Journal of Visceral Surgery (2014) 151, 161
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CORRESPONDENCE
Is regular depilation really
necessary after a pilonidal sinus
excision?
To the editor,
We read with great interest the recent update on supra-
infected pilonidal sinus disease [1]. The authors are to be
commended for their work on this difcult topic, a disease so
frequent, yet often neglected. Many publications exist, but
studies with a high level of evidence are rare. The authors,
as well as the doctoral thesis currently being written by one
of us (C.G.), underscore the high prevalence of recurrence,
a problem relatively specic to pilonidal sinus disease, a
commonplace occurrence in the young population, despite
the myriad of techniques described in the literature.
One particular point that caught our attention and is
far from negligible in this disease, is routine post-operative
depilation by whatever method (shaving, depilatory creams
or denitive depilation). The study that the authors cite
to support this policy is a descriptive study on denitive
depilation [2]. This study does not allow to conclude as to
its efcacy in the prevention of recurrence after excision
of pilonidal sinus disease. Other studies on denitive epila-
tion after pilonidal sinus disease excision have also shown
a tendency toward less recurrence [3,4] but their level of
evidence is weak.
Conversely, the study on razor depilation by Petersen
et al. clearly establishes that the risk of recurrence is
increased by post-operative shaving [5]. This retrospective
study included a large population of German military person-
nel. The goal was to analyze the recurrence rate according
to whether or not post-operative shaving was performed.
They selected 504 patients at random from a cohort of
1960 patients undergoing operation for pilonidal sinus dis-
ease between 1980 and 1996.
Patients were contacted by telephone to determine
whether a recurrence had occurred or not. Of 504 patients
contacted, 113 had performed regular razor hair removal
post-operatively for a mean duration of 7.5 months while
391 had not. The recurrence rate was 30.1 % (34/113) in
the razor group vs. 19.7 % (77/391) in the non-razor group
(P = 0.01). One possible explanation for this increased recur-
rence rate could be the creation of cutaneous micro-lesions
related to razor shaving (well recognized in pre-operative
skin preps [6] where such procedures are contra-
indicated) and because the shaved hair stalk is beveled;
1878-7886/$ see front matter 2014 Elsevier Masson SAS. All rights reserved.
http://dx.doi.org/10.1016/j.jviscsurg.2014.02.001
both mechanisms potentially contribute to recurrence by
favoring cutaneous penetration of the stalk into the gluteal
cleft [5].
Post-operative depilation, while seemingly logical, can-
not be recommended. Denitive depilation is the only
method that seems to be of value, although the level of
evidence is low and the method is not currently reim-
bursed, which makes implementation difcult in France.
Post-operative mechanical razor depilation should be aban-
doned. Electric razor or depilatory creams have not been
specically investigated. Notwithstanding, post-operative
removal of all hair seems logical to facilitate post-operative
care and decrease the risk of recurrence by eliminating the
cause of the disease. The best way to ensure this depila-
tion therefore remains to be shown, and this is an excellent
topic for a future study by the French Association for Clinical
Research (FRENCH).
Disclosure of interest
The authors declare that they have no conicts of interest
concerning this article.
References
[1] Parades V, Bouchard D, Janier M, Berger A. Pilonidal sinus dis-
ease. J Visc Surg 2013;150(4):23747.
[2] Oram Y, Kahraman F, Karincaoglu Y, Koyuncu E. Evaluation of
60 patients with pilonidal sinus treated with laser epilation after
surgery. Dermatol Surg 2010;36:8891.
[3] Badawy EA, Kanawati MN. Effect of hair removal by Nd:YAG
laser on the recurrence of pilonidal sinus. J Eur Acad Dermatol
Venereol 2009;23:8836.
[4] Odili J, Gault D. Laser depilation of the natal cleft: an aid to
healing the pilonidal sinus. Ann R Coll Surg Engl 2002;84:2932.
[5] Petersen S, Wietelmann K, Evers T, Hser N, Matevossian E, Doll
D. Long-term effects of postoperative razor epilation in pilonidal
sinus disease. Dis Colon Rectum 2009;52:1314.
[6] Mise jour de la confrence de consensus. Gestion propra-
toire du risque infectieux Hygines 2013, Volume XXI, no 4, ISSN
1249-0075.
C. Gaudin , J. Podevin , P.-A. Lehur
Clinique de chirurgie digestive et endocrinienne,
Htel-Dieu, CHU de Nantes, 1, place A.-Ricordeau,
44093 Nantes cedex 1, France
Corresponding author.
E-mail address: christophe.gaudin@chu-nantes.fr
(C. Gaudin)
Available online 27 March 2014