EP108 - A Novel Approach to Recurrent Pilonidal Disease: Modified Gips with Lateral Curettage

Saturday, May 10, 2025

3:20 PM – 3:25 PM PT

Location: Monitor 2, Sails Pavilion, Upper Level

ePoster Presenter(s)

Aubrey Swinford, MD

Resident
University of Southern California/Los Angeles General
South Pasadena, CA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Jordan Martucci, MD

Resident
University of Southern California/ Los Angeles General
Los Angeles, California, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
SW

Sabrina Woll, BA

Medical Student
University of Southern California
Los Angeles, California, United States

Disclosure information not submitted.
AG

Abhinav Gupta, MD

General Surgery Resident
University of Southern California
Los Angeles, California, United States

Disclosure information not submitted.
LP

Lauren Polyakov, n/a

Medical Student
Keck School of Medicine
Los Angeles, California, United States

Disclosure information not submitted.
MK

Margaret V. Kudlinski, B.S.

Medical Student
Keck School of Medicine of USC
Los Angeles, California, United States

Disclosure information not submitted.
CH

Christine Hsieh, MD

Assistant Professor of Clinical Surgery
Keck School of Medicine, University of Southern California
Los Angeles, California, United States

Disclosure information not submitted.

Senior Author(s)

Sang W. Lee, FASCRS

Professor and Chief of Colon and Rectal Surgery
USC Keck school of Medicine
Los Angeles, California, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Aubrey Swinford, MD: This individual has no financial relationships with ineligible companies.

Jordan Martucci, MD: This individual has no financial relationships with ineligible companies.

Sang W. Lee, FASCRS: This individual has no relevant relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Pilonidal disease (PD), a common condition occurring in the sacrococcygeal area, involves obstructed hair follicles that cause inflammation and abscesses leading to pit or sinus tract formation.(1) PD can significantly impact a patient’s quality of life, and thus it is imperative to optimize treatment and minimize postoperative recurrence in this patient population.(2) Universally the most frequently performed surgical technique for PD is wide excision of the pilonidal cyst and its tracts. In recent years, however, minimally invasive surgery (MIS) has become commonplace in the PD treatment algorithm, with sinusectomy, endoscopic sinus ablation, and laser therapy being the most frequently performed MIS procedures.(3)
In 2008, Dr. Moshe Gips originally described the sinusectomy: excision of epithelialized tracts and debridement of pilonidal cysts, leaving orifices open to drain and heal by secondary intention.(4) Some studies have demonstrated that the Gips technique is a safe, efficient, and cost-effective approach to PD treatment. Unfortunately, recurrence rates for this technique have been shown to be as high as 33%.(5-8)
Current American Society of Colon and Rectal Surgeons (ASCRS) guidelines state that operative strategies for recurrent pilonidal disease should distinguish between acute and chronic disease. There is a paucity of evidence favoring any one surgical technique.(9) Our study aims to investigate outcomes of patients with recurrent PD who have undergone a modified Gips procedure, in which the pilonidal sinus is elliptically excised and the fistulous extensions are curetted, but not formally resected.

Methods/Interventions: We conducted a retrospective review of all patients with recurrent PD who underwent the modified Gips procedure with a single surgeon at our institution from 2016 to 2024. Patients were included in the final analysis if they underwent excision of pilonidal sinus(es) with curettage of laterally extending fistula tracts. Patients were excluded if they underwent any other surgical intervention for PD, including a traditional Gips procedure or flap reconstruction. Primary outcome was PD recurrence. Secondary outcomes included time to wound healing and incidence of postoperative infection. Relevant demographic, operative, and outcomes data were reviewed.

Results/Outcomes: Fifteen patients with recurrent PD underwent the modified Gips procedure by a single surgeon. Of these, 13 (86.7%) were male, and 8 (53.3%) were White. The average operative time was 21.1 ± 7.5 minutes, with an estimated blood loss of 1.8 mL. Fourteen patients (93.3%) attended at least one follow-up visit, an average of 17.1 ± 9.4 days postoperatively. All 14 had fully healed or well-healing wounds, although 43% reported drainage at the initial follow-up. No postoperative infections or recurrences were noted at the first visit. Three patients (20%) recurred and were ultimately referred for flap coverage (Table 1).

Conclusion/Discussion: The modified Gips procedure, involving elliptical excision of pilonidal sinuses with curettage of lateral fistulous extensions, demonstrated favorable short-term outcomes, with excellent wound healing and no early infections. However, a 20% recurrence rate highlights the need for long-term follow-up and additional interventions in recurrent cases. This technique offers a viable, minimally invasive option for managing recurrent PD. Further studies with larger cohorts are necessary to confirm its long-term efficacy.