What are the complications of pilonidal cyst and sinus?

Updated: May 20, 2019
  • Author: Alex Koyfman, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Recurrence of the abscess is by far the most common complication. Most literature reviewed quote a rate between 40% and 50%, although 58% will heal primarily by 5 weeks.

Primary incision and drainage seems to clearly be the primary mode of treatment; for recurrent disease presentations, a multitude of surgical techniques, from incision and curettage and marsupialization to wide excision with flap procedures, have been described throughout the years. A continuum seems to exist, from fairly simple to more complex procedures that should be offered to patients as needed given their particular needs; obviously, the surgeon's own training and experience will factor into the operative decision. [3, 1]

Cochrane Database of Systematic Reviews article published in 2007 showed no significant difference in outcomes between techniques involving primary closure versus healing by secondary intention, though the review did recommend off-line closure when primary closure is performed. [15]  A series of treatments of the local region with phenol have also been described, with a low incidence of recurrence reported. [1]

Wound infection after primary incision and drainage is rare but described. At least one article suggests broad-spectrum antibiotics should be administered given the possibility of both aerobic and anaerobic infection at the incision site. [4]

Squamous cell carcinoma after recurrence of pilonidal disease has been described; it is rare in incidence but, when diagnosed, requires en bloc surgical resection and appropriate oncologic care with local radiation and possibly chemotherapy. [1]

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