Slovenská chirurgia 1e/2026

Pilonidal sinus – outpatient surgical treatment by cutting elastic ligature, 22 years of experiences

Introduction: Pathogenetically, sinus pilonidalis (SP) is an inflammation of the skin and subcutaneous tissue of the intergluteal (IG) cleft. The absence of causal dermatological treatment of SP leads to purulent complications, subcutaneous abscesses and fistulas, which are the subject of surgical treatment. The range of published guidelines, recommendations, operations and surgical procedures is very wide and diverse. Today, in the era of social networks and artificial intelligence, patients are sufficiently informed about the methods of treatment of SP. On patient platforms, they evaluate them, share their experiences and make decisions.

Patients group and method: From June 2004 to April 2026, 437 patients with SP were treated surgically on an outpatient basis. 136 (32%) patients with pilonidal abscess and 301 (68%) patients with chronic fistula. 382 (87%) patients with a diagnosis of primary SP and 55 (13%) patients with a diagnosis of sinus pilonidalis recidivans (SPR) after conventional invasive excision(s). All were treated on an outpatient basis by a cutting elastic ligature.

Results: The treatment process of primary SP lasted an average of 8 weeks, for SPR 12 weeks. The postoperative follow-up interval was 3 years. In the group of 437 patients, 27 patients (6%) had a recurrence, in the interval of 6 months to 8 years from the cure of primary SP. 21 of them were cured again by cutting elastic ligature. Definitively cured SP/SPR by cutting elastic ligature, including 21 cured recurrences, were 431 patients (98%).

Conclusion: The outpatient treatment method of cutting elastic ligature, used in a group of 437 patients, can definitively cure surgically manifest SP/SPR without hospitalization, invasive excision, outpatiently without interruption of work ability. It is a simple, outpatient procedure, under local anesthesia, significantly individualized, with minimal discomfort and impact on quality of life, repeatable, financially inexpensive, with definitive cure of SP. Treatment with cutting elastic ligature should be preferred to hospitalization and conventional invasive excision.

Keywords: pilonidal sinus, outpatient surgical treatment, cutting elastic ligature, laser epilation