Surgery for uncomplicated pilonidal disease: simpler is better

Chronic pilonidal disease continues to be a therapeutic challenge. Discrepancies in technique, recurrence rates, complications, time to return to work/school, and patient's aesthetic satisfaction between the various treatment options have led to controversy over the best approach. It is undeniable that the best technique should strike a balance between recurrence and surgical morbidity. Despite the plethora of various complex surgical options, it seems that one of the oldest and simplest methods such as incision and curettage can balance the various desirable outcomes without excessive morbidity. In this manuscript, we review the literature and the evidence supporting this surgical procedure. We conclude that incision and curettage should be considered as the initial option for most patients with chronic uncomplicated pilonidal disease, and that more complex surgical options should be reserved for severe and recurrent cases.