How to deal with asymptomatic Pilonidal Disease

Many patients ask us what they should do if they have visible evidence of pilonidal disease without pain, drainage or bleeding.

Unfortunately, there is no firm answer, and the individual patient needs to impose his or her philosophy on the situation and direct their own treatment plan. This comes up with many other general surgical problems. Do you fix an asymptomatic hernia? Asymptomatic gallstones? The answer usually depends on whether you are someone who tends to be proactive in preventing problems, or someone who wants to wait and see what kind of problems develop.

However, it is important that you have enough facts to make an intelligent decision about how to proceed.

Here are some facts that you can use to help in your decision making process.

  • Pilonidal disease is rarely a lift threatening condition.
  • Home remedies may keep symptoms at  bay for a while, but there is no guarantee.
  • The effectiveness of surgery depends on the exact operation and the experience of the surgeon.
  • The category of “off midline closure” operations, such as the cleft-lift have the best success rate.
  • If you consult with five different physicians, you will get five totally different answers about how to proceed.
  • If you rush into surgery, and have an open excision, and it does not heal, you will have created a situation you’ll wish you had avoided.
  • Procedures like pit picking, EPSIT, and laser surgery may or may not work, but they usually do not make a subsequent cleft-lift more difficult.
  • If you really have no symptoms other than a slightly tender chronic lump, or some enlarged midline pores, you may go a long time without any problems, possibly forever.
  • If you develop a pilonidal abscess at a critical time in your life, it may disrupt work, vacation, holidays, or other important events.
  • If you have had an abscess, and it was drained surgically or drained on its own, it may or may not come back.

So, this really comes down to whether you want to be proactive, and get this taken care of so that it is not a problem in the future; or you want to wait and see what happens.

Either course of action is appropriate, but if you choose a wait and see approach, you have to be philosophical if it acts up at a time that causes you to cancel some important plans so you can deal with it as needed.

It is our opinion that if you have surgery, a cleft-lift is the option with the quickest recovery and least chance of recurrence.