Over the last 60 years, numerous surgical methods have been developed for the treatment of pilonidal cysts and tailbone fistula, many of which are minimally invasive techniques. Nevertheless, most surgeons, especially in Germany, prefer generous excision of the soft tissue with open wound healing - despite long, complication-prone healing phases and recurrence rates of up to 35%.
Against the background of general dissatisfaction with the results of this traditional procedure, surgeons Peter H. Lord and Douglas M. Millar presented the first minimally invasive surgical technique for the treatment of the pilonidal sinus in 1965. The introduction of this method and all other minimally invasive techniques go back to the realization that the pits in the gluteal fold are the cause for the development of the pilonidal disease, which is by no means exclusively congenital.
With the Lord and Millar method, the pits are cut out very sparingly, the resulting skin wounds are usually less than 5 millimetres. If chronic abscesses or fistula ducts are present next to the wrinkle, these are opened by an additional skin incision and cleaned with a curette. Hair and inflammatory tissue are removed from the fistula ducts via the cut-out pits with small brushes. The procedure is performed under local anaesthesia.
After the operation, the wounds are not sutured but only provided with a hemostatic dressing. Suturing the wounds should increase the risk of wound healing disorders, inflammation and also the recurrence of fistulas. For wound treatment, showering several times a day is recommended, followed by blow-drying. Sitting baths are ineffective and not recommended, as is the application of ointments. Simple dressings or bandages are sufficient to cover wounds. During wound healing, which takes an average of 3-4 weeks, the hair around the wounds must be carefully removed, e.g. by shaving weekly.
A recurrence of tailbone fistulas was observed in studies in 3-4% of cases, especially when the wounds had been sutured. Most fistula recurrences occur within the first 6 months after the operation.
Literature sources:
Lord PH, Millar DM (1965) Pilonidal sinus: a simple treatment. Br J Surg 52:298–300
Kooistra HP (1942) Pilonidal sinuses. Am J Surg 55:3–17
Patey DH, Scarff RW (1946) Pathology of postanal pilonidal sinus; its bearing on treatment. Lancet 2:484–486
Allen-Mersh TG (1990) Pilonidal sinus: finding the right track for treatment. Br J Surg 77:123–132
Edwards MH (1977) Pilonidal sinus: a 5-year appraisal of the Millar-Lord treatment. Br J Surg 64:867–868
