• False: The recovery from cleft-lift is prolonged and painful. The recovery from cleft-lift is one of the easier recoveries when compared to the various other procedures for pilonidal disease. Most patients say that the pain is minimal, and they only take analgesic pain medications for a few days. There are no open wounds, packing, or shaving. There is a small drain that is left in place for a few days, and removed in the office. Most patients are back to full activity, except contact sports, within a week. Here is a link to a post on our Facebook Page with what our patients think about the ease of their recovery.

 

    • False: Cleft-Lift is a “new” procedure. It depends on your definition of “new”. Dr Bascom began writing about this in the early 1990’s, and his operation is a modification of one by Dr Karydakis which was described before that. Dr Immerman has been performing this since 1993, and now has a 99% success rate.

 

    • False: Most surgeons don’t perform the cleft-lift because it doesn’t work. The cleft-lift, as with every procedure, has a learning curve. If it is not done properly, it will not work, so it is important to see a surgeon who has experience and success with the procedure. Most surgeons were not taught this procedure during their residency training and had to learn it afterwards. At our clinic the success rate is 99%.

 

    • False: Not all patients with pilonidal disease are “candidates” for a cleft-lift. In medicine, anything is possible, but in the last twenty years we have never seen a patient in whom a cleft-lift was not possible. Certainly, in some patients it is more difficult than others. If a patient finds that their surgeon does not feel that they are a candidate for a cleft-lift, they should investigate whether they can find a surgeon who is more comfortable with difficult cases. We have been successfully operating on patients who have failed other operations for many years.

 

    • False: I’m seeing a board certified surgeon, and he is recommending wide excision – so I should follow his/her advice. In general, the advice given by a board certified general surgeon or colorectal surgeon is good and should be followed. But, in this specific situation there seem to be many surgeons who are not familiar with the cleft-lift procedure, and therefore do not address it. If it is not discussed by your surgeon – you should find a surgeon who is familiar with the procedure.

 

    • False: The cleft-lift is best done by a colorectal surgeon. It is strange that pilonidal disease is categorized as a colorectal problem, since it has no relationship to the colon or rectum. Many colorectal surgeons are not interested or experienced in the treatment of this disease – but others are. General surgeons and plastic surgeons may or may not have an interest in this. Dermatologists, to my knowledge, are not skilled in the cleft-lift procedure. The best guideline for finding a surgeon is to look for one who is experienced and interested in treating pilonidal disease. Our bias is that he, or she, should be experienced with cleft-lift also.

 

    • False: The cleft-lift procedure should be reserved for difficult, severe, or recurrent disease. Different surgeons will have different criteria for when a cleft-lift is appropriate. Some will reserve it for recurrent disease, but others view it as the first line procedure for anyone with symptoms and a deep gluteal cleft. Dr Immerman’s personal observation is that patients don’t want the most minimal treatment, they want the most effective. Recurrences are demoralizing, disruptive, expensive, and painful. Over the last 20 years we have gone from recommending it only for the most severe cases, to recommending it to any patient with symptomatic pilonidal disease and a deep cleft. This is based on our observations, high success rate, and our attempt to get patients through this problem as quickly and pain free as possible.

 

    • False: If I have wide excision and it fails, I can always have a cleft-lift later. This is usually true, but the scarring and distortion from the excision will usually make the cleft-lift more difficult. In addition, the recurrent disease often appears very close to the anus, which also makes the cleft-lift harder, and may affect the success rate.

 

    • False: The cleft lift has a high postoperative infection rate. In our clinic, we have about a 2% infection rate with the cleft lift. This is much lower than any of the other procedures for pilonidal disease.

 

    • False: I’ll save time and money by seeing a local surgeon who does not perform cleft-lift. If my disease comes back, I’ll travel to see someone who does. This may or may not be wise. There are times when open excision results in prolonged healing, time off of work and school, expensive dressing changes, wound-vac application, multiple office visits, and significant discomfort. In general, the most successful procedure is also the most cost effective. In our opinion, a successful cleft-lift will be the most cost effective in the long run, even if you factor in out-of-pocket travel expenses

 

    • False: A cleft-lift will significantly change the appearance of my buttocks. Although the procedure flattens the cleft, once things heal, the contour appears relatively normal – just not the way it was before. With clothes on, there is usually no visible change in the size of the buttocks. There is usually a vertical scar off the center-line on one side or the other. If you would like to see a examples of how a post-op cleft-lift looks, click here. Be aware that this is a gallery of photos of buttocks with scars! At four weeks the scar will be pink. The color should fade over 6-12 months.

This link will take you to a discussion of the various procedures used for treating pilonidal disease.