Groupe hospitalier Paris Saint-Joseph, Institut Léopold Bellan, Service de proctologie médico-chirurgicale, 185, rue Raymond Losserand, 75014 Paris
Pilonidal disease is a frequent suppurative condition and affects 0.7% of the population. It occurs twice as often in men as in women, usually between the ages of 15 and 30. The physiopathology is still controversial. Surgical excision is the standard treatment. In France, the most common procedure is a lay-open excision with healing by secondary intention. This procedure has low recurrence rates, but involve daily nursing care, prolonged time to heal and time off from work. Excision and primary repair or flap-based procedures can reduce healing time and time off from work but they expose to higher recurrence rates than excision with healing by secondary intention. Old minimally invasive approaches such as laying open (deroofing) and curettage or phenolization are also associated with minimal morbidity but with higher recurrence rates. Currently, new minimally invasive techniques are currently being developed. The goals are eradicate the suppuration, obtain healing as rapidly as possible, and limit the morbidity as much as possible. Endoscopic and laser treatment of pilonidal disease have shown promising results, with failure rates of less than 10 % at 1 year, few complications and low morbidity. However, these interesting results need to be confirmed by better quality studies with longer follow-up.