Pilonidal sinus, if not symptomatic, is usually treated conservatively without surgery. If an infection develops and abscess forms, surgery to incise and drain the abscess may be required. If the infection is recurrent, surgery is almost always needed to prevent it from recurring.
Various types of surgery is available for treatment of pilonidal sinus. The objective in any pilonidal sinus surgery is the same: remove the pits and any fistulous tracts and change the contour of the natal cleft so it does not recur. The type of surgery chosen depends on the complexity of the sinus tracts and various other patient factors.
This involves removing of the whole sinus plus any fistulous tracts with its surrounding soft tissue. The wound is then left open to heal by secondary intention. This is a very effective way of treating pilonidal sinus and has a low recurrence rate. The disadvantage is that patient is left with a open wound that will take weeks to heal (depending on size and complexity of the pilonidal sinus).
Excision Surgery and Reconstructive Flap
This is the same as above in terms of removing the whole sinus tract. The defect is then repaired and closed using some form of reconstructive flap, A reconstructive flap involves making further incisions in the skin and moving them to cover the defect created by the resection of the pilonidal sinus. This also changes the shape of the natal cleft which aims to reduce the rate of recurrence.
This does involve more dissection and there is a risk of wound break down in the post operative period.
There are some increasing evidence to suggest that by simply deroofing the sinus tract, ie. removing the top of the tract, may be enough to prevent the sinus from coming back. This is the least invasive of all the procedures and is effective in most patients. More studies are required to recommend this as a routine procedure.