What type of surgeon covers pilonidal cysts?

Surgical Management of Pilonidal Cysts

Pilonidal cysts should be managed by general surgeons or colorectal surgeons who have experience with this condition, as they are the specialists who routinely perform these procedures.

Appropriate Surgical Specialists

Pilonidal cysts (also called pilonidal disease) are chronic intermittent disorders of the sacrococcygeal region that require surgical management. The following specialists typically manage this condition:

• General Surgeons: Most commonly perform pilonidal cyst excisions, particularly for uncomplicated cases
• Colorectal Surgeons: Often manage more complex or recurrent pilonidal disease
• Pediatric Surgeons: May manage pilonidal cysts in children and adolescents 1

Surgical Approaches

Several surgical techniques are used to treat pilonidal cysts, with selection based on disease complexity:

• Primary Closure: Fastest healing time but has approximately 11% recurrence rate 2
• Karydakis Procedure: Most commonly performed (77% of surgeons use this technique) 3
• Marsupialization: Lower recurrence rate (4%) compared to other techniques 2
• Wide Excision with Secondary Healing: Reserved for grossly infected and complex cysts 2
• Other Techniques: Include rhomboid flaps, Bascom cleft lift, Z-plasty, and gluteal rotation flaps 3

Considerations for Referral

When referring patients with pilonidal cysts:

• Simple, Uncomplicated Cases: Can be managed by general surgeons
• Complex or Recurrent Cases: Should be referred to colorectal surgeons or high-volume surgeons who specialize in pilonidal disease
• Pediatric Cases: Should be referred to pediatric surgeons, especially for children 5 years or younger 1

Clinical Outcomes and Challenges

It's important to note that:

1. Actual recurrence rates are higher than reported in published literature, with 64% of surgeons reporting recurrence rates above 5% and 37% reporting rates above 10% 3
2. High-volume surgeons (performing >23 operations per year) are more likely to offer multiple surgical options (55%) compared to low-volume surgeons (16%) 3
3. Complete healing is typically fastest with primary closure techniques, despite a 14% postoperative wound infection rate 2

Emerging Treatment Options

Newer, less invasive approaches are being developed:

• Endoscopic Treatment: Shows promising results with relatively low recurrence rates (9%) and complication rates (7%) 4
• Laser and Light Treatments: May provide longer disease-free intervals for patients with recurrent disease, especially those with hirsutism 5

Conclusion

When considering which surgeon should manage a pilonidal cyst, the decision should be based on the complexity of the case and the surgeon's experience with pilonidal disease. General surgeons and colorectal surgeons are the primary specialists who manage this condition, with pediatric surgeons handling cases in younger patients.