Pilonidal means “nest of hairs” and between the buttocks is a site that hairs (usually from the scalp) have burrowed deep to the skin and created a foreign body reaction. Once the hairs are beneath the skin in the midline they cause repeated eruptions of infection. Traditionally the surgery for this condition was to make an incision in the midline between the buttocks to remove the hairs, however this cut was an invitation for further hairs and the recurrence rates were high, in fact the surgery was often worse than the disease!

There are some modern day techniques that reduce the chance of recurrence and it makes sense to perform the smallest of these first but if there is recurrence one of the other techniques can be offered with low recurrence rates.

Bascom’s procedure (above) which involves an incision away from the midline to burrow down under the midline and remove the hairs and infection. This is one lateralising procedure that keeps the scar away from the natal cleft (which is where the buttocks meet in the midline)




This is the result at the end of a procedure that is used to treat resistant pilonidal disease, it is called a Limberg Flap and involves a few days in hospital. It has a very low recurrence rate but is usually offered to patients who have had simpler operations first which have not cured the problem.