Update Course Rewind: Pilonidal Disease 2019

The GIPS procedure can be performed in the clinic or on an outpatient basis

Dr. Lee sometimes performs GIPS procedures in his office

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

Some surgeons use sinus endoscopy (cystoscopy) after pit excision to identify and remove remaining hair and granulation tissue

The key to successful pit excision is excising all pits to access the cavity and thoroughly cleaning it out

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)

Dr. Lee occasionally uses hydrogen peroxide to help clean out the tract but does not use sclerosing agents

Aggressive scraping of tissue using Cottes and gauze is necessary to ensure no disease is left behind

After hair removal with a clamp, all granulation tissue must be scraped out

Traditional unroofing and marsupialization required 4 to 6 weeks for complete healing

During healing, the area must be kept free of hair with weekly shaving

If incisions close too early, granulation can be managed in clinic by reopening and using silver nitrate around the sides to keep incisions open

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

Dr. Lee does not use perioperative antibiotics for GIPS unless there is an abscess, because wounds are left open to drain

GIPS can be performed even in the presence of acute abscess depending on the degree of cellulitis and patient illness

For acute abscesses managed with GIPS, a vessel loop technique can be used to allow better drainage of the abscess cavity

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