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Langenbeck's Archives of Surgery
Erschienen in: Langenbeck's Archives of Surgery 8/2021

05.05.2021 | Systematic Reviews and Meta-analyses

German National Guideline on the management of pilonidal disease: update 2020

verfasst von: I. Iesalnieks, A. Ommer, A. Herold, D. Doll

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 8/2021

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Abstract

Background

The present German National Guideline is an updated version of previous Guideline published in 2014. It aims to compare various treatment methods and to assist physicians with evidence-based recommendations.

Methods

Systemic literature review.

Results

Three types of disease manifestation could be differentiated: asymptomatic disease, an acute abscess, and the chronic pilonidal disease. At present, there is no treatment method fulfilling all desired criteria: simple, painless procedure associated with rapid wound healing, and low recurrence rate. Thus, treatment modality should be tailored to disease manifestation and extent.

Conclusion

Asymptomatic pilonidal disease should not be treated. A pilonidal abscess should be unroofed. After resolution of the acute inflammation, the disease should be treated definitely. As for today, sinus excision is the standard treatment of the chronic pilonidal disease. Wide excision and open treatment of chronic disease is a safe procedure which, however, leads to prolonged secondary healing and time off-work, as well as to considerable recurrence rate. The extent of excision should be as limited as possible. Excision and midline wound closure is associated with impaired outcomes. Today, it has become obsolete. Minimally invasive procedures (e.g., pit picking surgery) represent a treatment option for chronic pilonidal disease. However, the recurrence rate is higher compared to excision procedures. Nevertheless, they may be used for small primary disease. Off-midline procedures should be used for disease not suitable for minimally invasive treatments. The Limberg flap and the Karydakis procedure are two best described methods which are associated with similar short- and long-term results.
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Metadaten
Titel
German National Guideline on the management of pilonidal disease: update 2020
verfasst von
I. Iesalnieks
A. Ommer
A. Herold
D. Doll
Publikationsdatum
05.05.2021
Verlag
Springer Berlin Heidelberg
Erschienen in
Langenbeck's Archives of Surgery / Ausgabe 8/2021
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-020-02060-1

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