Choosing a surgeon

Choosing a surgeon

Patients have many choices regarding the type of physician they see for treatment of their pilonidal disease. Often, the diagnosis is made by an emergency room, urgent care, or primary care physician. I have even seen patients referred to orthopedics, spine surgeons, or “tailbone specialists” because of misdiagnosis of the cause of the pain.

Pilonidal disease is unusual regarding which type of surgeon is considered the specialist in this disease process. The best treatment is a cleft lift, which is a plastic surgical rotation and advancement flap. But, plastic surgeons are usually not comfortable working around the anus because that is not usually part of their training. Colorectal surgeons seem to be the agreed upon “experts” in treating pilonidal disease, but pilonidal disease does not involve the colon or rectum – so it is not really something they are interested in, nor are they comfortable with plastic surgical flaps. Often, patients with pilonidal disease end up seeing general surgeons – and again, they may or not have the skill-set to deal with a pilonidal cyst or sinus effectively. So, it really requires a surgeon of any kind with an interest in learning how to treat this disease, good technical skills, and compassion for what patients with pilonidal disease endure.

So, although the surgical treatment might be done by a general surgeon, colorectal surgeon, dermatologist or plastic surgeon. The best surgeon is one with a long experience and high success rate in treating pilonidal disease. It is my strong preference that the surgeon be skilled in the cleft-lift operation or Karydakis procedure.

Whichever kind of surgeon you see, it is important to ask about their experience and success rate, as well as their strategy regarding what to do if the surgery is not successful. There should be a “Plan B”, since none of these methods is 100% all the time. If they say they’ve never had a failure – be skeptical.