PILONIDAL SURGERY

A pilonidal cyst is a common skin condition that occurs at the base of the spine in the cleft between your buttocks and often they cause no problem. However, if a pilonidal cyst becomes infected then it can cause pain and swelling or even turn into an abscess. Pleas see under conditions for more information.

A pilonidal abscess can resolve itself or respond to a course of antibiotics. However, pilonidal surgery is often the only way to treat the cause of the abscess and remove all the infected tissue to prevent recurring cycles of infection and pain.

Frequently Asked Questions

If you have an abscess which has not responded to antibiotics then the only thing that can be done at the time is to drain the abscess under a genial anaesthetic. Once the infection has settled then you may need remedial surgery to prevent it happening again.

Pilonidal disease can be treated permanently so as to prevent the symptoms and cycles of infection. There are several ways this can be achieved some more invasive than others.

Minimal surgery or ‘pit picking’

This is where the pits are explored and cleaned out. This often leaves small openings that heal reasonably quickly. This method is not used very often and is only suitable when there is very minimal disease and only a couple of pits.

Excision (surgical removal) of the pilonidal tissue.

This is where the surgeon removes the diseased tissue completely. There is then a choice of creating some form of plastic surgery flap to cover the wound or to leave the wound open and packed for it to heal naturally from the inside. The are pros and cons to each approach and Mr. Stellakis will discuss which is your best option.

If you have been told that you need to have your pilonidal disease removed then you have choice as to whether to close the wound or to leave it open to heal by what is termed secondary intention. There are pros and cons of each approach and the final decision is normally down to you. If there is residual severe infection then the open approach maybe your only option.

Leaving it open to heal naturally

This is called the ‘bomb proof’ option as it rarely fails to achieve its goals. You can do pretty much what you want as soon as the initial discomfort of surgery settles. For example going to work and your normal daily activities. The down side is you may have a sizeable wound that needs attention every day for the first 2 to 3 weeks and then less so as time passes. You will have to attend the clinic on a daily basis to have the pack and dressing inspected and changed. This usually takes about 20 minutes. The interval between pack changes increases with time but bear injury mind it can take up to 3 months to heal and sometimes, rarely, even longer. Surprisingly the open wound is not painful and apart from the disruption to your day you can do what ever you want.

Closing the wound

Closing the wound means that it heals much more quickly and you do not need to come in on daily basis for dressing changes. That said you will need to attend a few times in the first 2 to 3 weeks to check on healing. You will also have a drain inserted into the wound at the initial surgery that will need to be removed approximately 3 days after surgery. This is done in outpatients and takes about  20 minutes.

Full healing takes place at about 2 to 4 weeks. The big disadvantage is that during the first 2 and sometimes 3 weeks you must absolutely not sit for any longer than 5 minutes on your bottom. This may not sound like much but is surprisingly disruptive to you daily activities. It means eating on your side, working on you side or standing up. Closing the wound involves the formation of some form of plastic flap and the problem with these is they can fail to heal and then break down so you are left with an open wound with daily packing. If this happens very occasionally you may need further surgery to clean it out which is a setback.  . With closure techniques Mr.Stellakis achieves full healing in approximately 90% of his patients. To achieve this though it is essential to follow the post operative instructions.

The recovery very much depends on whether the wound is close or left open. Please see other FAQs in the is section. Generally if left open full healing takes place by 3 months and if closed 3 to 4 weeks.

As with any operation there are always some risk of which you should be aware such as bleeding, infection and  the extremely rare risk of the anaesthetic.  For pilonidal operations there are some specific ones that are not generally serious but are  worth mentioning and depend on the type of operation that you have. These include failure of the wound to heal if it is closed; delayed healing if the wound is left open and recurrence of the pits. If they happen these complications can be managed. Wound breakdown occurs in about 10% of patients and can be reduced considerably if post operative instructions are followed. Rarely the wounds when healed are fragile and can sometimes breakdown at a later stage to a minor degree. Mr Stellakis will explain this in detail before surgery and discuss any concerns you may have.

Please refer to our information sheet for more details.

Open wounds

There are no real do’s and dont’s here. As long as you attend for you daily dressing pack change you can pretty much do what ever you want. It is probably best to bathe or shower just before coming in so it does not matter if the dressing pack falls out.

Closed wounds

For this to work you need to be very careful. Mr.Stellakis will create a bespoke plan for you but generally you must not sit on your bottom at all for first and possibly second week. Limited sitting time for upto 30 minutes its usually aloud in the 3rd week as long the wound is healing well. After the first 3 days you can have a daily shower and once the wound is dry you can apply another dressing. It is important after opening your bowels you are careful not to contaminate the wound whilst cleaning. Heavy exercise (ie gym work, cycling, running and sports) must be avoided until Mr.Stellakis states otherwise. Driving is not permitted in the first 2 weeks as it inevitably entails sitting down. Unfortunately ‘kneeling chairs’ are to be avoided as they create a shearing force on the wound.

Keeping the area hair free

This is essential to prevent recurrent pilonidal disease. You will have a complete shave of the area prior to surgery performed by Mr Stellakis or one of his team.  When you come back for visits and review the nurses or Mr Stellakis will remove any hair growing back and this includes lower back hair. Once everything has healed it is still important to remain hair free in that area and many people consider electrolysis or similar procedures for a more permanent solution.