Persistent pilonidal disease: What to do when your initial surgery fails?

The crude rate of persistent or recurrent disease following surgical interventions for pilonidal disease correlates with the duration of follow-up. Furthermore, patient and disease related factors, body habitus, and the choice of surgical technique impact both short and long-term outcomes. Despite modern advances in surgical care, persistent and recurrent disease remain a challenge to the surgeon and the patient. Currently there is no standard of care or consensus as to the choice of operation for either primary, persistent, or recurrent disease. The selection of an operation for an individual patient is often determined by the surgeon's training background, personal experience, and own biases. A variety of techniques have been described to treat pilonidal disease ranging from simple minimally invasive procedures to operations entailing wide excision with primary closure, flap reconstruction, or wound management by secondary healing. In this article we share our perspective and approach to patients with persistent disease following failed intervention.