Pilonidal disease occurs in the natal cleft as a result of midline openings or pits. Hair and bacteria can get inside the pits, and lead to infections, cysts and fistula tracts. This can become a chronic problem. While conservative management options can effectively treat actively painful disease, these rarely lead to a permanent cure.
When the cyst is infected, we can treat with antibiotics or by draining the infected area. These options serve to treat the infection, but do not treat the underlying disease. After pain and drainage from the infection subsides, the cyst, sinus tracts, and pit remain.
Outside of infection, other management techniques include removing the surrounding hair and washing with hibiclens. These will help reduce the risk of infection, but again, do not treat the underlying disease.
Aside from the small percentage of people whose disease spontaneously heals itself, most will need to undergo surgery to remove the area containing the cyst, sinus tracts, and pits, thus allowing for a permanent cure. After years of development of different surgical techniques, the current gold standard procedure is called the Cleft Lift surgery, or Bascom flap procedure. This procedure involves removing the diseased area and creating a flap that rotates from one side of your buttock to the other, flattening the natal cleft, which allows for improved wound healing and decreased recurrence of pilonidal disease.
While it is unfortunate that the majority of patients will have to undergo surgery for their pilonidal disease to permanently go away, there have been many leaps and bounds in the surgical techniques over the past 20 years that allow for improved patient outcomes. It is incredibly important to find a surgeon who not only performs the cleft lift procedure, but who has extensive experience and performs the procedure regularly. Pilonidal disease is complicated, and the more experienced the surgeon, the better the surgical outcome.