German national guideline on the management of pilonidal disease.
OBJECTIVE
The present national guideline aims to provide recommendations for physicians involved in the treatment of patients with pilonidal disease. It has been published previously as an extended version in German language.


METHODS
This is a systemic literature review. The present guideline was reviewed and accepted by an expert panel in a consensus conference.


RESULTS
Some of the present guideline conclusions were based on low- to moderate-quality trials. Therefore, an agreement was necessary in those cases to provide recommendations. However, recommendations regarding the most frequently used surgical procedures were based on numerous prospective randomized trials.


CONCLUSIONS
An asymptomatic pilonidal disease does not require treatment. A pilonidal abscess should be incised. After regression of the acute inflammation, a definitive treatment method should be applied. An excision is the standard treatment method for the chronic pilonidal disease. Open wound healing is associated with a low postoperative morbidity rate; however, it is complicated by a long healing time. The minimally invasive procedures (e.g., pit picking surgery) represent a potential treatment option for a limited chronic pilonidal disease. However, the recurrence rate is higher compared to open healing. Excision followed by a midline wound closure is associated with a considerable recurrence rate and increased incidence of wound complications and should therefore be abandoned. Off-midline procedures can be adopted as a primary treatment option in chronic pilonidal disease. At present, there is no evidence of any outcome differences between various off-midline procedures. The Limberg flap and the Karydakis flap are most thoroughly analyzed off-midline procedures.
Department of Surgery, Städtisches Klinikum München Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany. iesalnieks_igors@hotmail.com.
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Iesalnieks
End- und Dickdarm-Zentrum Essen, Essen, Germany.
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Ommer
Department of Surgery, Asklepios-Klinik Altona, Hamburg, Germany.
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Petersen
Department of Surgery, St. Marienhospital Vechta, Vechta, Germany.
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Doll
End- und Dickdarmzentrum Mannheim, Mannheim, Germany.
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Herold
D005858:Germany; D006801:Humans; D010864:Pilonidal Sinus / Q000601:surgery*; D017410:Practice Guidelines as Topic; D058106:Wound Closure Techniques; D014945:Wound Healing
Pilonidal abscess; Pilonidal disease; Pilonidal sinus; Surgery