# Pilonidal Disease — GCMD Library living collection

Everything in the library about pilonidal disease — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 29 cited statements

## Episodes
### Surgical Management
- [Update Course Rewind: Pilonidal Disease 2019](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925) — podcast · 13:26 · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925.md)

### Evidence & Research
- [Journal of Pediatric Surgery Article Review: July 2023, PAPS Issue](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900) — podcast · 10:46 · [machine version](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900.md)

### Case-Based Learning
- [Pilonidal Cyst Case Presentation: Update Course 2015](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982) — video · 5:08 · [machine version](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982.md)

## Chapters
- [0:01](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=1) Case presentation and timing of definitive surgery (Ep 1)
- [0:54](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=54) Bascom pit-picking technique (Ep 1)
- [2:19](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=139) Risk factors affecting management (Ep 1)
- [2:43](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=163) Surgical options for definitive management (Ep 1)
- [3:34](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=214) Management of recurrent disease (Ep 1)
- [4:20](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=260) Laser hair removal as adjunct (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=0) Introduction and App Promotion (Ep 2)
- [0:40](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=40) Introduction to Pilonidal Disease and GIPS Procedure (Ep 2)
- [2:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=137) Case Presentation and Rationale for GIPS (Ep 2)
- [4:53](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=293) GIPS Technique and Key Principles (Ep 2)
- [7:00](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=420) Advanced Techniques and Wound Management (Ep 2)
- [9:03](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=543) Research, Antibiotics, and Acute Abscess Management (Ep 2)
- [11:53](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=713) Summary and Closing (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=0) Introduction and Episode Overview (Ep 3)
- [1:08](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=68) Cryoanalgesia Impact on Pectus Excavatum Repair Outcomes (Ep 3)
- [3:20](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=200) Chest Tube Management After Pediatric Lung Resection (Ep 3)
- [6:08](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=368) Laser Hair Reduction for Pilonidal Disease Recurrence Prevention (Ep 3)
- [8:45](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=525) Summary and Closing Remarks (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- After 2-3 recurrences of pilonidal cyst, definitive surgery is indicated rather than repeat I&D. (opinion) [Ep 1 · 0:30](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=30)
- The Bascom technique involves excising 1-millimeter pits at skin level under local anesthesia, allowing secondary healing, with 70% not recurring by their data (though no control group exists). (clinical) [Ep 1 · 0:54](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=54)
- For large draining sinuses or recurrence after pit excision, formal OR excision of the entire affected area with off-midline layered closure and drain placement is performed. (clinical) [Ep 1 · 1:28](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=88)
- Physical exam findings including deep gluteal fold and heavy hair burden are high-risk factors for pilonidal disease recurrence. (clinical) [Ep 1 · 2:25](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=145)
- For severely infected pilonidal disease, open excision with wet-to-dry dressing changes or wound VAC is an option. (clinical) [Ep 1 · 2:50](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=170)
- Post-operative management with prone positioning until wound healing is critical for preventing recurrence; pilonidal disease is fundamentally a wound healing problem. (opinion) [Ep 1 · 3:43](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=223)
- Plastic surgery consultation for flap reconstruction with strict prone post-operative positioning is used for multiply recurrent pilonidal disease. (clinical) [Ep 1 · 3:54](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=234)
- One patient reported laser hair removal as the most painful procedure they had experienced, completing only half a session and refusing further treatment. (clinical) [Ep 1 · 4:28](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=268)
- Laser hair removal for pilonidal disease is expensive and insurance reimbursement has not been successful. (clinical) [Ep 1 · 4:46](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=286)
- Insurance coverage for laser hair reduction varies, with some agencies covering it while in Canada advocacy to health systems is needed, making effectiveness data important for coverage decisions. — Mary Brindle (opinion) [Ep 3 · 8:12](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=492)
- All three articles were chosen as PAPS Award winners at the annual conference. — Mary Brindle (clinical) [Ep 3 · 8:55](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=535)
- The three studies represent evolutionary (rather than revolutionary) advances important for day-to-day pediatric surgical care management. — Mary Brindle (opinion) [Ep 3 · 9:01](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=541)
- The GIPS procedure can be performed in the clinic or on an outpatient basis — Steven Lee (clinical) [Ep 2 · 3:54](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=234)
- Dr. Lee sometimes performs GIPS procedures in his office — Steven Lee (clinical) [Ep 2 · 3:54](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=234)
- GIPS procedure shows clearly improved outcomes with respect to healing times, recovery times, and decreased need for additional operations and recurrence rates compared to traditional open excisions — Steven Lee (clinical) [Ep 2 · 4:34](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=274)
- Some surgeons use sinus endoscopy (cystoscopy) after pit excision to identify and remove remaining hair and granulation tissue — Meera Kotagal (clinical) [Ep 2 · 5:31](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=331)
- The key to successful pit excision is excising all pits to access the cavity and thoroughly cleaning it out — Steven Lee (clinical) [Ep 2 · 6:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=390)
- If disease is left behind, there will be recurrence, but most recurrences involve hair coming out and can be managed with repeat procedure or pit picking (plucking hairs) — Steven Lee (clinical) [Ep 2 · 6:30](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=390)
- Dr. Lee occasionally uses hydrogen peroxide to help clean out the tract but does not use sclerosing agents — Steven Lee (clinical) [Ep 2 · 7:18](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=438)
- Aggressive scraping of tissue using Cottes and gauze is necessary to ensure no disease is left behind — Steven Lee (clinical) [Ep 2 · 7:46](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=466)
- After hair removal with a clamp, all granulation tissue must be scraped out — Steven Lee (clinical) [Ep 2 · 7:46](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=466)
- Traditional unroofing and marsupialization required 4 to 6 weeks for complete healing — Steven Lee (clinical) [Ep 2 · 8:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=497)
- During healing, the area must be kept free of hair with weekly shaving — Steven Lee (clinical) [Ep 2 · 8:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=497)
- If incisions close too early, granulation can be managed in clinic by reopening and using silver nitrate around the sides to keep incisions open — Steven Lee (clinical) [Ep 2 · 8:17](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=497)
- The Midwest Pediatric Surgery Consortium is starting recruitment for a multi-center cohort study comparing largely invasive to minimally invasive procedures with standardized GIPS and medical management recommendations — Alex Cassar (clinical) [Ep 2 · 9:14](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=554)
- Dr. Lee does not use perioperative antibiotics for GIPS unless there is an abscess, because wounds are left open to drain — Steven Lee (clinical) [Ep 2 · 10:05](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=605)
- GIPS can be performed even in the presence of acute abscess depending on the degree of cellulitis and patient illness — Elizabeth Byerly (clinical) [Ep 2 · 10:42](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=642)
- For acute abscesses managed with GIPS, a vessel loop technique can be used to allow better drainage of the abscess cavity — Elizabeth Byerly (clinical) [Ep 2 · 10:42](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=642)
- When draining a pilonidal abscess in the emergency department, drainage should be performed off midline so that when a tract forms, it will be off midline — Steven Lee (clinical) [Ep 2 · 11:09](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=669)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- The Karydakis flap is superior to excision only and comparable to the modified Limberg flap for pilonidal disease. — The host summarizing the discussion [Ep 1 · 3:10](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=190)
- The modified elliptical rotation flap has short-term results comparable to Limberg and Karydakis flaps, though less data exists. — The host summarizing the discussion [Ep 1 · 3:10](https://qa.library.globalcastmd.com/watch/pilonidal-cyst-case-presentation-update-course-2015-982?t=190)
- The cryoanalgesia study compared patients from 2011 to 2021, with 29 patients receiving cryoanalgesia and 15 not receiving it. — Cecilia Gigena summarizing the discussion [Ep 3 · 1:39](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=99)
- Patients who received cryoanalgesia had shorter hospital stays: 3.0 days versus 5.4 days for those without cryoanalgesia. — Cecilia Gigena summarizing the discussion [Ep 3 · 1:48](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=108)
- Hospital costs were slightly lower (less than $1000 difference) in patients who received cryoanalgesia despite the expensive equipment. — Cecilia Gigena summarizing the discussion [Ep 3 · 2:00](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=120)
- Cryoanalgesia was associated with a 70% decrease in complication rates, from approximately 33% down to 17%. — Mary Brindle summarizing the discussion [Ep 3 · 2:31](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=151)
- The chest tube study included 130 lung resections performed between 2013 and 2022. — Mary Brindle summarizing the discussion [Ep 3 · 3:48](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=228)
- Of the 130 procedures, 59 were lobectomies (group 1), 19 were diagnostic wedge resections (group 2), and 52 were excisional wedge resections (group 3). — Em Gootee summarizing the discussion [Ep 3 · 3:55](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=235)
- In lobectomy patients (group 1), 75% had no air leak and median chest tube duration was 2 days. — Jamie Schnuck summarizing the discussion [Ep 3 · 4:12](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=252)
- In diagnostic wedge resection patients (group 2), nearly 90% had no air leak and median chest tube duration was 1 day. — Em Gootee summarizing the discussion [Ep 3 · 4:30](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=270)
- In excisional wedge resection patients (group 3), 80% had no air leak and median chest tube duration was 1 day. — Em Gootee summarizing the discussion [Ep 3 · 4:39](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=279)
- Most chest tubes were removed on the first day after surgery and a majority of patients did not have an air leak. — Jamie Schnuck summarizing the discussion [Ep 3 · 4:48](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=288)
- The pilonidal disease study included 198 patients presenting between 2019 and 2022, with data prospectively gathered in a retrospective study design. — Mary Brindle summarizing the discussion [Ep 3 · 6:37](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=397)
- The pilonidal disease cohort included 21 patients with skin types 1-2, 156 with skin types 3-4, and 21 with skin types 5-6, with approximately 151 having dark colored hair. — Cecilia Gigena summarizing the discussion [Ep 3 · 6:51](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=411)
- To reach 75% hair reduction requires a mean of 4.8 to 6.8 laser ablation sessions depending on skin and hair characteristics. — Cecilia Gigena summarizing the discussion [Ep 3 · 7:34](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=454)
- Dark hair and skin types 5-6 were associated with higher recurrence rates in pilonidal disease after laser hair reduction. — Cecilia Gigena summarizing the discussion [Ep 3 · 7:47](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=467)
- The overall recurrence rate for pilonidal disease after laser hair reduction was 6%. — Cecilia Gigena summarizing the discussion [Ep 3 · 7:47](https://qa.library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-july-2023-paps-issue-7900?t=467)
- The GIPS procedure was first presented in 2017 by Dr. Aaron Lipscar at the update course — Rod summarizing the discussion [Ep 2 · 1:18](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=78)
- Within a year after the 2017 presentation, most surgeons switched from their preferred technique to the GIPS procedure — Rod summarizing the discussion [Ep 2 · 1:18](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=78)
- The GIPS procedure was adopted because it was easy, minimally invasive, and had equal if not better outcomes than traditional open excisions — Rod summarizing the discussion [Ep 2 · 1:18](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=78)
- The GIPS technique involves using punch biopsies (trephines) to excise pits, then using a mosquito clamp to clear the tract — Todd Ponsky summarizing the discussion [Ep 2 · 4:57](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=297)
- Using a scope to ensure complete tract clearance can prevent recurrence but requires extra time and equipment — Rod summarizing the discussion [Ep 2 · 6:04](https://qa.library.globalcastmd.com/watch/update-course-rewind-pilonidal-disease-2019-3925?t=364)

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