Techniques in Coloproctology

, Volume 22, Issue 1, pp 7–14 | Cite as

The effect of hair removal after surgery for sacrococcygeal pilonidal sinus disease: a systematic review of the literature

  • A. A. PronkEmail author
  • L. Eppink
  • N. Smakman
  • E. J. B. Furnee



It has been suggested that removal of body hair in the sacrococcygeal area prevents recurrence after surgery for sacrococcygeal pilonidal sinus disease (SPSD). The aim of this study was to review the literature regarding the effect of hair depilation on the recurrence rate in patients surgically treated for SPSD.


A systematic search was performed in PubMed, EMBASE, and The Cochrane Library by using synonyms for SPSD. Title, abstract, and full text were screened by two independent reviewers. Data were systematically collected from all included studies by using a standardized data extraction form.


The search and selection yielded 14 studies, involving 963 patients. The study design of the included studies was: retrospective cohort (n = 7), prospective cohort (n = 3), randomized controlled trial (n = 2), and case–control (n = 2).The mean length of follow-up was 37.0 (standard error of the mean: 35.0) months. The recurrence rate was 9.3% (34 out of 366 patients) in patients who had laser hair removal, 23.4% (36 out of 154 patients) in those who had razor shaving/cream depilation, and 19.7% (85 out of 431 patients) in those who had no hair removal after surgery for SPSD.


This systematic review showed a lower recurrence rate after laser hair removal compared to no hair removal and razor/cream depilation. Due to the small sample size and limited methodological quality of the included studies, a high-quality randomized controlled trial is required.


Sacrococcygeal pilonidal sinus disease Hair removal Recurrence Laser treatment Razor shaving Cream depilation 



The authors would like to thank Aart Huisman Stichting E. Scarrot, MD, Department of Histopathology, Southmead Hospital, Bristol, UK.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was not obtained.


  1. 1.
    Chintapatla S, Safarani N, Kumar S, Haboubi N (2003) Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. Tech Coloproctol 7:3–8CrossRefPubMedGoogle Scholar
  2. 2.
    Søndenaa K, Andersen E, Nesvik I, Søreide JA (1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 10:39–42CrossRefPubMedGoogle Scholar
  3. 3.
    Shafigh Y, Beheshti A, Charkhchian M, Rad F (2014) Successful treatment of pilonidal disease by intense pulsed light device. Adv Clin Exp Med 23:277–282CrossRefPubMedGoogle Scholar
  4. 4.
    Elsey E, Lund JN (2013) Fibrin glue in the treatment for pilonidal sinus: high patient satisfaction and rapid return to normal activities. Tech Coloproctol 17(1):101–104CrossRefPubMedGoogle Scholar
  5. 5.
    Al-Khamis A, McCallum I, King PM, Bruce J (2010) Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev 1:CD006213Google Scholar
  6. 6.
    Karydakis GE (1992) Easy and successful treatment of pilonidal sinus after explanation of it’s causative process. Aust N Z J Surg 62:385–389CrossRefPubMedGoogle Scholar
  7. 7.
    Doll D, Luedi MM, Wysocki AP (2016) Pilonidal sinus disease guidelines: a minefield? Tech Coloproctol 20(4):263–264. CrossRefPubMedGoogle Scholar
  8. 8.
    Badawy EA, Kanawati MN (2009) Effect of hair removal by Nd:YAG laser on the recurrence of pilonidal sinus. J Eur Acad Dermatol Venereol 23:883–886CrossRefPubMedGoogle Scholar
  9. 9.
    Conroy FJ, Kandamany N, Mahaffey PJ (2008) Laser depilation and hygiene: preventing recurrent pilonidal sinus disease. J Plast Reconstr Aesthet Surg 61:1069–1072CrossRefPubMedGoogle Scholar
  10. 10.
    Ghnnam WM, Hafez DM (2011) Laser hair removal as adjunct to surgery for pilonidal sinus: our initial experience. J Cutan Aesthet Surg 4:192–195CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Girgin M, Kanat BH, Ayten R, Cetinkaya Z, Kanat Z, Turkoglu A et al (2012) Minimally invasive treatment of pilonidal disease: crystallized phenol and laser. Int Surg 97:288–292CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Lindholt-Jensen CS, Lindholt JS, Beyer M, Lindholt JS (2012) Nd-YAG laser treatment of primary and recurrent pilonidal sinus. Lasers Med Sci 27:505–508CrossRefPubMedGoogle Scholar
  13. 13.
    Khan M, Javed A, Govindan K, Rafiq S, Thomas K, Baker L et al (2016) Control of hair growth using long-pulsed alexandrite laser in an efficient and cost effective therapy for patients suffering from recurrent pilonidal disease. Laser Med Sci 31:857–862CrossRefGoogle Scholar
  14. 14.
    Kok K, Osmani OA, Odeke M, Eltigani EA (2011) Recurrent pilonidal sinus disease: Do lasers have the answer? Med Laser Appl 26:62–66CrossRefGoogle Scholar
  15. 15.
    Odili J, David G (2002) Laser depilation of the natal cleft pilonidal sinus aid to healing the. Ann R Coll Surg Engl 84:29–32PubMedPubMedCentralGoogle Scholar
  16. 16.
    Oram Y, Kahraman F, Karincaoğlu Y, Koyuncu E (2010) Evaluation of 60 patients with pilonidal sinus treated with laser epilation after surgery. Dermatol Surg 36:88–91CrossRefPubMedGoogle Scholar
  17. 17.
    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 52:131–134CrossRefPubMedGoogle Scholar
  18. 18.
    Schulze SM (2006) Treatment of pilonidal disease with laser epilation. Am Surg 72:534–537PubMedGoogle Scholar
  19. 19.
    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
  20. 20.
    Lukish JR, Kindelan T, Marmon LM, Pennington M, Norwood C (2009) Laser epilation is a safe and effective therapy for teenagers with pilonidal disease. J Pediatr Surg 44:282–285CrossRefPubMedGoogle Scholar
  21. 21.
    Beller EM, Glasziou PP, Altman DG, Hopewell S, Bastian H, Chalmers I et al (2013) PRISMA for Abstracts: reporting systematic reviews in journal and conference abstracts. PLoS Med 10:e1001419CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Jadad AR, Andrew M, Carroll D, Crispin J, Reynolds JM, Gavaghan DJ et al (1996) Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 17:1–12CrossRefPubMedGoogle Scholar
  23. 23.
    Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605CrossRefPubMedGoogle Scholar
  24. 24.
    Centre for Evidence-Based Medicine (2009). Cited 28 Aug 2015
  25. 25.
    Bascom J (1980) Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 87:567–572PubMedGoogle Scholar
  26. 26.
    Segre D, Pozzo M, Perinotti R, Roche B (2015) The treatment of pilonidal disease: guidelines of the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol 19:607–613. CrossRefPubMedGoogle Scholar
  27. 27.
    Doll D, Bosche FD, Stauffer VK et al (2017) Strength of occipital hair as an explanation for pilonidal sinus disease caused by intruding hair. Dis Colon Rectum 60(9):979–986. CrossRefPubMedGoogle Scholar
  28. 28.
    Bosche F, Luedi MM, van der Zypen D, Moersdorf P, Krapohl B, Doll D (2017) The hair in the sinus: sharp-ended rootless head hair fragments can be found in large amounts in pilonidal sinus nests. World J Surg. Google Scholar
  29. 29.
    Doll D, Krueger CM, Schrank S, Dettmann H, Petersen S, Duesel W (2007) Timeline of recurrence after primary and secondary pilonidal sinus surgery. Dis Colon Rectum 50:1928–1934CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  • A. A. Pronk
    • 1
    Email author
  • L. Eppink
    • 2
  • N. Smakman
    • 1
  • E. J. B. Furnee
    • 3
  1. 1.Department of SurgeryDiakonessenhuisUtrechtThe Netherlands
  2. 2.Department of Internal MedicineSint Antonius ZiekenhuisNieuwegeinThe Netherlands
  3. 3.Department of Abdominal SurgeryUniversity Medical Center GroningenGroningenThe Netherlands

Personalised recommendations