From the Guidelines
Pilonidal cysts should be treated with a deroofing technique for acute and chronic lesions, as it appears to be effective with a lower recurrence rate compared to incision and drainage. When considering treatment options for pilonidal cysts, it's essential to weigh the benefits and risks of each approach, prioritizing morbidity, mortality, and quality of life as outcomes.
- For mild cases, conservative management may be sufficient, including warm sitz baths, careful hair removal, and good hygiene practices, as well as over-the-counter pain medications like acetaminophen or ibuprofen 1.
- However, for infected cysts, a more invasive approach may be necessary, such as incision and drainage under local anesthesia, followed by packing the wound with gauze that needs changing daily, and antibiotics like cephalexin or clindamycin may be prescribed for significant infections.
- Recurrent or severe cases often require surgical intervention, including excision of the cyst and surrounding tissue, with post-surgery wound care involving regular cleaning with saline solution and dressing changes 1.
- The deroofing technique, described by van der Zee et al in 2010, has shown promising results with a 17% recurrence rate and 90% patient satisfaction, making it a viable option for treating pilonidal cysts 1.
- In contrast, incision and drainage has been associated with recurrence rates approaching 100%, although it provides acute relief when other methods are not feasible 1.
- Electrosurgical destruction and cryosurgery have also been characterized in few studies, but there is inadequate evidence to recommend their use 1.
- Prevention measures, such as maintaining good hygiene, avoiding prolonged sitting, regular hair removal in the area, and wearing loose-fitting clothing, can also help reduce the risk of pilonidal cysts.
From the Research
Pilonidal Cyst Treatment Options
- Pilonidal cysts are a painful condition that primarily affect young adult men, with various operative techniques described in the literature for resolving them, including excision with midline closure, sinusectomy, and flap repair 2, 3.
- A study comparing primary midline closure with and without closed incision negative pressure therapy after pilonidal cyst excision found that the use of negative pressure therapy reduced hospital stay, pain, and healing time 2.
- A systematic review of the management of pilonidal disease recommended avoiding excision with midline closure and instead using minimal surgical procedures or non-operative techniques, with equivalent or better outcomes 3.
- Another review of the management of pilonidal disease highlighted the heterogeneity of treatment modalities and the need for standardization of definitions and outcomes to develop evidence-based treatment algorithms 4.
Non-Operative Treatment Options
- Conservative non-operative management strategies, including improved hygiene, depilation, and lifestyle modification, can help prevent and minimize disease activity 4.
- Epilation techniques using laser and intense pulse light therapy can be used as primary and adjunct treatment modalities 4.
- Phenol and fibrin injection can also be used to promote closure of pilonidal sinuses 4.
Operative Treatment Options
- Traditional 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 4.
- Minimally invasive operative approaches, including sinusectomy and endoscopic approaches, have recently gained popularity 4.
- Flap repair is a preferred treatment option for recurrent or persistent disease, with acceptable recurrence rates and faster recovery times 3.