Pilonidal Disease


Welcome to the APSA Quality and Safety committee Pilonidal Disease Toolkit. This page is intended to help anyone who is interested in Quality Improvement (QI) pertaining to Pilonidal Disease.

Available toolkit projects are listed below. Many of the approaches described are evidence-based - some are not. These approaches have not been approved by APSA.

Minimally Invasive Pilonidal Management

At the Pediatric Surgical Services, The Permanente Medical Group, Kaiser Hospital a protocol was devised for conservative management of pilonidal disease focusing on hygiene and local wound care in the outpatient setting.



Stakeholders: surgeons, nurses, nurse practitioners, physician assistants, medical assistants, primary care providers, patients and families

Challenges and Solutions:

  • Challenges:
    • Setting up a uniform clinic flow pathway
    • Decrease historically aggressive, costly, and morbid procedures
  • Solutions:
    • Share EPIC SmartPhrases

Links to published data (used to develop the protocol): [1]

Submitted by: Thomas Curran, MD

Additional Implementers: Doug Miniati, MD, Jennifer Keller, MD

Recent Research

For recent research pertaining to the management of patients with pilonidal disease, please refer to references [2][3][4][5][6][7][8].


  1. Armstrong JH, Barcia PJ. Pilonidal sinus disease. The conservative approach. Arch Surg. 1994;129(9):914-7; discussion 917-9.  [PMID:8080372]
  2. Check NM, Wynne NK, Mooney DP. Resolution of Mild Pilonidal Disease in Adolescents Without Resection. J Am Coll Surg. 2022;235(5):773-776.  [PMID:36102566]
  3. Metzger GA, Apfeld JC, Nishimura L, et al. Principles in treating pediatric patients with pilonidal disease - An expert perspective. Ann Med Surg (Lond). 2021;64:102233.  [PMID:33868675]
  4. Henry OS, Farr BJ, Check NM, et al. A minimally invasive pilonidal protocol improves quality of life in adolescents. J Pediatr Surg. 2021;56(10):1861-1864.  [PMID:33279217]
  5. Delshad HR, Henry O, Mooney DP. Improving Resource Utilization and Outcomes Using a Minimally Invasive Pilonidal Protocol. J Pediatr Surg. 2020;55(1):182-186.  [PMID:31676078]
  6. Halleran DR, Lopez JJ, Lawrence AE, et al. Recurrence of Pilonidal Disease: Our Best is Not Good Enough. J Surg Res. 2018;232:430-436.  [PMID:30463753]
  7. Minneci PC, Halleran DR, Lawrence AE, et al. Laser hair depilation for the prevention of disease recurrence in adolescents and young adults with pilonidal disease: study protocol for a randomized controlled trial. Trials. 2018;19(1):599.  [PMID:30382903]
  8. Kallis MP, Maloney C, Lipskar AM. Management of pilonidal disease. Curr Opin Pediatr. 2018;30(3):411-416.  [PMID:29553956]
  9. Delshad HR, Dawson M, Melvin P, et al. Pit-picking resolves pilonidal disease in adolescents. J Pediatr Surg. 2019;54(1):174-176.  [PMID:30661599]
  10. Gips M, Melki Y, Salem L, et al. Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients. Dis Colon Rectum. 2008;51(11):1656-62; discussion 1662-3.  [PMID:18516645]
Last updated: February 21, 2023