ORIGINAL ARTICLE Is the cleft lift procedure for non-acute sacrococcygeal pilonidal disease a definitive treatment? Long-term outcomes in 74 patients P. M. Ortega • J. Baixauli • J. Arredondo • M. Bellver • C. Sa ´nchez-Justicia • S. Ocan ˜a • J. L. Herna ´ndez-Lizoain Received: 25 September 2013 / Accepted: 23 January 2014 Ó Springer Japan 2014 Abstract Purpose No definitive surgical treatment for non-acute pilonidal disease has been established thus far. We herein report the short-term and long-term outcomes of 74 con- secutive patients who underwent the cleft lift procedure for non-acute pilonidal disease. Methods A total of 74 consecutive patients who under- went the cleft lift procedure for the treatment of non-acute pilonidal disease were evaluated. Results Complete healing was achieved in 54 patients (73 %). Wound seroma was observed in 12 patients (15 %) in the first week, and this persisted until the second week in 10 patients (13 %). Partial dehiscence was found in eight patients (11 %). One patient presented with complete wound dehiscence (1 %), and another experienced early postoperative bleeding (1 %). Wound infection was observed in one patient (1 %). The median follow-up period was 51.5 months (range 15–88 months). Three cases of recurrences were observed, which occurred after 51, 42 and 12 months of follow-up. Conclusions If longer-term follow-up is achieved, defin- itive conclusions may be obtained. However, the present results suggest that the cleft lift procedure may become the gold standard technique for the surgical management of non-acute pilonidal disease. Keywords Pilonidal disease Á Surgical treatment Á Cleft lift Á Cleft closure Introduction Pilonidal disease (PD) is an acute or chronic painful inflammatory disease originating in the gluteal cleft. It affects an estimated 26 per 100,000 individuals, occurring primarily in young adults between the age of 15 and 35 years, with a 3:1 male predominance. The risk factors described include a family history, sedentary occupation, local trauma and obesity [1, 2]. The etiology of the disease remains controversial, but it is generally accepted that it is an acquired condition caused by several factors, with its main etiological factor being hair found in the cyst. Moreover, the skin status at the site of entry (maceration, scar and humidity) and the depth of the natal cleft are important factors related to its develop- ment [3]. The appropriate choice of treatment depends on the patient, the extent of the disease and the acute or chronic form of the disease. However, most often, no single treatment fulfills the following most basic requirements in terms of suitability: simple, short hospital stay, minimal postoperative pain, low recurrence rate, easy wound care, early return to activities of daily life and cost-effectiveness [4]. Therefore, PD presents many therapeutic challenges to surgeons worldwide. When Bascom and Bascom [5] described the cleft lift technique (CLT), they suggested that the hair follicle itself was the source of local sepsis, and consequently, damage to the epidermis in the deep natal cleft by bacteria and moisture was directly related to its development. In addition, the authors advocated pit excision and lateral drainage for refractory PD, thus resulting in two different procedures that can be combined for better efficacy [6]. In the present study, we report the prospective short- and long-term outcomes after CLT in patients with various non-acute PD disorders. P. M. Ortega (&) Á J. Baixauli Á J. Arredondo Á M. Bellver Á C. Sa ´nchez-Justicia Á S. Ocan ˜a Á J. L. Herna ´ndez-Lizoain Department of General Surgery, University Clinic of Navarra, University of Navarra, Avda. Pı ´o XII 36, 31008 Pamplona, Navarra, Spain e-mail: pmtnezortega@gmail.com 123 Surg Today DOI 10.1007/s00595-014-0923-3