Pilonidal disease surgery in the pediatric patient: less is more!

Sacrococcygeal pilonidal disease is common in the pediatric population and its incidence is increasing. Psychological stigmatization is common. Adolescent patients have unique challenges in body image, communication with family members and caregivers, and hygienic practices. Acute infection requires antibiotics and abscess require drainage. Chronic disease is managed with noninvasive therapies or minimally invasive surgical debridement procedures, which may be repeated for simple recurrences. Larger excision and off-midline flap reconstructions are reserved for complex and extensive disease or multiple recurrences that are refractory to less invasive excisional techniques. Common presentation of pediatric pilonidal disease, available therapies, anticipated outcomes, and a suggested treatment algorithm are presented in this article.