Pilonidal sinus infection and surgical treatment

What happens if you require surgery for pilonidal sinus infection? Mr Manoj Sen FRCS (Eng), consultant general and emergency surgeon with specialist knowledge and esteemed experience in colorectal surgery, shares his expert knowledge in this procedure.

What is a pilonidal sinus infection?

A pilonidal sinus is a condition which affects the natal cleft, which is a very small stretch of soft tissue in between the buttocks overlying the tail bone.  It consists of little pits, numbering one or several which occur usually in the midline between the two buttocks.

It is a condition which affects younger people between their late twenties and mid-forties and is more common in men over women.  It is also more likely to occur in people with dark hair rather than lighter hair.

These pits may be observed in many people who have no problems at all and can even be an incidental finding when the doctor examines the area for another condition which may be totally unrelated.  Therefore, a pilonidal sinus is not necessarily a condition which will give rise to problems and trouble for the patients.

When does pilonidal sinus infection require surgical treatment?

A pilonidal sinus can get infected with the infection festering in the small pits mentioned above and this can even give rise to repeated bouts of infection with a foul-smelling discharge or even an abscess formation with formation of pus around the area, intense pain and a light fever.  These conditions require surgical treatment.

In a vast majority of cases where a pilonidal sinus gets infected the patient would require a general anaesthetic as the operation itself would be quick and is easily tolerated by the patient. More often than not, it only involves an overnight stay after surgery in the hospital.

Is anaesthetic used during pilonidal sinus surgery?

In a minority of cases, where the sinuses become chronic or persistent and the patient has no acute symptoms, a smaller procedure is possible especially if it involves a very small area in the natal cleft. A local anaesthetic has been used by some surgeons. It is entirely a matter of the surgeon’s preference.

What happens during surgery for pilonidal sinus infection?

A whole team is dedicated to performing the surgery for pilonidal sinus infection.  This would include the consultant surgeon and his assistance, the anaesthetist and the theatre scrub team.  Equally, if not more important, is the after care of the patient and nurses experienced in wound care and tissue care are an essential part of this treatment. This is because this phase could carry on for weeks and even a few months following surgery.

With the anaesthetised patient we usually lie them on the front on the operating table or on his or her side.  If it is a case of a pilonidal abscess, it is then drained and all the diseased tissues scraped away, cleaned and washed out.  The hole is then packed with a special dressing which absorbs all the secretions from human tissue and this would then take several weeks to heal from the bottom upwards.

In a minority of cases where the sinus is not left open but actually stitched together in the form of what is known as a ‘flap’ (for example, a Limberg flap and more complicated flaps which are usually performed by a plastic surgical team).  The recovery time is shorter provided the wound heals.  This could take up to two weeks.

How long does pilonidal sinus surgery last?

Most cases are performed as day cases, the minority being done with the patients staying overnight.  The surgery itself rarely lasts for more than one hour and the patient is sure to return to work after a fortnight and if it is a small procedure done under local anaesthetic (circumstance permitting) they could return to work within the week.

When can I return to work and activity after surgery for pilonidal sinus infection?

A lot depends on what sort of work the patient is doing and if it is a desk job that should not cause any problem.  What must be avoided is a shearing force which takes place between the two buttocks of any human being sliding in opposite directions, when they walk, climb or run a lot and this should be done in moderation or even avoided in the immediate post-surgical period. Therefore, I advise my patients not to over-exert themselves following surgery so as to allow the area to heal properly.

What is the success rate of pilonidal sinus surgery?

The success rate of pilonidal sinus surgery is difficult to quantify.  The most successful operation is when the area is excised in its totality and left open without stitching to heal slowly by nature. This is a longer process and could take from a month to three months but if proper tissue care is taken after the operation and the patient keeps the area shaven and devoid of any ingrowing hair, the success rate is very high. In fact, this method carries the highest success rate of all of them.

Operations where the wound is closed are less successful.  This is because there is always a wound breakdown rate which varies from patient to patient.  Naturally patients that have diabetes and who have poor healing powers will take longer to heal.

There is a significant recurrence rate which varies from 10 to 20 per cent in the best of hands.

Do you require surgical treatment for pilonidal sinus infection? If you would like to find out more about the procedure or require advice regarding other colorectal conditions, get in touch with Mr Manoj Sen FRCS (Eng). Find his Top Doctors profile here.