Pilonidal Sinus Surgery

Conservative treatment

Conservative treatment of a pilonidal sinus is aimed at managing symptoms and preventing recurrence, especially in mild or early-stage cases. Good hygiene is key – this includes regular cleaning of the area, keeping it dry and removing hair through shaving or laser treatments to prevent hair buildup in the sinus tract. Lifestyle changes such as avoiding prolonged sitting, maintaining a healthy weight and wearing loose clothing can also help to reduce pressure and friction in the affected area. In mild cases of inflammation or discomfort, warm compresses can help, and a short course of oral antibiotics can be prescribed if an infection is present. Another minimally invasive option is phenol injection, where a chemical is used to cauterise the sinus tract and promote healing. While these non-surgical options can work in some cases, they may not eliminate the sinus. Chronic or recurrent cases usually require surgical intervention for long-term resolution.

Various surgical procedures are available, each tailored to the severity and specifics of the condition. The goal of these pilonidal surgery options is to clean the sinus, promote healing and prevent further infections.

Initial consultation

During the consultation, your consultant colorectal surgeon will decide on the best surgical procedure for you based on your condition and other factors. Common surgical options are incision and drainage, wide excision and endoscopic pilonidal sinus treatment – each with its own benefits and recovery time.

Pre-operative assessments

The pre-assessment clinic, usually held 2 weeks before the operation, involves routine blood tests and health evaluations to ensure you are fit for surgery. The anaesthetist will discuss the anaesthesia with you, and any necessary adjustments to your medications will be made. This evaluation identifies potential issues that could impact the surgery, so you are well-prepared.

Pre-surgery instructions

You will be given specific pre-surgery instructions to avoid complications. Fasting is usually required, so you should stop eating or drinking after midnight before the surgery, including clear liquids. If you eat or drink before the surgery, make sure to inform the doctor or nurse immediately.

Pilonidal sinus surgery usually involves general anaesthesia, meaning that you will be unconscious and pain-free during the operation.

Incision and drainage

Incision and drainage is a common method for acute infections or abscesses associated with pilonidal sinus disease. In this procedure, a small incision is made to allow the pus to escape and reduce the infection and inflammation. This procedure has a high success rate, especially for localised infections and provides immediate relief from symptoms.

The procedure is straightforward, and patients can go home the same day. Post-procedure wound care and hygiene are key to preventing recurrence and promoting healing.

Wide excision

Wide excision is a more extensive surgery where the entire cyst and a significant portion of the surrounding skin are removed. This is usually recommended for chronic or recurrent pilonidal sinus disease and aims to eliminate the sinus and any potential sinus tracts.

After the surgery, the wound is usually left open to heal naturally, which can take several weeks. Regular dressing changes and proper wound care during this period ensure a smooth recovery and help prevent infections.

Endoscopic pilonidal sinus treatment

Endoscopic pilonidal sinus treatment is a minimally invasive option where a flexible tube with a camera is used to perform the surgery. This reduces the pain and recovery time, making it a preferred choice for many patients. The endoscopic approach allows for precise removal of the sinus tract with minimal damage to surrounding tissues.

Patients who undergo this treatment usually have a quicker return to normal activities and less post-operative discomfort compared to traditional surgical management. This minimally invasive option is ideal for those who want faster healing and less risk of complications.

The choice of wound closure depends on the extent of the surgery and the surgeon’s preference for primary closure. Proper wound care is crucial to ensure healing and prevent complications like bleeding or wound reopening.

Surgery takes about 30-45 minutes, and patients are then transferred to the recovery room for nursing staff to monitor.

Immediate aftercare

Right after your surgery, it’s important to keep the wound area clean and dry to support healing. Follow your healthcare team’s instructions closely, especially when it comes to wound care. This includes daily cleaning of the natal cleft area to help prevent infection.

You’ll likely be prescribed pain relief and laxatives to manage discomfort and keep your bowel movements regular. Try to avoid sitting for long periods—staying mobile helps your recovery. Maintaining proper hygiene and caring for the surgical site can greatly reduce the risk of post-operative infections.

Long-term recovery

Healing from pilonidal sinus surgery typically takes between 6 to 8 weeks, depending on the type of procedure you had. During this time, avoid heavy lifting and prolonged sitting to minimise strain on the area and promote healing.

Be aware that pilonidal sinus disease can recur, and wound healing may be slower if you have certain health conditions or if you smoke. Engaging in light activity, as advised by your healthcare provider, helps improve circulation and supports a smoother recovery.

Potential risks and complications

There’s a risk – up to 30% – that pilonidal sinus disease may come back, especially if you’re overweight or have coarse body hair in the affected area.

Infection is a common complication and may lead to abscesses, causing pain and swelling. If your wound doesn’t heal properly, you might experience discharge, which could require antibiotics. To avoid issues with bowel movements, do your best to prevent constipation or straining – this can reduce pressure on the surgical site.

Regular care and monitoring are key to managing these risks effectively.

Follow-up and long-term care

You’ll usually have a follow-up appointment about two weeks after surgery, especially if stitches need to be removed. These check-ins are important, as they help catch any early signs of complications and make sure your recovery is on the right track.

If you notice any concerning symptoms more than a week after surgery, don’t hesitate to contact your GP. Complete wound healing may take 8 weeks or longer, so staying on top of follow-up appointments is essential for a full and successful recovery.