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Dr. Bernhard Hofer & Kollegen - Treatment centre for the Pilonidal SinusMunich region

Pilonidal Sinus?

Welcome to our specialist clinic for the Pilonidal Sinus

Bump on your butt? Pain over the tailbone? Moisture or blood on the laundry? Unpleasant smell? Or did you just happen to notice a small opening in the gluteal fold?

If you are familiar with these symptoms, you probably suffer from one (Sinus Pilonidal SinusPilonidalis, lat. for hair nest dimples)

Since 2004 I have specialized in the treatment of this disease and in 2012 I founded the treatment center for it Pilonidal Sinusin the heart of Munich.

On these pages you will learn everything you need to Pilonidal Sinusknow about the diagnosis:

  • How is the diagnosis made?
  • Is surgery necessary?
  • Are there alternative treatments?
  • How to avoid complications and a protracted healing process?

We have put all the important facts on this homepage. Here you will also find innovative therapy options. Some can already be found in the expert guidelines, but not every doctor knows them. Our specialists Dr. Hofer, Dr. Bärtl and Dr. Schuster will advise you on all therapy options.

For all those who want to know more about it, subpages with detailed information are currently being created. Have a look more often, we fill the page almost daily with new information.

Didn't find what you were looking for? This page is still under construction. Visit the main page of our practice for more information: Proctological Practice Dr. Hofer Munich

Info: What is a Pilonidal Sinus (synonym Pilonidal Cyst, Tailbone Cyst)?

Fistula is the name given to a tubular duct that does not occur in healthy people as a result of inflammation. At the coccyx the cause is often the storage of hair in the subcutaneous tissue. The technical term Sinus pilonidalis literally means "hair nest" (Latin pilus 'hair' and nidus 'nest') A pilonidal sinus has nothing to do with the bone of the coccyx or an embryonic malformation ("dermoid cyst, sacral dermoid"). The body cannot break down the keratin that makes up the hair. As a result, the hair is surrounded by a capsule of scar tissue. Bacteria penetrate through the opening of the hair root, which is called the porus or pit. The inflammation can be chronic (= Pilonidal Sinus) or acute (= coccyx abscess).

Can one Pilonidal Sinusalso be created by other mechanisms? Which factors influence the risk of getting onePilonidal Sinus? What can be done for prevention or in the early stages? How do you distinguish an anal fistula Pilonidal Sinusfrom an inverse acne? Answers to these questions can be found on our page Origin of a Pilonidal Sinus.

Diagram Pilonidal Sinuslateral
Pilonidal sinus lateral view

Pilonidal Sinus - not rare at all

... and yet rarely seen in a non-specialized institution

The frequency of this Pilonidal Sinusis increasing: Every year, 48 out of 100,000 inhabitants suffer from a coccyx fistula, men three times more frequently than women. Most of them are between 15 and 40 years old. Approximately 50,000 patients are operated on in Germany every year. In other words, every surgeon in Germany treats only 1.4 patients Pilonidal Sinusper year. In contrast, we see more than 1000 patients diagnosed with pilonidal sinus every year.

Picture of Pilonidal Sinus
Sinus Pilonidalis, clearly visible the tiny primary openings (pits)

A job for the expert

To which doctor at Pilonidal Sinus?

Usually the patient is referred to the surgeon. There's surgery coming up. The supposedly minor intervention can have unexpectedly large consequences. Complications or a disturbed or missing wound healing make further treatments necessary. The result may be an inability to work for many months. Or the fistula on the tailbone keeps coming back: The relapse rate (medical: recurrence rate) is stated to be up to 57 % after conventional surgery (Deutsches Ärzteblatt 2019).

For this reason, it is important to consult an expert experienced and specialised in the treatment of the pilonidal sinus right from the start.

We have the experience

Decide now for a targeted and gentle treatment

Good decisions are based on experience.

John U. Bascom M.D., pioneer of modern pilonidal surgery, Eugene/Oregon U.S.A., 1925 - 2013

Our specialists Dr. Bernhard Hofer, Dr. Klaus Bärtl and Dr. Susanne Schuster will be happy to advise you on diagnosis, treatment and last but not least aftercare and prevention of Pilonidal Sinus. Your appointment for a non-binding consultation with our specialists is now just a mouse click or phone call away.

An extensive operation and/or a hospital stay are almost never necessary. Our treatments can be performed painlessly under local anesthesia and on an outpatient basis.


Surgery for coccyx fistula (as at 14.11.2019)


Treatments for coccyx fistula (as at 14.11.2019)


Experience since 2012 in laser therapy and laser surgery

Private and statutory insurances

Full approval for examination and treatment by insurances

Dr. Bernhard Hofer

Dr. Bernhard Hofer

Chief Physician, Founder
Specialist in surgery, visceral surgery and proctology.

Dr. Klaus Bärtl

Chief Senior Physician and Deputy Senior Physician
Specialist in visceral surgery, emergency doctor. Employee doctor of the practice.

Dr. Susanne Schuster

Conservative consultation hours
Specialist in surgery. Conservative consultation. Employee doctor of the practice.

Our ratings

Patients are satisfied with our advice and treatment

Experience & Reviews about Pilonidal Sinus Center Munich
Visceral surgeons (abdominal surgery)
in Munich on jameda

Surgery for sinus pilonidalis

Is there a cure without an operation? How to choose the best technique of surgery!

In the pilonidal sinus there is almost always hair completely embedded under the skin. You can't see them from the outside. As a result, shaving and intensive wound treatment can lead to the closure of a fistula opening. However, this apparent healing is not permanent. The fistula keeps bursting open. Physical rest, bathing in a sitz, train ointments and antibiotics also help only temporarily. At the very least, these measures can save time in order to plan gentle treatment.

All fistulas will heal if they are not kept open. A pilonidal sinus is a foreign body - fistula, where hair is the foreign body. If the hair is removed, the fistula will heal.

Peter H. Lord and Douglas M. Millar, founders of the pit picking operation for the Pilonidal Sinus, BRIT. J. SURG, 1965, Vol. 52

Radical excision with open wound treatment ("butcher method")

The story of the operation that Pilonidal Sinusbegins with an error
Pilonidal Sinus OP incision
Cutting guidance during the conventional cutting of a Pilonidal Sinus

When the diagnosis of pilonidal sinus became increasingly common at the beginning of the last century, especially among soldiers in the World War ("Jeep's Disease"), it was considered a congenital disease involving an embryonic malformation.

In other words, a relapse (recurrence) could not occur after complete removal. However, after recurrences were observed, the extent of the operations continued to expand. This radical distance (Latin 'radix', root) became established worldwide. Although this theory has been refuted since Patey, most surgeons still adhere to this outdated therapy concept today.

Cutting out with plastic wound closure (flap plastic)

Karydakis - OP, Limberg Flap, Dufourmentel Flap
Operation after Karydakis at Pilonidal Sinus
Mobilisation of the flap during the Karydakis operation

Although obvious, the closure of the surgical wound by suture is often unsuccessful. The suture in the midline often leads to disturbances in wound healing and infections. The result is that the seam must be broken or reopened.

Only a suture shifted to the side (medically: lateralized) can be promising. The prerequisite for such a suture, however, is a large-area detachment of the skin and subcutis from the base, the so-called mobilization of a flap. In our experience, the best results are achieved with Karydakis plastic. A correct cut in this technique, introduced by a Greek military surgeon, requires great experience. Even with optimal implementation, the rate of wound healing disorders is stated to be up to 20 %.

Less is more

How to avoid complications and shorten the healing time

The usual procedure after radical surgery, which is still recommended in many textbooks and guidelines, is open wound treatment. The often 5-10 cm long and 3-5 cm wide wound should slowly fill with scar tissue. To avoid a superficial, premature closure, the wound cavity is often stuffed with a tamponade.

The special conditions in the area of the gluteal folds with constant movements, shearing forces, mechanical stress during sitting, moisture and bacterial colonisation of this region hinder normal wound healing. As already mentioned, the attempt to close the wound by suture has its pitfalls.

Typical problems after conventional pilonidal sinus surgery

9 reasons to think about the best surgical technique
  • Long healing period from months to years
  • Necessity of complex and painful wound treatments
  • Frequent wound healing disorders
  • Frequent recurrences due to hair growing into the wound bed
  • Tearing open the scar after wound closure by suture or plastic reconstruction
  • Repeated hospital stays and operations
  • Loss of income and career break due to long and repeated incapacity to work
  • Restrictions on athletic fitness and weight gain
  • Limitations of body feeling and sexuality
Pilonidal Sinus Inflammation of gluteal fold

The Alternative: "Pit Picking 2.0"

Pit Picking Operation, Laser - OP (SiLaC®), Sinusectomy, Endoscopy (EPSiT)

Laser Hair Removal
Laser hair removal as a supplement to pit picking surgery

On the basis of the "new" products developed in England and becoming popular in the USA pit-picking technique we offer various variants of this gentle treatment. Pit-picking refers to the selective removal of the affected hair roots as skin cylinders with a diameter of 2-5 mm and the cleaning of the fistula tract from deposited hair fragments.

The more perfectly this goal is achieved, the lower the risk of recurrence. Depending on the respective findings, laser treatment of the fistula from the inside using a glass fibre probe (SiLaC®) or precise peeling of the fistula capsule (sinusectomy or fistulectomy) is best suited.

With long and branched fistulas, optimal safety can be achieved by video endoscopic control (endoscopic pilonidal sinus therapy EPSiT).

Follow-up treatment after Pilonidal Sinus-OP

Optimize healing process and avoid relapses

No matter how far away you live away from us - we guide you on the process of healing with advice by mail and telephone. And with permanent hair removal using a state-of-the-art diode laser, we offer surgery and relapse prevention from a single source.

Pit picking under the guidance of Dr Bascom
With this little parcel from Pit Picking pioneer John U. Bascom M.D., the history of today's Pilonidal Sinus Center in Munich began.

Why a treatment centre?

This is how the idea of specializing in the coccyx fistula came about.

It must have been about 2003. After completing my specialist examination, I was entitled to operate without supervision. The first procedures waiting for a young surgeon are the supposedly simple ones - like the removal of a pilonidal sinus. In the specialist training, the complete excision of the fistula region down to the bone, which is today called the "butcher method" by many patients, was taught. My friend and colleague Dr. K. had to undergo a painful wound treatment lasting nine months after such an operation.

Pit picking according to Bascom picture
Pit picking: The ingrown hair root is removed as a tiny cylinder of skin. Bascom used an additional lateral incision, which we can avoid in most cases with grown routine today.

A revolutionary new method

to treat the Pilonidal Sinuscomes from England and the USA

"There must be another way," were his words, which I couldn't get out of my head. My research led me to the method of Dr. John Bascom. from the USA, the original from Dr. Peter Lord "Pit Picking". At that time, communication was still analogous. For this reason, a package of instructions, a video CD and self-drawn graphics gave the go-ahead to try a different way of healing onePilonidal Sinus.

Despite an initial success rate of only about 50%, the patients were happy to have escaped the standard operation. As a result, more and more inquiries came in. Today we achieve cure rates of almost 90% and operate in the year 800 - 1000 patients from all over the world. From this we have learned that minimally invasive techniques are not only suitable for a first operation. Rather, it can also be used to help patients with relapses and non-healing wounds after radical surgery.

Current guideline Pilonidalsine

Ommer, A., Berg, E., Breitkopf, C., Bussen, D., Doll, D., Fürst, A., Herold, A., Hetzer, F., Jacobi, T., Krammer, H., Lenhard, B., Osterholzer, G.., Petersen, S., Ruppert, R., Schwandner, O., Sailer, M., Schiedeck, T., Schmidt-Lauber, M., Stoll, M., Strittmatter, B., & Iesalnieks, I. (2014). S3 guideline: Sinus pilonidalis. coloproctology, 36(4), 272-322.

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