Pilonidal Sinus

What is pilonidal disease?

Pilonidal disease is an acute or chronic inflammatory condition in the midline of the natal cleft (tailbone). It is believed to result from a reaction to hair embedded in the skin in the crease between the buttocks. During World War II, nearly 100, 000 US army recruits were affected leading to the name “Jeep disease”. Pilonidal disease may present as an acute abscess or as a chronic pilonidal sinus.

What is the cause of pilonidal disease?

There are a few theories on the cause of the disease. The most popular theory is that it is an acquired disease due to loose hairs in the midline cleft. These are driven into the skin, leading to infection and/or chronic inflammation. There are a variety of other factors that influence the development of the disease. It is more common in men than women, more frequent in obese patients and those with thick course hair and deep natal clefts. It is unusual to develop pilonidal disease after the age of 40.

What are the symptoms?

Symptoms vary from no symptoms to a small lump to a large painful mass. There can be a chronic wound with discharge of fluid or blood. Sometimes, the sinus can become infected with a swollen, tender, painful red lump which may discharge pus with a foul odour. Some patients have recurrent infections or non-healing discharging wounds.

How is pilonidal disease treated?

Acute abscess – generally treated with incision and drainage under a general anaesthetic.

Chronic pilonidal disease – depends on the symptoms and the nature and severity of the disease. There is a wide spectrum in the severity of pilonidal sinus disease that dictates the treatment recommendations. There are a number of options including:

• excision/curette with healing by secondary intention (eg Bascom)
• wide excision with flap repair (eg Karydakis or Limberg)
• simple excision and primary closure
• wide excision and healing by secondary intention
• Endoscopic Pilonidal Sinus Treatment (EPSiT).

The best option for you depends on the disease and your symptoms and should be discussed with your surgeon.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.