Besides The Cleft-lift, What Other Treatments Might A Pilonidal Specialist Offer?
At the most conservative end of the treatments spectrum, a nonsurgical depilatory technique, i.e. hair removal, may be used. This may be application of a topical agent (e.g. Nair), shaving, or waxing. Laser ablation is also an option but has limitations and setbacks. We add to this nonsurgical approach lifestyle modifications, the most important of which is optimized sitting habits.
Moving into the surgical realm, but remaining conservative, the pit-picking technique is a good first line approach that can be performed. Advantages are minimal incisions to heal, and very little “down time”. In this technique, intracyst diseased tissue is removed in a piecemeal fashion. The associated sinus tracts are aggressively debrided, irrigated and cauterized. Pilonidal Treatment Center of New Jersey is also excited to be the first high-volume center in the US to offer an endoscopic pit-picking technique, which adds direct visualization for the surgeon. This technique is known as EPSIT (endoscopic pilonidal sinus treatment).
Finally, in select patients with limited disease, a more limited but complete excisional procedure referred to as the “simple pilonidal cystectomy” can be performed. This operation cleanly excises the cyst along healthy skin margins and fully closes the wound. Unlike the cleft-lift procedure, however, the simple pilonidal cystectomy does not recontour the cleft. Also, the incision is at least 50% shorter than that of the cleft-lift. Although recurrent disease is more common with this approach, it “burns no bridge” and, if needed, a cleft-lift can always be done later in life.