Symposium on outpatient anorectal procedures. Pilonidal disease.

Many procedures have been advocated to treat pilonidal disease, suggesting that no one method is highly efficacious. In the office, the surgical approach is directed towards three aspects of the condition: pilonidal abscess, recurrent pilonidal disease following surgery and chronic pilonidal disease following spontaneous rupture of an abscess or secondary to incision and drainage. In managing the acute pilonidal abscess, an intradermal injection is given over the indurated, fluctuant area as well as the midline orifice which can almost always be identified. The midline orifice is incised and the incision carried into the abscess cavity. The edges of the cavity are excised. Healing takes place secondarily. A second procedure is rarely needed.