Three Points to Ponder with Pilonidal Sinus Surgery

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by SoniaV. SoniaV. (New)

Specializes in community health nurs. Has 25 years experience.

The best operative management for Pilonidal Sinus Surgery is mostly dependent on the type of surgical procedure being considered along with healing time, post-op care, and reoccurrence prevention.

After repeat appearances, The Pilonidal Abscess needs to stay gone!

Three Points to Ponder with Pilonidal Sinus Surgery

Pilonidal Cyst Overview

A pilonidal cyst is a tunnel that usually forms in the coccyx area, filled with ingrown hair, and skin waste.  If it becomes infected it grows into a painful abscess filled with pus and/or blood. The American Academy of Family Physicians indicates acute treatment is often incision and drainage with a 60% success rate.  In the other 40%, the abscess returns, or several sinuses may form. Most common in younger people with sedentary life or work style. This chronic condition is known as Pilonidal Sinus Disease. The patient lives with a persistent skin condition, knowing that it's there even when you don't feel it, enduring the incision and drainage with every flare-up.

Surgical Treatment

The next step the doctor might recommend is the surgical removal of the pilonidal tract altogether. To help narrow down the best procedure for the patient, because no one procedure is preferred over all the rest, three topics to consider are:

  1. Healing time depends on the chosen procedure
  2. Post-op care and prevention of infection
  3. No guarantee of a cure, it has the possibility of recurrence even after surgery

Healing time depends on the chosen procedure

The objective of pilonidal sinus surgery is to remove all or as much of the cyst and surrounding tissue. Seal the sinus to keep it free of debris.  National Library of Medicine article listed four main methods for operative management of Pilonidal Sinus Disease:

  1. Incision & Drainage
  2. Excision and healing by secondary intention
  3. Excision and primary closure
  4. Excision and reconstruction flap techniques

Depending on the procedure, the surgical treatment may involve local or general anesthesia, outpatient or hospital stay, and post-op dressing changes upon discharge home.  Complete recovery can be from 1-3 months, depending on the chosen procedure. 

It also mentioned a new move toward endoscopic treatment such as Video Assisted-Ablation of Pilonidal Sinus (VAAPS) and Endoscopic pilonidal sinus treatment (EPiST).  It requires local anesthesia, usually no dressing changes, other than wound evaluation, and keeping up with good hygiene practices in the area. Patients' general time off from work is between 1-5 days without complications. This newer approach does take longer to perform and requires specialist, expensive equipment.

Post-op care and Infection prevention

Standard principal of wound care will apply and patient education upon discharge.  The patient should keep any follow-up appointments with the doctor. There will be prescribed pain medication because of pain in the coccyx area, and abstain from vigorous activity at least for a month.  No sitting for long periods on hard areas or surfaces.  Use a donut cushion to sit on.  Follow wound care as per doctors' instructions to prevent infection or recurrence.  Instructions on when to contact the doctors such as fever, drainage from the incision, escalating pain, redness, warmth to touch, or inflammation near the incision.  There might be scarring to the area, but it usually fades with time.

No Guarantees

Sadly pilonidal sinus disease can come back even after surgery.  For example, an excision technique leaving the wound open has shown a low recurrence rate, but a longer healing time.  This procedure will require general anesthesia, some days in the hospital post-op, not to mention a lengthy recovery (8-10 weeks).  If the patient does not adhere to wound care instructions as prescribed, a new sinus can form or the site becomes infected.  Following preventive measures will be the key to keeping the cyst from forming again.  Performing and maintaining hair removal procedures, like laser hair removal, waxing, or using hair removal products every 2-3 weeks may prevent the cyst from coming back once healing has been completed. 

Conclusion

Pilonidal Sinus Disease is unbearable during a sudden flare-up, The awkwardness of receiving treatment in a private area of the body is uncomfortable, and the loss of workdays indirectly affects the patient in the long run. The encouraging news is there are several options to contemplate.  The best source to talk to regarding what will best fix the sufferer’s chronic condition is to speak to the treating surgeon or patient’s doctor. Postoperatively, implementing improved lifestyle changes such as avoiding a sedentary way of life and keeping up with hair removal practices might prevent the return of a cyst back into existence.


References

Pilonidal Disease Management: Guidelines from the ASCRS

Pilonidal sinus disease: Review of current practice and prospects for endoscopic treatment

Pilonidal Cyst Surgery Procedures and Recovery

What Causes a Skin Abscess?

What Is a Pilonidal Cyst?

Pilonidal cyst

SoniaV.

SoniaV. has 25 years experience and specializes in community health nursing.

2 Articles   2 Posts

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3 Comment(s)

Rogue1

Rogue1

Specializes in Pediatrics. Has 6 years experience. 32 Posts

Interesting article--thank you!  I work in peds so I see this on a regular basis, but I did not realize recurrence can be so tenacious.  From the outside it can seem like not such a big deal but for the patients battling it (especially the older ones) it is horrible.

nursej22, MSN, RN

Specializes in Public Health, TB. Has 37 years experience. 2,364 Posts

My husband had surgery for this when he was in high school, excision and closure with no recurrence.

He took antibiotics off and on as a kid, but with onset of adolescence and coarser body hair it became intolerable.

 

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My son had pilonidal cyst surgery. There are 3 surgeons in the country who use a cleft procedure…where they operate and smooth out the cleft between the buttocks and I believe move it a little off center. It’s much less invasive, the recovery time is much shorter, and the recurrence rate is something like 2 percent. I have no idea why we are allowing surgeons to operate the traditional way, remove huge amounts of tissue, to just have the problem recur.