Many years ago (back in the late 70's), I saw Dr. Crile (a renowned cancer surgeon) at the Cleveland Clinic for treatment of my pilonidal issue. He did the procedure indicated below (crochet hook, rubber drain). This resolved the issue for the next 30 years - only recently has it started to trouble me some again - unfortunately, Dr. Crile has passed away. Nonetheless, I thought folks might be interested in the comments from his book. From: Surgery: Your Choices Your Alternatives by Dr. George C. Crile, Jr.,M.D. 1978 The acute abscesses that occur over the tailbone are called pilonidal cysts. The open, draining sinuses that occur in the same area are called pilonidal sinuses. Pilo means "hair" and nid means "nest"; these are "hair nest" diseases. They are of special interest because, of all of the absurd overtreatments that through the centuries surgeons have devised, the prime example is the operation for pilonidal disease. Pilonidal disease it the result of ingrown hairs. In hairy persons the cleft between the buttocks directs the hairs downward toward the little depression that many people have just at the tip of the tailbone where, in the development of the embryo, the nervous system turned in from the skin. The hairs penetrate the skin of this tender area and embed themselves in the tissues, where they fester, causing abscesses or draining sinuses. Sometimes there are only a few hairs and sometimes there is a large collection, forming a sort of hair ball. All that needs to be done is to have the hair removed. Often it can be done in the office, under local anesthesia, by opening the abscess and inserting a little rubber tube which is anchored in place for two or three weeks until the hairs have been extruded and the cavity has filled in. The tube is then withdrawn, the buttocks are shaved or treated with a depilatory to remove all hair, and the area is soon healed. In the case of a draining sinus, the hairs that cause the trouble often can be removed by scraping out the tract with a little crochet hook. Again the buttocks are shaved and usually the sinus heals up. When it doesn't it can be opened by a minor operation and scraped clean of all hair. But what is the standard operation done in hospitals throughout the country? The standard operation for pilonidal cyst or sinus is to cut the whole thing out just as if it were a cancer. Since the area is infected, healing is slow. Often the surgeon doesn't shave the buttocks, with the result that the irritation from the hair as the patient walks keeps scraping the wound open so that it never heals. Then the surgeon admits the patient for a skin graft. Often a week or more of hospitalization is involved, as well as the discomfort of a large operation in a sore place. Why do surgeons do all this when the disease is so easily cured by a simple office treatment? The question is impossible to answer, except in terms of economics and habit A century ago when pilonidal disease was first described by an English surgeon, he noted that by looking closely the hair could be seen growing into it from without. Then someone else described a congenital misplacement of tissue in the pelvis that causes what is known as a presacral dermoid (skin like) cyst that contains skin, hair, and teeth. Very, very rarely, one of these drains externally from the same area as a pilonidal sinus. The dermoid cyst, of course, has to be removed, because hair follicles are growing within it, whereas pilonidal disease can be treated by simply removing the hair that grows into it from without. Somehow the two conditions got confused in the minds of surgeons and of teachers in medical schools, so that removal of the whole cyst or sinus became standard practice for the treatment of ingrown hairs. In the 1940's, studies were made by surgeons and pathologists that showed beyond doubt that there were no hair roots or follicles in pilonidal abscesses or sinuses. Undeterred, surgeons kept on cutting them out to get rid of the last nonexistent root. Pilonidal cysts or sinuses affect young men. The condition is aggravated by bumpy riding - it was called "jeep disease" in WW II. Radical operations done for this disease caused more prolonged disability than any other surgical condition at the San Diego Naval Hospital. When I worked there, there was always a ward full of pilonidal convalescents. Some of them took a year to heal. You can't blame fee-for-service surgery for the radical pilonidal operations that were done on military personnel during the war. It is the teaching that must get the blame. This in turn may have been influenced by the fee-for-service system, because it is surgeons who teach surgery, and most of them get their income from fee-for-service surgery. There would be little incentive for them to switch from an operation for which they get paid hundreds of dollars to a simple office treatment for which they get paid very little. It would also be impossible for a teacher of surgery to teach a treatment he was not practicing. Hence, even though the true nature and proper treatment of pilonidal disease has been known for more than thirty years, radical surgery still is the most commonly recommended treatment. Please , if anyone wants to hospitalize you for an operation for previously untreated pilonidal disease, refuse the operation and go looking for another surgeon!"