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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

Abstract

Purpose

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.

Methods

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

Results

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.

Conclusions

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.

Keywords

Pilonidal sinus Pilonidal disease Pilonidal abscess Surgery 

Notes

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.

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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

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