Treatment of Pilonidal Disease, Bascom Procedure

What is pilonidal disease ?

A pocket of infection that occurs in the tailbone area is called a "pilonidal" cyst or abscess. These infections begin as enlarged pores in the crease between the buttocks. Pieces of hair can enter these pores, burrow their way underneath, and cause infection under the skin. Sometimes this causes minor irritation, but other times it can cause a painful infection that requires surgical drainage. Different patients have different degrees of symptoms from this problem. Once pilonidal infections begin, they may continue to cause problems unless surgically treated.

Treatment of pilonidal disease can be a challenging and frustrating experience for both the patient and the physician. Dealing with this problem has been a challenge that Dr. Steven Immerman has taken on since he began his surgical practice in 1981. We are experts at this type of repair, and have a success rate of 98% on the patients who have their pilonidal repair done at our clinic. Almost 90% need only one procedure.

“When searching the surgical literature one finds literally dozens of different procedures that have been proposed for this disease. I have personally tried many of these methods, and after much experimentation and frustration I have adopted a procedure that is very successful.”
Steven C. Immerman, M.D., FACS

Why most surgery for Pilonidal Disease fails
The most commonly performed procedures for pilonidal disease involve a excision (removal) of the affected area of skin and underlying tissue, including re-closing the wound and suturing the edges of the wound to the sacrum, or open packing with healing by secondary intention (requiring drainage, dressings and wound care).

Surgeons are taught to remove all the disease and either attempt closure (which usually fails), or give up on the idea of primary healing and either suture the wound edges to the sacrum or just leave the wound open to heal secondarily. What these procedures fail to address is that the disease process is caused by the deep natal cleft. A deep cleft remains moist at almost all times, promotes growth of anaerobic bacteria, and creates negative pressure which sucks hairs into enlarged pores. Any procedure that does not address the cleft has a high failure rate. But, unfortunately, procedures that do not address the cleft are done the most frequently in the US.

What we do differently, and why you should consider us.
The procedure that Dr. Immerman does attempts to flatten the cleft, and move any incisions off of the midline so they can heal primarily. Unfortunately, this is often easier said than done, and in infrequent occasions requires more than one procedure - particularly in patients who have already had multiple previous excisions, a very deep cleft, or disease adjacent to the anus.

Dr. Immerman does a procedure called the Bascom procedure. This procedure, also called “cleft closure” or “cleft lift” has become the procedure of choice at our clinic because of our success, even in patients who have had multiple previous excisional procedures, or who have had to deal with long term open wounds. This procedure is performed as an outpatient under general anesthesia.The pockets of infection are removed and the buttock crease is adjusted. After the operation, the buttock crease will be slightly flatter. This usually heals in a couple of weeks without any packing or special dressings. There is a small drain that is placed and removed in a few days.

We welcome long-distance referrals. We are familiar with treating out-of-town patients, and do our best to accommodate their travel schedules; frequently we see the patient for their first visit in the morning, and perform surgery later that same day. Dr. Immerman’s pilonidal surgery is routinely performed at the OakLeaf Surgical Hospital, in Eau Claire, WI. This is a small surgical hospital, perfectly suited to this type of outpatient surgery, which was ranked by Consumer Reports as the number one hospital in the nation in patient satisfaction in 2009.

At Evergreen Surgical we have had extensive experience with pilonidal disease. Not all surgeons perform cleft closure, but we are very excited about the excellent results that we have achieved with our patients.

We welcome self referrals from patients with this problem, and often make arrangements to see out of town patients for care of this frustrating problem.

If you would like more information, or would like to make an appointment, please call our office directly at 715-832-1044, or email us.

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