Treatment of Pilonidal Cysts, Bascom Procedure (Cleft Lift)

What are pilonidal cysts?

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. His results are excellent, with approximately 90% of his patients demonstrating complete primary healing after one procedure, and 98% complete primary healing when the few patients that required a second procedure are included.

"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
Surgeons are taught to remove all the visible disease and either attempt closure (which usually fails), or give up on the idea of primary healing. When that happens, they 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 buttock crease (natal cleft). A deep buttock crease remains moist at almost all times, promotes growth of bacteria, and creates negative pressure which sucks hairs into enlarged pores. Any procedure that does not address the configuration of the buttock crease has a high failure rate. But, unfortunately, procedures that do not address the cleft are done the most frequently in the United States and Canada.

What we do differently, and why you should consider us.
The procedure that Dr. Immerman performs attempts to flatten the cleft, and move any incisions off of the midline so they can heal quickly. This is often easier said than done, and on infrequent occasions more than one procedure is needed - particularly in patients who have already had multiple previous excisions, a very deep cleft, or disease adjacent to the anus. This procedure is much more successful than excision and primary closure, or excison alone.

Dr. Immerman does a procedure called the Bascom procedure. This procedure, also called "cleft closure" or "cleft lift" has become his procedure of choice because of his 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 self referrals. We are familiar with treating out-of-town patients, and do our best to accommodate their travel schedules; frequently we see a patient for their first visit in the morning, and perform surgery later that same day. Although traveling far from home may seem overly complicated, having this problem resolved without months of dealing with open wounds may actually be the more efficient way to deal with this problem. 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 (see ranking).

Eau Claire is easily accessible via Interstate 94, just 90 miles east of Minneapolis, MN. It is also reachable by air via Minneapolis/St. Paul International Airport (shuttle service available from MSP to Eau Claire) or by a connection through Chicago (United Airlines) directly to the local Chippewa Valley Regional Airport.

Dr. Immerman is a provider for many insurance products. Our staff will help with filing all insurance claims and assist in determining coverage for any procedures we perform.

More Information
If you are interested in more information about pilonidal disease visit our Evergreen Surgical Pilonidal Clinic Website ( If you would like more information, or would like to make an appointment, please call our office directly, Monday through Friday: 715.832.1044 -- 9am to 5pm, or email us. If you are interested in a medical journal article written by Dr Immerman on his series of patients having the Cleft-Lift Procedure, follow this link.