Radical treatment of acute pilonidal abscess by marsupialization

Simple drainage is the most common treatment of pilonidal abscess, but later definitive surgery is often necessary. However, radical treatment can also be performed in a single step by several procedures and even better results. The Authors describe the technique of marsupialization and analyse its long-term outcomes in a retrospective study. Between 1992 and 2001, 43 consecutive patients underwent drainage, curettage and marsupialization for acute pilonidal abscess. The procedure was carried out in outpatient setting (day surgery) after local or spinal anaesthesia. Management of the wound was left to the patient and was periodically checked at our out service. The average operating time was 20 minutes. Complete healing required 4-10 weeks in 95.3% of the patients; a persistent chronic fistula was observed in 4.7%. During the follow-up, 6 recurrences (14.6%) were observed in the healed patients. The treatment was then successful in 81.3% of the cases. Our experience shows that it is possible to carry out a radical management of pilonidal abscess in a single step with a high complete healing rate. Marsupialization proved to be a fast procedure and mainly feasible in the outpatient setting.