La Peer Colorectal Surgeons Now Using Cutting-Edge Pilonidal Disease Treatment

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The rhomboid flap technique used by colorectal surgeons at La Peer Health Systems offers numerous benefits over traditional treatments for pilonidal cysts.

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The rhomboid flap is a clever technique that takes advantage of geometry, to reduce the tension on the wound, which minimizes the risks of wound breakdown and recurrence of disease.

Often described as a painful bump over the tailbone or between the buttocks, pilonidal disease is an abnormal skin pit that afflicts an estimated 0.7 percent of the general population. In its simplest form, pilonidal disease is asymptomatic and may not require treatment beyond maintenance of personal hygiene. When infected, a pilonidal cyst can become quite painful and may require surgery as the only definitive therapy.

For years, surgical treatment of pilonidal disease has involved removal of hair and other debris from the infected tissue. During the traditional procedure, the affected tissue was removed down to the sacral bone. The surrounding tissue would then be re-approximated for a simple closure. Unfortunately, due to tension on the tissue in this region, wound failure rates approximating 50% have been reported. Given this high rate of failure, most surgeons have adopted the open wound technique of treatment, which while mitigating the rate of wound breakdown (since the wound is left open from the get go), leaves a wound that will slowly heal over the course of several months.

At the La Peer Department of Colorectal Surgery, however, physicians are using an innovative method known as a rhomboid flap to enhance surgical outcomes.

“The rhomboid flap is a clever technique that takes advantage of geometry, to reduce the tension on the wound, which minimizes the risks of wound breakdown and recurrence of disease,” said Dr. Allen Kamrava, a La Peer colorectal surgeon. “When surgery is necessary, the rhomboid flap approach provides patients the greatest chance of both curing the disease and maximizing post-operative comfort.”

Treatment for a pilonidal cyst depends on severity of discomfort and progression of the infection. In the acute setting, a simple incision and drainage is performed to remove infection. Once the active inflammation has subsided, however, surgical removal of the entire segment of diseased tissue is the only way to minimize the risk or recurrence.

During the outpatient surgical procedure, a rhomboid-shaped skin flap is created and the infected tissue around the pilonidal cyst is removed. In several peer-reviewed studies, the rhomboid flap method has demonstrated the lowest reported wound failure rates and recurrence rates.

According to Gary H. Hoffman, MD, a board-certified colorectal surgeon at La Peer Health Systems, the condition is most common in post-pubertal young adults. Factors that may increase the risk of disease include poor personal hygiene, obesity, and local trauma.

“Early evaluation of a pilonidal cyst is crucial to limiting disease progression and reducing the risk of recurrence,” said Dr. Hoffman. “If an infection does occur, individuals should know that with the proper care from an experienced surgeon, the condition is highly curable.”

In the last year, 26 of La Peer's surgeons were reviewed by peers and given the Patient's Choice Award. The Patients' Choice honor is given to doctors who provide incredible service to their patients. In 2012 alone, more than 200,000 patients across America provided reviews and feedback regarding their personal treatment and experiences with doctors. The Patients' Choice award is given to doctors who receive rave reviews for their work and dedication in their medical field.

La Peer Health Systems is an outpatient surgery center in Beverly Hills, founded by doctors and focused on providing excellent patient care alongside the most cutting-edge medical treatments available. With 50 world-renowned physicians in 14 specialties, comprehensive medical treatment is offered that takes patients from consultation to diagnosis, treatment, surgery, and ultimately aftercare. The 14 medical departments include orthopedics & sports medicine, gastroenterology, head & neck surgery, colorectal & general surgery, podiatry, ophthalmology, pain management, plastics & reconstructive surgery, gynecology, spine surgery, interventional cardiology, bariatric surgery, thoracic surgery, and anesthesiology. Unlike large hospitals, La Peer's unique structure offers extremely personal care in a safe and controlled environment.

More information about La Peer Health Systems can be found at

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Risa Luksa

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