Pilonidal sinus: finding the right track for treatment.

Management of pilonidal sinus is frequently unsatisfactory. No method satisfies all requirements for the ideal treatment--quick healing, no hospital admission, minimal patient inconvenience, and low recurrence--but greater awareness of the strengths and weaknesses of existing methods would lead to improved management. Early excision of the pilonidal pit at the time of treatment of pilonidal abscess reduces the high (40 per cent) risk of subsequent sinus. Treatments for pilonidal sinus that flatten the natal cleft halve the risk of recurrence. En block excision of pilonidal sinus with secondary healing should be abandoned and emphasis given to development of treatments, such as primary asymmetric closure, which have more potential. Some treatments are operator-dependent and, to achieve the best results, junior surgeons must be correctly trained and supervised. Future treatment studies must be prospective and randomized, and should compare healing time, recurrence rates beyond 3 years, nurse and hospital visits, patient inconvenience and loss of income.