Patient Information - Summary
The term pilonidal sinus comes from Latin and means “a cavity containing hair.” It refers to an inflammatory condition occurring along the cleft between the buttocks, where small openings may form on the skin surface, leading to pockets beneath the skin. These pockets typically contain loose hairs that have become embedded.
Pilonidal disease most commonly affects teenagers and young adults. Symptoms may include pain, swelling, and local discharge. In some cases, it can progress to an abscess that requires urgent surgical drainage.
Treatment Options
1. Wide Excision Surgery
This traditional surgical approach involves complete removal of the affected area, including skin openings and underlying pockets. It is usually performed under general anesthesia.
The surgical wound may be left open to heal naturally (by secondary intention) or closed with stitches, depending on the surgeon’s preference.
Advantages:
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Technically straightforward procedure
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Requires only basic surgical skills
Disadvantages:
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Requires hospitalization
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Long healing time (up to several months if left open)
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Significant pain and activity limitations during recovery
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High risk of wound infection and delayed healing
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Recurrence rate of approximately 10–20%
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Recurrence often requires repeat wide excision
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Noticeable scarring and cosmetic deformity
2. Minimally Invasive Surgery
This approach involves the targeted removal of each pilonidal opening and thorough cleaning of the sinus tracts, without large tissue resection. It is often performed under local anesthesia (though general anesthesia may also be used).
Advantages:
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No hospitalization required
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Rapid recovery – most patients return to normal activity within a few days
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Minimal pain due to small surgical wounds
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No stitches
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Very low infection risk
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Repeatable in case of recurrence
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No significant cosmetic damage
Disadvantages:
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Recurrence rate of about 15–20%
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Success depends on the surgeon’s experience and technique
Postoperative Care
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Wash the surgical area with regular soap and water twice a day, starting the day after surgery.
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Keep the surgical wounds covered with gauze pads, placed between the buttocks to keep them apart. Secure the gauze with adhesive tape.
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In cases of delayed healing or rapid hair regrowth in the area, local hair removal with a depilatory cream is recommended once or twice a week, until healing is complete.
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For postoperative pain, you may take Metamizole or Paracetamol – up to 4 tablets per day. For stronger pain, you may use ibuprofen-based painkillers (e.g., Nurofen, Advil, Motrin).
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Follow-up with the surgeon is important to ensure proper healing and to prevent hair from entering the wounds.
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You may return to work and regular daily activities within a few days (in minimal procedures). Avoid cycling, running, and swimming in public places until healing is complete and as advised by your surgeon.
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Seek urgent medical attention if any of the following symptoms appear: fever above 38°C, increasing pain, swelling of the surgical site, or bleeding that does not stop with thick dressing and local pressure.
Recurrence of Pilonidal Disease
Pilonidal disease may recur months or even years after surgery, regardless of the treatment method.
Recurrence is more common in younger individuals and often results from continuing disease activity and the formation of new tracts and openings in the cleft area.
New skin openings or non-healing wounds may require further surgical treatment.
If operative wounds remain open for a prolonged period , weekly local hair removal using a depilatory cream, along with continued wound dressing and buttock separation, can promote closure.
Laser hair removal, once healing is complete, may reduce the risk of recurrence based on preliminary research findings.
