Langenbeck's Archives of Surgery

, Volume 401, Issue 5, pp 599–609 | Cite as

German national guideline on the management of pilonidal disease

  • I. IesalnieksEmail author
  • A. Ommer
  • S. Petersen
  • D. Doll
  • A. Herold
Systematic Reviews and Meta-analyses



The present national guideline aims to provide recommendations for physicians involved in the treatment of patients with pilonidal disease. It has been published previously as an extended version in German language.


This is a systemic literature review. The present guideline was reviewed and accepted by an expert panel in a consensus conference.


Some of the present guideline conclusions were based on low- to moderate-quality trials. Therefore, an agreement was necessary in those cases to provide recommendations. However, recommendations regarding the most frequently used surgical procedures were based on numerous prospective randomized trials.


An asymptomatic pilonidal disease does not require treatment. A pilonidal abscess should be incised. After regression of the acute inflammation, a definitive treatment method should be applied. An excision is the standard treatment method for the chronic pilonidal disease. Open wound healing is associated with a low postoperative morbidity rate; however, it is complicated by a long healing time. The minimally invasive procedures (e.g., pit picking surgery) represent a potential treatment option for a limited chronic pilonidal disease. However, the recurrence rate is higher compared to open healing. Excision followed by a midline wound closure is associated with a considerable recurrence rate and increased incidence of wound complications and should therefore be abandoned. Off-midline procedures can be adopted as a primary treatment option in chronic pilonidal disease. At present, there is no evidence of any outcome differences between various off-midline procedures. The Limberg flap and the Karydakis flap are most thoroughly analyzed off-midline procedures.


Pilonidal sinus Pilonidal disease Pilonidal abscess Surgery 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

Ethical approval: This article does not contain any studies with human participants or animals performed by any of the authors. Therefore, no informed consent had to be obtained prior to preparation of current manuscript.


  1. 1.
    Phillips, B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B, Dawes M (2009) Oxford Centre for Evidence-based medicine—levels of evidence.
  2. 2.
    Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O’Connell D, Oxman AD, Phillips B, Schünemann HJ, Edejer T, Varonen H, Vist GE, Williams JW Jr, Zaza S, GRADE Working Group (2004) Grading quality of evidence and strength of recommendations. BMJ 328:1490PubMedCrossRefGoogle Scholar
  3. 3.
    Ommer A, Berg E, Breitkopf C, Bussen D, Doll D, Fürst A, Herold A, Hetzer F, Jacobi TH, Krammer H, Lenhard BH, Osterholzer G, Petersen S, Ruppert R, Schwandner O, Sailer M, Schiedeck THK, Schmidt-Lauber M, Stoll M, Strittmatter B, Iesalnieks I (2014) S3-Leitlinie: sinus pilonidalis. Coloproctology 36:272–322CrossRefGoogle Scholar
  4. 4.
    Doll D, Friederichs J, Boulesteix AL, Düsel W, Fend F, Petersen S (2008) Surgery for asymptomatic pilonidal sinus disease. Int J Color Dis 23:839–844CrossRefGoogle Scholar
  5. 5.
    Doll D, Friederichs J, Dettmann H, Boulesteix AL, Duesel W, Petersen S (2008) Time and rate of sinus formation in pilonidal sinus disease. Int J Color Dis 23:359–364CrossRefGoogle Scholar
  6. 6.
    Hussain ZI, Aghahoseini A, Alexander D (2012) Converting emergency pilonidal abscess into an elective procedure. Dis Colon rectum 55:640–645PubMedCrossRefGoogle Scholar
  7. 7.
    Khalil PN, Brand D, Siebeck M, Hallfeldt K, Mutschler W, Kanz KG (2009) Aspiration and injection-based technique for incision and drainage of a sacrococcygeal pilonidal abscess. J Emerg Med 36:60–63PubMedCrossRefGoogle Scholar
  8. 8.
    Jensen SL, Harling H (1988) Prognosis after simple incision and drainage for a first-episode acute pilonidal abscess. Br J Surg 75:60–61PubMedCrossRefGoogle Scholar
  9. 9.
    Dogru O, Camci C, Aygen E, Girgin M, Topuz O (2004) Pilonidal sinus treated with crystallized phenol: an eight-year experience. Dis Colon rectum 47:1934–1938PubMedCrossRefGoogle Scholar
  10. 10.
    Kaymakcioglu N, Yagci G, Simsek A, Unlu A, Tekin OF, Cetiner S, Tufan T (2005) Treatment of pilonidal sinus by phenol application and factors affecting the recurrence. Tech Coloproctol 9:21–24PubMedCrossRefGoogle Scholar
  11. 11.
    Olmez A, Kayaalp C, Aydin C (2013) Treatment of pilonidal disease by combination of pit excision and phenol application. Tech Coloproctol 17:201–206PubMedCrossRefGoogle Scholar
  12. 12.
    Aksoy HM, Aksoy B, Egemen D (2010) Effectiveness of topical use of natural polyphenols for the treatment of sacrococcygeal pilonidal sinus disease: a retrospective study including 192 patients. Eur J Dermatol 20:476–481PubMedGoogle Scholar
  13. 13.
    Aygen E, Arslan K, Dogru O, Basbug M, Camci C (2010) Crystallized phenol in nonoperative treatment of previously operated, recurrent pilonidal disease. Dis Colon rectum 53:932–935PubMedCrossRefGoogle Scholar
  14. 14.
    Kayaalp C, Olmez A, Aydin C, Piskin T, Kahraman L (2010) Investigation of a one-time phenol application for pilonidal disease. Med Princ Pract 19:212–215PubMedCrossRefGoogle Scholar
  15. 15.
    Kelly SB, Graham WJ (1989) Treatment of pilonidal sinus by phenol injection. Ulster Med J 58:56–59PubMedPubMedCentralGoogle Scholar
  16. 16.
    Sakçak I, Avşar FM, Coşgun E (2010) Comparison of the application of low concentration and 80 % phenol solution in pilonidal sinus disease. JRSM Short Rep 1:5PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Bruce RM, Santodonato J, Neal MW (1987) Summary review of the health effects associated with phenol. Toxicol Ind Health 3:535–568PubMedCrossRefGoogle Scholar
  18. 18.
    Lord PH, Millar DM (1965) Pilonidal sinus: a simple treatment. Br J Surg 52:298–300PubMedCrossRefGoogle Scholar
  19. 19.
    Bascom J (1980) Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 87:567–572PubMedGoogle Scholar
  20. 20.
    Nordon IM, Senapati A, Cripps NP (2009) A prospective randomized controlled trial of simple Bascom’s technique versus Bascom’s cleft closure for the treatment of chronic pilonidal disease. Am J Surg 197:189–192PubMedCrossRefGoogle Scholar
  21. 21.
    Senapati A (2003) Failed pilonidal surgery: new paradigm and new operation leading to cures. Tech Coloproctol 7:211PubMedCrossRefGoogle Scholar
  22. 22.
    Iesalnieks I, Deimel S, Kienle K, Schlitt HJ, Zülke C (2011) Pit-picking surgery for pilonidal disease. Chirurg 82:927–931PubMedCrossRefGoogle Scholar
  23. 23.
    Colov EP, Bertelsen CA (2011) Short convalescence and minimal pain after out-patient Bascom’s pit-pick operation. Dan Med Bull 58:A4348PubMedGoogle Scholar
  24. 24.
    Majeski J, Stroud J (2011) Sacrococcygeal pilonidal disease. Int Surg 96:144–147PubMedCrossRefGoogle Scholar
  25. 25.
    Maghsoudi H, Nezami N, Ghamari AA (2011) Ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture. Can J Surg 54:78–82PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Gips M, Melki Y, Salem L, Weil R, Sulkes J (2008) Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients. Dis Colon rectum 51:1656–1662PubMedCrossRefGoogle Scholar
  27. 27.
    Soll C, Hahnloser D, Dindo D, Clavien PA, Hetzer F (2008) A novel approach for treatment of sacrococcygeal pilonidal sinus: less is more. Int J Color Dis 23:177–180CrossRefGoogle Scholar
  28. 28.
    Soll C, Dindo D, Steinemann D, Hauffe T, Clavien PA, Hahnloser D (2012) Sinusectomy for primary pilonidal sinus: less is more. Surgery 150:996–1001CrossRefGoogle Scholar
  29. 29.
    Kement M, Oncel M, Kurt N, Kaptanoglu L (2006) Sinus excision for the treatment of limited chronic pilonidal disease: results after a medium-term follow-up. Dis Colon rectum 49:1758–1762PubMedCrossRefGoogle Scholar
  30. 30.
    Oncel M, Kurt N, Kement M, Colak E, Eser M, Uzun H (2002) Excision and marsupialization versus sinus excision for the treatment of limited chronic pilonidal disease: a prospective, randomized trial. Tech Coloproctol 6:165–169PubMedCrossRefGoogle Scholar
  31. 31.
    Ortiz HH, Marti J, Sitges A (1977) Pilonidal sinus: a claim for simple track incision. Dis Colon rectum 20:325–328PubMedCrossRefGoogle Scholar
  32. 32.
    Mohamed HA, Kadry I, Adly S (2005) Comparison between three therapeutic modalities for non-complicated pilonidal sinus disease. Surgeon 3:73–77PubMedCrossRefGoogle Scholar
  33. 33.
    Al-Homoud SJ, Habib ZS, Abdul Jabbar AS, Isbister WH (2001) Management of sacrococcygeal pilonidal disease. Saudi Med J 22:762–764PubMedGoogle Scholar
  34. 34.
    Fazeli MS, Lebaschi AH, Adel MG, Kazemeini AR (2008) Evaluation of the outcome of complete sinus excision with reconstruction of the umbilicus in patients with umbilical pilonidal sinus. World J Surg 32:2305–2308PubMedCrossRefGoogle Scholar
  35. 35.
    Füzün M, Bakir H, Soylu M, Tansuğ T, Kaymak E, Haŕmancioğlu O (1994) Which technique for treatment of pilonidal sinus—open or closed? Dis Colon rectum 37:1148–1150PubMedCrossRefGoogle Scholar
  36. 36.
    McCallum IJ, King PM, Bruce J (2008) Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis. BMJ 336:868–871PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Reboa G, Gipponi M, Testa T, Giannini G, Scala M, Dalla Costa R, Strada P (2007) Regenerative medicine for the definitive surgical repair of pilonidal sinus. A new method of wound reconstruction. In Vivo 21:529–534PubMedGoogle Scholar
  38. 38.
    Søndenaa K, Andersen E, Søreide JA (1992) Morbidity and short term results in a randomised trial of open compared with closed treatment of chronic pilonidal sinus. Eur J Surg 158:351–355PubMedGoogle Scholar
  39. 39.
    Testini M, Piccinni G, Miniello S, Di Venere B, Lissidini G, Nicolardi V, Bonomo GM (2001) Treatment of chronic pilonidal sinus with local anaesthesia: a randomized trial of closed compared with open technique. Color Dis 3:427–430CrossRefGoogle Scholar
  40. 40.
    Al-Hassan HK, Francis IM, Neglén P (1990) Primary closure or secondary granulation after excision of pilonidal sinus? Acta Chir Scand 156:695–699PubMedGoogle Scholar
  41. 41.
    Gendy AS, Glick RD, Hong AR, Dolgin SE, Soffer SZ, Landers H, Herrforth M, Rosen NG (2011) A comparison of the cleft lift procedure vs wide excision and packing for the treatment of pilonidal disease in adolescents. J Pediatr Surg 46:1256–1259PubMedCrossRefGoogle Scholar
  42. 42.
    Gidwani AL, Murugan K, Nasir A, Brown R (2010) Incise and lay open: an effective procedure for coccygeal pilonidal sinus disease. Ir J Med Sci 179:207–210PubMedCrossRefGoogle Scholar
  43. 43.
    Iesalnieks I, Agha A, von Breitenbuch P, Schlitt HJ, Fürst A (2006) Chirurgische Behandlung des sinus pilonidalis. Viszeralchirurgie 41:399–406CrossRefGoogle Scholar
  44. 44.
    Jamal A, Shamim M, Hashmi F, Qureshi MI (2009) Open excision with secondary healing versus rhomboid excision with Limberg transposition flap in the management of sacrococcygeal pilonidal disease. J Pak Med Assoc 59:157–160PubMedGoogle Scholar
  45. 45.
    Matter I, Kunin J, Schein M, Eldar S (1995) Total excision versus non-resectional methods in the treatment of acute and chronic pilonidal disease. Br J Surg 82:752–753PubMedCrossRefGoogle Scholar
  46. 46.
    Rabie ME, Al Refeidi AA, Al Haizaee A, Hilal S, Al Ajmi H, Al Amri AA (2007) Sacrococcygeal pilonidal disease: sinotomy versus excisional surgery, a retrospective study. ANZ J Surg 77:177–180PubMedCrossRefGoogle Scholar
  47. 47.
    Solla JA, Rothenberger DA (1990) Chronic pilonidal disease. An assessment of 150 cases. Dis Colon rectum 33:758–761PubMedCrossRefGoogle Scholar
  48. 48.
    Stansby G, Greatorex R (1989) Phenol treatment of pilonidal sinuses of the natal cleft. Br J Surg 76:729–730PubMedCrossRefGoogle Scholar
  49. 49.
    Greenberg R, Kashtan H, Skornik Y, Werbin N (2004) Treatment of pilonidal sinus disease using fibrin glue as a sealant. Tech Coloproctol 8:95–98PubMedCrossRefGoogle Scholar
  50. 50.
    Al-Salamah SM, Hussain MI, Mirza SM (2007) Excision with or without primary closure for pilonidal sinus disease. J Pak Med Assoc 57:388–391PubMedGoogle Scholar
  51. 51.
    Popeskou S, Christoforidis D, Ruffieux C, Demartines N (2011) Wound infection after excision and primary midline closure for pilonidal disease: risk factor analysis to improve patient selection. World J Surg 35:206–211PubMedCrossRefGoogle Scholar
  52. 52.
    Gaston EA, Wilde WL (1965) Epidermoid carcinoma arising in a pilonidal sinus. Dis Colon rectum 8:343–348PubMedCrossRefGoogle Scholar
  53. 53.
    Doll D (2007) Sinotomy versus excisional surgery for pilonidal sinus. ANZ J Surg 77:599–600PubMedCrossRefGoogle Scholar
  54. 54.
    Iesalnieks I, Deimel S, Schlitt HJ (2013) Karydakis flap for recurrent pilonidal disease. World J Surg 37:1115–1120PubMedCrossRefGoogle Scholar
  55. 55.
    Iesalnieks I, Fürst A, Rentsch M, Jauch KW (2003) Erhöhtes Rezidivrisiko nach primärem medianen Wundverschluss bei Patienten mit Pilonidalsinus. Chirurg 74:461–468PubMedCrossRefGoogle Scholar
  56. 56.
    Kronborg O, Christensen K, Zimmermann-Nielsen C (1985) Chronic pilonidal disease: a randomized trial with a complete 3-year follow-up. Br J Surg 72:303–304PubMedCrossRefGoogle Scholar
  57. 57.
    Lorant T, Ribbe I, Mahteme H, Gustafsson UM, Graf W (2011) Sinus excision and primary closure versus laying open in pilonidal disease: a prospective randomized trial. Dis Colon rectum 54:300–305PubMedCrossRefGoogle Scholar
  58. 58.
    Keshvari A, Keramati MR, Fazeli MS, Kazemeini A, Meysamie A, Nouritaromlou MK (2015) Karydakis flap versus excision-only technique in pilonidal disease. J Surg Res 198:260–266PubMedCrossRefGoogle Scholar
  59. 59.
    Al-Khamis A, McCallum I, King PM, Bruce J (2011) Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev :CD006213Google Scholar
  60. 60.
    Abramson DJ, Cox PA (1954) The marsupialization operation for pilonidal cysts and sinuses under local anesthesia with lidocaine; an ambulatory method of treatment. Ann Surg 139:341–349PubMedPubMedCentralCrossRefGoogle Scholar
  61. 61.
    Aydede H, Erhan Y, Sakarya A, Kumkumoglu Y (2001) Comparison of three methods in surgical treatment of pilonidal disease. ANZ J Surg 71:362–364PubMedCrossRefGoogle Scholar
  62. 62.
    Ersoy OF, Karaca S, Kayaoglu HA, Ozkan N, Celik A, Ozum T (2007) Comparison of different surgical options in the treatment of pilonidal disease: retrospective analysis of 175 patients. Kaohsiung J Med Sci 23:67–70PubMedCrossRefGoogle Scholar
  63. 63.
    Meban S, Hunter E (1982) Outpatient treatment of pilonidal disease. Can Med Assoc J 126:941PubMedPubMedCentralGoogle Scholar
  64. 64.
    Watters N, Macdonald IB (1958) Marsupialization of pilonidal sinus and abscess: a report of 50 cases. Can Med Assoc J 79:236–240PubMedPubMedCentralGoogle Scholar
  65. 65.
    Gencosmanoglu R, Inceoglu R (2005) Modified lay-open (incision, curettage, partial lateral wall excision and marsupialization) versus total excision with primary closure in the treatment of chronic sacrococcygeal pilonidal sinus: a prospective, randomized clinical trial with a complete two-year follow-up. Int J Color Dis 20:415–422CrossRefGoogle Scholar
  66. 66.
    Karakayali F, Karagulle E, Karabulut Z, Oksuz E, Moray G, Haberal M (2009) Unroofing and marsupialization vs. rhomboid excision and Limberg flap in pilonidal disease: a prospective, randomized, clinical trial. Dis Colon rectum 52:496–502PubMedCrossRefGoogle Scholar
  67. 67.
    Abu Galala KH, Salam IM, Abu Samaan KR, El Ashaal YI, Chandran VP, Sabastian M, Sim AJ (1999) Treatment of pilonidal sinus by primary closure with a transposed rhomboid flap compared with deep suturing: a prospective randomised clinical trial. Eur J Surg 165:468–472PubMedCrossRefGoogle Scholar
  68. 68.
    Baier PK, Baumgartner U, Furtwängler A, Holzinger F, Schöffel U (2002) Therapy of the pilonidal sinus—primary wound closure or open wound after excision. Zentralbl Chir 127:310–314PubMedCrossRefGoogle Scholar
  69. 69.
    Brieler HS (1997) Infected pilonidal sinus. Langenbecks Arch Chir Suppl Kongressbd 114:497–500PubMedGoogle Scholar
  70. 70.
    Denkers D, Girona J (1996) Der abszedierte sinus pilonidalis der Steißbeinregion—Möglichkeiten der chirurgischen Versorgung. Coloproctology 18:257–259Google Scholar
  71. 71.
    Doll D, Evers T, Matevossian E, Petersen S (2009) Outcome of chronic pilonidal disease treatment after ambulatory plain midline excision and primary suture. Am J Surg 197:693–694PubMedCrossRefGoogle Scholar
  72. 72.
    Dudink R, Veldkamp J, Nienhuijs S, Heemskerk J (2011) Secondary healing versus midline closure and modified Bascom natal cleft lift for pilonidal sinus disease. Scand J Surg 100:110–113PubMedGoogle Scholar
  73. 73.
    Holmebakk T, Nesbakken A (2005) Surgery for pilonidal disease. Scand J Surg 94:43–46PubMedGoogle Scholar
  74. 74.
    Lee SL, Tejirian T, Abbas MA (2008) Current management of adolescent pilonidal disease. J Pediatr Surg 43:1124–1127PubMedCrossRefGoogle Scholar
  75. 75.
    Muzi MG, Milito G, Cadeddu F, Nigro C, Andreoli F, Amabile D, Farinon AM (2010) Randomized comparison of Limberg flap versus modified primary closure for the treatment of pilonidal disease. Am J Surg 200:9–14PubMedCrossRefGoogle Scholar
  76. 76.
    Muzi MG, Milito G, Nigro C, Cadeddu F, Farinon AM (2009) A modification of primary closure for the treatment of pilonidal disease in day-care setting. Color Dis 11:84–88CrossRefGoogle Scholar
  77. 77.
    Nursal TZ, Ezer A, Calişkan K, Törer N, Belli S, Moray G (2010) Prospective randomized controlled trial comparing V-Y advancement flap with primary suture methods in pilonidal disease. Am J Surg 199:170–177PubMedCrossRefGoogle Scholar
  78. 78.
    Tavassoli A, Noorshafiee S, Nazarzadeh R (2011) Comparison of excision with primary repair versus Limberg flap. Int J Surg 9:343–346PubMedCrossRefGoogle Scholar
  79. 79.
    Akca T, Colak T, Ustunsoy B, Kanik A, Aydin S (2005) Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease. Tech Coloproctol 92:1081–1084Google Scholar
  80. 80.
    Okuş A, Sevinç B, Karahan O, Eryilmaz MA (2012) Comparison of Limberg flap and tension-free primary closure during pilonidal sinus surgery. World J Surg 36:431–435PubMedCrossRefGoogle Scholar
  81. 81.
    Patey DH, Scarff RW (1946) Pathology of postanal pilonidal sinus; its bearing on treatment. Lancet 2:484–486PubMedCrossRefGoogle Scholar
  82. 82.
    Bascom JU (1987) Repeat pilonidal operations. Am J Surg 154:118–122PubMedCrossRefGoogle Scholar
  83. 83.
    Monro RS (1967) A consideration of some factors in the causation of pilonidal sinus and its treatment by Z-plasty. Am J Proctol 18:215–225PubMedGoogle Scholar
  84. 84.
    Monro RS, McDermott FT (1965) The elimination of causal factors in pilonidal sinus treated by Z-plasty. Br J Surg 52:177–181PubMedCrossRefGoogle Scholar
  85. 85.
    Karydakis GE (1973) New approach to the problem of pilonidal sinus. Lancet 2:1414–1415PubMedCrossRefGoogle Scholar
  86. 86.
    Gwynn BR (1986) Use of the rhomboid flap in pilonidal sinus. Ann R Coll Surg Engl 68:40–41PubMedPubMedCentralGoogle Scholar
  87. 87.
    Akinci OF, Coskun A, Ozgonul A, Terzi A (2006) Surgical treatment of complicated pilonidal disease: limited separate elliptical excision with primary closure. Color Dis 8:704–709CrossRefGoogle Scholar
  88. 88.
    Bessa SS (2007) Results of the lateral advancing flap operation (modified Karydakis procedure) for the management of pilonidal sinus disease. Dis Colon rectum 50:1935–1940PubMedCrossRefGoogle Scholar
  89. 89.
    Bessa SS (2013) Comparison of short-term results between the modified Karydakis flap and the modified Limberg flap in the management of pilonidal sinus disease: a randomized controlled study. Dis Colon rectum 56:491–498PubMedCrossRefGoogle Scholar
  90. 90.
    Kitchen PR (1996) Pilonidal sinus: experience with the Karydakis flap. Br J Surg 83:1452–1455PubMedCrossRefGoogle Scholar
  91. 91.
    Moran DC, Kavanagh DO, Adhmed I, Regan MC (2011) Excision and primary closure using the Karydakis flap for the treatment of pilonidal disease: outcomes from a single institution. World J Surg 35:1803–1808PubMedCrossRefGoogle Scholar
  92. 92.
    Morden P, Drongowski RA, Geiger JD, Hirschl RB, Teitelbaum DH (2005) Comparison of Karydakis versus midline excision for treatment of pilonidal sinus disease. Pediatr Surg Int 21:793–796PubMedCrossRefGoogle Scholar
  93. 93.
    Sözen S, Emir S, Güzel K, Ozdemir CS (2011) Are postoperative drains necessary with the Karydakis flap for treatment of pilonidal sinus? (Can fibrin glue be replaced to drains?) A prospective randomized trial. Ir J Med Sci 180:479–482PubMedCrossRefGoogle Scholar
  94. 94.
    Bascom J, Bascom T (2002) Failed pilonidal surgery: new paradigm and new operation leading to cures. Arch Surg 137:1146–1150PubMedCrossRefGoogle Scholar
  95. 95.
    Guner A, Boz A, Ozkan OF, Ileli O, Kece C, Reis E (2013) Limberg flap versus Bascom cleft lift techniques for sacrococcygeal pilonidal sinus: prospective, randomized trial. World J Surg 37:2074–2080PubMedCrossRefGoogle Scholar
  96. 96.
    Ates M, Dirican A, Sarac M, Aslan A, Colak C (2011) Short and long-term results of the Karydakis flap versus the Limberg flap for treating pilonidal sinus disease: a prospective randomized study. Am J Surg 202:568–573PubMedCrossRefGoogle Scholar
  97. 97.
    Anderson JH, Yip CO, Nagabhushan JS, Connelly SJ (2008) Day-case Karydakis flap for pilonidal sinus. Dis Colon rectum 51:134–138PubMedCrossRefGoogle Scholar
  98. 98.
    Cihan A, Ucan BH, Comert M, Cesur A, Cakmak GK, Tascilar O (2006) Superiority of asymmetric modified Limberg flap for surgical treatment of pilonidal disease. Dis Colon rectum 49:244–249PubMedCrossRefGoogle Scholar
  99. 99.
    Akin M, Leventoglu S, Mentes BB, Bostanci H, Gokbayir H, Kilic K, Ozdemir E, Ferahkose Z (2010) Comparison of the classic Limberg flap and modified Limberg flap in the treatment of pilonidal sinus disease: a retrospective analysis of 416 patients. Surg Today 40:757–762PubMedCrossRefGoogle Scholar
  100. 100.
    Arslan K, Said Kokcam S, Koksal H, Turan E, Atay A, Dogru O (2014) Which flap method should be preferred for the treatment of pilonidal sinus? A prospective randomized study. Tech Coloproctol 18:29–37PubMedCrossRefGoogle Scholar
  101. 101.
    Can MF, Sevinc MM, Hancerliogullari O, Yilmaz M, Yagci G (2010) Multicenter prospective randomized trial comparing modified Limberg flap transposition and Karydakis flap reconstruction in patients with sacrococcygeal pilonidal disease. Am J Surg 200:318–327PubMedCrossRefGoogle Scholar
  102. 102.
    Ersoy E, Devay AO, Aktimur R, Doganay B, Ozdoğan M, Gündoğdu RH (2009) Comparison of the short-term results after Limberg and Karydakis procedures for pilonidal disease: randomized prospective analysis of 100 patients. Color Dis 11:705–710CrossRefGoogle Scholar
  103. 103.
    Tokac M, Dumlu EG, Aydin MS, Yalcın A, Kilic M (2015) Comparison of modified Limberg flap and Karydakis flap operations in pilonidal sinus surgery: prospective randomized study. Int Surg 100:870–877PubMedPubMedCentralCrossRefGoogle Scholar
  104. 104.
    Neşşar G, Kayaalp C, Seven C (2004) Elliptical rotation flap for pilonidal sinus. Am J Surg 187:300–303PubMedCrossRefGoogle Scholar
  105. 105.
    Eryilmaz R, Okan I, Coskun A, Bas G, Sahin M (2009) Surgical treatment of complicated pilonidal sinus with a fasciocutaneous V-Y advancement flap. Dis Colon rectum 52:2036–2040PubMedCrossRefGoogle Scholar
  106. 106.
    Sharma PP (2006) Multiple Z-plasty in pilonidal sinus—a new technique under local anesthesia. World J Surg 30:2261–2265PubMedCrossRefGoogle Scholar
  107. 107.
    Lieto E, Castellano P, Pinto M, Zamboli A, Pignatelli C, Galizia G (2010) Dufourmentel rhomboid flap in the radical treatment of primary and recurrent sacrococcygeal pilonidal disease. Dis Colon rectum 53:1061–1068PubMedCrossRefGoogle Scholar
  108. 108.
    Quinodoz PD, Chilcott M, Grolleau JL, Chavoin JP, Costagliola M (1999) Surgical treatment of sacrococcygeal pilonidal sinus disease by excision and skin flaps: the Toulouse experience. Eur J Surg 165:1061–1065PubMedCrossRefGoogle Scholar
  109. 109.
    Lahooti M, Taheri PA, Nezami BG, Assa S (2008) Sacrococcygeal pilonidal sinus treated by a new fascio-cutaneous flap. Dis Colon rectum 51:588–592PubMedCrossRefGoogle Scholar
  110. 110.
    Polat C, Gungor B, Karagul S, Buyukakincak S, Topgul K, Erzurumlu K (2011) Is oval flap reconstruction a good modification for treating pilonidal sinuses? Am J Surg 201:192–196PubMedCrossRefGoogle Scholar
  111. 111.
    Krand O, Yalt T, Berber I, Kara VM, Tellioglu G (2009) Management of pilonidal sinus disease with oblique excision and bilateral gluteus maximus fascia advancing flap: result of 278 patients. Dis Colon rectum 52:1172–1177PubMedCrossRefGoogle Scholar
  112. 112.
    Naja MZ, Ziade MF, El Rajab M (2003) Sacrococcygeal local anaesthesia versus general anaesthesia for pilonidal sinus surgery: a prospective randomised trial. Anaesthesia 58:1007–1012PubMedCrossRefGoogle Scholar
  113. 113.
    Schmittner MD, Dieterich S, Gebhardt V, Weiss C, Burmeister MA, Bussen DG, Viergutz T (2013) Randomised clinical trial of pilonidal sinus operations performed in the prone position under spinal anaesthesia with hyperbaric bupivacaine 0.5 % versus total intravenous anaesthesia. Int J Color Dis 28:873–880CrossRefGoogle Scholar
  114. 114.
    Bertelsen CA (2011) Cleft-lift operation for pilonidal sinuses under tumescent local anesthesia: a prospective cohort study of peri- and postoperative pain. Dis Colon rectum 54:895–900PubMedCrossRefGoogle Scholar
  115. 115.
    Søndenaa K, Nesvik I, Gullaksen FP, Furnes A, Harbo SO, Weyessa S, Søreide JA (1995) The role of cefoxitin prophylaxis in chronic pilonidal sinus treated with excision and primary suture. J Am Coll Surg 180:157–160PubMedGoogle Scholar
  116. 116.
    Mahdy T (2008) Surgical treatment of the pilonidal disease: primary closure or flap reconstruction after excision. Dis Colon rectum 51:1816–1822PubMedCrossRefGoogle Scholar
  117. 117.
    Tocchi A, Mazzoni G, Bononi M, Fornasari V, Miccini M, Drumo A, Colace L (2008) Outcome of chronic pilonidal disease treatment after ambulatory plain midline excision and primary suture. Am J Surg 196:28–33PubMedCrossRefGoogle Scholar
  118. 118.
    Milone M, Musella M, Salvatore G, Leongito M, Milone F (2011) Effectiveness of a drain in surgical treatment of sacrococcygeal pilonidal disease. Results of a randomized and controlled clinical trial on 803 consecutive patients. Int J Color Dis 26:1601–1607CrossRefGoogle Scholar
  119. 119.
    Gurer A, Gomceli I, Ozdogan M, Ozlem N, Sozen S, Aydin R (2005) Is routine cavity drainage necessary in Karydakis flap operation? A prospective, randomized trial. Dis Colon rectum 48:1797–1799PubMedCrossRefGoogle Scholar
  120. 120.
    Colak T, Turkmenoglu O, Dag A, Akca T, Aydin S (2010) A randomized clinical study evaluating the need for drainage after Limberg flap for pilonidal sinus. J Surg Res 158:127–131PubMedCrossRefGoogle Scholar
  121. 121.
    Kirkil C, Böyük A, Bülbüller N, Aygen E, Karabulut K, Coşkun S (2011) The effects of drainage on the rates of early wound complications and recurrences after Limberg flap reconstruction in patients with pilonidal disease. Tech Coloproctol 15:425–429PubMedCrossRefGoogle Scholar
  122. 122.
    Eryilmaz R, Sahin M, Alimoglu O, Dasiran F (2003) Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap. Surgery 134:745–749PubMedCrossRefGoogle Scholar
  123. 123.
    Petersen S, Wietelmann K, Evers T, Hüser N, Matevossian E, Doll D (2009) Long-term effects of postoperative razor epilation in pilonidal sinus disease. Dis Colon rectum 52:131–134PubMedCrossRefGoogle Scholar
  124. 124.
    Conroy FJ, Kandamany N, Mahaffey PJ (2008) Laser depilation and hygiene: preventing recurrent pilonidal sinus disease. J Plast Reconstr Aesthet Surg 61:1069–1072PubMedCrossRefGoogle Scholar
  125. 125.
    Ganjoo A (2011) Laser hair reduction for pilonidal sinus—my experience. J Cutan Aesthet Surg 4:196PubMedPubMedCentralGoogle Scholar
  126. 126.
    Oram Y, Kahraman F, Karincaoğlu Y, Koyuncu E (2010) Evaluation of 60 patients with pilonidal sinus treated with laser epilation after surgery. Dermatol Surg 36:88–91PubMedCrossRefGoogle Scholar
  127. 127.
    Demircan F, Akbulut S, Yavuz R, Agtas H, Karabulut K, Yagmur Y (2015) The effect of laser epilation on recurrence and satisfaction in patients with sacrococcygeal pilonidal disease: a prospective randomized controlled trial. Int J Clin Exp Med 8:2929–2933PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • I. Iesalnieks
    • 1
    Email author
  • A. Ommer
    • 2
  • S. Petersen
    • 3
  • D. Doll
    • 4
  • A. Herold
    • 5
  1. 1.Department of SurgeryStädtisches Klinikum München BogenhausenMunichGermany
  2. 2.End- und Dickdarm-Zentrum EssenEssenGermany
  3. 3.Department of SurgeryAsklepios-Klinik AltonaHamburgGermany
  4. 4.Department of SurgerySt. Marienhospital VechtaVechtaGermany
  5. 5.End- und Dickdarmzentrum MannheimMannheimGermany

Personalised recommendations