PILONIDAL-SINUS DISEASE - THE CONSERVATIVE APPROACH

Objective: To examine the role of conservative, nonexcisional methods in the treatment of pilonidal sinus disease. Design: Pilot nonrandomiz ed cohort study and follow-up retrospective study. Setting and Patient s: In the pilot study, all patients treated for pilonidal sinus diseas e consecutively over 3 years at an Army community hospital, and in the follow-up study within a closed federal population, all patients admi tted with a diagnosis of pilonidal sinus disease over 17 years to an A rmy medical center. Interventions: Conservative, nonexcisional therapy (meticulous hair control by natal cleft shaving, improved perineal hy giene, and limited lateral incision and drainage for abscess) with ini tial comparison to excisional procedures. Main Outcome Measures: Occup ied-bed days for conservative vs excisional therapy during a 3-year pi lot study and the number of admissions and procedures performed for pi lonidal sinus disease at an institution dedicated to conservative trea tment alone. Results: Complete healing over 83 occupied-bed days was d emonstrated in 101 consecutive cases managed during 1 year with the co nservative method, whereas slower healing over 4760 occupied-bed days was observed in 229 patients undergoing 240 operative procedures durin g the preceding 2 years. With application of conservative treatment ov er 17 years, only 23 excisional operatoions were performed. Conclusion s: Conservative therapy effectively controls pilonidal sinus disease i n the nonoperative outpatient setting while promoting near-normal work status and is preferred over excisional operations.