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<p>The pilonidal sinus is an acquired condition. The aim of these guidelines is to highlight the advantages and disadvantages of the various treatment methods based on an evidence-based literature review and to provide an optimal, evidence-based treatment recommendation. For the first time, the issue of the pilonidal sinus in children and adolescents has also been included.</p><p>There are three forms of pilonidal sinus: the asymptomatic finding without exudation, the acutely abscessing and the chronic-symptomatic pilonidal sinus. The most common form of the pilonidal sinus is the chronic stage with intermittent secretions. Currently, there is no universal treatment that meets all requirements for a&#xa0;simple, painless treatment with rapid wound healing and a&#xa0;low recurrence rate.</p><p>An asymptomatic pilonidal sinus does not require treatment. An abscess should be promptly and adequately surgically drained. Healing after abscess drainage alone is possible. Alternatively, minimally invasive or plastic surgery can be secondarily performed. Minimally invasive techniques represent a&#xa0;primary treatment option for the localized uncomplicated chronic form, although a&#xa0;higher recurrence rate must be expected compared to excision techniques. Otherwise, in cases of a&#xa0;chronic sinus, surgical excision with or without subsequent closure is the standard treatment. The size of the excision should be limited to the absolute minimum necessary; preparation into healthy tissue depth is not required, the presacral fascia should not be denuded and the incision should be distant from the anus. Open wound treatment with secondary wound healing is a&#xa0;safe procedure but especially for large wound areas it is associated with a&#xa0;long healing time, inability to work and a&#xa0;not negligible recurrence rate. Alternatively, plastic (asymmetric) techniques and local flaps should be used. Limberg and Karydakis flaps are currently the most commonly used plastic procedures with a&#xa0;low recurrence rate and equivalent results. Laser hair removal can be useful in selected cases, although the literature does not yet enable a&#xa0;general recommendation. For adolescents under 22&#xa0;years of age, laser epilation is routinely recommended as an adjunct to surgical therapy.</p><p>Regarding the treatment of pilonidal sinus in children and adolescents, in principle, all procedures extensively described for adults are available; however, a&#xa0;particularity arises from the fact that recurrences occur significantly more frequently and earlier than in adults. There is a&#xa0;clear recommendation in favor of the use of minimally invasive techniques.</p>

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S3-Leitlinie: Sinus pilonidalis. Version 3.0 (2026)

  • 期刊论文

  • 发表日期：

    2026年5月13日

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  • A. Ommer,
  • I. Iesalnieks,
  • D. Doll,
  • S. Petersen,
  • V. Kahlke,
  • J. Schneider,
  • M.-Ch. Stefanescu,
  • Ch. Oetzmann von Sochaczewski,
  • J. Kirsch,
  • C. Breitkopf,
  • D. Bussen,
  • A. Fürst,
  • H. Krammer,
  • F. Kühn,
  • M. Stoll,
  • T. Laubert,
  • M. Sailer,
  • O. Schwandner

摘要

The pilonidal sinus is an acquired condition. The aim of these guidelines is to highlight the advantages and disadvantages of the various treatment methods based on an evidence-based literature review and to provide an optimal, evidence-based treatment recommendation. For the first time, the issue of the pilonidal sinus in children and adolescents has also been included.

There are three forms of pilonidal sinus: the asymptomatic finding without exudation, the acutely abscessing and the chronic-symptomatic pilonidal sinus. The most common form of the pilonidal sinus is the chronic stage with intermittent secretions. Currently, there is no universal treatment that meets all requirements for a simple, painless treatment with rapid wound healing and a low recurrence rate.

An asymptomatic pilonidal sinus does not require treatment. An abscess should be promptly and adequately surgically drained. Healing after abscess drainage alone is possible. Alternatively, minimally invasive or plastic surgery can be secondarily performed. Minimally invasive techniques represent a primary treatment option for the localized uncomplicated chronic form, although a higher recurrence rate must be expected compared to excision techniques. Otherwise, in cases of a chronic sinus, surgical excision with or without subsequent closure is the standard treatment. The size of the excision should be limited to the absolute minimum necessary; preparation into healthy tissue depth is not required, the presacral fascia should not be denuded and the incision should be distant from the anus. Open wound treatment with secondary wound healing is a safe procedure but especially for large wound areas it is associated with a long healing time, inability to work and a not negligible recurrence rate. Alternatively, plastic (asymmetric) techniques and local flaps should be used. Limberg and Karydakis flaps are currently the most commonly used plastic procedures with a low recurrence rate and equivalent results. Laser hair removal can be useful in selected cases, although the literature does not yet enable a general recommendation. For adolescents under 22 years of age, laser epilation is routinely recommended as an adjunct to surgical therapy.

Regarding the treatment of pilonidal sinus in children and adolescents, in principle, all procedures extensively described for adults are available; however, a particularity arises from the fact that recurrences occur significantly more frequently and earlier than in adults. There is a clear recommendation in favor of the use of minimally invasive techniques.