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This is a very common question we get from patients with “minimal disease”. However, it is seldom an issue with patients who have ongoing symptoms or severe disease.

You need surgery for sure if you have the following:

  • Ongoing pain with sitting or discomfort with firmness in the area.

  • More than one episode of abscess formation that either drained on its own or required surgical drainage by a surgeon or another physician.

  • Open wound with chronic drainage and bleeding or infected red tissue protruding from the wound.

  • Open pores with episodic drainage of either blood or fluid.

  • Pruritis (itching) from ongoing drainage or dark pigmentation of the cleft from ongoing irritation

  • Multiple pores in the midline even if no symptoms.

  • Had surgery in the past for pilonidal disease removal and now you have a recurrence.

All these symptoms signify the presence of embedded hair tracts and infected debris under the surface of the skin that will keep causing infections, abscesses and more widely spread tunnels. The only way to get rid of this is surgery. Clipping the hair, laser hair removal and other topical salves or remedies will never get deep enough to take care of the problem.

These patients will need surgical intervention, preferably in the form of a cleft lift, sooner than later. Waiting adds to the problem by making the condition worse, the surgery more difficult and the complication rate higher.

However, if you have “minimal disease” you have a choice.

Minimal disease is defined by:

  • One or 2 pores (pits) in the midline with no or minimal discomfort and no drainage whatsoever.

  • History of a single pilonidal abscess that got drained adequately and healed completely with no residual pain, openings or drainage from the area.


It is impossible to know which patients with these symptoms will go on to have further problems. There is no good, long term study that shows us what happens with these. However, from experience, most of these patients will eventually have progression of their disease, and have to deal with it, often at an inconvenient time.

One thing I emphasize to patients with minimal disease is that every patient is different. Not only the disease but your approach to the disease, your life style and how the disease is affecting your life and those around you.

If you have minimal disease and:

  • you do not have any discomfort or pain related to it

  • Your job or daily activities do not involve long periods of sitting

  • You are not constantly worried about the area.

waiting and doing nothing is an option. In this case you have to follow the instructions to minimize flare ups (outlined in the next section) for the rest of your life.


It is also important to understand that if you develop any of the above symptoms or signs that indicate you need surgery, you should seek surgical advice. Putting surgery off and waiting until the disease is very advanced or your life is turned upside down is not an option in this case.

However, if you have minimal disease but:

  • Want to be proactive about it

  • Your job involves sitting for long periods of time

  • You have a lot of body hair

  • The area is intermittently causing you discomfort

  • You are constantly worried about it

 then, surgery should be the better option. With the cleft lift procedure and its added benefits of quick recovery and low failure rate, you should not postpone surgery.



It is extremely unlikely that pilonidal disease becomes life threatening. There are very few cases in the literature of chronic open wounds turning into skin cancer after years of chronic irritation. However, the condition can make your life or the life of your loved ones miserable. We know of several patients who filed for disability or quit their jobs because of pilonidal disease. It is certainly possible to wait and consider surgery when circumstances allow. However, Dr. Wadie's advice is that once you have the above mentioned indications, it is better to get the problem under control and “put it behind your back”.

We are here to help you make a decision. Dr. Wadie thinks it makes sense to have surgery before you have multiple sinus tract openings, wounds close to the anus, or the pilonidal disease has become an overriding issue in your life. However, the decision is ultimately yours.

Do I need to have surgery if I have pilonidal disease?: Text
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