Before & After

Please be aware that the following before and after photos of patients may be considered graphic by some.  If you do not wish to view surgical photos of patients please go to another screen.

Please note, that except where indicated, patients are photographed lying on their stomachs with their buttocks in view.  So the left side of the photo represents the left side of the patient.

Here are two photos to demonstrate the natal cleft and how it is hidden from view when one is standing.  The first photo shows a pilonidal sufferer standing.  The verical black lines mark the line of skin contact of both buttock cheeks.  The horizontal line serves a reference to the horizon and is marked as the lowest part of the buttock exposed when a patient sits on a chair.

Cleft with chair line

Please note how the natal cleft is completely hidden and there is not sign that the patient has a chronic pilonidal problem.

Natal Cleft

In this photo the patient’s buttock cheeks are spread apart to reveal a deep cleft or valley.  The shaded area is the natal cleft.  Multiple dilated midline pits and a sinus draining to the top right (better seen in other, non-shaded photos below) are revealed.

Here is a classic example of very symptomatic, primary pilonidal disease. This patient, a male in his early 20s, has developed several large dilated midline pits (previously infected hair follicles) and a draining sinus off to the upper portion of his natal cleft.

classic_pilonidal_example_vert

These photos show a patient who has suffered for 6 years with pilonidal disease. He has undergone 3 operations by other surgeons, all of which have broken down resulting in a much worse pilonidal problem.

Dr. Sternberg performed a cleft lift procedure and he rapidly recovered. The post-op photo was taken only 3 weeks after surgery. For the first time in years, he was able to return to athletics.

Here is an example of college student who has suffered from pilonidal disease since mid high school.

He had 3 previous operations from other surgeons, all of which failed. You can see that he developed a huge chronic open wound very close to the anus. His natal cleft is very scarred from the prior operations, which involved a wide excision and midline closure.

Dr. Sternberg performed a cleft lift procedure. He ends up with an excellent post-op result.

This photo demonstrates the island of skin that is typically removed during a the cleft lift procedure (outlined on the right).

pilonidal debris
Here is a photo of the debris and hair commonly removed from the chronic abscess of a chronic pilonidal sufferer at the time of cleft lift surgery.

Post-op photo showing drain

Here is an immediate post-op photo of a a young female patient with a ‘passive drain’ (the blue double rubber band). This patient is lying down on her stomach and her head/torso is to the left in the photo. The passive drain is placed through the skin coverage flap to allow fluid that accumulates under the skin flap to drain so that the flap will stick and heal to the underlying tissue.

Complete-with-drain-web

Here’s an immediate post-op photo of a patient with steri-strips and drain in place. This is the drain configuration that I use now. The drain comes through the lower portion of the skin incision and passes through a skin opening that I create near the top of the flap. The drain is a loop and can be rotated.

Pilonidal Surgery

This website should help you with this important decision: what is the best surgical option for...

1) primary disease with multiple or large pits,
2) persistent or recurrent disease,
3) an unhealed wound after one or several pilonidal surgeries

Dr. Jeffrey Sternberg

Dr Jeffrey Sternberg is a leading Colon and Rectal surgeon.Dr. Sternberg is active in the national leadership of the American Society of Colon and Rectal Surgeons and has been elected President of the Northern California Chapter of the American Society of Colon and Rectal Surgery. Extending his commitment to the care of patients with Inflammatory Bowel Disease, Dr. Sternberg serves on the Board of Directors of the Northern California Chapter of the Crohn’s & Colitis Foundation of America.

Surgical Director
Center For Inflammatory Diseases
California Pacific Medical Center

Clinical Assistant Professor
of Surgery

University of California San Francisco

Contact Dr. Sternberg through San Francisco Surgical Medical Group.
415-668-0411
415-923-3020