median (interquartile range [IQR]) age of the cohort was 24 (14) years. Eleven patients had a history of a previous pilonidal procedure. Seven patients were treated successfully with a reaspiration. Overall, 10 patients required incision and drainage after a median (IQR) follow-up time of 29 (47) months. Fifty-six patients returned completed questionnaires. The median (IQR) of the VAS for the overall satisfaction of the procedure was 9 (5). CONCLUSIONS: Aspiration of a pilonidal abscess in selected patients is effective in 83%, and it is associated with high overall satisfaction rates.", "provenance": [ { "field": "population", "quote": "All patients presenting with an acute pilonidal abscess during the period December 2010 and December 2014 in York Hospital, UK" }, { "field": "intervention", "quote": "treated with bedside aspiration under local anesthetic, followed by oral cefalexin and metronidazole for 7 days" }, { "field": "comparator", "quote": "The traditional open incision and drainage of a pilonidal abscess is associated with slow healing and delayed return to normal daily activities." }, { "field": "n", "quote": "a total of 100 patients were treated with aspiration and antibiotics" }, { "field": "primaryOutcome", "quote": "to assess safety, effectiveness, and patient satisfaction of aspiration followed by antibiotics for a pilonidal abscess" }, { "field": "result", "quote": "Aspiration of a pilonidal abscess in selected patients is effective in 83%, and it is associated with high overall satisfaction rates." }, { "field": "followUp", "quote": "10 patients required incision and drainage after a median (IQR) follow-up time of 29 (47) months" } ] }, { "id": "pmid:27779984", "pmid": "27779984", "doi": null, "nctId": null, "pmcid": null, "title": "Excision and Primary Closure May Be the Better Option in the Surgical Management of Pilonidal Disease in the Pediatric Population", "firstAuthor": "Zagory", "multipleAuthors": true, "journal": "Am Surg", "year": 2016, "design": "retrospective", "n": 60, "nField": "reported", "population": "young patients (ages 13-20) with pilonidal disease needing surgery", "intervention": "surgical removal of the cyst with the wound stitched closed (primary closure)", "comparator": "surgical removal with wound left open to heal on its own (secondary intention) or flap closure", "primaryOutcome": "cyst coming back (recurrence), complications, and hospital stay length", "result": "stitched closure had lower recurrence (33.3%) than open healing (58.8%) and shortest hospital stay", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a retrospective chart review at one hospital, not a randomized trial, so it can't prove one method truly causes better outcomes.", "directness": "indirect", "limitations": "retrospective single-institution study; groups not randomized so patient differences could affect results", "followUp": "", "plainFinding": "Surgical stitched closure beat open healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27779984/", "sourceText": "The optimal management of pilonidal disease in the pediatric population is still debated. We conducted a retrospective review of patients 21 years old and younger who underwent surgical management for pilonidal disease between 2009 and 2013 at a single pediatric institution. Sixty patients (41.7% male) were included in the analysis, with a mean age of 15.0 years (range, 13-20). Twelve (20%) had a prior drainage procedure for pilonidal abscess before the definitive operative treatment. After excision to the presacral fascia, 36 (60%) had primary closure, 17 (28.3%) were left to heal by secondary intention, and 7 (11.7%) had flap closure. Overall recurrence rate was 41.7 per cent with 33.3 per cent in the primary, 58.8 per cent in the secondary, and 42.9 per cent in the flap group, respectively. Ten (16.7%) patients developed postoperative complications, which were similar among surgical groups, gender, and body mass index. The average length of stay was 0.67 (median 0, range, 0-5) days. Primary closure had the shortest length of stay (analysis of variance P = 0.04), and flap closure had no reoperations (analysis of variance P < 0.01). Pilonidal disease remains surgically challenging. Our data suggest that excision and primary closure is a better option in the pediatric population.", "provenance": [ { "field": "population", "quote": "patients 21 years old and younger who underwent surgical management for pilonidal disease between 2009 and 2013 at a single pediatric institution" }, { "field": "intervention", "quote": "primary closure" }, { "field": "comparator", "quote": "left to heal by secondary intention" }, { "field": "primaryOutcome", "quote": "Overall recurrence rate was 41.7 per cent with 33.3 per cent in the primary, 58.8 per cent in the secondary, and 42.9 per cent in the flap group" }, { "field": "result", "quote": "Overall recurrence rate was 41.7 per cent with 33.3 per cent in the primary, 58.8 per cent in the secondary, and 42.9 per cent in the flap group, respectively" }, { "field": "n", "quote": "Sixty patients (41.7% male) were included in the analysis" } ] }, { "id": "pmid:27551895", "pmid": "27551895", "doi": "10.1308/rcsann.2016.0260", "nctId": null, "pmcid": "PMC5392818", "title": "Endoscopic pilonidal abscess treatment: a novel approach for the treatment of pilonidal abscess", "firstAuthor": "Jain", "multipleAuthors": true, "journal": "Ann R Coll Surg Engl", "year": 2017, "design": "case-series", "n": 19, "nField": "reported", "population": "patients with acute pilonidal abscess, median age 24", "intervention": "endoscopic pilonidal abscess treatment (EPAT), a minimally invasive surgical procedure", "comparator": "none (compared to historical conventional incision and drainage)", "primaryOutcome": "wound healing, postoperative pain, and recurrence requiring further treatment", "result": "all wounds healed within 6 weeks, pain was minimal, but 21% needed further treatment for pilonidal disease later", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a very small, uncontrolled case series of a surgical procedure performed by doctors, so it cannot answer whether self-draining a cyst at home is safe.", "directness": "indirect", "limitations": "small sample size, no comparison group, single-centre, short follow-up for recurrence assessment", "followUp": "6 weeks", "plainFinding": "Doctor-performed minimally invasive drainage, not self-popping.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27551895/", "sourceText": "INTRODUCTION Pilonidal abscess is a common surgical emergency. Conventional treatment with incision and drainage is associated with significant postoperative morbidity. We report our initial experience of using minimally invasive endoscopic technique for the treatment of pilonidal abscesses, referred to as endoscopic pilonidal abscess treatment (EPAT). MATERIALS AND METHODS A prospective database of all patients undergoing EPAT between January 2015 and March 2016 at Whiston Hospital was maintained. Data regarding patient demographics, peroperative variables and postoperative follow-up were recorded. RESULTS Nineteen patients were included, male to female ratio was 53 : 47 and median age of the cohort was 24 years (interquartile range 22-25 years). EPAT was the primary procedure for 10 patients and 9 had EPAT for recurrent pilonidal abscesses. There were no readmissions and none needed further surgery within 6 weeks of having the procedure. In all patients, complete wound healing was achieved within 6 weeks; all reported minimal postoperative pain (median postoperative visual analogue scale score 1) and immediate return to the activities of daily life. Four of the nineteen patients (21%) required definitive intervention for pilonidal disease in the follow-up period. CONCLUSIONS EPAT is a novel, minimally invasive technique for the treatment of acute pilonidal abscesses. It is safe, associated with reduced postoperative morbidity, recurrence rate and quick wound healing. Initial encouraging results require further investigations on a larger group of patients in a multicentre setting.", "provenance": [ { "field": "n", "quote": "Nineteen patients were included" }, { "field": "population", "quote": "median age of the cohort was 24 years (interquartile range 22-25 years)" }, { "field": "intervention", "quote": "using minimally invasive endoscopic technique for the treatment of pilonidal abscesses, referred to as endoscopic pilonidal abscess treatment (EPAT)" }, { "field": "comparator", "quote": "Conventional treatment with incision and drainage is associated with significant postoperative morbidity" }, { "field": "primaryOutcome", "quote": "In all patients, complete wound healing was achieved within 6 weeks; all reported minimal postoperative pain" }, { "field": "result", "quote": "Four of the nineteen patients (21%) required definitive intervention for pilonidal disease in the follow-up period" } ] }, { "id": "pmid:26900142", "pmid": "26900142", "doi": null, "nctId": null, "pmcid": null, "title": "Less is more: \"incision and curettage\" as an optimal procedure for recurrent pilonidal disease", "firstAuthor": "Demir", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2015, "design": "case-series", "n": 42, "nField": "reported", "population": "patients with recurrent pilonidal disease (cyst near tailbone that came back after prior treatment)", "intervention": "surgical incision and curettage (scraping out the cyst) performed by surgeons", "comparator": "none; single group, no comparison treatment", "primaryOutcome": "pain, recovery time, and recurrence after the procedure", "result": "low pain scores, quick return to activities, and no recurrence over three years", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a small single-group study with no comparison group, so it only describes outcomes of one surgical method rather than proving it is better or safer than alternatives.", "directness": "indirect", "limitations": "abstract states no comparison group, small sample, and the procedure is a clinician-performed surgical technique for recurrent disease, not self-popping or natural drainage of a first-time cyst", "followUp": "three-year follow-up period", "plainFinding": "Surgical drainage worked well, no recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26900142/", "sourceText": "AIM: Although pilonidal disease has been a well-known entity for more than a century, recurrence of pilonidal disease is still not rare. The optimal surgical approach to recurrent disease is under debate. In this study, we aimed to investigate the efficacy of \"incision and curettage\" procedure for recurrent pilonidal disease. MATERIAL AND METHODS: From May 2009 to May 2013, 42 patients (37 male/5 female) underwent surgical treatment for recurrent pilonidal disease. Incision and curettage of granulation tissue, hair and debris in the cavity were performed in all cases. Data collection included demographics, visual analogue scale (VAS) score, hospital stay, return to daily activities (lying, sitting down in comfort) and work, and complete wound healing time. RESULTS: Mean operating time was 16.6±4.7 (10-24) minutes. Mean pain score was 1.4±1.1 (0-5) with VAS. The mean duration of returning to daily activities such as comfortable lying down, sitting and returning to work were 1.6±0.8 (1-4) days, and 3.3±2.3 (1-15) days, and 10.2±5.4 (5-33) days, respectively. The mean wound healing time was 19.9±7.8 (7-52) days. During the three-year follow-up period, no recurrence was observed. DISCUSSION: \"Incision and curettage\" may be performed as first-line treatment for recurrent cases. It does not require surgical skill and can be easily applied in a short time. CONCLUSION: This simple surgical option, incision curettage provides short hospital stay and quick return to daily activities, in addition to patient comfort and satisfaction. KEY WORDS: Pilonidal sinus, Recurrence, Sacrococcygeal.", "provenance": [ { "field": "n", "quote": "42 patients (37 male/5 female) underwent surgical treatment for recurrent pilonidal disease" }, { "field": "population", "quote": "42 patients (37 male/5 female) underwent surgical treatment for recurrent pilonidal disease" }, { "field": "intervention", "quote": "Incision and curettage of granulation tissue, hair and debris in the cavity were performed in all cases" }, { "field": "comparator", "quote": "Incision and curettage of granulation tissue, hair and debris in the cavity were performed in all cases" }, { "field": "primaryOutcome", "quote": "Data collection included demographics, visual analogue scale (VAS) score, hospital stay, return to daily activities (lying, sitting down in comfort) and work, and complete wound healing time." }, { "field": "result", "quote": "During the three-year follow-up period, no recurrence was observed." }, { "field": "result", "quote": "Mean pain score was 1.4±1.1 (0-5) with VAS." } ] }, { "id": "pmid:26817020", "pmid": "26817020", "doi": "10.3393/ac.2015.31.6.243", "nctId": null, "pmcid": "PMC4724706", "title": "Pilonidal Abscess Associated With Primary Actinomycosis", "firstAuthor": "Oh", "multipleAuthors": true, "journal": "Ann Coloproctol", "year": 2015, "design": "case-series", "n": 1, "nField": "reported", "population": "a 25-year-old woman with a pilonidal abscess", "intervention": "surgical drainage and debridement plus antibiotics", "comparator": "no comparator", "primaryOutcome": "recovery after treatment", "result": "she recovered well after surgical drainage and one week of antibiotics", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether self-draining is safe or not.", "directness": "indirect", "limitations": "Single case report; no comparison between self-drainage and professional treatment; does not address self-popping at all.", "followUp": "", "plainFinding": "Surgical drainage plus antibiotics worked.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26817020/", "sourceText": "Pilonidal disease in the sacrococcygeal region usually presents as abscesses, recurrent inflammation, cellulitis or fistula tracks. However, few reports on actinomycosis affecting pilonidal sinuses have been published. We report a case of a 25-year-old woman who presented with a pilonidal abscess who underwent surgical drainage and debridement. Pus from the pilonidal abscess was sent for microbiology, which grew actinomyces turicensis associated with prevotella bivia and peptostreptococci. She was treated with oral amoxicillin-clavulanate after surgical drainage for one week and recovered well. Actinomycosis associated with pilonidal abscesses, though uncommon, should be recognized and can be satisfactorily treated with a combination of surgical drainage and antibiotics.", "provenance": [ { "field": "n", "quote": "a 25-year-old woman" }, { "field": "population", "quote": "a 25-year-old woman who presented with a pilonidal abscess who underwent surgical drainage and debridement" }, { "field": "intervention", "quote": "surgical drainage and debridement" }, { "field": "comparator", "quote": "treated with oral amoxicillin-clavulanate after surgical drainage for one week" }, { "field": "primaryOutcome", "quote": "recovered well" }, { "field": "result", "quote": "She was treated with oral amoxicillin-clavulanate after surgical drainage for one week and recovered well." } ] }, { "id": "pmid:26690708", "pmid": "26690708", "doi": "10.1016/j.jpedsurg.2015.10.076", "nctId": null, "pmcid": null, "title": "Improving outcomes in pilonidal sinus disease", "firstAuthor": "Braungart", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2016, "design": "retrospective", "n": 19, "nField": "reported", "population": "children with pilonidal sinus disease", "intervention": "surgical excision of the pilonidal sinus with primary midline closure using a full-thickness flap", "comparator": "no comparator group within this study", "primaryOutcome": "rates of recurrence, wound dehiscence, and wound infection after surgery", "result": "22% recurrence, 44% wound dehiscence, and 28% wound infection after this surgical technique", "resultDirection": "harm", "quality": "low", "qualityWhy": "This is a small, single-center retrospective case series with no control group, so it can't reliably show whether the technique is better or worse than other options.", "directness": "indirect", "limitations": "Retrospective design, single center, small sample size, no comparison group, and reliance on telephone follow-up.", "followUp": "13months (3.5-67months)", "plainFinding": "High complication rates after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26690708/", "sourceText": "BACKGROUND: Optimal surgical treatment for pilonidal sinus disease remains controversial. Studies in children are uncommon with overall high postoperative recurrence and infection rates (20%). Our unit adopted a technique for excision of the pilonidal sinus with primary midline closure using a full-thickness flap. We present our results of this technique in the pediatric age group. METHODS: Single-center retrospective review and telephone follow-up was performed, including all children undergoing pilonidal sinus excision from 2005 to 2014 using the same operative technique and preoperative/postoperative care. RESULTS: 19 children were identified. Median age was 15years, and 47% were male. All had previously infected sinuses, with 5 requiring abscess drainage. Median follow-up was 13months (3.5-67months). Histology confirmed pilonidal sinus in 18/19 cases (one developmental malformation excluded from subsequent analysis). Recurrence requiring further surgery occurred in 4/18 (22%) patients at a median of 9months (range 8-36), wound dehiscence in 8/18 (44%), and wound infection in 5/18 (28%) cases. Laser hair removal of the natal cleft was performed in 7/18 (39%) patients with no further recurrence. CONCLUSION: This is the first report of this technique in children which showed a higher incidence of complications than a comparable adult study. Our study underlines the importance of accurate long-term outcomes when introducing new techniques to evaluate operation-associated morbidity. Our preliminary results of laser hair removal are promising but need to be evaluated with a prospective study.", "provenance": [ { "field": "n", "quote": "19 children were identified." }, { "field": "population", "quote": "all children undergoing pilonidal sinus excision from 2005 to 2014" }, { "field": "intervention", "quote": "excision of the pilonidal sinus with primary midline closure using a full-thickness flap" }, { "field": "comparator", "quote": "Single-center retrospective review and telephone follow-up was performed, including all children undergoing pilonidal sinus excision from 2005 to 2014 using the same operative technique and preoperative/postoperative care." }, { "field": "primaryOutcome", "quote": "Recurrence requiring further surgery occurred in 4/18 (22%) patients at a median of 9months (range 8-36), wound dehiscence in 8/18 (44%), and wound infection in 5/18 (28%) cases." }, { "field": "result", "quote": "Recurrence requiring further surgery occurred in 4/18 (22%) patients at a median of 9months (range 8-36), wound dehiscence in 8/18 (44%), and wound infection in 5/18 (28%) cases." } ] }, { "id": "pmid:26377583", "pmid": "26377583", "doi": "10.1007/s10151-015-1369-3", "nctId": null, "pmcid": null, "title": "The treatment of pilonidal disease: guidelines of the Italian Society of Colorectal Surgery (SICCR)", "firstAuthor": "Segre", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2015, "design": "guideline", "n": null, "nField": "not-reported", "population": "people with pilonidal disease, especially young people", "intervention": "nonoperative treatments (shaving, laser hair removal, fibrin glue, phenol injection) and surgical excision with closure", "comparator": "surgical excision with healing left open (secondary intention) vs. different surgical closure techniques", "primaryOutcome": "healing rates and recurrence of pilonidal disease", "result": "nonoperative methods showed satisfactory healing and recurrence rates but evidence was low quality; no surgical technique was clearly better than another", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is an expert guideline summarizing mostly small, low-quality studies rather than new rigorous research.", "directness": "indirect", "limitations": "The abstract states most underlying studies are small series with low-quality evidence, and the guideline does not address self-draining or self-popping of cysts at all.", "followUp": "", "plainFinding": "No clear best treatment found.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26377583/", "sourceText": "The Italian Society of Colorectal Surgery (SICCR.) has prepared clinical practice guidelines to help its members to optimize the treatment of pilonidal disease, a very common condition, especially among young people, and therefore of great importance on a socioeconomic level. The SICCR committee of experts on pilonidal disease analyzed the international literature and evaluated current evidence. Nonoperative management includes gluteal cleft shaving, laser epilation as well as fibrin glue and phenol injection: reported healing rates and recurrence incidence are satisfactory but the majority of studies are small series with low-quality evidence. Surgical therapy which can be divided into two categories: excision of diseased tissue with primary closure using different techniques or excision with healing by secondary intention. On the whole, no clear benefit is demonstrated for one technique over the other.", "provenance": [ { "field": "population", "quote": "pilonidal disease, a very common condition, especially among young people" }, { "field": "intervention", "quote": "Nonoperative management includes gluteal cleft shaving, laser epilation as well as fibrin glue and phenol injection" }, { "field": "intervention", "quote": "Surgical therapy which can be divided into two categories: excision of diseased tissue with primary closure using different techniques or excision with healing by secondary intention." }, { "field": "comparator", "quote": "excision of diseased tissue with primary closure using different techniques or excision with healing by secondary intention" }, { "field": "primaryOutcome", "quote": "reported healing rates and recurrence incidence are satisfactory" }, { "field": "result", "quote": "reported healing rates and recurrence incidence are satisfactory but the majority of studies are small series with low-quality evidence" }, { "field": "result", "quote": "no clear benefit is demonstrated for one technique over the other" } ] }, { "id": "pmid:26054992", "pmid": "26054992", "doi": null, "nctId": null, "pmcid": null, "title": "Topical Agents and Dressings for Pilonidal Sinus Wound Healing by Secondary Intention: A Scoping Review", "firstAuthor": "Woo", "multipleAuthors": true, "journal": "Surg Technol Int", "year": 2015, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus wounds healing by secondary intention", "intervention": "topical agents and dressings (hydrogel, silver, honey, zinc, foam, negative pressure therapy, platelet rich plasma, plant extracts)", "comparator": "other dressings or no specific comparator stated", "primaryOutcome": "wound healing of pilonidal sinus wounds", "result": "some evidence these dressings may help healing, reduce bacteria, or ease pain, but evidence is weak", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a scoping review of studies with methodological limitations and biases, so the evidence is too weak to draw firm conclusions", "directness": "indirect", "limitations": "evidence remains insufficient in light of methodological limitations and biases of the studies", "followUp": "", "plainFinding": "Weak evidence on wound dressings, not relevant to popping.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26054992/", "sourceText": "Pilonidal disease (PD) is a chronic and debilitating condition. The overall aim of the scoping review is to map and summarize a wide range of evidence to examine which topical agent or dressing is effective in promoting pilonidal wound healing by secondary intention. Review of this cumulative body of evidence will inform care and guide dressing selection for PD related wounds and delineate future research priorities based on identified knowledge gaps and clinical practice issues. Overall, there is some evidence to suggest that topical applications of hydrogel, silver, honey, zinc, selected foam materials, negative pressure wound therapy, platelet rich plasma, and plant extracts may promote wound healing. Topical treatment using polyhexamethylene biguanide and silver may be beneficial in reducing bacterial burden. Finally, silver, honey, and hydrocolloid dressings may help alleviate wound related pain. However, evidence remains insufficient in light of methodological limitations and biases of the studies.", "provenance": [ { "field": "population", "quote": "which topical agent or dressing is effective in promoting pilonidal wound healing by secondary intention" }, { "field": "intervention", "quote": "topical applications of hydrogel, silver, honey, zinc, selected foam materials, negative pressure wound therapy, platelet rich plasma, and plant extracts" }, { "field": "comparator", "quote": "Topical treatment using polyhexamethylene biguanide and silver may be beneficial in reducing bacterial burden." }, { "field": "primaryOutcome", "quote": "which topical agent or dressing is effective in promoting pilonidal wound healing by secondary intention" }, { "field": "result", "quote": "there is some evidence to suggest that topical applications of hydrogel, silver, honey, zinc, selected foam materials, negative pressure wound therapy, platelet rich plasma, and plant extracts may promote wound healing" }, { "field": "limitations", "quote": "evidence remains insufficient in light of methodological limitations and biases of the studies" } ] }, { "id": "pmid:26042534", "pmid": "26042534", "doi": "10.1002/14651858.CD011278.pub2", "nctId": null, "pmcid": "PMC10960640", "title": "Negative pressure wound therapy for treating surgical wounds healing by secondary intention", "firstAuthor": "Dumville", "multipleAuthors": true, "journal": "Cochrane Database Syst Rev", "year": 2015, "design": "meta-analysis", "n": 69, "nField": "reported", "population": "people with surgical wounds left open to heal, including one study on wounds after pilonidal sinus excision", "intervention": "negative pressure wound therapy (a vacuum dressing)", "comparator": "alginate dressing or silicone dressing", "primaryOutcome": "wound healing, complications, and resource use", "result": "not enough evidence to tell if negative pressure therapy helps these wounds heal", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "Only two small trials with 69 people total were found, giving almost no reliable data.", "directness": "indirect", "limitations": "The trials reported limited outcome data on healing, adverse events and resource use, and only one of the two studies involved pilonidal sinus wounds, none involved unopened or self-drained cysts.", "followUp": "", "plainFinding": "No clear evidence either way.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26042534/", "sourceText": "BACKGROUND: Following surgery, incisions are usually closed by fixing the edges together with sutures (stitches), staples, adhesive glue or clips. This process helps the cut edges heal together and is called 'healing by primary intention'. However, not all incised wounds are closed in this way: where there is high risk of infection, or when there has been significant tissue loss, wounds may be left open to heal from the 'bottom up'. This delayed healing is known as 'healing by secondary intention'. Negative pressure wound therapy (NPWT) is one treatment option for surgical wounds that are healing by secondary intention. OBJECTIVES: To assess the effects of negative pressure wound therapy (NPWT) on the healing of surgical wounds healing by secondary intention (SWHSI) in any care setting. SEARCH METHODS: For this review, in May 2015 we searched the following databases: the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials; Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations; Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication. SELECTION CRITERIA: Published or unpublished randomised controlled trials (RCTs) comparing the effects of NPWT with alternative treatments or different types of NPWT in the treatment of SWHSI. We excluded open abdominal wounds from this review as they are the subject of a separate Cochrane review that is in draft. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS: We located two studies (69 participants) for inclusion in this review. One study compared NPWT with an alginate dressing in the treatment of open, infected groin wounds. and one study compared NPWT with a silicone dressing in the treatment of excised pilonidal sinus. The trials reported limited outcome data on healing, adverse events and resource use. AUTHORS' CONCLUSIONS: There is currently no rigorous RCT evidence available regarding the clinical effectiveness of NPWT in the treatment of surgical wounds healing by secondary intention as defined in this review. The potential benefits and harms of using this treatment for this wound type remain largely uncertain.", "provenance": [ { "field": "n", "quote": "We located two studies (69 participants) for inclusion in this review." }, { "field": "population", "quote": "one study compared NPWT with a silicone dressing in the treatment of excised pilonidal sinus" }, { "field": "intervention", "quote": "Negative pressure wound therapy (NPWT) is one treatment option for surgical wounds that are healing by secondary intention." }, { "field": "comparator", "quote": "One study compared NPWT with an alginate dressing in the treatment of open, infected groin wounds. and one study compared NPWT with a silicone dressing in the treatment of excised pilonidal sinus." }, { "field": "primaryOutcome", "quote": "The trials reported limited outcome data on healing, adverse events and resource use." }, { "field": "result", "quote": "There is currently no rigorous RCT evidence available regarding the clinical effectiveness of NPWT in the treatment of surgical wounds healing by secondary intention as defined in this review." } ] }, { "id": "pmid:25664095", "pmid": "25664095", "doi": null, "nctId": null, "pmcid": "PMC4307542", "title": "A new approach: oblique excision and primary closure in the management of acute pilonidal disease", "firstAuthor": "Ciftci", "multipleAuthors": true, "journal": "Int J Clin Exp Med", "year": 2014, "design": "prospective-cohort", "n": 128, "nField": "reported", "population": "patients with pilonidal abscesses treated at a hospital", "intervention": "oblique excision and primary closure performed by a surgeon", "comparator": "incision and drainage performed by a surgeon", "primaryOutcome": "development of chronic pilonidal sinus and time to return to work", "result": "chronic sinus developed in 78.8% after incision and drainage versus 6.0% after oblique excision and primary closure, but healing took slightly longer with primary closure", "resultDirection": "mixed", "quality": "low", "qualityWhy": "patients were not randomized, treatment depended on which of two surgeons saw them, which can bias results", "directness": "indirect", "limitations": "not randomized; each surgeon used only one method, so outcomes could reflect surgeon skill as well as technique", "followUp": "", "plainFinding": "Surgical closure beat simple drainage for recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25664095/", "sourceText": "AIM: To compare incision and drainage with oblique excision and primary closure in the treatment of pilonidal abscesses. MATERIALS AND METHODS: In this prospective study, one of two surgeons at the same hospital performed incision and drainage as the treatment method for patients presenting with pilonidal abscesses. (Group A). The other surgeon performed oblique excision and primary closure (Group B). The rate of development of chronic pilonidal sinus and time to return to active work were assessed using the chi-square and Student's t-tests to compare the two methods of treatment. Of the 128 patients, incision and simple drainage was applied to 69 patients and primary closure was applied to 59 patients. RESULTS: The rate of development of chronic pilonidal sinus was 78.8% in Group A and 6.0% in Group B (P < 0.001). In Group A, the average healing time and time to return to active work were 18 and 25 days, respectively. In Group B, these times were 22 and 27 days, respectively (P < 0.001). CONCLUSION: Oblique excision and primary closure may be a preferable treatment for acute pilonidal abscesses because of its low rate of chronic sinus development.", "provenance": [ { "field": "n", "quote": "Of the 128 patients, incision and simple drainage was applied to 69 patients and primary closure was applied to 59 patients." }, { "field": "population", "quote": "patients presenting with pilonidal abscesses" }, { "field": "intervention", "quote": "The other surgeon performed oblique excision and primary closure (Group B)." }, { "field": "comparator", "quote": "one of two surgeons at the same hospital performed incision and drainage as the treatment method for patients presenting with pilonidal abscesses. (Group A)." }, { "field": "primaryOutcome", "quote": "The rate of development of chronic pilonidal sinus and time to return to active work were assessed" }, { "field": "result", "quote": "The rate of development of chronic pilonidal sinus was 78.8% in Group A and 6.0% in Group B (P < 0.001)." }, { "field": "result", "quote": "In Group A, the average healing time and time to return to active work were 18 and 25 days, respectively. In Group B, these times were 22 and 27 days, respectively (P < 0.001)." } ] }, { "id": "pmid:25541849", "pmid": "25541849", "doi": "10.5505/tjtes.2014.62547", "nctId": null, "pmcid": null, "title": "Comparison of early surgery (unroofing-curettage) and elective surgery (Karydakis flap technique) in pilonidal sinus abscess cases", "firstAuthor": "Kanat", "multipleAuthors": true, "journal": "Ulus Travma Acil Cerrahi Derg", "year": 2014, "design": "retrospective", "n": 53, "nField": "reported", "population": "patients treated for pilonidal sinus abscesses", "intervention": "early surgery (unroofing-curettage) followed by dressing and secondary healing", "comparator": "elective surgery (pilonidal sinus excision and Karydakis flap) after drainage-antibiotic therapy", "primaryOutcome": "complications, recurrence rate and treatment duration", "result": "no difference in complications or recurrence, but treatment duration was significantly shorter with drainage-antibiotic therapy followed by Karydakis flap surgery", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a small retrospective study of only 53 patients comparing two surgical approaches, not a randomized trial, so it carries limited weight.", "directness": "indirect", "limitations": "Retrospective design, small sample size, and this compares two professional surgical/drainage approaches rather than self-popping versus spontaneous drainage.", "followUp": "14 months", "plainFinding": "Professional drainage then flap surgery healed faster.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25541849/", "sourceText": "BACKGROUND: The aim of this study is to compare the effectiveness and success of early (acute) period local surgical intervention (unroofing-curettage) followed by dressing and secondary healing with the surgery performed in elective conditions (pilonidal sinus excision and Karydakis flap) following conventional abscess treatment (drainage-antibiotic therapy) in pilonidal sinus abscess cases. METHODS: The data of the patients treated for pilonidal sinus abscesses in our clinic between January 2012 and March 2013 were analyzed, retrospectively. Those who had early surgery were determined as Group S, and those who had elective surgery following drainage-antibiotic therapy were determined as Group K. Patients in both groups were compared in terms of age, gender, complications, recurrence rate and healing time. Patients were followed for an average of 14 months. RESULTS: Of the 53 patients included in the study, 28 were in Group S and 25 in Group K. The mean age and gender distribution of both groups were similar and a significant difference was not found between the groups in terms of complication development and recurrence. However, there was a statistically significant difference between the groups in terms of treatment duration (p=0.02). CONCLUSION: In treating acute pilonidal abscesses, the Karydakis method, following drainage-antibiotic therapy, is a preferable method due to its shorter treatment duration and higher patient comfort.", "provenance": [ { "field": "n", "quote": "Of the 53 patients included in the study, 28 were in Group S and 25 in Group K." }, { "field": "population", "quote": "The data of the patients treated for pilonidal sinus abscesses in our clinic between January 2012 and March 2013 were analyzed, retrospectively." }, { "field": "intervention", "quote": "early (acute) period local surgical intervention (unroofing-curettage) followed by dressing and secondary healing" }, { "field": "comparator", "quote": "surgery performed in elective conditions (pilonidal sinus excision and Karydakis flap) following conventional abscess treatment (drainage-antibiotic therapy)" }, { "field": "primaryOutcome", "quote": "Patients in both groups were compared in terms of age, gender, complications, recurrence rate and healing time." }, { "field": "result", "quote": "a significant difference was not found between the groups in terms of complication development and recurrence. However, there was a statistically significant difference between the groups in terms of treatment duration (p=0.02)." } ] }, { "id": "pmid:25418942", "pmid": "25418942", "doi": null, "nctId": null, "pmcid": null, "title": "[Pilonidal sinus - diagnosis at the intersection of general and plastic surgery]", "firstAuthor": "Pazdírek", "multipleAuthors": true, "journal": "Rozhl Chir", "year": 2014, "design": "retrospective", "n": 67, "nField": "reported", "population": "patients with pilonidal sinus treated surgically", "intervention": "surgical removal of the sinus with primary closure or flap reconstruction", "comparator": "different surgical closure techniques (midline suture vs Limberg flap vs open wound)", "primaryOutcome": "wound healing and disease recurrence after surgery", "result": "flap reconstruction had less secondary healing and recurrence than midline closure", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Small retrospective single-center study comparing surgical techniques, not self-care versus spontaneous drainage.", "directness": "indirect", "limitations": "Retrospective design, small sample size, single institution.", "followUp": "within one year", "plainFinding": "Flap surgery had fewer recurrences than stitches.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25418942/", "sourceText": "INTRODUCTION: Pilonidal sinus predominantly affects young patients. Improper treatment results in long-term restrictions in everyday life and incapacity for work. The aim of the study was to find out what the results and current treatment options of pilonidal sinus are. MATERIAL AND METHODS: This is a retrospective analysis of 67 patients treated at the Department of Surgery of the Second Medical Faculty of Charles University and Motol Hospital in the period 20102013. We evaluated the type of surgery and infectious complications in the wound, as well as age, sex, BMI, smoking, employment of the patients, duration of wound drainage, length of hospital stay, time required to complete healing of the surgical wound, the surgeons erudition and disease recurrence. RESULTS: 50 (75%) patients underwent primary closure in the midline, Limberg flap was used in 15 (22%) patients. In 2 (3%) patients, the wound was left without suture. In the group of patients who had not undergone flap reconstruction, secondary wound healing occurred in 20 (40%) patients. In the group of patients where flap reconstruction was used, secondary healing occurred in 3 patients (20%). Relapse of the disease within one year occurred in the group of patients with primary suture in the midline in 4 (8%) patients; other patients had no recurrence. CONCLUSION: According to our experience as well as literary data, the treatment of choice is the extirpation of the sinus with primary suture beyond the midline using a flap reconstruction technique.", "provenance": [ { "field": "n", "quote": "retrospective analysis of 67 patients" }, { "field": "population", "quote": "Pilonidal sinus predominantly affects young patients." }, { "field": "intervention", "quote": "50 (75%) patients underwent primary closure in the midline, Limberg flap was used in 15 (22%) patients." }, { "field": "comparator", "quote": "In 2 (3%) patients, the wound was left without suture." }, { "field": "primaryOutcome", "quote": "We evaluated the type of surgery and infectious complications in the wound" }, { "field": "result", "quote": "Relapse of the disease within one year occurred in the group of patients with primary suture in the midline in 4 (8%) patients; other patients had no recurrence." } ] }, { "id": "pmid:25340864", "pmid": "25340864", "doi": null, "nctId": null, "pmcid": null, "title": "[Sinus pilonidalis - possibilities of surgical treatment]", "firstAuthor": "Jandík", "multipleAuthors": false, "journal": "Rozhl Chir", "year": 2014, "design": "retrospective", "n": 72, "nField": "reported", "population": "patients with pilonidal cyst disease needing surgery", "intervention": "surgical removal of the cyst with closure using a rhomboid skin flap", "comparator": "surgical removal of the cyst with closure using a straight line stitch (primary suture)", "primaryOutcome": "rate of surgical site infection, drainage time, hospital stay, and overall healing", "result": "the flap method had fewer infections, quicker drainage, shorter hospital stay and better overall healing than the straight stitch method", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a small, non-randomized comparison of two surgical techniques from different time periods, not a controlled trial.", "directness": "indirect", "limitations": "abstract does not mention randomization, blinding, or control for confounding between the two time periods; does not address whether self-draining or letting the cyst heal naturally is safe.", "followUp": "", "plainFinding": "Flap surgery healed better than stitches.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25340864/", "sourceText": "INTRODUCTION: The author presents current knowledge about the therapy of pilonidal disease and compares it to his own experience with a group of patients treated for this disease in the period 20072014. MATERIAL AND METHODS: 169 patients with symptoms of pilonidal disease were treated; in 72 cases, surgery was indicated because of chronic state or recurrence of the disease. In 20072012, radical excision of sinus with primary suture of the defect was performed in 42 cases. In the period 20122014, 30 patients were operated on and the defect after excision was closed by rhomboid fasciocutaneous flap. RESULTS: When both methods of defect closure were compared, the second method showed significantly less surgical site infections, shorter time of drainage and hospitalization and overall healing. CONCLUSION: Closing the defect with rhomboid flap seems to be the optimal method for the surgical approach to pilonidal disease.", "provenance": [ { "field": "population", "quote": "169 patients with symptoms of pilonidal disease were treated; in 72 cases, surgery was indicated because of chronic state or recurrence of the disease" }, { "field": "n", "quote": "in 72 cases, surgery was indicated because of chronic state or recurrence of the disease" }, { "field": "intervention", "quote": "the defect after excision was closed by rhomboid fasciocutaneous flap" }, { "field": "comparator", "quote": "radical excision of sinus with primary suture of the defect was performed in 42 cases" }, { "field": "primaryOutcome", "quote": "the second method showed significantly less surgical site infections, shorter time of drainage and hospitalization and overall healing" }, { "field": "result", "quote": "the second method showed significantly less surgical site infections, shorter time of drainage and hospitalization and overall healing" } ] }, { "id": "pmid:24969346", "pmid": "24969346", "doi": "10.1007/s00104-014-2776-0", "nctId": null, "pmcid": null, "title": "[\"Pit picking\" surgery for patients with pilonidal disease : mid-term results and risk factors]", "firstAuthor": "Iesalnieks", "multipleAuthors": true, "journal": "Chirurg", "year": 2015, "design": "case-series", "n": 153, "nField": "reported", "population": "patients with pilonidal disease", "intervention": "minimally invasive \"pit picking\" surgery under local anesthesia", "comparator": "none (single-arm study, no comparison group)", "primaryOutcome": "recurrence of pilonidal disease after surgery", "result": "74% had no recurrence after a median follow-up of 30 months; smoking and prior abscess were linked to higher recurrence risk", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a small retrospective single-arm study of a selected patient group with no comparison group, so it can't tell us if this is better than leaving a cyst alone.", "directness": "indirect", "limitations": "No control group, patients were selected, and the study is retrospective with only mid-term follow-up.", "followUp": "30 months", "plainFinding": "Minor surgery helped most patients.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24969346/", "sourceText": "BACKGROUND: Minimally invasive procedures have increasingly been used to treat pilonidal disease; however, the mid-term and long-term results have not been evaluated extensively yet. PATIENTS AND METHODS: All patients underwent \"pit picking\" surgery. The surgery was performed under local anesthesia. The technique of \"pit picking\" was: all midline pits were removed by excising a margin of skin of < 1 mm. An incision of 1 cm parallel to one side of the natal cleft opened the chronic abscess cavity. No specific postoperative wound care was given. RESULTS: A total of 153 patients (126 males) underwent \"pit picking\" surgery between June 2007 and November 2010. Follow-up information was available for 148 patients (97 %). Of the patients 74% had no recurrence after a median follow-up time of 30 months and 8 more patients (5 %) remained asymptomatic after a second\"pit picking\" procedure. By multivariate analysis, smoking (hazard ratio [HR] 2.1) and occurrence of an abscess during the course of disease (HR 2.7) were statistically significantly associated with the disease recurrence after \"pit picking\" surgery. CONCLUSION: Approximately three quarters of selected patients with pilonidal disease benefit from minimally invasive \"pit picking\" surgery.", "provenance": [ { "field": "n", "quote": "A total of 153 patients (126 males) underwent \"pit picking\" surgery" }, { "field": "population", "quote": "patients with pilonidal disease" }, { "field": "intervention", "quote": "\"pit picking\" surgery. The surgery was performed under local anesthesia." }, { "field": "comparator", "quote": "All patients underwent \"pit picking\" surgery." }, { "field": "primaryOutcome", "quote": "disease recurrence after \"pit picking\" surgery" }, { "field": "result", "quote": "Of the patients 74% had no recurrence after a median follow-up time of 30 months and 8 more patients (5 %) remained asymptomatic after a second\"pit picking\" procedure." } ] }, { "id": "pmid:24923266", "pmid": "24923266", "doi": "10.1016/j.anaerobe.2014.05.009", "nctId": null, "pmcid": null, "title": "Skin and soft-tissue infections caused by Actinobaculum schaalii: report of two cases and literature review", "firstAuthor": "Tena", "multipleAuthors": true, "journal": "Anaerobe", "year": 2014, "design": "case-series", "n": 2, "nField": "reported", "population": "patients with skin and soft-tissue infections, including one with a pilonidal abscess and one immunocompromised patient with an inguinal abscess", "intervention": "surgical drainage plus antibiotic treatment with cloxacillin", "comparator": "none reported", "primaryOutcome": "clinical outcome after treatment", "result": "both patients recovered well after surgical drainage and cloxacillin treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "Only two patients with no comparison group, so it can't show whether draining it yourself versus letting it drain naturally makes a difference.", "directness": "indirect", "limitations": "Case report of only two patients with no control group; caused by a rare bacterium and does not compare self-draining to spontaneous drainage.", "followUp": "", "plainFinding": "Surgical drainage plus antibiotics worked well.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24923266/", "sourceText": "Skin and soft-tissue infections (SSTIs) caused by Actinobaculum spp. are very rare. In the present study, we report two cases and review the literature. The first case was an immunocompromised patient with an extensive cellulitis secondary to an inguinal abscess, and the second case was a patient with a pilonidal abscess. Clinical outcomes of both patients were good after surgical drainage and treatment with cloxacillin. The review of the literature showed that SSTIs caused by Actinobaculum spp. are usually located on the perineal and inguinal regions and can be severe, particularly in immunocompromised patients. SSTIs caused by Actinobaculum spp. can be overlooked because identification is often difficult and they can be considered as contaminants.", "provenance": [ { "field": "n", "quote": "we report two cases and review the literature" }, { "field": "population", "quote": "the second case was a patient with a pilonidal abscess" }, { "field": "intervention", "quote": "Clinical outcomes of both patients were good after surgical drainage and treatment with cloxacillin." }, { "field": "comparator", "quote": "Clinical outcomes of both patients were good after surgical drainage and treatment with cloxacillin." }, { "field": "primaryOutcome", "quote": "Clinical outcomes of both patients were good after surgical drainage and treatment with cloxacillin." }, { "field": "result", "quote": "Clinical outcomes of both patients were good after surgical drainage and treatment with cloxacillin." } ] }, { "id": "pmid:24426457", "pmid": "24426457", "doi": "10.1007/s12262-012-0489-5", "nctId": null, "pmcid": "PMC3726804", "title": "Limberg flap for sacrococcygeal pilonidal sinus a safe and sound procedure", "firstAuthor": "Aithal", "multipleAuthors": true, "journal": "Indian J Surg", "year": 2013, "design": "case-series", "n": 30, "nField": "reported", "population": "patients with sacrococcygeal pilonidal sinus, including primary and recurrent disease", "intervention": "Limberg flap rotation surgery", "comparator": "none (single group, no comparison)", "primaryOutcome": "wound infection, pain relief, recurrence rates, and return to work", "result": "all patients healed with minimal pain, 5-day hospital stay, return to work in 3 weeks, some flap complications, no recurrences", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a small uncontrolled case series of surgical patients, not a study of self-popping versus letting a cyst drain on its own, so it tells us little about that question.", "directness": "indirect", "limitations": "small sample of 30 patients, no comparison group, surgical population rather than untreated or self-managed cysts", "followUp": "", "plainFinding": "Surgical flap repair healed well.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24426457/", "sourceText": "Sacrococcygeal pilonidal sinus (SC-PSD) is an acquired condition usually seen in young adults especially males. This prospective study has been performed to determine effects of the Limberg flap rotation surgery for sacrococcygeal pilonidal sinus, its feasibility to the patients, their compliance, and outcomes such as wound infection, postoperative pain relief, recurrence rates, and return to work. A total of 30 patients were operated by the same two surgeons from January 2009 to June 2011, including both primary and recurrent diseases, and patients with previous incision and drainage done for the pilonidal abscess. All patients successfully underwent surgery, with very minimal postoperative pain, stayed in hospital for average 5 days, returned to work after 3 weeks, with 3 patients having flap edema, 2 having flap necrosis, and no recurrences so far. Patients with flap edema and flap necrosis took 2-3 weeks to heal with regular dressing and antibiotic usage. Limberg flap for sacrococcygeal pilonidal sinus was found very useful and sound in terms of postoperative pain, infection rates, and early return to work with almost nil recurrences.", "provenance": [ { "field": "n", "quote": "A total of 30 patients were operated" }, { "field": "population", "quote": "Sacrococcygeal pilonidal sinus (SC-PSD) is an acquired condition usually seen in young adults especially males" }, { "field": "population", "quote": "including both primary and recurrent diseases, and patients with previous incision and drainage done for the pilonidal abscess" }, { "field": "intervention", "quote": "Limberg flap rotation surgery for sacrococcygeal pilonidal sinus" }, { "field": "comparator", "quote": "All patients successfully underwent surgery" }, { "field": "primaryOutcome", "quote": "outcomes such as wound infection, postoperative pain relief, recurrence rates, and return to work" }, { "field": "result", "quote": "All patients successfully underwent surgery, with very minimal postoperative pain, stayed in hospital for average 5 days, returned to work after 3 weeks, with 3 patients having flap edema, 2 having flap necrosis, and no recurrences so far" } ] }, { "id": "pmid:23911903", "pmid": "23911903", "doi": "10.1016/j.jviscsurg.2013.05.006", "nctId": null, "pmcid": null, "title": "Pilonidal sinus disease", "firstAuthor": "de Parades", "multipleAuthors": true, "journal": "J Visc Surg", "year": 2013, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal disease, mostly men aged 15 to 30", "intervention": "surgical treatment of pilonidal abscess or sinus (incision, excision, or closure techniques)", "comparator": "different surgical approaches, such as open wound healing versus primary closure", "primaryOutcome": "recurrence and healing after surgical treatment", "result": "the abstract states the abscess must be surgically evacuated, and compares surgical techniques for recurrence and healing, but does not discuss self-draining or popping the cyst at home", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a general review of surgical techniques, not a study measuring outcomes of home drainage versus professional care, so it carries little weight for this specific question.", "directness": "indirect", "limitations": "The abstract is a narrative review describing surgical options and does not address self-drainage, home popping, or spontaneous drainage specifically.", "followUp": "", "plainFinding": "Needs surgical drainage, not self-popping", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23911903/", "sourceText": "Pilonidal disease is a frequent suppurative condition that occurs twice as often in men as in women, usually between the ages of 15 and 30. Pilonidal disease is located beneath the skin of the sacro-coccygeal region. It presents acutely as an abscess under tension while the chronic form gives rise to intermittent discharge from pilonidal sinus(es). Diagnosis is clinical and usually straightforward. In the large majority of cases, treatment is surgical but there is no consensus as to the 'ideal' technique. Acute abscess must be evacuated and an off-midline incision seems preferable. Excision is the standard definitive treatment but the choice of wide versus limited excision depends on the school of thought. The widespread practice in France is to leave the wound open, relying on postoperative healing by secondary intention. This technique has a low rate of recurrence but has the disadvantages of requiring local nursing care; the healing process is prolonged, usually associated with a temporary but prolonged cessation of activity. Primary wound closure techniques are less restrictive but their recurrence rate is probably higher. A direct midline suture is best after a small excision, but for a more extended wound, plastic reconstruction techniques are preferred; data in the literature favor asymmetric closure techniques such as those described by Karydakis and Bascom.", "provenance": [ { "field": "population", "quote": "Pilonidal disease is a frequent suppurative condition that occurs twice as often in men as in women, usually between the ages of 15 and 30." }, { "field": "intervention", "quote": "In the large majority of cases, treatment is surgical but there is no consensus as to the 'ideal' technique." }, { "field": "comparator", "quote": "The widespread practice in France is to leave the wound open, relying on postoperative healing by secondary intention." }, { "field": "comparator", "quote": "Primary wound closure techniques are less restrictive but their recurrence rate is probably higher." }, { "field": "primaryOutcome", "quote": "This technique has a low rate of recurrence but has the disadvantages of requiring local nursing care; the healing process is prolonged" }, { "field": "result", "quote": "Acute abscess must be evacuated and an off-midline incision seems preferable." } ] }, { "id": "pmid:23798021", "pmid": "23798021", "doi": "10.1024/0040-5930/a000423", "nctId": null, "pmcid": null, "title": "[Therapy of pilonidal sinus--is more always better]", "firstAuthor": "Steinemann", "multipleAuthors": false, "journal": "Ther Umsch", "year": 2013, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "young men with pilonidal sinus disease", "intervention": "minimal-invasive sinusectomy or plastic surgical wound closure", "comparator": "radical excision with open wound healing", "primaryOutcome": "recurrence of pilonidal sinus after surgery", "result": "both minimally invasive surgery and flap closure had low recurrence rates (7% and 3%) compared to traditional open healing", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a narrative review of surgical techniques, not a study of self-draining or popping cysts, so it offers no direct evidence on that question.", "directness": "indirect", "limitations": "abstract does not address self-drainage or popping cysts at home; it only discusses surgical excision methods performed by clinicians.", "followUp": "4 years", "plainFinding": "Surgical excision works better than open healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23798021/", "sourceText": "Nowadays the etiology of pilonidal sinus is explained as an acquired disease in form of ruptured hair follicles. It occurs most frequently in the proximal rima ani. Pilonidal disease is common in young men. Acute abscess formation and chronic discharge from the fistula represent indications for surgery. Surgical therapy has evolved from radical excision followed by months of open wound healing towards procedures causing less morbidity. In case of an acute abscess it is important to separate time-wise incision of the abscess in local anaesthesia from definitive excision of the fistula. Two surgical methods are compelling. First the minimal-invasive sinusectomy with sparse excision of the pori and the fistula preserving intact subcutaneous tissue. This procedure can be performed in local anaesthesia in an outpatient setting. The recurrence rate after 4 years is 7 %. Alternatively there is the possibility of a primary plastic wound closure by a rotation flap. Open wound healing can be avoided and the recurrence rate is as low as 3 %. To prevent recurrences a laser epilation has to be considered on individual decision.", "provenance": [ { "field": "population", "quote": "Pilonidal disease is common in young men." }, { "field": "intervention", "quote": "the minimal-invasive sinusectomy with sparse excision of the pori and the fistula preserving intact subcutaneous tissue" }, { "field": "comparator", "quote": "radical excision followed by months of open wound healing" }, { "field": "primaryOutcome", "quote": "The recurrence rate after 4 years is 7 %." }, { "field": "result", "quote": "the possibility of a primary plastic wound closure by a rotation flap. Open wound healing can be avoided and the recurrence rate is as low as 3 %." }, { "field": "followUp", "quote": "The recurrence rate after 4 years is 7 %." } ] }, { "id": "pmid:23559647", "pmid": "23559647", "doi": "10.1136/bcr-2012-008382", "nctId": null, "pmcid": "PMC3644915", "title": "Non-operative therapy for pilonidal sinus in adolescence: crystallised phenol application, 'report of a case'", "firstAuthor": "Gulpinar", "multipleAuthors": true, "journal": "BMJ Case Rep", "year": 2013, "design": "case-series", "n": 3, "nField": "reported", "population": "teenagers with pilonidal sinus (a cyst near the tailbone)", "intervention": "crystallised phenol chemical treatment applied in clinic", "comparator": "none; no comparison group", "primaryOutcome": "complete healing of the cyst sinus", "result": "all three patients' cysts healed, though one girl needed a second phenol treatment after 2 weeks of drainage", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "Only 3 patients were treated with no comparison group, so it can't show whether this is safer or better than other options.", "directness": "indirect", "limitations": "Very small number of patients (3), no control group, and it studies a clinic-administered chemical treatment rather than self-popping or spontaneous drainage at home.", "followUp": "2 weeks", "plainFinding": "Clinic phenol treatment healed cysts.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23559647/", "sourceText": "Pilonidal sinus (PS) is an acquired disease at the sacrococcygeal region that can be treated by different surgical techniques. Crystallised phenol application seems to be an alternative therapy to surgery with higher success rates, lower costs, faster recovery and earlier return to work. We aimed to state the success of phenol application for PS in adolescence. A 14-year-old boy with recurrent PS, an 18-year-old girl with the history of pilonidal abscess and a 15-year-old girl with PS was hospitalised. All patients underwent phenol application in an outpatient setting. The patients were followed thereafter. The 14-year-old boy and 18-year-old girl did not face any problems and all sinuses healed completely. The 15-year-old girl was followed for 2 weeks because of intergluteal maceration and ongoing drainage. She underwent another phenol application and the course after intervention was uneventful with complete healing of the sinus. Crystallised phenol application seems to be a promising non-operative therapy for PS in adolescents.", "provenance": [ { "field": "n", "quote": "A 14-year-old boy with recurrent PS, an 18-year-old girl with the history of pilonidal abscess and a 15-year-old girl with PS was hospitalised." }, { "field": "population", "quote": "A 14-year-old boy with recurrent PS, an 18-year-old girl with the history of pilonidal abscess and a 15-year-old girl with PS was hospitalised." }, { "field": "intervention", "quote": "All patients underwent phenol application in an outpatient setting." }, { "field": "comparator", "quote": "Pilonidal sinus (PS) is an acquired disease at the sacrococcygeal region that can be treated by different surgical techniques." }, { "field": "primaryOutcome", "quote": "all sinuses healed completely" }, { "field": "result", "quote": "The 14-year-old boy and 18-year-old girl did not face any problems and all sinuses healed completely. The 15-year-old girl was followed for 2 weeks because of intergluteal maceration and ongoing drainage. She underwent another phenol application and the course after intervention was uneventful with complete healing of the sinus." } ] }, { "id": "pmid:23373363", "pmid": "23373363", "doi": null, "nctId": null, "pmcid": null, "title": "Minor vs complete excision of pilonidal sinus--early postoperative period", "firstAuthor": "Petrović", "multipleAuthors": true, "journal": "Acta Chir Iugosl", "year": 2012, "design": "retrospective", "n": 127, "nField": "reported", "population": "patients with pilonidal sinus (cyst/abscess) needing surgery", "intervention": "less extensive (minor) excision of the pilonidal sinus", "comparator": "complete/midline excision or marsupialisation of the pilonidal sinus", "primaryOutcome": "time to healing, failure to heal, and recurrence after surgery", "result": "minor excision healed faster (2-5 weeks vs 4-21 weeks) with no recurrence in short follow-up, versus 13.63% failure to heal and 3.63% recurrence after complete excision", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a small, non-randomized comparison of two different patient groups treated in different time periods, with very short follow-up.", "directness": "indirect", "limitations": "not randomized, two groups from different time periods, small numbers in the minor-excision group, very short follow-up (about 11 months)", "followUp": "11.11 months", "plainFinding": "Smaller surgical excision healed faster.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23373363/", "sourceText": "Pilonidal sinus arises in the natal cleft of the sacrococcigeal region either as a cyst or as an abscess collection containing hair. It is predominantly a condition of younger people. When presenting as an abscess it usually requires surgical incision and drainage, or bursts spontaneously. In general, there are various surgical approaches to this condition, from very simple to complex ones. Each technique has its supporters and justifications. In the 3 years period, from 2009-2011, 110 treatments of the pilonidal disease were performed on our department. Midline excision was performed in 75 (68.18%) patients and the rest had marsupielisation done. The average discharge time was 1.14 days. Failure to heal occurred in 15 patients (13.63%). During that period we saw recurrence in 4 patients (3.63%). All the patients were coming to our department for postoperative care. The shortest healing time was 4 weeks and longest 21 weeks. During the period may 2011-May 2012 we performed 17 less extensive excisions. All the patients were discharged from the clinic within 23 hours and returned to their daily activities within 5 days. Healing time varied from 2 weeks to 5 weeks. In only one patient with the extensive excision healing time was 8 weeks. Although we had a short follow up period of 11.11 months, we saw no recurrence yet. Our results show that simple individual approach to every patients gives fastest and most comfortable results.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus arises in the natal cleft of the sacrococcigeal region either as a cyst or as an abscess collection containing hair." }, { "field": "intervention", "quote": "we performed 17 less extensive excisions" }, { "field": "comparator", "quote": "Midline excision was performed in 75 (68.18%) patients and the rest had marsupielisation done." }, { "field": "primaryOutcome", "quote": "Failure to heal occurred in 15 patients (13.63%)." }, { "field": "result", "quote": "All the patients were discharged from the clinic within 23 hours and returned to their daily activities within 5 days. Healing time varied from 2 weeks to 5 weeks." }, { "field": "n", "quote": "110 treatments of the pilonidal disease were performed on our department" }, { "field": "n", "quote": "we performed 17 less extensive excisions" }, { "field": "followUp", "quote": "we had a short follow up period of 11.11 months" } ] }, { "id": "pmid:23078365", "pmid": "23078365", "doi": "10.1111/j.1610-0387.2012.08007.x", "nctId": null, "pmcid": null, "title": "Incision and drainage preceding definite surgery achieves lower 20-year long-term recurrence rate in 583 primary pilonidal sinus surgery patients", "firstAuthor": "Doll", "multipleAuthors": true, "journal": "J Dtsch Dermatol Ges", "year": 2013, "design": "retrospective", "n": 583, "nField": "reported", "population": "military patients having surgery for a pilonidal sinus", "intervention": "incision and drainage of the abscess before the definitive surgery", "comparator": "letting the abscess burst open on its own before the definitive surgery", "primaryOutcome": "rate of the cyst coming back over 20 years", "result": "20-year recurrence was 24% in the drained group versus 35% in the spontaneous-rupture group", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it is a retrospective comparison of two groups, not a randomized trial, so other differences between the groups could explain the result.", "directness": "indirect", "limitations": "Abstract does not describe how the groups were assigned, and this is a planned clinical incision and drainage before surgery, not a patient draining a cyst themselves at home.", "followUp": "20 years", "plainFinding": "Fewer recurrences after clinical draining first.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23078365/", "sourceText": "BACKGROUND: It has long been suspected that acute infection leads to less satisfactory results in soft tissue surgery. Its influence on long-term recurrence rate in primary pilonidal sinus surgery has not been investigated yet. PATIENTS AND METHODS: 583 patients (military cohort) were analyzed, comparing an incision and drainage (I&D) group preceding surgery (n = 286 pts) with a spontaneous abscess and empyema rupture group (n = 297 pts). Long-term recurrence rate up to 25 years following surgery was determined. RESULTS: The I&D group achieved a 20 year recurrence rate of 24 %, whereas the non-I&D-group had 35 % recurrences (p = 0.0034). Analyzing the subgroup with primary open wound treatment (n = 349 pts), the I&D group did significantly better after 20 years (16 % actuarial recurrence rate versus 34 %; p = 0.009; log-rank-test). CONCLUSIONS: Early I&D treatment preceding definite surgery for some weeks seem to give significant superior results compared to primary surgery without I&D. The combination of early I&D and asymmetric excision and out of the midline closure is expected to give even further improved results compared to this cohort. The optimum interval between I&D and definite surgery has still to be determined.", "provenance": [ { "field": "n", "quote": "583 patients (military cohort) were analyzed" }, { "field": "population", "quote": "583 patients (military cohort) were analyzed, comparing an incision and drainage (I&D) group preceding surgery (n = 286 pts) with a spontaneous abscess and empyema rupture group (n = 297 pts)" }, { "field": "intervention", "quote": "an incision and drainage (I&D) group preceding surgery" }, { "field": "comparator", "quote": "a spontaneous abscess and empyema rupture group" }, { "field": "primaryOutcome", "quote": "Long-term recurrence rate up to 25 years following surgery was determined." }, { "field": "result", "quote": "The I&D group achieved a 20 year recurrence rate of 24 %, whereas the non-I&D-group had 35 % recurrences (p = 0.0034)." } ] }, { "id": "pmid:22991682", "pmid": "22991682", "doi": "10.1155/2012/310187", "nctId": null, "pmcid": "PMC3443993", "title": "Pilonidal Disease Mimicking Fistula-in-Ano in a 15-Year-Old Female", "firstAuthor": "Iqbal", "multipleAuthors": true, "journal": "Case Rep Surg", "year": 2012, "design": "case-series", "n": null, "nField": "not-reported", "population": "15-year-old female with pilonidal disease", "intervention": "", "comparator": "", "primaryOutcome": "", "result": "The following paper describes an unusual presentation of a pilonidal cyst with fissure and perianal drainage", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a single case report describing an unusual presentation, not a study testing treatment methods or outcomes, so it cannot show whether self-draining a cyst is safe.", "directness": "indirect", "limitations": "Single case report; does not address self-treatment, popping, or spontaneous drainage safety or outcomes.", "followUp": "", "plainFinding": "Not relevant to this question.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/22991682/", "sourceText": "Pilonidal disease typically presents with an abscess or intermittent pain and drainage in the sacrococcygeal region during the pubertal years. Further examination typically reveals pits in the midline of the sacrococcyx area due to entrapment of hair with recurrent entrapment, infection, and drainage. The following paper describes an unusual presentation of a pilonidal cyst with fissure and perianal drainage.", "provenance": [ { "field": "population", "quote": "Pilonidal disease typically presents with an abscess or intermittent pain and drainage in the sacrococcygeal region during the pubertal years." }, { "field": "result", "quote": "The following paper describes an unusual presentation of a pilonidal cyst with fissure and perianal drainage." } ] }, { "id": "pmid:22595842", "pmid": "22595842", "doi": "10.1097/DCR.0b013e31824b9527", "nctId": null, "pmcid": null, "title": "Converting emergency pilonidal abscess into an elective procedure", "firstAuthor": "Hussain", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2012, "design": "prospective-cohort", "n": 40, "nField": "reported", "population": "patients with acute pilonidal abscess, excluding those who were septic, immune-compromised, diabetic, or had skin necrosis", "intervention": "needle aspiration of the abscess under local anesthetic plus oral antibiotics", "comparator": "", "primaryOutcome": "days to return to normal activities, response to treatment, and residual inflammation", "result": "38 of 40 patients had complete resolution of inflammation and returned to normal activities the next day", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a single-center study without a comparison group, so it can't directly prove aspiration is better than other approaches like self-draining.", "directness": "indirect", "limitations": "No control group for comparison, not randomized, and excludes more severe or complicated abscess cases.", "followUp": "median of 5 days", "plainFinding": "Faster healing with drainage, antibiotics.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/22595842/", "sourceText": "BACKGROUND: Improvements in outcome after surgery for elective pilonidal sinus disease have yet to be matched for those presenting with acute disease. Traditional approaches to the management of acute pilonidal abscess have been associated with slow healing and significant loss of working time. OBJECTIVE: The aim of this study was to report our approach in which a temporizing intervention allows subsequent definitive treatment with low morbidity. DESIGN: This article presents a prospective cohort study. SETTING: This study was performed in acute admissions to the Surgical Unit in York Teaching Hospital. PATIENTS: Patients presenting with acute pilonidal abscess, not septic, immune-compromised, or diabetic, and without skin necrosis, underwent aspiration on the surgical ward. INTERVENTION: Aspiration of pilonidal abscess under local anesthetic was performed with the use of a wide-bore needle. The abscess cavity was drained to dryness, samples were sent to the laboratory for microbiology, and empirical oral antibiotics were commenced, covering anaerobes and aerobes. Review was arranged for within 7 days to plan elective excision and primary closure of the underlying pilonidal sinus. MAIN OUTCOME MEASURES: The primary outcomes measured were the number of days required to return to normal activities, response to treatment, and any residual inflammation. RESULTS: Fifty-six patients were referred with acute pilonidal abscess. Forty patients met the criteria for aspiration and empirical antibiotic treatment. All were allowed to go home the same day and were reviewed within a median of 5 days. Thirty-eight (38/40) patients demonstrated complete resolution of acute inflammation and were back to normal activities the following day. Fifteen patients subsequently underwent day-case excision and primary closure at a median of 9 weeks. Another 13 are awaiting surgery, and 10 patients have declined further treatment. Two (2/40) patients did not respond, one of whom did not receive the appropriate antibiotics. Both were managed with incision and drainage. CONCLUSIONS: Aspiration and antibiotic management of pilonidal abscess is effective in 95% of acute cases in preventing the need for emergent laying open and allows for subsequent elective surgery.", "provenance": [ { "field": "population", "quote": "Patients presenting with acute pilonidal abscess, not septic, immune-compromised, or diabetic, and without skin necrosis, underwent aspiration on the surgical ward." }, { "field": "intervention", "quote": "Aspiration of pilonidal abscess under local anesthetic was performed with the use of a wide-bore needle." }, { "field": "primaryOutcome", "quote": "The primary outcomes measured were the number of days required to return to normal activities, response to treatment, and any residual inflammation." }, { "field": "result", "quote": "Thirty-eight (38/40) patients demonstrated complete resolution of acute inflammation and were back to normal activities the following day." }, { "field": "n", "quote": "Forty patients met the criteria for aspiration and empirical antibiotic treatment." }, { "field": "followUp", "quote": "were reviewed within a median of 5 days" } ] }, { "id": "pmid:22343201", "pmid": "22343201", "doi": "10.2478/v10035-011-0104-7", "nctId": null, "pmcid": null, "title": "Non-surgical treatment of umblical pilonidal sinus in adolescent and adult cases", "firstAuthor": "Sarmast", "multipleAuthors": true, "journal": "Pol Przegl Chir", "year": 2011, "design": "case-series", "n": 51, "nField": "reported", "population": "adolescent and adult people with umbilical pilonidal sinus disease", "intervention": "non-surgical (conservative) treatment of the pilonidal sinus", "comparator": "surgical treatment for those who later needed it", "primaryOutcome": "whether conservative treatment succeeded without needing surgery", "result": "90.6% success in cases 25 years or younger and 73.7% success in older cases", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it is a small, non-randomized case series of a different (umbilical) type of pilonidal disease with no true comparison group, so it can't tell us whether popping a typical cyst yourself is safe.", "directness": "indirect", "limitations": "No control group, not randomized, specific to umbilical pilonidal sinus rather than the usual sacrococcygeal pilonidal cyst, and the exact non-surgical method isn't described.", "followUp": "", "plainFinding": "Conservative treatment often avoided surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/22343201/", "sourceText": "UNLABELLED: THE AIM OF THE STUDY was to evaluate result of non-surgical treatment among adolesecent and adult cases. MATERIAL AND METHODS: This study was carried out on cases with umbilical pilonidal disease who refused surgical treatment as first line treatment. Duration of study was from 2003 to 2006. If a patient due to complication required surgery, was not excluded from study. Data was analyzed by SPSS ver 13.0 (Chicago, IL, USA). RESULTS: In this study, 51 cases were included. Mean ± SD in male was 23.57±6.11 (range 16-40) and female was 27.93±11.38 (range 15-60). Patients were divided in two groups. Group 1 included cases ≤ 5 yrs and consisted of 32 cases. Cases >25 yrs were placed in group 2 (19 cases). From 51 cases included in this study, 43 of them were appropriate for non-surgical treatment. Eight cases underwent surgical treatment. Of 51 cases, 35 cases (68.6%) were male and 31.4% were female. Of 43 cases who treated conservatively, 29 (67.44%) cases were male and 14 (32.56%) were female. There was no significant difference between rate of successful conservative treatment among cases >25 yrs and cases ≤ 25 yrs. There was no significant different between different duration of manifestation. CONCLUSION: In this study we found successful non-surgical treatment in 90.6% of cases ≤ 25 yrs and 73.7% of cases >2 yrs. Non-surgical treatment may be appropriate option in uncomplicated cases. Another study is recommended to confirm this method of treatment.", "provenance": [ { "field": "population", "quote": "cases with umbilical pilonidal disease who refused surgical treatment as first line treatment" }, { "field": "n", "quote": "51 cases were included" }, { "field": "intervention", "quote": "non-surgical treatment" }, { "field": "comparator", "quote": "Eight cases underwent surgical treatment." }, { "field": "primaryOutcome", "quote": "successful non-surgical treatment" }, { "field": "result", "quote": "successful non-surgical treatment in 90.6% of cases ≤ 25 yrs and 73.7% of cases >2 yrs" } ] }, { "id": "pmid:22026306", "pmid": "22026306", "doi": "10.9738/1393.1", "nctId": null, "pmcid": null, "title": "Sacrococcygeal pilonidal disease", "firstAuthor": "Majeski", "multipleAuthors": true, "journal": "Int Surg", "year": 2011, "design": "case-series", "n": 127, "nField": "reported", "population": "Patients with sacrococcygeal pilonidal disease", "intervention": "Bascom surgical procedure", "comparator": "None (no comparison group)", "primaryOutcome": "Wound healing time and recurrence of disease", "result": "Lateral incision healed in a mean of 12 days; recurrence occurred in 3 of 127 patients", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a small uncontrolled case series of one surgical technique, not a comparison of self-popping versus natural drainage, so it offers very limited evidence for this question.", "directness": "indirect", "limitations": "No comparison group; abstract does not discuss self-drainage or incision versus natural rupture at all.", "followUp": "", "plainFinding": "Surgical incision healed well, low recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/22026306/", "sourceText": "The ideal treatment for pilonidal disease remains controversial with many accepted procedures in current clinical use. This case series is focused on the results of the Bascom procedure for the treatment of sacrococcygeal pilonidal disease. The records of 127 consecutive patients treated by the authors for sacrococcygeal pilonidal disease were reviewed. The Bascom surgical procedure was performed on 127 consecutive patients in a clinical surgical practice. The series included 98 male and 29 female patients. The mean age of the patients reported in this series was 23 years, with a range of 14 to 49 years of age. The lateral incision healed in a mean of 12 days, with a range of 8 to 30 days. Recurrent disease occurred in 3 patients in this series. The Bascom surgical procedure for the treatment of sacrococcygeal pilonidal disease was found in this clinical practice series to have an excellent cure rate with a low recurrence rate. Patient satisfaction was high.", "provenance": [ { "field": "n", "quote": "The records of 127 consecutive patients treated by the authors for sacrococcygeal pilonidal disease were reviewed." }, { "field": "population", "quote": "sacrococcygeal pilonidal disease" }, { "field": "intervention", "quote": "The Bascom surgical procedure was performed on 127 consecutive patients in a clinical surgical practice." }, { "field": "comparator", "quote": "This case series is focused on the results of the Bascom procedure for the treatment of sacrococcygeal pilonidal disease." }, { "field": "primaryOutcome", "quote": "The lateral incision healed in a mean of 12 days, with a range of 8 to 30 days." }, { "field": "result", "quote": "Recurrent disease occurred in 3 patients in this series." } ] }, { "id": "pmid:21982072", "pmid": "21982072", "doi": "10.1016/j.surg.2011.07.015", "nctId": null, "pmcid": null, "title": "Phenol procedure for pilonidal sinus disease and risk factors for treatment failure", "firstAuthor": "Dag", "multipleAuthors": true, "journal": "Surgery", "year": 2012, "design": "case-series", "n": 76, "nField": "reported", "population": "patients with pilonidal sinus disease (a cyst near the tailbone) who had not had it before", "intervention": "phenol treatment injected into the sinus (phenolization), done as outpatient procedure", "comparator": "no comparison group", "primaryOutcome": "complete healing and treatment failure/recurrence", "result": "67% of patients healed successfully, mean healing time was 16 days, and only 1 patient (2%) had recurrence over follow-up", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a single group of patients followed over time with no comparison group, so it cannot show whether the treatment works better than doing nothing.", "directness": "indirect", "limitations": "no control or comparator group; all patients received the same phenol procedure performed by clinicians, not self-drainage or spontaneous drainage", "followUp": "25 months (range, 13-48)", "plainFinding": "Clinic phenol treatment healed most cysts.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/21982072/", "sourceText": "BACKGROUND: The present study was designed to evaluate the results of phenolization for pilonidal sinus disease and the risk factors for treatment failure. METHODS: Between June 2005 and July 2009, 76 consecutive patients with nonrecurrent sacrococcygeal pilonidal sinus were treated with a phenol treatment and included in the study. The clinical (age, sex, story of treatment for abscess formation, and comorbidity), operative (localization and number of sinus openings and volume of cavity), and follow-up data (healing time, time off work, postoperative complications, morbidity, and number of phenolization sessions) of the patients was recorded. Gender, age, history of abscess drainage, number of sinus openings, localization of sinus openings, volume of cavity, and the number of phenolization sessions were analyzed as risk factors for treatment failure. RESULTS: The overall success rate was 67% (51 of 76 patients). The mean time to complete healing was 16 days (range, 10-45). The time off work was 0 days. Age and gender were not found to be risk factors for treatment failure (P > .05 and P > .05, respectively). Patients with a history of abscess drainage and more than 3 sinus openings had a significantly higher risk of treatment failure (P = .001 and P = .046, respectively). There was no difference between the localization of sinus openings and treatment failure (P > .05). There were statistically significant differences between treatment failure and both the cavity volume and number of phenolization sessions (P = .016 and P = .001, respectively). Patients were followed up for a mean period of 25 months (range, 13-48). One patient (2%) showed recurrence. CONCLUSION: With an early return to work and low rates of complications and recurrence, phenolization is a simple outpatient procedure for the treatment of pilonidal sinus disease in selected patients.", "provenance": [ { "field": "n", "quote": "76 consecutive patients with nonrecurrent sacrococcygeal pilonidal sinus were treated with a phenol treatment" }, { "field": "population", "quote": "76 consecutive patients with nonrecurrent sacrococcygeal pilonidal sinus" }, { "field": "intervention", "quote": "treated with a phenol treatment" }, { "field": "comparator", "quote": "The present study was designed to evaluate the results of phenolization for pilonidal sinus disease" }, { "field": "primaryOutcome", "quote": "risk factors for treatment failure" }, { "field": "result", "quote": "The overall success rate was 67% (51 of 76 patients). The mean time to complete healing was 16 days (range, 10-45)." }, { "field": "result", "quote": "One patient (2%) showed recurrence." } ] }, { "id": "pmid:21533783", "pmid": "21533783", "doi": "10.1007/s10151-011-0684-6", "nctId": null, "pmcid": null, "title": "Does pilonidal abscess heal quicker with off-midline incision and drainage?", "firstAuthor": "Webb", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2011, "design": "retrospective", "n": 243, "nField": "reported", "population": "patients with an acute pilonidal abscess who had it surgically drained", "intervention": "incision made away from the midline (lateral) to drain the abscess", "comparator": "incision made directly on the midline to drain the abscess", "primaryOutcome": "time for the wound to heal", "result": "abscesses drained with a midline incision took about 3 weeks longer to heal than those drained with a lateral incision", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it is a retrospective chart review with a small matched subgroup and it excluded abscesses that drained on their own, so it cannot tell us whether self-draining or self-popping is safe.", "directness": "indirect", "limitations": "retrospective design; did not capture patients whose abscess drained spontaneously or were drained in the emergency department", "followUp": "", "plainFinding": "Off-center surgical cuts heal faster.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/21533783/", "sourceText": "BACKGROUND: No clinical trials have been done to guide the surgeon in the optimal technique of draining a pilonidal abscess. The aim of our study was to investigate whether the location of the incision influences wound healing. METHODS: Electronic records from the surgical database at our 200-bed district general hospital were reviewed for operative technique (midline vs. lateral) for patients who underwent incision and drainage for acute pilonidal abscess between January 2003 and February 2010. These patients were admitted from the Emergency Department with a pilonidal abscess, underwent operative drainage, and returned for follow-up. The main outcome measure was wound healing time. RESULTS: Two hundred and forty-three pilonidal abscesses were drained, 134 with a lateral and 74 with a midline incision. All patients underwent simple longitudinal incision. No patient underwent de-roofing, marsupialisation, or closure. Forty-eight patients with midline drainage who returned for follow-up were matched for gender, age, and microbiology culture results with patients who underwent lateral drainage. Almost all were drained under general anesthesia with a median postoperative stay of 1 day. The overall length of follow-up was the same in both groups (P = 0.13). Abscesses that did not heal were followed-up for the same period of time irrespective of incision type (P = 0.48). Abscesses that healed after midline incision took approximately 3 weeks longer than those drained via a lateral incision (P = 0.02). Our study has limitations since it was a retrospective study that did not capture patients whose abscess drained spontaneously or were drained in the emergency department. CONCLUSIONS: Pilonidal abscess should be drained away from the midline.", "provenance": [ { "field": "population", "quote": "These patients were admitted from the Emergency Department with a pilonidal abscess, underwent operative drainage, and returned for follow-up." }, { "field": "n", "quote": "Two hundred and forty-three pilonidal abscesses were drained, 134 with a lateral and 74 with a midline incision." }, { "field": "intervention", "quote": "Electronic records from the surgical database at our 200-bed district general hospital were reviewed for operative technique (midline vs. lateral) for patients who underwent incision and drainage for acute pilonidal abscess between January 2003 and February 2010." }, { "field": "comparator", "quote": "Electronic records from the surgical database at our 200-bed district general hospital were reviewed for operative technique (midline vs. lateral) for patients who underwent incision and drainage for acute pilonidal abscess between January 2003 and February 2010." }, { "field": "primaryOutcome", "quote": "The main outcome measure was wound healing time." }, { "field": "result", "quote": "Abscesses that healed after midline incision took approximately 3 weeks longer than those drained via a lateral incision (P = 0.02)." }, { "field": "limitations", "quote": "Our study has limitations since it was a retrospective study that did not capture patients whose abscess drained spontaneously or were drained in the emergency department." } ] }, { "id": "pmid:21251431", "pmid": "21251431", "doi": "10.1503/cjs.028509", "nctId": null, "pmcid": "PMC3038365", "title": "A pediatric surgeon's 35-year experience with pilonidal disease in a Canadian children's hospital", "firstAuthor": "Nasr", "multipleAuthors": true, "journal": "Can J Surg", "year": 2011, "design": "retrospective", "n": 121, "nField": "reported", "population": "teenagers with pilonidal cysts treated at a children's hospital", "intervention": "surgical removal of the cyst, done three different ways (cut open and packed, marsupialized, or cut out and stitched closed)", "comparator": "the three surgical methods compared against each other", "primaryOutcome": "how long the wound took to heal and whether the cyst came back", "result": "the cut-open-and-packed method took twice as long to heal but had the same chance of the cyst coming back as the other methods", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is a 35-year chart review of surgery choices made by one surgeon, not a study of whether popping a cyst at home is safe", "directness": "indirect", "limitations": "retrospective, surgery type was chosen arbitrarily rather than randomly, and it only covers formal surgical treatment, not self-drainage or popping", "followUp": "", "plainFinding": "Surgical methods compared; no self-draining advice.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/21251431/", "sourceText": "BACKGROUND: There is an ongoing debate regarding the optimal surgical management for pilonidal disease in the pediatric population. The purpose of this study was to evaluate a pediatric surgeon's experience at a Canadian children's hospital over 35 years. METHODS: We performed a retrospective review of the charts of patients seen and treated from July 1969 to December 2003, inclusive. All patients were evaluated for age, sex, clinical diagnosis, infection, treatment, healing time, complications and results. RESULTS: In all, 121 adolescents with pilonidal disease (64 boys, 57 girls) with a mean age of 15 (range 12-19) years were evaluated at the same children's hospital. The 107 (88%) patients with infection (46% acute) underwent surgery. At operation, all 107 pilonidal cysts were either excised and packed open, marsupialized or excised and closed primarily without drainage under general anesthesia; the operation performed was arbitrarily chosen. Vacuum-assisted closure was not used. All patients received antibiotics. The time for healing after the initial operation in the group whose cysts were excised and packed open was at least twice as long (75 d) as in the other 2 groups (p = 0.031). Disease recurred in 24 (22%) patients, 6 (25%) of whom experienced 2 recurrences. Among the 90 patients in the excised and packed open group, 20 (22%) experienced recurrences and 5 (25%) experienced 2 recurrences. Among the 13 patients in the marsupialized group, 3 (23%) experienced recurrences and 1 (33%) experienced 2 recurrences. Among the 4 patients in the excised and closed primarily without drainage group, 1 (25%) experienced a recurrence and none experienced 2 recurrences (p = 0.12). Each recurrence was smaller than the original. All wounds eventually healed. There were no other complications and no deaths. A multivariable logistic regression analysis revealed that the type of surgical approach was not predictive of recurrence after controlling for age and sex. CONCLUSION: Age, sex and surgical approach were not predictive of recurrence. From our experience, excision and packing open the wound produced a longer morbidity but offered the same results compared with marsupialization or excision and primary closure without drainage.", "provenance": [ { "field": "population", "quote": "121 adolescents with pilonidal disease (64 boys, 57 girls) with a mean age of 15 (range 12-19) years were evaluated at the same children's hospital" }, { "field": "intervention", "quote": "all 107 pilonidal cysts were either excised and packed open, marsupialized or excised and closed primarily without drainage under general anesthesia" }, { "field": "comparator", "quote": "the operation performed was arbitrarily chosen" }, { "field": "primaryOutcome", "quote": "patients were evaluated for age, sex, clinical diagnosis, infection, treatment, healing time, complications and results" }, { "field": "result", "quote": "The time for healing after the initial operation in the group whose cysts were excised and packed open was at least twice as long (75 d) as in the other 2 groups (p = 0.031)" }, { "field": "n", "quote": "121 adolescents with pilonidal disease (64 boys, 57 girls)" } ] }, { "id": "pmid:21251419", "pmid": "21251419", "doi": "10.1503/cjs.026309", "nctId": null, "pmcid": "PMC3116700", "title": "Ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture", "firstAuthor": "Maghsoudi", "multipleAuthors": true, "journal": "Can J Surg", "year": 2011, "design": "case-series", "n": 150, "nField": "reported", "population": "people with chronic pilonidal sinus disease, average age 22", "intervention": "outpatient surgery to cut out the sinus and stitch it closed (lateral incision and primary suture)", "comparator": "none; all patients received the same surgery", "primaryOutcome": "wound healing, complications, and recurrence of the sinus", "result": "no sinus came back, healing was fast, and only a few wound infections or blood collections occurred", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a single group of patients followed with surgery and no comparison group, so it can't show whether this approach is better than other options.", "directness": "indirect", "limitations": "No control group, not randomized, and the abstract doesn't mention blinding or how recurrences were tracked after the study period.", "followUp": "Mar. 20, 2005, to Mar. 20, 2008", "plainFinding": "Surgery healed well, no recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/21251419/", "sourceText": "BACKGROUND: Outpatient management is appropriate for chronic pilonidal sinuses. Even though there are different surgical treatments for pilonidal sinuses, the outcome may not be uniformly satisfactory. The aim of this paper was to examine the ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture. METHODS: We present our experience with outpatient management of asymptomatic chronic pilonidal disease. We prospectively studied patients presenting with pilonidal disease from Mar. 20, 2005, to Mar. 20, 2008. All were managed as outpatients. We reviewed presentation, treatment, healing, time off work and recurrences. RESULTS: In all, 150 patients (131 men and 19 women) with chronic pilonidal sinuses underwent ambulatory plain lateral excision and primary repair during the study period. The mean age of patients was 22.1 years. The mean duration of surgery was 18.4 minutes. No general complications occurred. Local complications consisted of 3 wound infections and 4 wound hematomas. No sinus recurrence occurred. The healing rate was fast in all patients. CONCLUSION: Advantages of ambulatory plain lateral excision and primary repair include immediate treatment, minimal pain and a quick return to normal activities. This method is a simple and effective procedure in the treatment of uncomplicated pilonidal sinuses.", "provenance": [ { "field": "population", "quote": "patients presenting with pilonidal disease" }, { "field": "intervention", "quote": "ambulatory plain lateral excision and primary repair" }, { "field": "comparator", "quote": "All were managed as outpatients." }, { "field": "primaryOutcome", "quote": "We reviewed presentation, treatment, healing, time off work and recurrences." }, { "field": "result", "quote": "No sinus recurrence occurred. The healing rate was fast in all patients." }, { "field": "n", "quote": "In all, 150 patients (131 men and 19 women) with chronic pilonidal sinuses underwent ambulatory plain lateral excision and primary repair during the study period." } ] }, { "id": "pmid:21125608", "pmid": "21125608", "doi": "10.1002/bjs.7292", "nctId": null, "pmcid": null, "title": "Simple day-case surgery for pilonidal sinus disease", "firstAuthor": "Thompson", "multipleAuthors": true, "journal": "Br J Surg", "year": 2011, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "patients with pilonidal sinus disease", "intervention": "simple day-case surgery removing midline skin pits with lateral drainage of the abscess/sinus", "comparator": "wide excisional surgery and expectant (non-surgical) management", "primaryOutcome": "effectiveness of treatment, healing, return to work, and complications", "result": "Simple pit removal with lateral drainage worked well for most patients, while patients with minimal symptoms or a single acute abscess could be managed by watching and waiting", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a narrative literature review of varied studies, not a controlled trial, so it can't firmly prove which approach is best.", "directness": "indirect", "limitations": "The abstract states non-surgical treatments' long-term results are unknown, and the review excluded papers on new or modified techniques, limiting generalizability.", "followUp": "", "plainFinding": "Minor cases can be watched; surgery removes pits.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/21125608/", "sourceText": "BACKGROUND: Pilonidal disease is a common and usually minor disease. Although wide excisional surgery has been common practice, there are more simple alternatives. This review focused on the aetiology and management of pilonidal disease. METHODS: A comprehensive review of the literature on pilonidal disease was undertaken. MEDLINE searches for all articles listing pilonidal disease (1980-2010) were performed to determine the aetiology and results of surgical and non-surgical treatments. Single papers describing new techniques or minor modifications of established techniques were excluded. Further articles were traced through reference lists. RESULTS: Patients with minimal symptoms and those having drainage of a single acute abscess can be treated expectantly. Non-surgical treatments may be of value but their long-term results are unknown. There is no rational basis or need for wide excision of the abscess and sinus. Simple removal of midline skin pits, the primary cause of pilonidal disease, with lateral drainage of the abscess and sinus is effective in most instances. Hirsute patients with extensive primary disease and deep natal clefts, or with recurrent disease and unhealed midline wounds, may also require flattening of the natal cleft with off-midline skin closure. These more conservative procedures are usually done as a day case, require minimal care in the community and are associated with a rapid return to work. They also avoid the occasional debilitating complications of surgical treatment. CONCLUSION: Simple day-case surgery to eradicate midline skin pits without wide excision of the abscesses and sinus is rational, safe and effective for patients with pilonidal sinus disease.", "provenance": [ { "field": "population", "quote": "Pilonidal disease is a common and usually minor disease." }, { "field": "intervention", "quote": "Simple removal of midline skin pits, the primary cause of pilonidal disease, with lateral drainage of the abscess and sinus is effective in most instances." }, { "field": "comparator", "quote": "Although wide excisional surgery has been common practice, there are more simple alternatives." }, { "field": "primaryOutcome", "quote": "These more conservative procedures are usually done as a day case, require minimal care in the community and are associated with a rapid return to work." }, { "field": "result", "quote": "Patients with minimal symptoms and those having drainage of a single acute abscess can be treated expectantly." }, { "field": "result", "quote": "Simple day-case surgery to eradicate midline skin pits without wide excision of the abscesses and sinus is rational, safe and effective for patients with pilonidal sinus disease." } ] }, { "id": "pmid:20357505", "pmid": "20357505", "doi": "10.1159/000285291", "nctId": null, "pmcid": null, "title": "Investigation of a one-time phenol application for pilonidal disease", "firstAuthor": "Kayaalp", "multipleAuthors": true, "journal": "Med Princ Pract", "year": 2010, "design": "case-series", "n": 30, "nField": "reported", "population": "patients with chronic pilonidal disease, from simple to complex sinuses", "intervention": "a one-time application of phenol into the pilonidal sinus cavity", "comparator": "none; no control group used, no repeat phenol or curettage during follow-up", "primaryOutcome": "wound healing rate and postoperative recovery", "result": "83% of patients were symptom-free at 2 months, with an overall success rate of 70% after accounting for later recurrences", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, single-group study of only 30 patients with no comparison group, so it can't show how this treatment compares to other options or to doing nothing.", "directness": "indirect", "limitations": "No control group, no randomization, and small sample size of 30 patients.", "followUp": "2 months", "plainFinding": "Phenol treatment healed most pilonidal cysts.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/20357505/", "sourceText": "OBJECTIVE: To investigate wound healing rates and postoperative recovery of patients after a one-time phenol application for pilonidal disease. SUBJECTS AND METHODS: A total 30 consecutive patients with chronic pilonidal disease ranging from midline to complex sinuses were enrolled in the study. No preoperative laboratory examinations or bowel preparation were required. No antibiotic prophylaxis or sedation was used. A small incision was made on the midline and hair/debris in the sinuses was removed. A cotton swab with saturated phenol was moved into the cavity and the phenol was left for 2 min. No special dressing was necessary and patients left the hospital immediately afterwards. Patients filled out a daily questionnaire for 7 days. We did not intervene in the wounds with a second phenol application or curettage during the observation period. Wounds were inspected at weekly intervals for 2 months. RESULTS: At the end of the third day, 97% of the patients were pain-free and 100% of the patients were free from analgesics. Time off work was 2 days for most patients (93.3%). Twenty-eight (93.3%) patients were satisfied with the procedure, they found it easy and painless and suggested the procedure to other patients. Twenty-five (83%) patients were asymptomatic at the end of 2 months' observation and the remaining 5 patients had unhealed sinuses. Mean time for wound healing was 25 days (range 10-63 days). There were 4 recurrences after a mean of 14 months' follow-up and the overall success rate was 70%. CONCLUSIONS: A one-time phenol application was an effective treatment for pilonidal disease with acceptable wound healing rates, less postoperative pain and less time off work. Hence it can be an alternative treatment modality.", "provenance": [ { "field": "n", "quote": "A total 30 consecutive patients with chronic pilonidal disease" }, { "field": "population", "quote": "patients with chronic pilonidal disease ranging from midline to complex sinuses" }, { "field": "intervention", "quote": "a one-time phenol application for pilonidal disease" }, { "field": "comparator", "quote": "We did not intervene in the wounds with a second phenol application or curettage during the observation period." }, { "field": "primaryOutcome", "quote": "To investigate wound healing rates and postoperative recovery of patients after a one-time phenol application for pilonidal disease." }, { "field": "result", "quote": "Twenty-five (83%) patients were asymptomatic at the end of 2 months' observation and the remaining 5 patients had unhealed sinuses." }, { "field": "result", "quote": "There were 4 recurrences after a mean of 14 months' follow-up and the overall success rate was 70%." } ] }, { "id": "pmid:20336891", "pmid": "20336891", "doi": null, "nctId": null, "pmcid": null, "title": "Gluteal fascial advancement: an innovative, effective method for treating pilonidal disease", "firstAuthor": "Washer", "multipleAuthors": true, "journal": "Am Surg", "year": 2010, "design": "retrospective", "n": 83, "nField": "reported", "population": "patients who had surgery for pilonidal disease", "intervention": "gluteal fascial advancement surgical technique", "comparator": "standard primary closure surgery", "primaryOutcome": "wound breakdown, recurrence, and early wound drainage after surgery", "result": "significant difference in incidence of wound breakdown (0 vs 21%), recurrence (0 vs 20%), and early wound drainage (6 vs 32%), with an 80 per cent reduction in wound complications after gluteal fascial advancement", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective comparison of surgical techniques with a small number of patients in one group, not a study of self-draining or popping a cyst.", "directness": "indirect", "limitations": "Retrospective database review comparing two surgical techniques; abstract does not address self-drainage or spontaneous rupture of cysts.", "followUp": "", "plainFinding": "Fewer complications with one surgery type.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/20336891/", "sourceText": "The ideal elective surgical procedure for pilonidal disease is debated. Simple excision and closure is commonly performed but is associated with a high incidence of wound complications and recurrence. We developed a simple modification of primary closure, which involves the elevation, mobilization, and closure of the gluteal fascia. The purpose of this study is to compare outcomes of this gluteal fascial advancement technique with standard primary closure for the treatment of pilonidal disease. We retrospectively reviewed our surgical database to include all patients who underwent surgery for pilonidal disease from 2004 to 2007. Patients who underwent primary closure (n = 66) were compared with patients who underwent gluteal fascial advancement (n = 17). Demographic data as well as recurrence and the incidence of wound complications were examined. There was a significant difference in incidence of wound breakdown (0 vs 21%), recurrence (0 vs 20%), and early wound drainage (6 vs 32%). Overall there was an 80 per cent reduction in wound complications after gluteal fascial advancement compared with primary closure. Gluteal fascial advancement is a simple modification of standard primary closure and is associated with fewer wound complications and recurrences.", "provenance": [ { "field": "n", "quote": "Patients who underwent primary closure (n = 66) were compared with patients who underwent gluteal fascial advancement (n = 17)." }, { "field": "population", "quote": "all patients who underwent surgery for pilonidal disease from 2004 to 2007" }, { "field": "intervention", "quote": "gluteal fascial advancement technique" }, { "field": "comparator", "quote": "standard primary closure" }, { "field": "primaryOutcome", "quote": "recurrence and the incidence of wound complications were examined" }, { "field": "result", "quote": "There was a significant difference in incidence of wound breakdown (0 vs 21%), recurrence (0 vs 20%), and early wound drainage (6 vs 32%)." } ] }, { "id": "pmid:20091138", "pmid": "20091138", "doi": "10.1007/s11845-009-0450-1", "nctId": null, "pmcid": null, "title": "Incise and lay open: an effective procedure for coccygeal pilonidal sinus disease", "firstAuthor": "Gidwani", "multipleAuthors": true, "journal": "Ir J Med Sci", "year": 2010, "design": "retrospective", "n": 204, "nField": "reported", "population": "patients with coccygeal pilonidal sinus disease needing surgery", "intervention": "surgical incision and lay open of the sinus tract", "comparator": "abscess drainage alone, or other surgical excision/closure methods", "primaryOutcome": "need for further surgery due to recurrence", "result": "incision and lay open had fewer repeat surgeries than drainage alone in emergency cases", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a retrospective, non-randomized review of surgical records, so it cannot reliably rule out bias or confounding.", "directness": "indirect", "limitations": "Retrospective design, not randomized, and surgeon grade/procedure choice were not controlled for.", "followUp": "", "plainFinding": "Surgical lay-open beat drainage alone.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/20091138/", "sourceText": "AIM: This study aims to analyze the outcome of various procedures performed for coccygeal pilonidal disease. METHODS: Between January 1999 and February 2004, patients with coccygeal pilonidal disease were included. Data were analyzed for the nature of operation (elective/emergency), grade of surgeon, type of procedure and further definitive surgery. RESULTS: Two hundred and four patients underwent surgery for coccygeal pilonidal disease. One hundred and thirty-six patients had emergency surgery (abscess drainage: 61; abscess drainage + lay open: 75) and further definitive procedure was performed in 20 (33.3%) and 8 (11.1%) patients, respectively (P = 0.013, Fishers' exact test). Sixty-eight patients had elective surgery (incision and lay open: 34; excision and lay open: 24; excision and closure/Bascom's/other: 10) and further procedure for recurrence was noted among 3 (8.8%), 5 (20.8%) and 4 (40%) patients, respectively (P = 0.17, chi(2) test). CONCLUSION: In patients with coccygeal pilonidal sinus disease, a single-stage incision and lay open of the sinus tract is the most efficient operation, especially during emergency surgery.", "provenance": [ { "field": "n", "quote": "Two hundred and four patients underwent surgery for coccygeal pilonidal disease." }, { "field": "population", "quote": "patients with coccygeal pilonidal disease were included" }, { "field": "intervention", "quote": "a single-stage incision and lay open of the sinus tract is the most efficient operation" }, { "field": "comparator", "quote": "abscess drainage: 61; abscess drainage + lay open: 75" }, { "field": "primaryOutcome", "quote": "further definitive procedure was performed in 20 (33.3%) and 8 (11.1%) patients, respectively" }, { "field": "result", "quote": "further definitive procedure was performed in 20 (33.3%) and 8 (11.1%) patients, respectively (P = 0.013, Fishers' exact test)" } ] }, { "id": "pmid:18634729", "pmid": "18634729", "doi": "10.1308/003588408X285955", "nctId": null, "pmcid": "PMC2645736", "title": "Sinus excision, release of coccycutaneous attachments and dermal-subcuticular closure (XRD procedure): a novel technique in flattening the natal cleft in pilonidal sinus treatment", "firstAuthor": "Marzouk", "multipleAuthors": true, "journal": "Ann R Coll Surg Engl", "year": 2008, "design": "case-series", "n": 66, "nField": "reported", "population": "adults with long-term pilonidal sinus (mostly young men, median age 27)", "intervention": "surgical removal of the sinus with release of attachments to the tailbone and stitched closure (XRD procedure)", "comparator": "none - all patients had the same surgery, compared before and after", "primaryOutcome": "wound complications and recurrence after surgery", "result": "no sinuses came back after about 22 months follow-up, though 18% had minor wound problems", "resultDirection": "benefit", "quality": "low", "qualityWhy": "single group of patients followed over time with no comparison group, so it can't show whether this is better than other options.", "directness": "indirect", "limitations": "no control group, single surgical technique only, relatively small number of patients", "followUp": "median, 22.5 months (range, 12-38 months)", "plainFinding": "New surgery technique, no recurrences", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/18634729/", "sourceText": "INTRODUCTION: The objective of this study was to analyse, prospectively, the outcome of a new technique - excision of pilonidal sinus and flattening the natal cleft by division of the coccycutaneous attachments at the lower end of the incision. PATIENTS AND METHODS: Sixty-six consecutive patients with chronic pilonidal sinuses were treated between 1995 and 2001. The procedure consisted of an elliptical, wide, local excision, release of the coccycutaneous attachments and primary closure using dermal-subcuticular closure (XRD). Suction drains were used until drainage was minimal. The height of skin level at the lower angle of the wound from the coccyx was measured intra-operatively before and after division of the coccycutaneous attachments. Postoperatively, patients were assessed for hospital stay, return to normal activity, complications and recurrence. RESULTS: Sixty-four patients (97%) were males, median age 27 years. The height of skin level rose from a mean of 1.8 cm (95% CI, 1.78-1.85) to a mean of 3.8 cm (95% CI, 3.77-3.88; P < 0.001). Morbidity affected 12 patients (18%), epidermal separation of the lower wound angles (6 patients), seromas (5 patients) and 1 wound dehiscence at 2 weeks. All other wounds healed primarily without dehiscence. There were no recurrences after a median follow-up of 22.5 months (range, 12-38 months). CONCLUSIONS: Release of the coccycutaneous attachments is an easy technique to learn, which seems to be an effective way of flattening the natal cleft and may result in lower recurrence rate. This technique should be tried in uncomplicated pilonidal sinus disease before more complex procedures are attempted.", "provenance": [ { "field": "n", "quote": "Sixty-six consecutive patients with chronic pilonidal sinuses were treated between 1995 and 2001." }, { "field": "population", "quote": "Sixty-four patients (97%) were males, median age 27 years." }, { "field": "intervention", "quote": "an elliptical, wide, local excision, release of the coccycutaneous attachments and primary closure using dermal-subcuticular closure (XRD)" }, { "field": "comparator", "quote": "The height of skin level at the lower angle of the wound from the coccyx was measured intra-operatively before and after division of the coccycutaneous attachments." }, { "field": "primaryOutcome", "quote": "Postoperatively, patients were assessed for hospital stay, return to normal activity, complications and recurrence." }, { "field": "result", "quote": "There were no recurrences after a median follow-up of 22.5 months (range, 12-38 months)." }, { "field": "result", "quote": "Morbidity affected 12 patients (18%), epidermal separation of the lower wound angles (6 patients), seromas (5 patients) and 1 wound dehiscence at 2 weeks." } ] }, { "id": "pmid:18597974", "pmid": "18597974", "doi": "10.1016/j.jemermed.2007.11.052", "nctId": null, "pmcid": null, "title": "Aspiration and injection-based technique for incision and drainage of a sacrococcygeal pilonidal abscess", "firstAuthor": "Khalil", "multipleAuthors": true, "journal": "J Emerg Med", "year": 2009, "design": "case-series", "n": null, "nField": "not-reported", "population": "patients with a sacrococcygeal pilonidal abscess treated in the Emergency Department", "intervention": "needle aspiration of the abscess followed by injecting local anesthetic into the same cavity before incision and drainage", "comparator": "standard local anesthetic infiltration around the abscess before drainage", "primaryOutcome": "pain and tolerability during incision and drainage of the abscess", "result": "the technique was described as well tolerated and reduced the pain and difficulty usually encountered with this procedure", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a description of a new clinician technique with no patient numbers, no comparison data, and no measured outcomes, so it carries very little weight as evidence.", "directness": "indirect", "limitations": "No numbers of patients, no measured pain scores or outcome data, and no comparison group; this describes a clinician-performed ED procedure, not whether patients should drain a cyst themselves.", "followUp": "", "plainFinding": "Describes a less painful clinician drainage method only.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/18597974/", "sourceText": "The incision and drainage of a sacrococcygeal abscess is a common procedure in the Emergency Department (ED) both to decrease a patient's pain and to improve the local wound conditions for subsequent definitive surgical therapy. However, the local infiltration of anesthetics is often problematic due to the unacceptable and unavoidable pain resulting from the injection itself, as well as the inability to achieve a complete anesthetic response. Therefore, standard textbooks generally recommend the concomitant use of local and systemic analgesics in the treatment of sacrococcygeal abscesses. We describe herein an alternative technique to administer local analgesia after the aspiration of an abscess for incision and drainage of a sacrococcygeal abscess that is safe and rapid. The patient is placed in the prone position and the buttocks are separated from the midline with adhesive tape. The technique involves needle aspiration of the abscess with consecutive slow injections of the same amount of local anesthetic into the abscess cavity via the same needle, followed by abscess drainage by incision and gentle curettage. This method therefore eliminates multiple infiltrations of the abscess and the surrounding area and obviates the associated pain due to the low volume of anesthetic required. The described technique is well tolerated by the patient and reduces the frequently encountered difficulty with incision and drainage of coccygeal abscesses in the ED.", "provenance": [ { "field": "population", "quote": "incision and drainage of a sacrococcygeal abscess is a common procedure in the Emergency Department" }, { "field": "intervention", "quote": "needle aspiration of the abscess with consecutive slow injections of the same amount of local anesthetic into the abscess cavity via the same needle, followed by abscess drainage by incision and gentle curettage" }, { "field": "comparator", "quote": "the local infiltration of anesthetics is often problematic due to the unacceptable and unavoidable pain resulting from the injection itself" }, { "field": "primaryOutcome", "quote": "to decrease a patient's pain and to improve the local wound conditions for subsequent definitive surgical therapy" }, { "field": "result", "quote": "The described technique is well tolerated by the patient and reduces the frequently encountered difficulty with incision and drainage of coccygeal abscesses in the ED." } ] }, { "id": "pmid:18565338", "pmid": "18565338", "doi": "10.1016/j.amjsurg.2007.05.051", "nctId": null, "pmcid": null, "title": "Outcome of chronic pilonidal disease treatment after ambulatory plain midline excision and primary suture", "firstAuthor": "Tocchi", "multipleAuthors": true, "journal": "Am J Surg", "year": 2008, "design": "rct", "n": 103, "nField": "reported", "population": "patients with chronic pilonidal sinus needing surgery", "intervention": "surgical excision with wound drainage", "comparator": "surgical excision without drainage", "primaryOutcome": "wound complications and healing time", "result": "drainage group had fewer wound complications and faster healing than no-drainage group", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "Randomized but small, single-center surgical study not addressing self-draining at home.", "directness": "indirect", "limitations": "Small sample size, surgical setting only, does not address self-popping or spontaneous drainage at home.", "followUp": "", "plainFinding": "Draining surgical wound reduced complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/18565338/", "sourceText": "BACKGROUND: Pilonidal sinus (PS) is a common chronic disorder of the sacrococcygeal region. The optimal treatment for PS remains controversial, and recent reports have advocated different surgical approaches. METHODS: A prospective study was performed on 103 patients with nonrecurrent quiescent chronic discharging sinus. Excision with primary closure was performed on all patients. Patients were subdivided randomly into 2 groups. In group A, the excision was associated with drainage of the wound; in group B, the wound was not drained. RESULTS: Excision with primary closure and drainage was performed in 53 patients (group A). Drainage was omitted in 50 patients (group B). Minor wound complications occurred in 3 patients in group A and in 36 patients in group B. No complete dehiscence of the wound was observed in patients in group A and in 8 patients in group B. Complete healing was fastest in patients in group A. Sinus recurrence occurred in 1 patient in group A and in 2 patients in group B. CONCLUSION: Short- and long-term results suggest that limited midline excision with primary closure and wound drainage is a simple and effective procedure in the surgical treatment of uncomplicated PS. More demanding flap techniques and plasties should be reserved for complicated PS, which requires a wider excision.", "provenance": [ { "field": "n", "quote": "A prospective study was performed on 103 patients with nonrecurrent quiescent chronic discharging sinus." }, { "field": "population", "quote": "103 patients with nonrecurrent quiescent chronic discharging sinus" }, { "field": "intervention", "quote": "the excision was associated with drainage of the wound" }, { "field": "comparator", "quote": "the wound was not drained" }, { "field": "primaryOutcome", "quote": "Minor wound complications occurred in 3 patients in group A and in 36 patients in group B." }, { "field": "result", "quote": "Minor wound complications occurred in 3 patients in group A and in 36 patients in group B. No complete dehiscence of the wound was observed in patients in group A and in 8 patients in group B. Complete healing was fastest in patients in group A." } ] }, { "id": "pmid:18558194", "pmid": "18558194", "doi": "10.1016/j.jpedsurg.2008.02.042", "nctId": null, "pmcid": null, "title": "Current management of adolescent pilonidal disease", "firstAuthor": "Lee", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2008, "design": "retrospective", "n": 26, "nField": "reported", "population": "adolescents with pilonidal cysts needing surgery", "intervention": "wide local excision (cutting out the whole cyst)", "comparator": "unroofing and marsupialization (opening and stitching edges, less invasive)", "primaryOutcome": "complications, healing time, and need for repeat surgery", "result": "the less invasive unroofing procedure healed faster, had fewer complications, and fewer repeat operations than wide excision", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a small, retrospective, non-randomized comparison of two surgical techniques, not a study of self-draining versus leaving a cyst alone", "directness": "indirect", "limitations": "retrospective design, small sample, not randomized, and compares two surgical methods rather than self-popping versus spontaneous drainage", "followUp": "", "plainFinding": "Less invasive surgery healed faster.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/18558194/", "sourceText": "BACKGROUND: Controversy persists regarding the optimal management for adolescent pilonidal disease. We reviewed the outcome of wide local excision (WLE) vs unroofing and marsupialization (UM) for pilonidal disease. METHODS: A retrospective review 2002 to 2007 of adolescents undergoing surgical treatment of pilonidal disease was performed. Data were analyzed using Student's t test. RESULTS: Twenty-six patients were treated for pilonidal disease during this period. Average age was 16.7 years (range, 14-19 years) with 50% males. Nine patients underwent WLE and 17 had UM. Before initial evaluation, 44% of patients in the WLE group had drainage of acute abscess compared to 59% in the UM group (P > .05). Postoperative complications in the WLE group (78%) were significantly higher compared to the UM group (0%). Median time for final healing was significantly higher in the WLE group (32 weeks) compared to the UM group (6 weeks). The reoperative rate was also significantly higher in the WLE group (56%) compared to the UM group (0%). No patient had recurrent disease after complete healing in either group. CONCLUSION: Unroofing and marsupialization for primary pilonidal disease has a shorter time to heal and carries a lower complication and reoperative rate compared to WLE.", "provenance": [ { "field": "n", "quote": "Twenty-six patients were treated for pilonidal disease during this period." }, { "field": "population", "quote": "adolescents undergoing surgical treatment of pilonidal disease" }, { "field": "intervention", "quote": "wide local excision (WLE)" }, { "field": "comparator", "quote": "unroofing and marsupialization (UM)" }, { "field": "primaryOutcome", "quote": "Postoperative complications in the WLE group (78%) were significantly higher compared to the UM group (0%)." }, { "field": "result", "quote": "Unroofing and marsupialization for primary pilonidal disease has a shorter time to heal and carries a lower complication and reoperative rate compared to WLE." } ] } ], "faqs": [ { "q": "Is it okay to pop a pilonidal cyst myself?", "a": "No study has directly tested whether popping a pilonidal cyst yourself is safe. The available research only compares different ways doctors drain or treat these cysts, not self-popping at home, so there's no evidence either way." }, { "q": "What should I do if my pilonidal cyst pops on its own?", "a": "Keep the area clean and covered, and watch for spreading redness, fever, or chills. One study found that abscesses which burst open on their own, without a clinician draining them, were linked to the cyst returning more often over many years compared with doctor-performed drainage — so it's worth getting it checked rather than just leaving it." }, { "q": "Pilonidal cyst sharp pain after it popped — what does that mean?", "a": "Sharp pain with a draining cyst can simply mean the abscess has opened, but it can also signal ongoing infection. No study measured pain scores in this situation, so there's no research-based answer — severe or worsening pain is a reason to see a doctor rather than wait." }, { "q": "My pilonidal cyst area has chills and it popped — should I worry?", "a": "Chills can be a sign an infection is spreading beyond the local area. No study in this review tracked chills as an outcome, but this is generally a reason to seek medical care promptly rather than manage it at home alone." }, { "q": "My pilonidal cyst is warm to the touch — does a warm compress help it pop?", "a": "No study has tested whether a warm compress helps a pilonidal cyst drain at home. Some studies of general conservative care mention warm sitz baths alongside hygiene and hair removal, but none isolated the compress itself as the reason patients improved." } ], "searchedAs": [ "pilonidal cyst pop", "what to do if pilonidal cyst pops on its own", "early stage pilonidal cyst pop", "what to do if my pilonidal cyst pops at home", "pilonidal cyst sharp pain pilonidal cyst pop", "pilonidal cyst chills pilonidal cyst pop", "pilonidal cyst warm compress pilonidal cyst pop", "pilonidal cyst warm to touch pilonidal cyst pop" ], "patientTakeaway": "No study has tested whether it's safe to pop a pilonidal cyst yourself, so there's no research saying it is. What's actually been studied is having a cyst or abscess opened and cared for by a doctor or nurse, with proper follow-up. If your cyst is swollen, painful, or draining, get it looked at; if you develop fever, chills, or spreading redness, seek care urgently.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(\"Pilonidal Sinus\"[Mesh] OR pilonidal cyst[tiab] OR pilonidal abscess[tiab]) AND (drainage[tiab] OR \"Drainage\"[Mesh] OR rupture[tiab] OR self-drainage[tiab] OR incision[tiab])" }, "pubmedQueryTranslation": "(\"Pilonidal Sinus\"[MeSH Terms] OR \"pilonidal cyst\"[Title/Abstract] OR \"pilonidal abscess\"[Title/Abstract]) AND (\"Drainage\"[Title/Abstract] OR \"Drainage\"[MeSH Terms] OR \"rupture\"[Title/Abstract] OR \"self-drainage\"[Title/Abstract] OR \"incision\"[Title/Abstract])", "searchedOn": "2026-10-13", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Is it safe to pop a pilonidal cyst yourself?", "description": "No study has directly tested popping a pilonidal cyst yourself at home. See what 60 studies on cyst drainage and recurrence actually found." }, "lastChecked": "2026-10-13", "lastChanged": "2026-10-13", "nextCheckDue": "2026-11-13", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-13" }, "status": "published" }