Treatment of the pilonidal fistula is usually surgical. There are various surgical techniques which can be performed, minimally invasive ones which use small incisions, such as pit picking, and traditional ones in which the entire area of the fistula is generously cut out. All surgical procedures struggle with the same problems: It may come to wound healing problems or, however, the sacral fistula returns.
Whether wound healing is problematic or whether the fistula returns is not a matter of luck and does not necessarily depend on the surgeon. Studies have identified risk factors that patients bring with them and that lead more frequently to wound healing problems and recurrences of the fistula.
Risk factors
- the familial frequency of the pilonidal fistula
- smoking
- the diameter of the pilonidal cyst
- number of fistula ducts -> increased frequency of fistula recurrences
- major surgery under local anaesthesia (e.g. extensive fistula excision)
- plastic surgery (Limberg, Karydakis) -> increased incidence of wound healing problems
- extensive fistula excision with direct suture -> increased recurrence of fistulae
Unclear significance as risk factors
- obesity
- lack of body hygiene
- previous pilonidal abscess
Not a risk factor
- gender
- dark skin and dark hair colour
- inlaying of a wound drainage (for more extensive operations)
Bibliography:
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Al-Khayat H, Al-Khayat H, Sadeq A, Groof A, Haider HH, Hayati H et al. Risk factors for wound complication in pilonidal sinus procedures. J Am Coll Surg 2007;205(3):439–444
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