In the early 1980s, the American surgeon John Bascom developed the so-called follicle-removal operation, a minimally invasive procedure better known as pit picking. Further terms for the Bascom procedure are "minimally invasive surgery", "Bascom surgery", "pit pick" or "ambulatory surgery of pilonidal disease".
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| Paul Bascom, Photo of Dr. John Bascom, CC BY-SA 3.0 |
Bascom later developed another surgical method for the treatment of the tailbone fistula, the so-called cleft-lift procedure. Pit picking is therefore also known as "Bascom I", the cleft-lift method as "Bascom II".
The method is very similar to the Lord and Millar method, but the pits are cut out with an extremely narrow hem of just 1 millimetre and also only 2-3 millimetres deep. Pit-picking is performed on an outpatient basis under local anaesthesia. The wounds are not sutured but only covered with a dressing. Until healing, which usually takes only 2-3 weeks, the wounds have to be showered several times a day. Sitting baths and ointment treatments are not recommended.
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| Lord Lucan, Trephine surgery 1, CC BY-SA 4.0 |
The principle of the Bascom technique is based on the assumption that the pits lying in the gluteal fold are lined with a layer of skin that prevents the spontaneous closure of the pits, while at the same time providing a permanent entry point for bacteria, sweat and skin flakes. The pits are "picked out" by the pit picking method and can then heal. The procedure by which different variants are known is suitable only for manageable findings.
The recurrence rate for new fistulas of the pit picking method is between 10 - 20 %. It depends on how carefully the patients were selected for pit picking (only small findings, if possible without previous surgery), whether the findings are inflammation-free or accompanied by suppuration. Obesity and smoking are also risk factors for the recurrence of the tailbone fistula. Men develop a recurrence more frequently than women, for whom pit picking is almost ideal.
The big advantage of pit picking is the low strain on the patient. It can be performed on an outpatient basis under local anaesthesia, takes only a few minutes, requires no extensive wound care and enables a rapid resumption of professional and leisure activities.
Literature sources:
Bascom J (1980) Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 87:567–572
Gips M, Melki Y et al (2008) Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients. Dis Colon Rectum 51:1656–1662 (discussion 1662–1663)
Majeski J, Stroud J (2011) Sacrococcygeal pilonidal disease. Int Surg 96:144–147
Senapati A, Cripps NP et al (2000) Bascom’s operation in the day surgical management of symptomatic pilonidal sinus. Br J Surg 87:1067–1070
Colov EP, Bertelsen CA (2011) Short convalescence and minimal pain after out-patient Bascom’s pit-pick operation. Dan Med Bull 58: A4348
Maghsoudi H, Nezami N et al (2011) Ambulatory treatment of chronic pilonidal sinuses with lateral incision and primary suture. Can J Surg 54:78– 82
Lord PH, Millar DM (1965) Pilonidal sinus: a simple treatment. Br J Surg 52:298–300
Bascom J (1983) Pilonidal disease: long-term results of follicle removal. Dis Colon Rectum 26:800–807
Gips M, Melki Y et al (2008) Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients. Dis Colon Rectum 51:1656–1662 (discussion 1662–1663)
Thompson MR, Senapati A et al (2011) Simple day-case surgery for pilonidal sinus disease. Br J Surg 98:198–209
