Treatment of the pilonidal disease depends on the stage of the disease.
Asymptomatic form
The tailbone fistula does not cause any discomfort but does not heal spontaneously. Instead, it normally persists for life and can go into the acute form (abscess formation) or into the chronic stage. However, a precautionary surgical removal of the tailbone fistula is not recommended. Anyone who has tailbone fistula or pilonidal cyst that does not cause any discomfort does not need surgical treatment.
Acute form (abscess)
If the pilonidal disease leads to abscess formation, a rapid surgical opening of the abscess is necessary, with which the infection situation including pain and possibly also fever is controlled. However, the surgical abscess opening does not lead to healing of the tailbone fistula; it remains after the surgical wound has healed. The final removal of pilonidal cyst and fistula should not be performed as part of an abscess operation, but only after the inflammatory environmental reaction has subsided, i.e. after 2 to 3 weeks at the earliest.
Those who have to undergo an abscess opening will certainly not be pleased if they have to go to the surgeon again a few weeks later to remove cyst and fistulas. However, the two-phase concept - abscess opening and only in a 2nd operation removal of the cyst and fistulas - has some advantages:
- The emergency abscess opening can be carried out quickly and easily at any time of the day or night. Depending on the chosen procedure, the final renovation is much more time-consuming.
- The abscess is usually opened on an outpatient basis; the surgical removal of fistula, on the other hand, requires an inpatient stay, depending on the surgical technique.
- Another advantage is that the surgical removal of the fistula and, if necessary, the plastic coverage of the defect over the coccyx region can be better planned.
- After the inflammatory soft tissue changes caused by the abscess have subsided, the extent of surgical fistula removal is usually smaller.
- The risk of new fistula formation is lower with the two-phase concept.
Chronic pilonidal disease
The chronic pilonidal disease only very rarely heals spontaneously. The treatment is carried out surgically, whereby the time is freely selectable in contrast to the abscess opening, which usually does not tolerate a long time delay.
Literature sources:
Doll D, Friederichs J, Boulesteix AL et al (2008) Surgery for asymptomatic pilonidal sinus disease. Int J Colorectal Dis 23(9):839–844 4
Lauterbach HH, Konrad U (1999) Zweiphasenkonzept zur Therapie des infizierten Sinus pilonidalis. Chirurg Praxis 55:623–628 5
Doll D, Matevossian E, Hoenemann C et al (2013) Incision and drainage preceding definite surgery achieves lower 20-year long-term recurrence rate in 583 primary pilonidal sinus surgery patients. J Dtsch Dermatol Ges 11(1):60–64
Webb PM, Wysocki AP (2011) Does pilonidal abscess heal quicker with off-midline incision and drainage? Tech Coloproctol 15(2):179–183
Doll D, Friederichs J et al (2008) Surgery for asymptomatic pilonidal sinus disease. Int J Colorectal Dis 23:839–844
Hussain ZI, Aghahoseini A et al (2012) Converting emergency pilonidal abscess into an elective procedure. Dis Colon Rectum 55:640–645
Jensen SL, Harling H (1988) Prognosis after simple incision and drainage for a first-episode acute pilonidal abscess. Br J Surg 75:60–61
