Update Course Rewind: Pilonidal Disease 2019

The patient presented with two previous abscess drainages (I&Ds) in the emergency department within the past 6 months

At UCLA, the institution was transitioning from unroofing and marsupialization to minimal pit excision for pilonidal disease management as of 2019

The GIPS procedure was the most rapidly adopted technique ever presented at the update course

GIPS procedures can be done in the clinic or on an outpatient basis

The GIPS technique uses punch biopsies (trephines) to excise pits, followed by tract cleaning with a mosquito clamp

Some surgeons use sinus endoscopy (cystoscope) after pit excision to identify and remove remaining hair and granulation tissue from the cavity

The key principle is that excising all pits allows access to the cavity for thorough cleaning; leaving material behind leads to recurrence

Doctor Lee occasionally uses hydrogen peroxide to help clean out the tract but does not use sclerosing agents

Aggressive scraping of granulation tissue using Cottes and gauze is performed after hair removal

Traditional unroofing and marsupialization required roughly 4 to 6 weeks for complete healing

Weekly hair shaving is recommended during healing with one-week follow-up visits

If incisions close too early, silver nitrate can be used in clinic to keep the incisions open

The Midwest Pediatric Surgery Consortium is conducting a multi-center cohort study comparing largely invasive to minimally invasive procedures for pilonidal disease with standardized GIPS and medical management recommendations

Doctor Lee does not use antibiotics for GIPS procedures unless there is an abscess, because wounds are left open to drain

No perioperative antibiotics are needed for GIPS procedures

Doctor Byerly performs GIPS even in the presence of acute abscess, using a vessel loop technique for the abscess cavity to allow better drainage

For patients with significant cellulitis or systemic illness, formal abscess drainage is preferred over immediate GIPS

Doctor Lee advocates draining abscesses off midline so that when the tract forms, it will be off midline

For emergency department drainage with significant inflammation and infection, adequate clean-out often cannot be achieved, so simple abscess drainage is recommended