O1114: Utilization of a Standard Treatment Algorithm in Pilonidal Disease Lowers Recurrence After Previous Drainage or Excision Procedures

Background: Pilonidal disease is often treated with incision and drainage (I&D) of abscess or surgical excision, but has high recurrence. We hypothesize that following a standard treatment protocol decreases pilonidal recurrence, even after prior failed excision procedures.

Methods: From patients who presented to our pilonidal clinic, only those that had I&D, excision or both prior to presentation were included. After presentation, patients were started on regular epilation (manual shaving, laser) + pit excision if symptomatic. Median follow-up period was 287 (79-2792) days. Recurrences prior to presentation to our clinic were compared to those after starting our protocol. Paired t-Test was used to determine statistical significance with p set to 0.05.

Results: 57 patients (26 male, 30 female, 1 transgender male, average age 19±3 years) had procedures performed prior to presentation at our clinic: 41 patients (72%) had I&D, 8 (14%) had excision, while 8 underwent both. 34 patients (60%) recurred prior to presentation; 23 of these patients then underwent pit excision under our care. Out of all 57 patients, only 4 (7%) recurred after establishing care in our clinic and had pit excision under our care; this was significantly less than 34 (60%) patients that recurred before presenting to our clinic (p < 0.001). A total of 31 (54%) patients underwent pit excision under our care. 26 (46%) patients only underwent regular epilation without pit excision and did not experience recurrence. 15/23 patients that had not recurred prior to presentation did not require surgery as part of their treatment.

Conclusion: Despite undergoing multiple procedures, patients with pilonidal disease continue to have high recurrence rates. Use of a standard treatment algorithm that includes regular epilation with pit excision in select cases can reduce pilonidal recurrence. Some patients may only need regular epilation without additional surgical excision.