Pilonidal sinus disease. The conservative approach.

OBJECTIVE

To examine the role of conservative, nonexcisional methods in the treatment of pilonidal sinus disease.

DESIGN

Pilot nonrandomized cohort study and follow-up retrospective study.

SETTING AND PATIENTS

In the pilot study, all patients treated for pilonidal sinus disease consecutively over 3 years at an Army community hospital, and in the follow-up study within a closed federal population, all patients admitted with a diagnosis of pilonidal sinus disease over 17 years to an Army medical center.

INTERVENTIONS

Conservative, nonexcisional therapy (meticulous hair control by natal cleft shaving, improved perineal hygiene, and limited lateral incision and drainage for abscess) with initial comparison to excisional procedures.

MAIN OUTCOME MEASURES

Occupied-bed days for conservative vs excisional therapy during a 3-year pilot study and the number of admissions and procedures performed for pilonidal sinus disease at an institution dedicated to conservative treatment alone.

RESULTS

Complete healing over 83 occupied-bed days was demonstrated in 101 consecutive cases managed during 1 year with the conservative method, whereas slower healing over 4760 occupied-bed days was observed in 229 patients undergoing 240 operative procedures during the preceding 2 years. With application of conservative treatment over 17 years, only 23 excisional operations were performed.

CONCLUSIONS

Conservative therapy effectively controls pilonidal sinus disease in the nonoperative outpatient setting while promoting near-normal work status and is preferred over excisional operations.