Surgical Management of Complex or Recurrent Pilonidal Disease Requiring Wide Excision
Clinical Scenario
This protocol addresses patients with complex or recurrent pilonidal disease whose disease burden or failure to respond to simpler measures necessitates a wide excision. These cases present a greater reconstructive challenge, requiring careful surgical planning beyond standard excision.
Surgical Approach — Overview
Wide excision in this setting is typically paired with a flap-based reconstruction — a category of technique designed to reduce tension, reposition the natal cleft, and lower recurrence risk. Minimally invasive, endoscopy- or video-assisted approaches represent a distinct option for selected patients.
The specific choice among flap techniques and patient-selection criteria for minimally invasive approaches are detailed in the full protocol.
References
- Flap-based approaches (e.g., rhomboid, Limberg, Karydakis, cleft-lift) can be used for patients with complex or recurrent disease who require a wide excision.
- Minimally invasive approaches assisted by endoscopy or video are additional options, but often these require the use of specific equipment and physician proficiency in using the technique.
View source ↗