SMALL PITS
Small midline pits in the natal cleft may be the first finding.
BACK TO SERVICESDIAGNOSIS · SILAC · INDIVIDUALISED SELECTION
PILONIDAL DISEASE: INDIVIDUALISED TREATMENT AND SILAC LASER THERAPY
Pilonidal disease may present with small pits, persistent discharge or a painful abscess. Treatment is selected according to disease extent, acute inflammation and any previous procedures. Assessment is available in Athens for patients from Attica and throughout Greece.
SiLaC LASERMINIMAL ACCESSOFF-MIDLINE CLOSURE WHEN NEEDED
EXPLORE THE PROCEDURESELIXIS · ADVANCED CARE
Pilonidal disease is not the same in every patient
This is an acquired inflammatory condition of the natal cleft: loose hairs may penetrate the skin and form pits and subcutaneous tracts. The aim is the least invasive effective procedure that matches the true extent and complexity of disease.
SYMPTOMS
Symptoms and clinical diagnosis
Diagnosis is usually clinical, based on examination of the natal cleft and perianal area. Ultrasound or MRI is not routinely required, but may help in extensive, recurrent or atypical disease, or when an anal fistula must be excluded.
PAIN & TENDERNESS
Discomfort or pain, often worse while sitting, may accompany inflammation or an abscess.
SWELLING & REDNESS
Local swelling, warmth and redness suggest active inflammation.
DISCHARGE
Fluid, pus or blood, sometimes with an unpleasant odour, may drain through one or more openings.
RECURRENT EPISODES
Repeated swelling, drainage or previous procedures change treatment planning.
Openings close to the anus, persistent perianal discharge or an atypical lesion require assessment for alternative conditions such as an anal fistula or hidradenitis suppurativa.
PROCEDURES
Treatment according to disease pattern
There is no single operation suitable for everyone. An acute abscess, limited chronic disease and extensive or recurrent disease require different approaches.
ASYMPTOMATIC DISEASE & CARE
When pits are present without symptoms, prophylactic surgery is not recommended. Hygiene and modification of relevant risk factors form part of care.
- WHEN IT MAY BE CONSIDERED
- An incidental finding without pain, inflammation or discharge.
- WHAT IT INVOLVES
- Observation with clear advice on symptoms that require reassessment. Laser hair removal is different from intratract SiLaC treatment.
INCISION & DRAINAGE OF AN ACUTE ABSCESS
A painful abscess is treated primarily with drainage. Antibiotics may be needed for cellulitis or systemic infection, but do not replace drainage.
- WHEN IT MAY BE CONSIDERED
- Acute pain, tender swelling and a collection of pus.
- WHAT IT INVOLVES
- A lateral incision with adequate drainage. Once acute inflammation has settled, the need for definitive tract treatment is reassessed.
PIT PICKING / EPSiT & MINIMALLY INVASIVE OPTIONS
Removal of small pits and tract cleaning through limited access, with or without endoscopic visualisation.
- WHEN IT MAY BE CONSIDERED
- Selected limited, uncomplicated disease with few pits.
- WHAT IT INVOLVES
- Recovery is often faster than after wide excision, but the technique is not suitable for every anatomy and recurrence may occur over time.
04SiLaC
INTRATRACT SILAC LASER TREATMENT
After removal of hair and debris, a radial fibre delivers controlled energy along the tract, encouraging its wall to collapse and heal from within.
- WHEN IT MAY BE CONSIDERED
- Appropriately selected, mainly limited chronic disease without a large active abscess.
- WHAT IT INVOLVES
- SiLaC creates a small surgical wound and usually limited postoperative pain. It does not guarantee cure: delayed healing, infection or recurrence may occur, and some patients require repeat or different surgery.
EXCISION & OFF-MIDLINE CLOSURE
Techniques such as Karydakis, Bascom cleft lift or a Limberg flap move the scar away from the midline and flatten the deep natal cleft.
- WHEN IT MAY BE CONSIDERED
- Extensive, complex or recurrent disease and failure of an appropriate minimally invasive treatment.
- WHAT IT INVOLVES
- When excision and closure are required, off-midline closure is preferred. Primary closure directly in the midline is avoided because of poorer healing and recurrence outcomes.
Conceptual anatomical artwork for general information — not a patient photograph or an exact representation of an operation.
PLANNING & SAFETY
The least invasive effective operation — not simply the smallest incision
Tract extent, distance from the anus, abscess history, scarring and previous procedures determine whether minimal access is appropriate or a more durable reconstruction is needed.
MAPPING
Clinical mapping of pits, tracts and previous scars before treatment.
ACUTE ABSCESS
An active abscess is treated first with drainage rather than intratract laser application.
LIMITED DISEASE
Pit picking, EPSiT or SiLaC may be considered in carefully selected anatomy.
COMPLEX DISEASE
Extensive or recurrent disease may require off-midline excision and reconstruction.
QUESTIONS
FREQUENTLY ASKED QUESTIONS
Short answers before an individualised surgical assessment.
01Is pilonidal disease a true cyst?
Usually not. The term is widely used, but this is more accurately an acquired pilonidal disease with pits and tracts in the natal cleft.
02Is SiLaC laser treatment suitable for everyone?
No. It is mainly suited to selected limited chronic disease. A large abscess, extensive tracts, multiple scars or complex recurrence may require a different approach.
03Is laser treatment painless and recurrence-free?
No. Pain is often limited because the wound is small, but it varies between patients. No method eliminates the risk of infection, delayed healing or recurrence.
04How is this different from laser hair removal?
In SiLaC, a dedicated fibre delivers energy inside the cleaned tract. Laser hair removal acts externally on hair follicles and is a different procedure.
05When can I return to normal activities?
This depends on disease extent, the procedure, type of work and healing. Individual advice is provided for wound care, sitting, exercise and work without guaranteeing a fixed timetable.
06What happens in recurrent disease?
All tracts and scars are reassessed. Depending on the anatomy, another minimally invasive treatment or off-midline excision and reconstruction may be selected.
CLINICAL EVIDENCE
CLINICAL EVIDENCE
The final choice is based on the clinical presentation, individual anatomy and current guidance.
01European Society of Coloproctology · Guideline 2024European guideline for pilonidal diseaseOFFICIAL SOURCE02ASCRS · Management of Pilonidal DiseaseClinical guideline for diagnosis and treatmentOFFICIAL SOURCE03NICE · Endoscopic ablation for pilonidal sinusGuidance on endoscopic minimally invasive treatmentOFFICIAL SOURCE04SiLaC · Systematic reviewSystematic review of laser treatment and limitations of the evidenceOFFICIAL SOURCE05Radial laser surgery · Long-term cohortLong-term data highlighting recurrence risk and the need for careful selectionOFFICIAL SOURCE
This content is educational and does not replace medical assessment. No technique is appropriate for everyone; benefits, risks and alternatives are discussed individually.
INDIVIDUALISED SURGICAL ASSESSMENT
The right operation starts with the right indication.
Symptoms, investigations and alternatives are reviewed during consultation to create a safe, individualised treatment plan.
REA MED practice & directions