O3282: The Outcome of 1,115 Adolescent Pit Pickings in a Dedicated Pilonidal Care Clinic

Background: Pilonidal disease remains a difficult problem to resolve. Traditional operative management is associated with significant morbidity and costs. We intend to evaluate the outcome of an alternative method of pilonidal disease management, including pit-picking, on adolescents with pilonidal disease.

Methods: Consecutive patients presenting to the Pilonidal Care Clinic were managed by drainage of any un-drained collections, crease cleaning twice daily, and laser follicle ablation. Once inflammation was resolved, if pits were present patients underwent pit-picking in the clinic under local anesthesia. Those with too many pits in close proximity to do at once underwent sequential pit picking procedures. Laser crease follicle ablations continued until patients had minimal to no hair re-growth in the crease. Pilonidal disease was stratified by severity. Patient symptoms were collected prospectively and were reviewed.

Results: Of 1,133 patients with pilonidal disease seen in clinic, 149 were seen prior to March, 2016, when pit picking was first offered. Of 984 patients seen after that date 700 (71.1%) underwent 1,155 pit pickings, an average of 1.65 per patient (range 1-9). 668 patients (95.4%) underwent the procedure under local anesthesia in the clinic and 32 (4.6%) were done under general anesthesia in the operation room.

There were 402 (57.1%) males with a mean age of 17.25 years (range 8-30) and 298 females (42.9%) with a mean age of 16.2 years (range 11-26). 407 patients (58.1%) had mild disease, 226 (32.4%) moderate disease, 48 (6.9%) severe, and 13 (1.9%) dehisced wounds. 636 patients (90.9%) underwent an average of 3.5 laser follicle ablations (range 1-20) during their average 4.1 visits (range 1-20). Most patients required no non-narcotic analgesia, with other taking from 0-3 days of non-narcotic analgesia, and all returned promptly to pre-procedure activities.

230 patients (32.8%) graduated and 153 patients (21.8%) are still receiving care. 317 patients (45.3%) were lost to follow-up. 45 patients (9.6%) had active disease when last seen, 113 (16.1%) were hirsute but had no active disease, and 159 (22.7%) were lost right after their pit picking, with no assessment of disease activity.

Conclusion: Pit-picking as a component of an in-office minimally invasive care plan for pilonidal disease may help resolve the condition in patients who adhere to the treatment course. Better follow up data is required to fully evaluate the procedure.