About minimally invasive pilonidal surgery
Pit Picking (also called Bascom’s Operation, or Bascom 1) is one of the minimally invasive procedures used to treat pilonidal disease. This operation removes any midline pits, and destroys any sinus tracts and remaining abscess cavities. All of the minimally invasive procedures are similar in what they accomplish, they just differ in what method is used to accomplish this. The other methods use a laser, cryosurgery, phenol, suture material, or even an endoscope to directly look into the sinus tract.
Although these are all appealing in concept, they do not address the shape and depth of the gluteal cleft. They are “minimal” in the size of the incision, but until now there has not been a study that really looks at the success rate.
The latest data
In an open access article, from Dr Dietrich Doll from Germany, which came out in June of 2022, 327 patients with pilonidal disease were treated with either pit picking, open excision, or a Limberg Flap.
The article also demonstrated a 44% failure rate at 10 years for patients who had open excision – which approximates the 50/50 number that many surgeons equate with this procedure.
The data was statistically analyzed and predicted out to five years for the pit picking patients.
They found that the five year recurrence rate in the pit picking patients was 62%. In other words, approximately 2 out of 3 patients had failure within 5 years – about a 12% failure rate per year. Although this is a lower success rate than some other articles, it confirms what many surgeons intuitively have found, and it is why many of us do not offer pit picking, or any of the minimally invasive operations.
This series also showed a 22% failure rate in the Limberg Flap patients. This is in contrast to the failure rate of the cleft lift procedure, which Dr Immerman demonstrated in his 2021 article, which was 3.4% at 3 years using the same type of statistical analysis. That article can be viewed by following this link. Most likely, dedicated pilonidal surgeons who perform the cleft lift procedure frequently, have similar success rates.
This clinical research really shines a light on the place of pit picking, and probably all minimally invasive operations for pilonidal disease. As surgeons, we will rarely accept an operation with a 20-30% failure rate; one with a 62% failure rate would be completely unacceptable.
The conclusion of Dr Doll and his colleagues is:
“Although the technique is minimally invasive, fast, and cheap, it has a recurrence rate of 60%, without a benefit for the majority of patients.”
And, we agree with their conclusion. With the failure rate of open excision being 44% and pit picking 62% – it is difficult to justify these operations. We do not recommend either in our clinic.