In-Office Pit Excision for Pilonidal Disease Using Needle-Free Local Anesthesia: A Minimally Invasive, Non-Operative Treatment Approach

Treatment of pilonidal disease traditionally involves an operation under general anesthesia, which may have a period of postoperative disability and a significant recurrence rate. We report a novel treatment for pilonidal disease performed in-office using a pneumatic lidocaine injection device, requiring no pain medication or activity restrictions—supporting a non-operative standard of care.Patients with gluteal crease pits at our Pilonidal Care Clinic were offered pit excision as standard care. Prospective data on demographics, pain scores (0–10), and outcomes were collected in REDCap. Under sterile conditions, patients received 1% buffered lidocaine via pneumatic injection. Laser follicle ablation was followed by punch excision (1.5 or 2 mm) of full-thickness pit epithelium. Sinus tracts were probed but not excised. Patients were asked to wash the area twice daily, maintain normal activities, and return in 6 to 8 weeks. Patients requiring nidus incision and drainage (I&D) were excluded.About 130 patients underwent this technique between February and June 2024; 100 were included in the analysis (5 excluded for concurrent I&D, 25 lost to follow-up). Mean age was 18.1 years; 50% were male. At subsequent follow-up, 60% patients healed all pits, resolving their condition, with 64% (144/224) of all pits healed. Patients with three or more pits were more likely to need an additional pit excision. Mean procedure pain score was 1.6/10 (SD 1.21); no patient used pain medication or experienced disability. Ultimately, 88% of patients healed all of their pits.Pilonidal disease may be resolved non-operatively in a single outpatient clinic visit, without even a shot.