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Pilonidal surgery is often recommended when symptoms become painful, infected or recurrent. Pilonidal disease (also known as pilonidal sinus disease) is a common condition affecting the skin at the top of the buttock crease (natal cleft).
It can cause pain, swelling, discharge, recurrent infections and abscesses, and most commonly affects teenagers and young adults. Symptoms may develop gradually over time or present suddenly with a painful infection requiring urgent treatment.
Although pilonidal disease is not a serious condition, it can have a significant impact on quality of life, causing discomfort, embarrassment, time off work or education, and repeated courses of antibiotics. Effective treatment options are available, ranging from conservative management to advanced surgical techniques such as Bascom cleft lift surgery and EPSiT (Endoscopic Pilonidal Sinus Treatment).
Mr. Khalid Khan is a Consultant General and Colorectal Surgeon with a particular interest in pilonidal surgery, including Bascom cleft lift surgery and the management of recurrent and complex pilonidal disease.
Pilonidal disease occurs when loose hairs penetrate the skin, leading to infection and sinus formation.
What is Pilonidal Disease?
The term “pilonidal” means “nest of hair”.
Pilonidal disease occurs when loose hairs penetrate the skin within the groove between the buttocks (the natal cleft). This can lead to the formation of small pits and sinus tracts beneath the skin. Over time, these may become infected, causing pain, swelling, discharge or abscess formation.
Pilonidal disease is not cancerous and is a very common condition, particularly in young adults.
Common symptoms include:
- • Pain or tenderness at the top of the buttock crease
- • Swelling or recurrent abscesses
- • Discharge of fluid, pus or blood
- • Unpleasant odour from the affected area
- • Recurrent infections requiring antibiotics
- • Difficulty sitting comfortably
What causes Pilonidal Disease?
Pilonidal disease is an acquired condition rather than something people are born with.
The exact cause is not completely understood, but friction, pressure and movement within the buttock cleft can force loose hairs into the skin. This causes inflammation and the formation of pits and sinus tracts beneath the skin.
Several factors increase the risk of developing this condition:
Understanding these contributing factors is important because successful treatment involves not only removing the diseased tissue but also reducing the conditions that allow the problem to develop in the first place.
How Is Pilonidal Disease Treated?
The most appropriate treatment depends on:
- • The number of pits and sinus tracts
- • Whether infection is present
- • Previous surgery
- • The extent of the disease
- • Lifestyle factors and occupation
Treatment options range from conservative measures to surgical procedures.
1. Acute abscess
If there is a painful, swollen lump with pus, the abscess would need to be drained by incision and drainage usually performed under general anesthesia. This treats the acute episode but does not remove the underlying sinus tract.
2. Chronic or recurrent pilonidal sinus
Most chronic cases eventually benefit from pilonidal surgery, especially when sinus tracts continue to cause discomfort or repeated infections.
Non-surgical management
These cases may need a planned procedure. Regular hair removal (shaving or laser), good hygiene, keeping the area dry, and avoiding prolonged sitting.
Surgical treatments
1) Excision and leaving the wound open (healing by secondary intention)
This traditional approach involves removing the diseased tissue and leaving the wound open to heal naturally. It remains an effective treatment option for some patients, particularly those with extensive disease. However, healing can take several weeks or months and often requires regular wound dressings.
Illustration showing how Bascom cleft lift surgery treats pilonidal disease by removing the sinus and flattening the natal cleft to improve healing and reduce recurrence.
2) Bascom Cleft Lift Procedure
The Bascom cleft lift is an established off-midline surgical technique designed to remove the diseased tissue while also addressing the underlying factors that contribute to recurrence.
Unlike traditional operations that simply remove the diseased tissue, the Bascom cleft lift aims to reshape the anatomy of the buttock cleft itself.
How does the Bascom Cleft Lift Procedure work?
This condition often develops because the cleft between the buttocks is deep and narrow. This area can trap loose hairs, moisture and debris, creating an environment where infection can develop repeatedly.
During the operation:
- • The diseased tissue and sinus tracts are removed
- • The deep cleft is flattened
- • The wound is moved away from the midline
- • The area is reconstructed to create a shallower contour
This creates an environment that is easier to keep clean and less likely to trap hair and moisture.
💡 A simple way to understand it
Imagine a deep fold in the skin where hairs repeatedly become trapped and cause infection. The Bascom cleft lift removes the diseased tissue and reshapes that fold into a flatter contour. By reducing the depth of the cleft, the conditions that allow the problem to develop are significantly reduced.
✅ Advantages of Bascom cleft lift surgery
- ✓ Faster healing compared with leaving the wound open
- ✓ Earlier return to work, education and normal daily activities
- ✓ Less need for prolonged wound dressings
- ✓ Reduced discomfort during recovery
- ✓ Lower risk of recurrence compared with some traditional techniques
3) EPSiT (Endoscopic Pilonidal Sinus Treatment)
EPSiT is a minimally invasive technique used in some specialist centres. A small endoscopic camera is used to treat the sinus from within. Recovery may be quicker and postoperative discomfort may be less than with more extensive surgery. However, not all patients are suitable candidates and recurrence rates may be higher in more complex disease.
Long-Term Management & Recurrence Prevention
For any patient, the main goal of treatment is to stop the problem from coming back. Preventing recurrence is achieved through simple, key steps:
For those with chronic or complex issues, we create a tailored plan. Following this guidance can support healing and reduce the chance of needing further surgery. Our priority is lasting comfort and getting you back to your normal life quickly.
Which Treatment is Best?
Choosing the most appropriate treatment requires careful assessment by an experienced colorectal surgeon. This depends on:
- • Smoking history
- • The number of pits or tracts
- • Whether infection is present
- • Previous surgeries
- • Lifestyle factors (sitting at work, hair growth, etc.)
I discuss all options with patients and tailor treatment to minimise recurrence while ensuring the quickest recovery possible.
A personalised approach ensures patients receive the most appropriate treatment, whether conservative management, Bascom cleft lift surgery or other established surgical techniques.
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