From the Guidelines
Pilonidal sinus diagnosis involves identifying a recurrent abscess or cyst at the base of the spine or buttocks area, and treatment typically involves drainage and antibiotics.
Diagnosis
- A diagnosis of Pilonidal sinus is considered when a patient presents with a recurrent abscess at the base of the spine or buttocks area, which may be associated with a pilonidal cyst 1.
- The presence of a recurrent abscess at a site of previous infection should prompt a search for local causes such as a pilonidal cyst 1.
Treatment
- Treatment of Pilonidal sinus typically involves drainage of the abscess and culture of the abscess to guide antibiotic therapy 1.
- A 5- to 10-day course of an antibiotic active against the pathogen isolated may be prescribed to treat the infection 1.
- It is essential to drain recurrent abscesses early in the course of infection and consider further evaluation and treatment to prevent future recurrences 1.
From the Research
Diagnosis of Pilonidal Sinus
- Pilonidal disease is a chronic acquired condition that can cause significant morbidity and substantial burden to patients' quality of life 2, 3, 4
- The condition can range from a routine cyst with abscess to extensive chronic infection and sinus formation 4
- Diagnosis is often based on clinical presentation and evaluation of the patient's symptoms and medical history 5
Treatment Options for Pilonidal Sinus
- Treatment options for pilonidal disease vary considerably in their level of invasiveness, associated morbidity and disability, risks of complications, and effectiveness at preventing disease recurrence 5
- Conservative nonoperative management strategies include improved hygiene, depilation, and lifestyle modification, and focus on disease prevention and minimization of disease activity 5
- Epilation techniques using laser and intense pulse light therapy are also used as primary and adjunct treatment modalities 5
- Other nonoperative treatment modalities include phenol and fibrin injection to promote closure of pilonidal sinuses 5
- Operative management strategies include excision of affected tissue paired with various closure types, such as primary midline closure, primary off-midline closure techniques, and healing by secondary intention 5
- Minimally invasive operative approaches, including sinusectomy and endoscopic approaches, have also been developed 3, 5
Minimally Invasive Treatment Options
- Video Assisted-Ablation of Pilonidal Sinus (VAAPS) and Endoscopic Pilonidal Sinus Treatment (EPiST) are minimally invasive treatment options that have shown promising results 3
- These treatments aim to reduce morbidity and recurrence rates, and have been shown to have comparable short-term results to established treatments 3
- However, long-term outcomes data from further prospective randomized trials is needed to establish the efficacy of these treatments compared to traditional surgical methods 3
Challenges in Treatment
- The management of pilonidal disease must strike a balance between recurrence and surgical morbidity 2
- The ideal treatment for pilonidal disease would be simple, cost-effective, cause minimal pain, have a limited hospital stay, low recurrence rate, and require minimal time off from school or work 2
- However, the current evidence supporting different treatment options is limited by study quality, and there is a need for standardization of definitions used to characterize pilonidal disease and its outcomes to develop evidence-based treatment algorithms 5