Pilonidal Sinus Surgery

Living with pilonidal sinus disease can be physically and emotionally taxing. Its symptoms can interfere with daily activities, work, and social interactions, leading to frustration and reduced quality of life.

While conservative measures may provide relief, surgical intervention is usually necessary for long-term management. 

Pilonidal sinus: causes and symptoms

Causes

A pilonidal sinus, or pilonidal cyst, occurs when a small hole or tunnel forms within the skin, typically in the crease between the buttocks, just above the cleft. This condition usually develops when hair penetrates the skin and causes an infection, leading to a cyst or abscess.

Risk factors for this condition include obesity, a sedentary lifestyle, excessive sweating, and poor hygiene. Men are at higher risk of developing pilonidal sinus due to having more body hair than women. 

Symptoms

When infected, pilonidal sinus presents symptoms such as:

• pain
• swelling
• redness
• the formation of a pus-filled abscess

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Acute pilonidal abscess

When a pilonidal sinus becomes infected, it develops into an acute pilonidal abscess. The cyst turns into a painful, swollen lump filled with pus. 

The underlying cause of an acute pilonidal abscess is often the introduction of bacteria into the pilonidal cyst, commonly through the penetration of hair follicles or the accumulation of dirt and debris in the intergluteal cleft. Once bacteria enter the cyst, they proliferate rapidly, causing an immune response and the accumulation of pus within the abscess cavity.

Acute pilonidal abscesses may cause intense discomfort and require prompt medical attention. Without the appropriate treatment, repeated infections can escalate the risk of developing squamous cell carcinoma, a form of skin cancer. 

Chronic pilonidal sinus

Chronic pilonidal sinus represents a persistent or recurrent form of pilonidal disease. Unlike the acute phase, marked by the sudden onset of symptoms, chronic pilonidal sinus tends to develop gradually, with patients experiencing recurrent episodes of abscess formation, drainage, and discomfort.

Prolonged friction and pressure in the intergluteal cleft, hair penetration, and follicular occlusion contribute to the formation of sinus tracts and the development of chronic inflammation. Bacterial colonisation within the sinus cavities could also perpetuate the infection cycle and abscess formation.

Conservative treatment

While surgical intervention is often required for pilonidal sinus, there are conservative treatment methods that can be beneficial. Conservative treatment options for pilonidal sinus may provide temporary relief and include:

• Keeping the affected area clean and dry
• Using warm compresses to reduce pain and inflammation
• Taking pain relievers
• Shaving or hair removal in the affected area to prevent recurrence

If the patient continues to experience symptoms despite conservative treatment, elective surgery for pilonidal sinus disease may be an option to consider.

Surgical treatment

Surgical intervention is often necessary for managing pilonidal sinus, especially in chronic or recurrent disease cases. Several surgical procedures may be performed depending on the severity and extent of the condition. These include:

• Incision and marsupialisation
• Excision with primary closure
• The Bascom procedure
• The Karydakis procedure

Each of these procedures targets the pilonidal sinus differently, offering varying benefits.

Incision and marsupialisation

The incision and marsupialisation procedure begins with the abscess being incised, typically under local or general anaesthesia. This incision facilitates the drainage of pus and debris accumulated within the sinus tract, providing immediate relief to the patient. The surgeon then meticulously removes any hair or foreign matter from the sinus tract to prevent future episodes of infection.

Following this, the wound's edges are left unstitched, remaining open to promote healing from the inside out and reduce the recurrence risk.

Excision with primary closure

Excision with primary closure is a surgical technique commonly employed to manage smaller or uncomplicated pilonidal sinus tracts. Unlike marsupialisation, which leaves the wound open, this approach involves the complete excision of the sinus tract and surrounding tissue, followed by wound closure with sutures. 

Excision with primary closure poses a lower risk of postoperative complications compared to open wound healing techniques like marsupialisation.

Bascom procedure

The Bascom procedure, or cleft lift surgery, addresses pilonidal sinus disease, particularly in complex or recurrent cases. It involves the removal of the sinus tract and subsequent reconstruction of the affected area to minimise the risk of recurrence.

The Bascom procedure sees the complete excision of the sinus tract and affected tissue, followed by reconstruction of the surgical site. This differs from conventional methods that primarily focus on drainage or cyst removal, as it aims to eliminate the underlying pathology to reduce the risk of recurrence.

Karydakis procedure

Like the Bascom procedure, the Karydakis method aims to address the underlying pathology but employs a different method of wound closure. The procedure focuses on flattening the buttock cleft and creating a clean, flat wound surface to promote healing and lower the risk of recurrence.

The Karydakis procedure begins with the excision of the sinus tracts and affected tissue to remove the source of infection and inflammation. Following excision, the wound edges are sutured together to flatten the buttock cleft, promoting a smooth, flat wound surface.

Unlike traditional closure methods, which may leave the wound raised or uneven, the Karydakis technique's flat wound surface minimises the potential for hair and debris accumulation, reducing the risk of recurrent infection.

Recurrent pilonidal disease

Despite surgery, some patients still face a recurrence of pilonidal disease after treatment. This is often due to the infection of the wound, or abscess formation, which may lead to the formation of a new sinus tract inside the healing wound. 

The recurrence of pilonidal disease can also occur due to:

• Failure to lessen the depth of the natal cleft
• Poor wound care
• Lack of depilation (hair removal) around the wound

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Preventing recurrence of pilonidal sinus

While recurrence cannot be entirely eliminated, the following measures can help reduce the chances of recurrence.

1. Maintain good hygiene: Regularly clean the affected area with soap and water and pat dry. Avoid using harsh or irritating products that could exacerbate inflammation.
2. Hair removal: Since ingrown hairs play a significant role in developing pilonidal sinus disease, removing hair from the affected area can prevent recurrence. 
3. Manage moisture and friction: Wear loose-fitting clothing to allow air circulation and reduce sweating. Change out of sweaty clothing promptly after physical activity.
4. Adopt healthy lifestyle habits: Maintain a healthy body weight and be physically active to reduce pressure and friction in the buttock area. 
5. Follow postoperative care instructions: If you have undergone surgical treatment for pilonidal sinus disease, diligently adhere to your healthcare provider's postoperative care instructions. 
6. Consider preventive antibiotics: Surgeons may prescribe antibiotics to prevent infection recurrence. Follow your provider's recommendations regarding antibiotic therapy and complete the prescribed course as directed.

Pilonidal sinus surgery by The Colorectal Clinic

Surgery is often effective for individuals suffering from pilonidal sinus, providing long-term relief and improved quality of life. If you're experiencing symptoms of pilonidal sinus, consult with a specialist to explore the best treatment options available.

Under the guidance of Dr Wong Soong Kuan, The Colorectal Clinic offers support to patients before, during and after pilonidal sinus treatment. We ensure the surgical approach suits the patient's specific needs and provides the best outcome for each patient.

Schedule a consultation now.

Frequently Asked Questions

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