• Zeiad I Hussain, Assad Aghahoseini, and David Alexander.
• Department of Colorectal Surgery, York Hospital, York, UK. zeiadhussain@yahoo.com
• Dis. Colon Rectum. 2012 Jun 1;55(6):640-5.

BackgroundImprovements in outcome after surgery for elective pilonidal sinus disease have yet to be matched for those presenting with acute disease. Traditional approaches to the management of acute pilonidal abscess have been associated with slow healing and significant loss of working time.ObjectiveThe aim of this study was to report our approach in which a temporizing intervention allows subsequent definitive treatment with low morbidity.DesignThis article presents a prospective cohort study.SettingThis study was performed in acute admissions to the Surgical Unit in York Teaching Hospital.PatientsPatients presenting with acute pilonidal abscess, not septic, immune-compromised, or diabetic, and without skin necrosis, underwent aspiration on the surgical ward.InterventionAspiration of pilonidal abscess under local anesthetic was performed with the use of a wide-bore needle. The abscess cavity was drained to dryness, samples were sent to the laboratory for microbiology, and empirical oral antibiotics were commenced, covering anaerobes and aerobes. Review was arranged for within 7 days to plan elective excision and primary closure of the underlying pilonidal sinus.Main Outcome MeasuresThe primary outcomes measured were the number of days required to return to normal activities, response to treatment, and any residual inflammation.ResultsFifty-six patients were referred with acute pilonidal abscess. Forty patients met the criteria for aspiration and empirical antibiotic treatment. All were allowed to go home the same day and were reviewed within a median of 5 days. Thirty-eight (38/40) patients demonstrated complete resolution of acute inflammation and were back to normal activities the following day. Fifteen patients subsequently underwent day-case excision and primary closure at a median of 9 weeks. Another 13 are awaiting surgery, and 10 patients have declined further treatment. Two (2/40) patients did not respond, one of whom did not receive the appropriate antibiotics. Both were managed with incision and drainage.ConclusionsAspiration and antibiotic management of pilonidal abscess is effective in 95% of acute cases in preventing the need for emergent laying open and allows for subsequent elective surgery.

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