Why didn’t my doctor tell me about the cleft-lift procedure?

This is a common question from patients, who find us on the internet after struggling with this problem for months or years. Although we get more and more referrals from other physicians, most patients come to us after performing their own research.

Why don’t all surgeons perform the cleft-lift they way you do?

  1. It is rarely taught in residency. Most surgeons are taught wide excision by other surgeons they know and trust. These teachers may be experts in many areas of surgery, but fall short when it comes to treating pilonidal disease.
  2. There is not a lot of interest in this disease process.
  3. It is difficult to learn properly. Some surgeons attempt it, but have too many failures and abandon it because they have not been properly trained.
  4. The basic cleft lift does not address perianal disease. Even if a surgeon can do the basic cleft-lift, he most likely will not know how to deal with openings close to the anus

My surgeon says he is going to decide during surgery “if I am a candidate” for a cleft lift. Is that reasonable?

  1. Probably not. Experienced cleft-lift surgeons can perform the procedure in almost all situations, and the information needed to decide is determined by physical examination.
  2. Most of the time, patients end up with a large open wound, rather than a cleft-lift in this scenario.
  3. The problem with this approach is that it keeps you from going elsewhere to see a cleft-lift expert and getting the treatment you really need.

So, is this procedure so new that isn’t yet accepted by medical professionals?

  1. No, Dr. Bascom began writing about this in 1987, and his operation is a modification of the Karydakis Flap which had been already described at that point. Dr Immerman has been performing this since 1993 with encouragement from Dr Bascom.
  2. When surgeons take their board examinations, “cleft-lift” is the answer to the question of which procedure for pilonidal disease has the best results.
  3. A recent retrospective study of almost 90,000 patients concluded that the Bascom Cleft-Lift and the Karydakis procedures had the lowest recurrence rates. You can read the study by following this link.

OK. Then why didn’t somebody refer me to an experienced cleft-lift surgeon whey they saw I was having problems healing?

  1. Most surgeons are not even aware how successful the cleft-lift can be in experienced hands.
  2. Many primary care physicians are not aware of this operation, and are reluctant to send patients for any surgery because they have seen poor results from more commonly performed procedures.
  3. Physicians don’t know what they don’t know…
  4. If you’re interested, here is more on the subject on researching the best treatment for pilonidal disease.

So, should I ask my surgeon to do a cleft-lift for me

Probably not. To perform this operation with consistent success your surgeon should be taught the procedure by a cleft-lift expert, and then have performed dozens of operations. You have a much better chance of success by traveling to see a cleft-lift expert who has experience with the procedure.

University of Wisconsin-Eau Claire