Clinical Resources & Pilonidal Research Library

Pilonidal disease: Origin from follicles of hairs and results of follicle removal as treatment
Bascom, Surgery 1980 (updated 2006)

This updated classic (original 1980, revised with 2006 commentary) is one of the clearest medical explanations of where pilonidal disease starts. Bascom argues that, in most cases, the primary culprit is the midline pit itself, often an enlarged/distorted hair follicle, with loose hair becoming a later “opportunistic tenant” rather than the initial cause. He lays out a staged progression from enlarged follicle to infection, abscess, and chronic sinus, then backs the pit/follicle theory with clinical observations and histologic reasoning. If you’re a clinician, student, or serious prosumer, this paper gives you a coherent mechanism you can use to interpret what you’re seeing on exam and why recurrence happens.

The practical value is that Bascom ties origin to treatment strategy: drain acute abscesses first, address the diseased pits directly, and avoid creating large midline wounds that are prone to prolonged disability and non-healing. He also reports office-based outcomes for follicle (pit) removal and lateral “clean-out” of chronic cavities, and includes his later opinion shifts, notably moving toward the cleft lift earlier in cases with multiple pits, deep clefts, or slow healing. In short, it’s a bridge between “pathophysiology” and “what do we do differently tomorrow?” with enough detail to inform decision-making without being a step-by-step operative tutorial.

Pilonidals: Distilled Wisdom
Bascom (2010)

This short paper is Bascom’s compressed playbook for understanding why pilonidal disease becomes chronic and why some “standard” operations spiral into years of non-healing. He boils decades of clinical experience into two memorable rules: eliminate the pits (because pits are epithelialized funnels that won’t heal until removed) and respect the cleft environment (because the cleft can create a sealed, anaerobic space that perpetuates infection and breakdown). For clinicians, it’s a fast way to replace vague folklore with a coherent model you can apply at the bedside or in clinic.

The practical payoff is decision-making: when minimal removal of pits is likely enough, when it’s not, and why midline wounds and residual deep clefts are a setup for failure. Bascom also ties these principles directly to off-midline management and the mechanics of keeping closures out of the “danger zone,” which matters for surgeons trying to lower recurrence and for wound-care teams trying to understand why a wound won’t settle down. It’s not a randomized trial; it’s a clear mental framework that helps teams stop repeating the same expensive, morale-draining mistakes.

Pilonidal Sinus
Bascom, Current Theory in Colon & Rectal Surgery 1990

This chapter is Bascom’s practical “map of the territory” for pilonidal disease, starting with a key reframing: pilonidal isn’t one uniform condition, but at least three different clinical problems with different goals and failure modes. He walks through etiology (skin stretch and follicle breakdown, with hair as a secondary invader), pathology, presentation, and differential diagnosis, then makes a blunt argument clinicians will care about: wide excision is unnecessary and often creates the worst outcome, the chronic non-healing midline wound.

Where it becomes immediately useful is the treatment strategy: “stay out of the ditch” (avoid midline incisions), drain acute abscesses laterally, treat chronic disease by addressing the tiny midline openings while using a lateral cleanout approach, and reserve cleft closure for the “unhealed surgical incision” problem. Bascom explicitly sets expectations for what “good” treatment should look like (minimal disability, outpatient-friendly, low recurrence), making this a high-value resource for surgeons, trainees, and wound-care clinicians who want a coherent algorithm, not a grab-bag of procedures.

Pilonidal Sinus: Management in the Primary Care Setting
Kitchen, Australian Family Physician 2010

This paper matters because it gives a clear, pragmatic “front door” into pilonidal disease: what it is, how it presents, and what primary care clinicians should do first when someone shows up with pain, swelling, drainage, or an acute abscess. For professionals, it’s a high-yield refresher that helps avoid two common traps: treating every presentation as the same problem, and escalating too quickly to large excisions without understanding why recurrences and non-healing happen. For patients and prosumers, it’s useful because it frames the condition in plain clinical logic, explains why symptoms tend to cycle, and helps you understand what “good” early management looks like before you end up in the long, frustrating wound-care lane.

It’s also valuable because it connects initial management to long-term outcomes. The paper emphasizes basics that influence recurrence: draining acute abscesses appropriately, recognizing midline pits as the ongoing source of disease, and understanding when conservative care is reasonable versus when referral for a definitive off-midline approach makes sense. Professionals get an evidence-informed decision pathway they can apply in a busy clinic, and patients get language to advocate for themselves, ask better questions (for example, “Are there pits present?” and “What’s the plan to prevent recurrence?”), and understand why “just lancing it again” may not be a durable solution.

The Management of Pilonidal Disease
Sternberg, Current Surgical Therapy 2014

This article is useful because it gives a clear, clinician-grade “whole map” of pilonidal disease: what it is (acquired, not congenital), why the natal cleft environment drives chronic infection, and how to make the diagnosis by finding midline pits and distinguishing pilonidal disease from look-alikes like perianal fistula or hidradenitis. For medical professionals, it’s a high-yield synthesis you can use to teach trainees or standardize clinic practice. For patients and prosumers, it helps decode why the condition behaves in cycles and why some treatments fail even when they seem “aggressive.”

Where you really care is the emphasis on avoiding predictable failure modes. It warns that wide excisions aimed at a “cyst” can create large midline wounds in a deep cleft that often won’t heal, and it ties that to the anatomy and mechanics of the cleft (moisture, anaerobic conditions, shear). It also lays out practical management pivots: drain acute abscesses off midline, recognize that the primary pits are the real source, and when disease is significant or recurrent, consider asymmetric off-midline flap closure that shallows the cleft and moves the incision into open air where it can heal reliably. For clinicians, that’s a decision pathway; for patients, it’s a framework for asking the right questions before another round of “lance and wait.”

Pilonidal sinus: an overview of historical and current management modalities
Tam, et al., Updates Surg 2024

This 2024 open-access review is worth reading because it gives you a coherent “map of the territory” in one place: where pilonidal disease concepts came from, how thinking shifted toward an acquired disease, and how today’s management spans everything from primary care to the operating room. It explicitly summarizes the two major explanatory frameworks (Bascom’s follicle/pit-first model and Karydakis’s cleft mechanics/hair contribution model) and then uses that foundation to explain why older midline-heavy approaches repeatedly fail and why modern principles emphasize getting problems out of the midline cleft. PMC

Clinicians should care because it’s organized around real-world decision points: acute abscess care (including why drainage strategy matters and the limited role of antibiotics), chronic disease options, and where newer minimally invasive modalities fit into current practice. It highlights practical tradeoffs that matter to working-age patients, including recurrence risk, healing time, and time off work, and it gives you a contemporary synthesis you can use for teaching, counseling, and building a sane “step-up” algorithm that starts less invasively when appropriate and escalates thoughtfully when needed.

Minimal Surgery for Pilonidal Disease Using Trephines: Description of a New Technique
Gips et al., Dis Colon Rectum 2008

This paper is a cornerstone for anyone interested in minimally invasive pilonidal treatment because it describes a “trephine” (punch) technique that targets the true disease entry points (midline pits) and cleans out underlying cavities without wide excision. The authors report on 1,358 symptomatic patients treated in an outpatient setting, typically under local anesthesia, with short operative times and low early complication rates (reported postoperative infection 1.5%, early failure 4.4%). For patients and prosumers, this is the kind of evidence that supports a less-disabling early intervention path, often with a faster return to normal activity than traditional large excisions.

Professionals care because this isn’t a tiny case series, it’s a large, protocolized experience with meaningful follow-up. Healing (for those with full postoperative attendance) averaged about 3.4 weeks, and long-term follow-up (telephone interview of 1,165 patients, mean 6.9 years) provides recurrence estimates over time: about 6.5% at 1 year, 13.2% at 5 years, and 16.2% at 10 years. The paper also gives practical, reproducible details: probing pits, selecting trephine diameters, coring tracts into the cavity, thorough curettage/cleaning, and leaving openings unsutured with specific aftercare expectations. If you’re trying to expand minimally invasive adoption in the U.S., this is one of the strongest “big dataset” references showing that targeted pit-and-cavity management can be both low-morbidity and durable for many patients.

A novel approach for treatment of sacrococcygeal Pilonidal sinus: less is more
Soll et al., Int J Colorectal Dis 2007

This article matters because it offers a clear, reproducible example of modern minimal surgery for pilonidal disease, positioned explicitly as an alternative to wide excision and flap operations. The authors describe a standardized “sinusectomy” approach: probe the midline openings, inject diluted methylene blue to tag the tract, then selectively excise only the stained sinus tissue and leave the wounds open to heal secondarily. A key practical detail for clinicians is how outpatient-friendly this is: 73% of patients were treated as outpatients, and over half of cases were done under local anesthesia, with a median operative time of about 20 minutes.

This paper puts numbers behind the promise of “minimal” treatment. In 93 consecutive patients (2001–2004), they report a low complication rate (6.5%, managed conservatively) and, among respondents, a 5% recurrence rate at a median follow-up of 28 months. Patients returned to work quickly (median 2 weeks) even though the median time to complete skin closure was 5 weeks, which is an important counseling point: functional recovery can be faster than “perfect closure.” For patients and prosumers, this paper is helpful because it validates a middle path between repeated lancing and major flap surgery, and it provides realistic expectations about healing time, aftercare (showers and hair control), and what “success” can look like early in the disease course.

Endoscopic pilonidal sinus treatment: prospective multicentre trial
Meinero et al., 2016

This prospective multicentre trial matters because it’s one of the clearest “real-world” validations of EPSiT (Endoscopic Pilonidal Sinus Treatment) as a minimally invasive, outpatient-friendly approach. The authors enrolled 250 consecutive symptomatic patients across four centres (Italy/Switzerland), collected data prospectively, and defined clear endpoints for healing vs failure. For clinicians, it’s useful because it standardizes the concept: endoscopic visualization of the tracts/cavities, removal of hair/debris under direct vision, and ablation/cleaning of granulation tissue using a fistuloscope-based technique. For patients, it represents an important option in the “treat early, treat small” philosophy, aiming to avoid the disability and wound burden of wide excisions.

You care because the outcomes are strong and highly legible: with a mean follow-up of 12 months, 94.8% achieved complete healing (all within 2 months), with an average healing time around 26.7 days, and recurrence reported in 5% of cases. The study also reports a marked improvement in quality-of-life metrics within 15 days after surgery, which matters for counseling patients who are choosing between “bigger surgery now” versus a minimally invasive path with faster functional recovery. This paper is a high-yield anchor because it combines a scalable technique description with multicentre prospective results that clinicians can cite when justifying EPSiT as a legitimate first-line option for appropriately selected patients.

Endoscopic Pilonidal Sinus Treatment (EPSiT): Long-Term Results of a Prospective Series
Giarratano et al., (JSLS)

Medical professionals care about this prospective series because it moves EPSiT from “promising idea” into a repeatable, outcomes-tracked pathway with meaningful follow-up and pragmatic endpoints (healing, return to work, recurrence, satisfaction). The study followed 77 consecutive patients (mostly primary disease, some recurrent) treated with EPSiT and monitored them at structured intervals out to 24 months (median follow-up 25 months). It documents that the operation can be done as true day surgery (median stay 6.5 hours) with short operative time (median 18 minutes) and rapid functional recovery (median return to work 5 days) which is exactly the kind of “workflow reality” data clinicians need when deciding whether to adopt a new technique.

You also care because the results are unusually clean for pilonidal literature: median healing time 26 days, no major or minor complications reported, and a high satisfaction rate (97%), with six recurrences over the follow-up period. Even if a clinician remains cautious about generalizability (single-country experience, modest sample size), the paper gives a strong, citable signal that endoscopic management can deliver low morbidity and fast recovery while keeping recurrence in a competitive range. It’s particularly useful as a “long-term companion” to the multicentre EPSiT trial on your site: together they cover both scalability across centres and durability over time, which is the one-two punch most surgeons want before changing practice.

Impact of experience on recurrence after biopsy punch excision
Basso et al., Colorectal Disease 2022

This paper is worth a medical professional’s attention because it tackles the question that decides whether minimally invasive pilonidal surgery spreads or stalls: does it work in large numbers, and what makes it succeed? The authors report outcomes in 848 consecutive patients treated with biopsy punch excision (BPE), explicitly described as a “merged” Bascom pit-picking plus Gips-trephine approach (often called the Bascom–Gips procedure). It’s pragmatic, day-case surgery with reproducible technique details (punch sizing for midline vs lateral disease; small lateral incisions when needed; thorough debridement while “staying out of the ditch”). For a clinician considering adoption, this is the kind of high-volume operational dataset that helps justify adding BPE as a first-line option for appropriately selected patients.

The key contribution is the learning-curve signal: recurrence rates improved as the team gained experience. Overall recurrence was 8.1% at 12 months, 13.0% at 24 months, and 16.4% at 5 years, but when the series is split into three 2-year cohorts, 1-year recurrences steadily decreased from 12.9% → 6.7% → 5.1% across the earliest to latest biennia. That matters because it reframes “MIS recurrence” as partly a systems/training issue (case selection + technique refinement), not a fixed property of the procedure. The paper also reports fast functional recovery (return to work/school in a mean of ~4 days) and quantifies common but manageable issues like seroma/hematoma and bleeding. Bottom line: it supports BPE as an effective, inexpensive MIS tool, while warning that outcomes depend on experience and that >5-year follow-up is necessary to judge durability.

Failed Pilonidal Surgery: New Paradigm and new Operation Leading to Cures
Bascom, Arch Surg 2002

If you treat pilonidal disease and you’ve ever wondered why a patient can have “plenty of excision” yet still won’t heal, this paper is the blueprint for that puzzle. Bascom argues the problem is often not deep tissue, but epidermis trapped in a deep gluteal cleft where moisture, bacteria, and anaerobic conditions macerate skin and stall closure. The core idea is a paradigm shift: stop attacking healable deep tissue and instead change the hostile cleft environment that keeps wounds open.

It also matters because it provides outcomes data in a notoriously difficult population: 31 patients with severe, refractory disease (141 prior operations across the group, with wounds collectively open for an extraordinary cumulative duration) treated by reshaping the cleft with a skin flap while leaving deep tissue largely intact. In this series, all patients healed, most after a single procedure, with rapid healing reported in many cases and no recurrences noted in follow-up. For clinicians, that’s a rationale and evidence base for choosing an off-midline flap earlier in the “repeat failure” pathway. For prosumer patients, it explains why a surgeon may recommend cleft lift as the escape hatch from the loop of chronic non-healing.

Pilonidal Sinus: The Modified Karydakis Operation
Kitchen, Special to Pilonidal.org 2010

This paper is a compact, clinician-to-clinician technical note on the Modified Karydakis operation, written by a surgeon who has performed the procedure over decades and then refined it after observing Bascom’s cleft lift. It explains the logic behind Karydakis in a way that’s immediately useful for operative decision-making: recurrence tends to happen in the midline, so the repair must move the wound off-midline and shallow the cleft to reduce hair/debris accumulation and chronic maceration. It also gives real-world context on criticisms of classic Karydakis (excess fat excision, sacral fascia sutures causing pain, inpatient/general anesthesia) and how to modernize the approach.

You also care because it provides practical “how to make this easier and safer” modifications, not theory. Kitchen details technique elements surgeons actually struggle with: using generous local anesthetic with sedation in selected patients, creating the flap first to test closure tension, limiting excision depth (skin/dermis until the sinus is reached rather than routinely down to sacrum), managing secondary openings by curettage rather than creating T-shaped wounds, avoiding fixation sutures into sacral fascia unless necessary, and keeping all suture/drain holes out of the new midline. The mini-checklist style points (ellipse placement, methylene blue to identify branches, drain exit laterally, “loose loop” subcuticular suture to avoid cheese-wiring when sitting) make this a high-yield read for surgeons who want a reproducible off-midline flap technique with less pain, faster discharge, and fewer “why did this drift back to the midline?” failures.

Easy and Successful Treatment of Pilonidal Sinus after explanation of its Causative Process
Karydakis, ANZ J Surg 1992

This paper is worth reading because it’s one of the most influential “classic statements” linking mechanism to operative design. Karydakis lays out his causation model (the well-known Hair × Force × Vulnerability framework) and uses it to justify what remains a very modern surgical principle: reduce recurrence by removing the vulnerable midline raphe from the depth of the cleft and avoiding any scar or suture holes in the cleft midline (“no raphe, no wound at the depth”). Even if you don’t fully adopt the hair-first etiology, the practical message is still high-yield for surgeons: the natal cleft environment drives failure, and durable operations must reshape that environment.

Clinicians also care because it reports a very large experience with the advancing flap operation, including long follow-up and a clear recurrence signal. Karydakis describes applying the technique in 7,471 cases (1966–1990) with 95% followed for 2–20 years, reporting 55 recurrences in the first 6,545 cases (under 1%), and he explicitly links observed recurrences to technical lapses that re-created a midline portal (for example, a stitch entering the midline depth). The paper argues strongly for “hair insertion” as the primary cause, but many contemporary clinicians now view pilonidal disease as acquired, with follicular/pit pathology and cleft mechanics central and hair often contributory or secondary. In that light, this article’s enduring value is less “hair is the whole cause,” and more “off-midline, cleft-flattening principles prevent the nightmare outcomes.”

The Cleft Lift procedure for pilonidal disease renamed as a rotation and advancement flap procedure (RAF): Insights and technical tips for a successful outcome
Sternberg, (ScienceDirect) 2022

Medical professionals will care about this paper because it solves a very practical barrier to adoption: terminology chaos. Sternberg argues that “cleft lift,” “Bascom,” “Karydakis,” and other labels often describe closely related asymmetric off-midline flap concepts, but the inconsistent naming makes the literature hard to interpret and makes surgeons hesitant to adopt a procedure they can’t easily categorize or compare. He “deconstructs” the terminology and proposes a more anatomically descriptive name, the pilonidal RAF procedure (Rotation around the anus + Advancement across the natal cleft midline), while laying out straightforward technical principles intended to improve reliability and reproducibility.

They’ll also care because it pairs those teaching points with high-volume, practice-based outcome data in a difficult case mix. The abstract reports the author’s consecutive experience in 757 patients over 12 years, including 287 referred with recurrent disease or open wounds from prior surgery, with only 6 patients requiring a second operation in that series. Even before a reader digs into the full text for the “tips for success,” that combination, a clear description, a naming framework, and outcomes that include complex failures, makes it a high-yield reference for surgeons who want to standardize an off-midline approach, communicate it cleanly to colleagues/trainees, and justify it as a durable option when midline excisions and chronic wounds have already gone sideways.

The American Society of Colon and Rectal Surgeons’ Clinical Practice Guidelines for the Management of Pilonidal Disease
Johnson, et al., Dis Colon Rectum 2019

Clinicians should read this ASCRS Clinical Practice Guideline because it’s a standard-of-care compass for pilonidal disease in the U.S., written specifically to turn a chaotic menu of “surgeon preference” into graded, citable recommendations. Even if you’ve managed pilonidals for years, it’s useful as a shared reference for trainees, referrals, and protocol building: it covers the core evaluation (history/physical, risk factors, when to think about other anorectal pathology), and it explicitly states that routine labs/imaging are generally unnecessary.

The guideline is also valuable because it validates several less-invasive, high-demand options that patients increasingly ask about, and it does so with evidence grading. It recommends hair elimination (shaving or laser epilation) as a primary or adjunct measure in non-abscess disease, supports phenol application as an effective outpatient treatment for acute or chronic disease without abscess, and discusses fibrin glue as a primary or adjunct option (while noting limits/uncertainty in the evidence). It also addresses common “habit” decisions like antibiotics (recommend individualized consideration because benefit is unclear) and provides a framework for when to use incision and drainage versus more definitive operative management, giving you language that helps align patient expectations with modern practice.

Consensus statement of the Italian society of colorectal surgery (SICCR):: management and treatment of pilonidal disease
Milone/Basso et al., Tech Coloproctol 2021

Medical professionals should read this SICCR consensus statement because it’s a practice-standardizing document, not just another narrative review. It was built via a modified Delphi process backed by a systematic literature review (through July 2020), with recommendations graded by evidence level and agreement scoring. That matters when you’re teaching trainees, writing protocols, or trying to align a group practice around “what we do for acute vs chronic vs recurrent disease” without reinventing the wheel every time a patient shows up with a painful cleft. It also provides a strong differential and diagnostic approach (mostly clinical, with imaging reserved for edge cases near the anal verge where other anorectal pathology must be excluded).

Clinically, you care because the paper draws hard lines around decisions that drive outcomes. For chronic disease requiring closure, it states that off-midline closure should be the treatment of choice, summarizing evidence that midline closure has higher SSI and recurrence, and citing meta-analytic conclusions that primary midline closure should be abandoned in favor of sinusectomy/sinotomy or excision with off-midline closure. Just as important for your current strategy, it explicitly validates the modern minimally invasive arc: it reviews “targeted” techniques (Bascom-style pit procedures, punch/trephine variants, endoscopic approaches like EPSiT/VAAPS), notes where RCT data are still limited, and concludes that minimally invasive treatments should be the treatment of choice in limited disease (single or multiple midline pits).

Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis
McCallum et al., BMJ 2008

Medical professionals care about this BMJ systematic review because it distills a messy, procedure-heavy literature into a few decision-driving conclusions you can actually use: whether to leave a wound open or close it, and if closing, whether to close midline or off-midline. Across the randomized trials it included, the review found that primary closure generally speeds initial healing compared with open healing, but it also carries tradeoffs (for example, different patterns of complications and recurrence depending on technique). In other words, it helps clinicians stop arguing from anecdotes and start counseling patients with evidence about the basic closure strategy choices.

The most important “why you care” point is its clear signal about midline closure. The review reports that when closure is performed, off-midline closure outperforms midline closure on key outcomes, including lower infection and lower recurrence, reinforcing the broader modern shift away from putting scars and suture lines in the deep natal cleft. Even though it’s an older paper, it functions as a clean evidence anchor you can cite in protocols, referrals, and teaching: if you’re closing, don’t close in the midline. That message aligns tightly with Bascom/Karydakis principles and remains highly relevant in preventing the “nightmare” chronic non-healing wounds that are still created by outdated excisional approaches.

Pilonidal Cyst and Sinus
Nixon AT, Garza RF. Pilonidal Cyst and Sinus. [Updated 2023 Aug 8]. In: StatPearls

Clinicians should read this StatPearls review because it’s a fast, well-structured clinical baseline that covers the entire patient journey, from first presentation to operative and nonoperative options, written for the broad set of clinicians who actually see pilonidal disease (primary care, ED, pediatrics, surgery, wound care). It clearly summarizes the modern view of pilonidal disease as acquired, reviews common risk factors and physical exam findings (especially the importance of identifying midline pits), and emphasizes that diagnosis is usually clinical, with imaging reserved for unclear cases or when you need to rule out other pathology.

You also care because it’s a practical “choice architecture” document: it outlines the spectrum of management tools, when each is used, and what tradeoffs to counsel patients about. It summarizes evidence and controversies around hair removal, antibiotics, and adjuncts like phenol or fibrin products, and it highlights that treatment often requires interprofessional coordination (surgeons, primary care, nursing/wound clinicians) to avoid the common failure loop of repeat drainage and chronic non-healing. Even if a surgeon won’t learn a new technique here, this resource is excellent for standardizing the shared mental model across a care team, and for trainees it functions as a reliable starting point before diving into guidelines and procedure-specific studies.

Dr. John Bascom was one of the first to realize that “staying out of the ditch” was the key to avoiding unhealed Pilonidal wounds. His son, Thomas Bascom, carries on his work. Please note that these videos are narrated by the Dr. John Bascom after he had suffered a stroke.

Short version (9 minutes) on Medtube

Long version (40 minutes) on Medtube

Failed Pilonidal Surgery: New Paradigms & Operations Leading to Cures
Bascom, Slide Presentation 2002

This slide deck captures John Bascom’s “why this disease behaves the way it does” model, starting from the smallest unit of trouble: the midline pit. Bascom argues that many pilonidal flare-ups are driven by stretched follicles and trapped keratin/hair, and that early, targeted management can prevent escalation, including practical office-based steps and a strong emphasis on staying out of the midline cleft (“ditch”) when draining or operating. For clinicians and serious self-educators, it’s a compact way to understand the logic behind modern off-midline care and why some traditional approaches keep patients stuck in cycles of recurrence.

The second half shifts from principles to technique, outlining the Cleft Lift approach for complex or failed cases, including what typically causes non-healing (persistent deep cleft, overhang, remaining pits, excessive tension) and how the operation solves those problems by reshaping the cleft and bringing the closure into open air. The stepwise slides on markings, flap planning, tissue preservation, and shear control make this particularly useful for surgical learners or surgeons adopting off-midline repairs, while also giving prosumer patients a clearer mental model of what “a real fix” is trying to accomplish mechanically.

Quick Tutorial on the Bascom Pit-Picking Technique
Bascom, Special to Pilonidal.org 2010

This PDF is a practical, visual walkthrough of Bascom’s pit-picking technique, aimed at treating pilonidal disease by removing the true “source points” (the midline pits/enlarged follicles) while avoiding the big, slow-healing wounds that plague wide excisions. Bascom frames pit-picking as a “better preliminary operation” for many patients and emphasizes key principles that matter immediately in clinic: pits can be subtle unless the cleft skin is pulled downward, missing a meaningful pit drives recurrence, and acute abscesses should be drained laterally (“stay out of the ditch”).

Why it matters: for clinicians, this is a concise “how-to” for a low-morbidity, outpatient pathway that can resolve many early cases and reduce the risk of prolonged open wounds, while clearly stating its limits (complex non-healing problems may still need a cleft lift). For prosumer patients, it demystifies what “pit picking” actually involves (tiny midline excisions plus lateral drainage when needed), what the surgeon is looking for (pits that may be nearly invisible), and what early aftercare can look like, so you can ask better questions and recognize when a more definitive operation is being recommended.

Modified Karydakis Pilonidal Surgery
Kitchen, MEDtube

Pilonidal surgical technique of Modified Karydakis Procedure (similar to Bascom Cleft Lift) by Dr. Paul Kitchen. Like the Cleft Lift, one of the key components of the Modified Karydakis Procedure is making the natal cleft shallower and keeping the primary incision site off the midline where it can receive oxygen and heal. Dr. Paul Kitchen took Karydakis’ original work and modified it based on new information and techniques pioneers by Bascom. This surgical technique has been passed on to several other surgeons in Australia and worldwide.

EpSiT – Endoscopic Pilonidal Sinus Treatment
Cantarella, MEDtube 2023

Endoscopic video case: minimally invasive surgery for pilonidal disease.

Endoscopic Pilonidal Sinus Surgery – EPSiT
Slater, 2020

This video demonstrates the technique of Endoscopic Pilonidal Sinus surgery or EPSiT.

SiLaC surgery (Sinus Laser Closure)
biolitec 2018

Also a newer technique, the procedure utilizes a laser to destroy the diseased tissue and close the sinus tract, minimizing the need for extensive tissue removal. Unlike some others, this surgery has been adopted in the United States.

Minimally Invasive Surgery for Pilonidal Disease Using Punches (Trephines)
Moshe Gips, 2017

Dr Moshe Gips for contributed this presentation on minimally invasive surgery for PD, which was first presented at the International Pilonidal Sinus Disease Conference in Berlin, Sept 2017.