Dr. Immerman performs a procedure called the Bascom Cleft-Lift. This is a unique operation because it flattens the gluteal cleft, and moves the incision away from the midline so it can heal quickly. This procedure is also called “cleft-closure”, and has become Dr Immerman’s procedure of choice because of his high success rate. this includes patients who have had multiple previous operations. He has had extensive experience with patients who have had chronic open wounds or have open wounds close to the anus. 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 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.
It is important to understand that just because a procedure is called a “cleft-lift” by one surgeon, doesn’t mean it is the same procedure when performed by another surgeon. There is an extreme amount of variation between what surgeons are doing and calling a cleft-lift. We have seen many failed cleft-lifts performed by other surgeons, that do not look anything like the procedure that we perform. This web page shows the difference between a successful and an un-successful cleft-lift.
The cleft-lift is more challenging after previous failed operations
The basic cleft-lift operation works best for pilonidal disease up on the area around the sacrum where it usually begins. In patients who have had surgery that has failed, the situation can be drastically different for several reasons. One is that extensive tissue removal can interfere with the skin needed for the cleft-lift flap. Also, there are often openings and sinus tracts extending downward toward the anus – outside the area usually treated by the standard cleft-lift procedure. Most surgeons do not have a surgical strategy for dealing with these wounds and relegate the patient to prolonged local wound care, which may or may not be successful. Dr. Immerman has had extensive experience with dealing with these re-operative situations, and often can successfully extend the cleft-lift to treat these very low openings. However, these are the kinds of difficult cases that on rare occasions require a second procedure to get control.
Overall, in Dr. Immerman’s hands this procedure has a 98% success rate with one operation. However, as mentioned above there are situations when a second procedure is needed to adjust the anatomy a bit further. Our philosophy is to address these situations as soon as they are recognized, and proceed with a second procedure if necessary. These second procedures have been very successful.
About “Success Rates”
It is important to understand that although specific operations have names and “success rates” associated with them, all the various operations for pilonidal disease are very dependent on the ability and experience of the specific surgeon for their success or failure. You may read that the cleft-lift has a “success rate” less than described in this web site – and that is the result of combining the results of many surgeons and ascribing a “success rate” to the procedure.
The numbers we present here are based on Dr Immerman’s specific patients, and the actual success rate may vary from year to year – but has remained in the 97-99% range for the last few years. As time goes by, it is possible that our patients will develop recurrence and the numbers will go down, but we haven’t see this happen yet. We have had patients develop recurrences as far as a year or so postop, but this is unusual.