Pilonidal disease is a long-term skin condition that affects the groove between the buttocks (the “natal cleft”). It often starts as a painful abscess and can progress to small tunnels (sinus tracts) that intermittently discharge or become infected again.
It mainly affects teenagers and young adults. We now understand it as an acquired condition caused by loose hairs and friction in a deep cleft, with risk increased by prolonged sitting, obesity, and local skin vulnerability.
Through RCG Health, a multidisciplinary team led by consultant surgeon Mr Ricardo Camprodon, patients can access the whole pathway — from urgent abscess drainage to definitive off-midline surgery (including the Sail Flap technique). These operations flatten the cleft and move the scar away from the midline, reducing recurrence and wound breakdown.
What is Pilonidal Disease?
“Pilonidal” literally means “nest of hair.” Loose hair fragments and skin debris can penetrate softened skin in the cleft, triggering inflammation, infection, and sinus formation.
Typical symptoms include:
- Pain and swelling near the tailbone
- Tenderness
- Intermittent discharge
- Flare-ups with abscesses
Diagnosis is usually straightforward and made by examining midline pits and any off-midline openings.
How is it treated?
1) Acute abscess – incision & drainage (I&D)
When a painful lump develops, the fastest way to relieve symptoms is with I&D: a small cut to release pus, wash out the cavity, and let it drain. Relief is usually immediate.
However, recurrence after simple I&D is common (reported at 15–40%) because the underlying sinus tracts remain.
2) Chronic or recurrent disease – definitive procedures
When pilonidal disease keeps coming back, the goal is to remove diseased tracts and avoid a midline scar:
- Open excision with healing from the base (secondary intention): durable, but recovery involves more extended wound care.
- Primary closure off the midline (flap techniques): operations such as Karydakis, Bascom cleft-lift, Limberg, and Sail Flap flatten the cleft and place the scar away from the midline. Modern guidelines favour these methods because they reduce wound breakdown and recurrence.
- Minimally invasive options (trephination/“Gips”, EPSiT): sometimes useful for limited disease, though long-term results are variable. These are not a routine part of practice at RCG Health, but can be discussed.
Why Avoid the Midline?
Over time, midline closure has the highest recurrence rates. Some long-term studies indicate a recurrence rate of approximately 68% at 20 years.
Modern surgical practice therefore prefers off-midline closure with cleft flattening, as this reduces the risk of infection, wound breakdown, and long-term recurrence.
The Sail Flap Approach
At RCG Health, Mr Camprodon often uses the Sail Flap, an off-midline, tissue-sparing operation:
- Diseased tracts are excised or cleaned out
- A shallow flap of tissue is rotated like a “sail” to flatten the cleft and shift the scar off the midline
- A small drain is left in place for 5 days, and sutures are removed after 10 days
- Dressings are left undisturbed to support healing and reduce infection risk
Pain control is enhanced with long- and short-acting local anaesthetics. Antibiotics are given around the time of surgery.
Suitability:
- Works well for most unilateral or midline disease
- Very extensive disease may require referral to plastic/reconstructive colleagues
- Smoking increases wound complications — stopping beforehand is strongly advised
- Laser hair reduction can help reduce recurrence and may be offered before or after surgery
Why This Technique?
The Sail Flap follows key principles endorsed by international guidelines: off-midline closure, cleft flattening, and minimal tissue trauma. Together, these factors reduce the risk of infection, wound breakdown, and recurrence, while helping patients return to their daily lives more quickly.
Who Performs the Surgery?
Mr Ricardo Camprodon, Consultant General, Upper GI, Laparoscopic and Bariatric Surgeon, performs all pilonidal operations at RCG Health. He has a particular interest in pilonidal disease and extensive experience using the Sail Flap technique.
What Does the Evidence Say?
- There is no single “best” operation for every patient. Care should be tailored.
- Off-midline flap closures (Karydakis, Bascom, Limberg, Sail Flap) have lower recurrence and wound problems than midline closure.
- Midline primary closure has the highest long-term recurrence (up to ~68% at 20 years).
- Minimally invasive approaches may suit limited disease but vary in long-term success.
- Hygiene and hair-control measures improve outcomes after any procedure.
Recovery
- Day-case surgery in most patients; some need a short overnight stay
- Dressings: kept clean and dry, left in place until review
- Activity: avoid prolonged sitting/pressure initially; light activity resumed in 2–3 weeks
- Follow-up: review for drain and suture removal, plus discussion of ongoing hair management (clipping, depilatory creams, or laser)
Risks
Like all surgeries, pilonidal procedures carry some risks:
- Infection or bleeding
- Fluid collections (seroma/haematoma)
- Wound separation
- Recurrence
Off-midline techniques are designed to reduce these risks. Stopping smoking, maintaining a healthy weight, and managing diabetes further improve healing.
Preventing Recurrence
- Hair control — clipping, depilatory creams, or laser
- Hygiene — keeping the cleft clean and dry
- Lifestyle — healthy weight, avoiding prolonged sitting/pressure
These measures are recommended alongside any surgical approach.
Why Choose RCG Health?
With consultant-led expertise and a multidisciplinary team, patients are offered:
- Evidence-based treatment across the whole pathway — from urgent abscess drainage to advanced off-midline flap surgery
- Tailored aftercare, including hygiene and hair-control strategies
- A focus on durable healing, faster recovery, and fewer recurrences
- Surgery performed by Mr Ricardo Camprodon with a specialist interest in pilonidal disease
Next Steps
If pilonidal disease is affecting your comfort, work, or sport, long-term solutions are available.
You can discuss whether the Sail Flap or another approach is right for you. Patients who have had procedures elsewhere can also be reviewed for revision surgery.
(A separate page will cover revision surgery for pilonidal disease and infected sebaceous cysts.)
FAQs
What is the best operation?
It depends on your anatomy and the extent of the disease. In general, off-midline closure is recommended for chronic/recurrent disease because it reduces wound complications and recurrence.
Will it come back?
Recurrence is possible with any method, but the risk is lowest when the cleft is flattened, the scar is off the midline, and hair control is maintained.
Is minimally invasive surgery (Gips/EPSiT) an option?
Yes, in selected cases of limited disease. Recovery is often quicker, but long-term recurrence is variable.
How long is the recovery after a Sail Flap?
Most patients resume light activity within 2–3 weeks. Drains are usually removed after 5 days, and sutures after 10 days.
Further Reading & References
- JAMA Surgery Review (2023): overview of pilonidal disease management
- ASCRS Clinical Practice Guideline (2019): recommends drainage for abscesses and off-midline closure when primary closure is chosen
- Scientific Reports/Nature (2018–2020): show recurrence up to ~68% with midline closure at 20 years
- Surgical Clinics of North America (2024): highlights tailoring treatment and favouring off-midline closures
- RCG Health Sail Flap practice notes: day-case off-midline flap, typical recovery timelines, and aftercare strategies