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Article |

Pilonidal Sinus Disease The Conservative Approach

John H. Armstrong, MD, MC, USA; Peter J. Barcia, MD, MC, USA
Arch Surg. 1994;129(9):914-918. doi:10.1001/archsurg.1994.01420330028006.
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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.(Arch Surg. 1994;129:914-918)


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