The Sternberg Clinic is expert in the best surgery option for pilonidal cyst disease, with thousands of patients successfully treated.

Pilonidal disease (pie-low-NIE-dul), a chronic infection of the skin and underlying tissue near the tailbone is a common disorder. It typically affects people in their teens, 20s, and 30s. However, symptomatic disease and pilonidal sinus disease rarely resolve without surgery. It’s a fallacy that patients outgrow the disease in their 40s.

In its most severe form, Pilonidal Disease can be very debilitating, causing daily discomfort and limiting activity. Most operations reported to cure the disease are not reliable. Many sufferers of pilonidal disease become discouraged in their search for curative treatments as many surgeons and medical practitioners continue to misadvise patients to consider disfiguring procedures with high recurrence rates.

At The Sternberg Clinic for Pilonidal Surgery, we understand how challenging it is for patients to receive quality care. We are devoted to providing the best possible advice and treatment and educating the medical community about the best surgery option for pilonidal cyst… the Cleft Lift Procedure (also called the pilonidal RAF for rotation and advancement flap), a modern surgical technique with a very low complication rate that gets patients back to work and out exercising in about 10 days.

Is Surgery the Right Option for You?

Surgery for Pilonidal Disease is appropriate for individuals if it negatively affects the quality of their life and those who have had complications of procedures used to treat symptomatic disease such as a non-healing wound following surgery. Persistent irritation of the tailbone area, frequent drainage, and recurrent abscesses indicate that surgery may be appropriate. Some patients who require an ER or office drainage procedure for an acute abscess are so traumatized by the experience that they choose to have surgery to prevent a recurrence.

‘Conventional’ surgery for pilonidal disease is obsolete

Despite the apparent simplicity of the disease process, pilonidal disease often frustrates both patients and their surgeons because the disease often comes back after conventional surgical procedures. Most surgeons try and avoid operating on patients with pilonidal disease, as typical surgical outcomes are dismal and result in recurrent disease that is more complex than the original problem.

The most commonly performed procedures for pilonidal disease, which I will term conventional surgery, involve a wide excision of the affected area of skin and underlying fatty tissue and:

• Re-closing the wound in the midline, or
• Suturing the edges of the wound open (marsupialization).

Pilonidal disease is poorly understood, and many surgeons underappreciate recurrence following surgery. Most fail to appreciate that the deep cleft is the cause of the disease. These surgeons often remove too much skin and deep tissue and leave large defects that further deepen the cleft.  Conventional operations can create large, disfiguring wounds that require labor-intensive postoperative care. Unfortunately, these sub-optimal operations have become the so-called ‘standard of care’’.

Removing large amounts of tissue is unnecessary since the cause of pilonidal disease is the deep valley of the natal cleft, so removing normal tissue is unnecessary and harmful.  A large excision is unnecessary because there is no cyst, just an infection that will resolve once the cleft is made more shallow and the dead-space empty space) is removed. Furthermore, deep excision of the center of an airless, moist, diseased valley/cleft creates a wound that resists healing and increases the odds of recurrent disease.

What prevents healing with conventional surgery?

Pilonidal disease can respond to conventional surgery but often the remaining deep valley/cleft doesn’t allow enough air circulation for proper wound healing. The deep valley also stays moist, encouraging bacterial growth and additional skin damage. Because the cleft is still deep, the basic problem of trapping hair and debris in the pores of the cleft is still not corrected and pilonidal disease can happen again. Additionally, many surgeons place the incision in the midline or have it cross the midline, leading to a recurrence or non-healing wound.

Recurrent pilonidal disease requires a definitive surgical procedure to reduce the depth of the natal cleft valley so that it remains well aerated, dry, and shallow and hairs and debris can’t be trapped.

The Pilonidal RAF (Rotation and Advancement Flap)/Cleft Lift Procedure: Curing pilonidal disease with better engineering

Now that we know that the deep valley is the cause of the disease, why not fix the valley? The goals of an ideal Pilonidal Cyst Disease surgical procedure to treat chronic pilonidal disease or non-healing wounds that result from prior failed pilonidal procedures include:

• Reduce the depth of the cleft to shallow the ‘airless’ valley
• Remove only diseased areas and leave deeper, healthy tissue intact
• Reshape the cleft to prevent ‘divots’
• Make the incision outside the valley (lateralization) to allow the incision to heal in the open air
• Leave a closed wound (no packing required)
• Perform the surgery on an outpatient basis
• Cause little discomfort
• Easy postoperative care
• Allow patients to return to athletics within a few weeks
• Be cosmetically acceptable

Before and After The Pilonidal RAF /Cleft Lift Procedure

Photo Gallery

The Cleft Lift Procedure/Pilonidal RAF is the best surgical procedure that is highly successful in curing pilonidal disease if performed by an experienced surgeon.

Unfortunately, it’s difficult for patients to find a surgeon with experience in the Cleft Lift Procedure. Patients often need to travel to find such a surgeon. It’s worth it!

Meet Your Surgeon, Dr. Jeffrey Sternberg

After many years performing major abdominal operations including open and laparoscopic resections for colon cancer, rectal cancer, Crohn’s disease, and Ulcerative colitis, I have chosen to concentrate my efforts in a few highly specialized areas of surgery where I feel I can make the greatest positive impact on patients.

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