Towards a classification for sacrococcygeal pilonidal disease – Berlin 2017

pilonidal disease classification

  • Arkadiusz Peter Wysocki Griffith University Medical School. Griffith Health Centre - G40, Gold Coast Campus. Queensland 4222. Australia
  • Roland E Roland E Andersson Linköping University Department of Clinical and Experimental Medicine 581 83 Linköping, Sweden
  • Moshe Gips Assuta Medical Centre, HaBarzel St 20, Tel Aviv, Israel
  • Mustafa Girgin Elazığ Fırat Üniversite Mahallesi, Fırat Ünv., 23119 Elâzığ Merkez/Elazığ, Turkey
  • Ali Guner Department of General Surgery, Karadeniz Technical University, Trabzon, Turkey
  • Steven Immerman Evergreen Surgical, 719 West Hamilton Ave, Eau Claire, WI 54701 United States
  • Burhan H Kanat Elazığ Fırat Üniversite Mahallesi, Fırat Ünv., 23119 Elâzığ Merkez/Elazığ, Turkey
  • Cüneyt Kayaalp Department of Surgery, Inonu University , Bulgurlu Mahallesi, Malatya Elazığ Yolu 10.KM No:44210, 44000 Battalgazi/Malatya, Turkey
  • Marco Milone University of Naples Federico II. Department of Clinical Medicine and Surgery, via Pansini 5, 80131 Naples, Italy
  • Sven Petersen Allgemein- und Viszeralchirurgie, Asklepios Klinik Altona, Paul-Ehrlich-Straße 1, 22673 Hamburg, Germany
  • Asha Senapati Queen Alexandra Hospital, Portsmouth and St Mark’s Hospital, London, UK
  • Ekmel Tezel Gazi University School of Medicine, Department of Surgery, Besevler, Ankara, 06490, Turkey
  • Doll Dietrich Dept. Procto-Surgery, Marienhospital Vechta, Academic Teaching Hospital of the MH Hannover, Marienstr. 6-8, D-49377 Vechta, Germany
Keywords: pilonidal, classification, surgery, outcomes


Introduction: Sacrococcygeal Pilonidal Disease (SPD) presents in a variety of patterns. Multiple classifications have been proposed but none are in everyday use. In order to compare treatment outcomes, a method of categorizing is required.

Methods: Discussion over e-mail between several surgeons was performed over a period of 10 months.

Results: Surgeons recognize that SPD presents in a variety of patterns but there is a lack of scientific evidence on which to base a categorization system or treatment.

Conclusion: A simple classification system suitable for everyday use can be defined.

Author Biographies

Roland E Roland E Andersson, Linköping University Department of Clinical and Experimental Medicine 581 83 Linköping, Sweden

Linköping University Department of Clinical and Experimental Medicine 581 83 Linköping SWEDEN

Mustafa Girgin, Elazığ Fırat Üniversite Mahallesi, Fırat Ünv., 23119 Elâzığ Merkez/Elazığ, Turkey

Elazığ Fırat Üniversite Mahallesi, Fırat Ünv., 23119 Elâzığ Merkez/Elazığ, Turkey  


1. Gips, M., 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): p. 165662; discussion 1662-3.
2. Chia, C.L., V.W. Tay, and S.K. Mantoo, Endoscopic pilonidal sinus treatment in the Asian population. Surg Laparosc Endosc Percutan Tech, 2015. 25(3): p. e95-7.
3. Meinero, P., et al., Endoscopic pilonidal sinus treatment (EPSiT): a prospective multicentre trial. Colorectal Dis, 2016.
4. Bosche, F., et al., The Hair in the Sinus: Sharp-Ended Rootless Head Hair Fragments can be Found in Large Amounts in Pilonidal Sinus Nests. World J Surg, 2018. 42(2): p. 567-573.
5. Doll, D., et al., The presence of occipital hair in the pilonidal sinus cavity-a triple approach to proof. Int J Colorectal Dis, 2018. 33(5): p. 567-576.
6. Doll, D., et al., Strength of occipital hair as an explanation for pilonidal sinus disease caused by intruding hair. Dis Colon Rectum, 2017. 60(9): p. 979-986.
7. Stauffer, V.K., et al., Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence. Nature Sci Rep, 2018. 8(1): p. 127.
8. Tezel, E., A new classification according to navicular area concept for sacrococcygeal pilonidal disease. Colorectal Dis, 2007. 9(6): p. 575-6.
9. Doll, D. and P. Vassiliu, Another Pilonidal classification – PLLATIN. PSJ, 2018. 4(1): p. 1-3.
10. Murphy, S. and A.P. Wysocki, Pilonidal Sinus Disease surveys. Pilonidal Sinus Journal, 2017(3(1)): p. 19 - 27.
11. International Pilonidal Society. Survey towards pilonidal classification. 2018 9/9/2018 9/9/2018]; Available from:
12. Doll, D., et al., Time and rate of sinus formation in pilonidal sinus disease. Int J Colorectal Dis, 2008. 23(4): p. 359-64.
13. Doll, D., et al., Surgery for asymptomatic pilonidal sinus disease. International Journal of Colorectal Disease, 2008. 23(9): p. 839-844.
14. Hueston, J.T., The aetiology of pilonidal sinuses. Br J Surg, 1953. 41(167): p. 307-11.
15. Patey, D.H. and R.W. Scarff, Pathology of postanal pilonidal sinus; its bearing on treatment. Lancet, 1946. 2(6423): p. 484-6.
16. Kooistra, H.P., Pilonidal sinuses. Review of the literature and report of three hundred fifty cases. Am J Surg, 1942. LV 1(55): p. 3-17.
17. Franckowiak, J.J. and R.J. Jackman, The etiology of pilonidal sinus. Dis Colon Rectum, 1962. 5: p. 28-36.
18. Notaras, M.J., A review of three popular methods of treatment of postanal (pilonidal) sinus disease. Br J Surg, 1970. 57(12): p. 886-90.
19. Crookall, A., Preliminary report on the treatment of pilonidal sinus with silver nitrate. Trans. Amer. Proctol. Soc., 1927. 28: p. 32.
20. Maurice, B.A. and R.K. Greenwood, A Conservative Treatment of Pilonidal Sinus. Br J Surg, 1964. 51: p. 510-2.
21. Sames, P., Phenol as antiseptic. Br Med J, 1968: p. 56.
22. Stewart, T.J. and M. Bell, The treatment of pilonidal sinus by phenol injection. Ulster Med J, 1969. 38(2): p. 167-71.
23. Karydakis, G.E., Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg, 1992. 62(5): p. 385-9.
24. Dahl, H.D. and M.H. Henrich, [Light and scanning electron microscopy study of the pathogenesis of pilonidal sinus and anal fistula]. Langenbecks Arch Chir, 1992. 377(2): p. 118-24.
25. Allen-Mersh, T.G., Pilonidal sinus: finding the right track for treatment. Br.J.Surg., 1990. 77(2): p. 123-132.
26. Doll, D., et al., Family history of pilonidal sinus predisposes to earlier onset of disease and a 50% long-term recurrence rate. Dis Colon Rectum, 2009. 52(9): p. 1610-5.
27. Akinci, O.F., et al., Natal cleft deeper in patients with pilonidal sinus: implications for choice of surgical procedure. Dis Colon Rectum, 2009. 52(5): p. 1000-2.
28. Bolandparvaz, S., et al., Evaluation of the risk factors of pilonidal sinus: a single center experience. Turk J Gastroenterol, 2012. 23(5): p. 535-7.
29. Doll, D., et al., Stop insulting the patient: neither incidence nor recurrence in pilonidal sinus disease is linked to personal hygiene. Pilonidal Sinus Journal, 2015. 1(1): p. 11-19.
30. Robbins, C.R., Chemical and Physical Behavior of Human Hair. Vol. 5th Edition. 2012: SpringerVerlag Berlin Heidelberg.