Pilonidal Sinus Surgery Procedure, Recovery Time & Complications

A pilonidal sinus or PNS is a round sac of tissue that flares up on the top/crease of the buttcoks or the cleft. It causes a little hole or tunnel in the skin, which may get filled with pus or fluid, and ultimately lead to the formation of a cyst or abscess. Typically, skin infections are the leading cause of Pilonidal Sinuses. This condition is actually quite common, however, the affected individuals find it embarrassing and refrain from seeking treatment. Untreated pilonidal sinus stands the risk of getting infected, causes immense pain, and can also hamper your day to day activities.

When Should You See A Doctor For Your Pilonidal Sinus?

Some individuals have noticeable pilonidal sinus symptoms, while others don't. It usually starts appearing as a dimple-like depression at the cleft. However, when it gets affected, it grows into a cyst i.e., a closed sac containing fluid, or an abscess i.e., a swollen and inflamed tissue filled with pus. An infected pilonidal sinus typically causes the following symptoms:

• Pain while standing or sitting
• Red, sore skin around the cyst
• Swelling of the cyst
• Pus or blood in the cyst or abscess, along with a foul odor
• Protruding hair from the lesion
• Multiple holes or sinus tracts in the skin

What is Pilonidal Sinus Surgery?

Cases in which a Pilonidal sinus gets infected or stands the risk of becoming a cyst or abscess, surgery becomes requisite. Generally, surgeons use the following surgery methods to treat Pilonidal sinus:

Lancing: This procedure is performed under local anesthesia, and reduces the pain caused by the cyst or abscess. In this procedure, the doctor opens the abscess with a scalpel and extracts the dirt, blood, hair, and debris. The patient is sedated with anesthesia first. After cleaning, the doctor uses a sterile dressing to promote healing. The healing process usually lasts 4 to 6 weeks, and in most cases, no follow-ups or additional treatment is needed.

Open surgery for pilonidal sinus: Individuals with recurrent PNS or more than one sinus tract often require open surgery for pilonidal sinus. Open surgery for pilonidal cystectomy is of two types, Incision and drainage, and Pilonidal Cystectomy.

Let's learn about these two open procedures in detail

Doctors perform this open procedure under local anesthesia. It allows the patient to remain at ease during the surgery. Incision and Drainage becomes necessary when the cyst becomes infected. The surgeon starts by making an incision in the cyst, which allows the pus and infectious fluid to flow out. Next, the empty hole is packed with a gauze, and left open to heal. The recovery period after this procedure is 4 to 6 weeks. Till then, the patients are required to change the gauze at regular intervals. Also, to prevent the cyst from flaring up again, avoid shaving, waxing, or getting a laser hair removal.

If your pilonidal cyst is recurring, Pilonidal Cystectomy will be the best option for you. In simple words, Pilonidal Cystectomy is a traditional procedure performed to extract the cyst completely. It is done under general/regional anesthesia, which keeps the patient comfortable. During the procedure, the surgeon makes cuts to remove the affected area, in addition to the tissues, dead cells, and hair follicles. The doctor will examine the size of the cyst, and may or may not use surgical gauze to cover the area. If the infection is severe, the doctor might use a tube to drain the infectious fluid in the cyst. The tube will be taken off only after the cyst is completely free of fluid. This is done to prevent the infection from recurring.

Laser pilonidal sinus treatment-

Laser Pilonidal Sinus surgery is becoming popular by the day, mainly because it's a non-invasive procedure which doesn't cause scarring. In this procedure, the surgeon cleans the sinus, and then uses a high-intensity laser beam to destroy the tract and seal the sinus. The surgeon ensures that the entire pit of the sinus is removed, so the infection does not occur again. The procedure ensures higher precision in comparison to the above mentioned procedures, and causes little to no discomfort. Also, there's no wound, so only one day of dressing is required. On top of that, the laser energy ensures faster healing of the wound, which lets the patients ease back into their normal lives in no time.

Diagnosis Procedure

Any surgeon will perform a thorough diagnosis of the affected site before suggesting surgery. This allows the surgeon to understand the severity of the condition, and chalk out the best treatment plan. Doctors usually perform the diagnosis in the following steps:

Physical Examination

During the physical examination, the doctor will look at the affected area to diagnose the condition. Physical examination is enough in cases of complex and severe pilonidal sinuses. The doctor will also ask you about your symptoms, and medical history.

Digital examination: In this diagnostic test, the proctologist inserts a gloved and lubricated finger into the rectum to check for abnormal growths. Digital examination also helps the doctor figure out the depth of the tunnel and the extent of the disease.

Visual inspection: In this test, the doctor will use a proctoscope, anoscope, or sigmoidoscope to examine the lower rectum. The doctor will use these devices to examine the lining of your anal tissues. This helps the doctor check for the severity and growth of the tissues.

Lab swab test: In very rare circumstances, the proctologist will ask the patient to get a lab swab test. During the test, the doctor takes tissues from the affected area and sends them for a biopsy. The test is done to check if the tissues have grown cancerous to determine the best line of treatment where the pilonidal sinus grows severe.

How To Prepare For Pilonidal Sinus Surgery?

If you're planning to get Pilonidal sinus surgery, make sure that you're completely prepared for the surgery. Being prepared will keep you comfortable throughout, and would also support your recovery later on. So, here's how you can prepare for your Pilonidal sinus surgery:

1) In most cases, doctors ask patients to refrain from consuming water, food, or any other fluids for eight hours before the treatment. Why is it important? The presence of food within the digestive system can cause complications at the time of surgery.

2) Make sure you take all the drugs prescribed by the doctor before the surgery. Additionally, avoid taking medicines that your doctor has advised you to stop taking. Doctors usually ask patients to avoid drugs such as blood thinners, aspirin, anti-inflammatory medicines, etc, for a week before the surgery. Also, follow your doctor's instructions completely to avoid complications.

3) Carry all your medical reports at the time of surgery. Also, make sure you have an attendant with you.

4) You will be asked to keep the surgical area clean and dry after the surgery. So, make sure you take a shower before the surgery.

What Are The Risks Of Pilonidal Sinus Surgery?

Pilonidal surgeries aren't really complex. However, every patient must be aware of the risks and complications associated with the procedures. On that note, here are some potential risks and complications associated with pilonidal sinus surgery:

Trauma and bleeding: Cases in which the doctors perform the surgery inefficiently, there's a risk of trauma. It may be caused due to injured anal tissues. The injury may then lead to bleeding. The risk of trauma and bleeding is higher in pilonidal sinus open surgery. However, it also depends upon the experience of the surgeon performing the procedure.

Infection: Patients getting the pilonidal sinus surgery also stand the risk of developing infections. These infections can occur at any point during the surgery, especially in cases of open surgery. They are also common in patients who do not take proper measures to let the site heal properly.

Reaction to anesthesia: Some patients are allergic to anesthesia, but are unaware. Therefore, they can experience the side effects of anesthesia. This isn't very dangerous, and usually causes drowsiness and nausea. However, if these side effects do not subside after some time, get in touch with your doctor.

Squamous cell carcinoma: This complication is incredibly rare, but it has been reported in some cases. Squamous Cell Carcinoma is a type of skin cancer that occurs due to an abnormal growth of the squamous cells.

Even though these complications are quite rare, it's always good to be aware. Also, to minimize the risk of complications, one must get treated at the hands of an experienced surgeon. Additionally,make sure you discuss all these risks with your surgeon before the surgery. This will help you remain calm during the procedure. Additionally, taking care of the wound after the surgery is also incredibly important, and reduces the risk of complications.

Recovery After Pilonidal Sinus Surgery?

Typically, patients take 1 to 3 months to completely recover from Pilonidal Sinus surgery. After the surgery, the surgeon will give you some after surgery care tips that will help you recover faster. Follow these tips to a T in order to prevent complications, and ensure quick rec overy:

1. The surgeon might choose to leave the wound open or stitched. So, make sure you take complete care of the wound in both the cases.
2. Do the full course of medicines/antibiotics prescribed by the doctor.
3. Most people get back into their normal routine within a month of the surgery. Do visit the doctor for follow ups during this period, and get your stitches and wound checked.
4. If you experience any pain, take pain relieving medicines as prescribed by your doctor.
5. Avoid indulging in strenuous activities.
6. Don't sit on hard surfaces for prolonged periods.
7. Use a doughnut cushion. It will help prevent pain.