Abstract
Surgery is usually necessary to treat symptomatic pilonidal disease. However, some operations have the propensity to make the patient worse. Uncomplicated disease should therefore be treated by operations that excise the pits rather than excisional surgery. More complex disease, however, cannot be treated by these techniques. It has been shown in many publications that off- or out-of-midline closures have better outcomes than midline closures and wounds. Descriptions and results of these procedures are described. Midline wounds should be abandoned in favour of off-midline closures.
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