Pilonidal Cyst Surgery Success Rate: Factors That Influence The Outcome

The gluteal cleft-lift procedure is a highly effective cure for tailbone-area pilonidal disease, with reported success rates of 95-100%.  

According to several landmark reports, the lower the pilonidal disease, i.e. the closer the disease extends to the anus, the more challenging it is for the pilonidal surgeon to deliver this success.  This finding extends to cases in which the pilonidal surgeon is performing a revisional cleft-lift to correct a nonhealing surgical wound from a previously failed pilonidal operation. The lower the nonhealing surgical wound, the more challenging it is for the pilonidal surgeon to deliver a quickly healing and curative cleft-lift.  But hope persists!  In the aforementioned reports by B Shrager (Cureus 2024) and SC Immerman (Cureus 2021), impressive success rates and healing times were still seen in many patients with “edge-of-anus” nonhealing surgical wounds.  Shrager, for example, saw an operative success rate of 93.5% and a median healing time of 48 days in such morbid cases.

It should be emphasized that each surgical attempt, certainly those by nonspecialists ill-trained in the nuances of pilonidal treatment, generally results in a failure which is progressively lower and perianal in location.  The conclusion here is that this scenario should be avoided at all costs; it is preferable for a pilonidal patient with a nonhealing surgical wound to seek local wound care only over additional surgical remedies by a nonspecialist.  Surgical correction should absolutely be deferred until a dedicated cleft-lift specialist with extensive experience in revisional work is available to perform this surgery.