Treating Pilonidal Disease With Surgery

Pilonidal cysts, an uncommon and uncomfortable development, hinder walking, sitting, and lying down. If it doesn't settle, pilonidal illness develops. Pilonidal cysts hurt. If the growth becomes infected, it becomes difficult to treat without surgery. Pilonidal surgery removes the cyst and skin. Doctors explain why surgery is ideal, while many refuse and seek non-invasive treatments.

Who Is At Risk?

Certain people are at a higher risk of developing the pilonidal cyst. This is because of the inherent traits of the condition. It is more common in males because of their excessive hair growth. Obesity adds to skin flabs. This contributes to increased friction and pressure in the gluteal cleft, making the area vulnerable to irritation and infection. Failure to maintain proper hygiene and prolonged sitting hours or trauma can make the area sensitive. A family history of pilonidal disease is also common. 

Candidates For Pilonidal Cyst Removal Surgery

The idea of pilonidal cyst removal is to eliminate the cyst completely. Mild cyst may self-heal. Warm compress and Sitz Bath are effective ways to treat a mild pilonidal cyst. If the cyst increases in size or gets infected then non-invasive ways like incision and drainage help treat moderate cysts. 

A colorectal surgeon will recommend a cyst removal surgery if the symptoms are debilitating and the pain is excruciating. A surgery also becomes necessary if the condition is chronic and the rate of recurrence of pilonidal cyst is high. 

Indications Of Pilonidal Cyst Surgery

Surgical removal of the cyst is indicated if there is recurrent Infection. The surgical excision of the pilonidal cyst becomes essential as approximately 40 percent of them reappear following incision and drainage. A few people still experience lower back region stiffness and agony. If the  symptoms of the disease are prevalent, the surgical removal will help clear off the infected tissue. A pilonidal cyst surgery is unavoidable if the size of the cyst is big and area of infection is large. Lastly, if the patient fails to find relief from conventional treatment methods and antibiotic usage, the surgeon will definitely prescribe a surgical removal. 

Types Of Surgery 

Pilonidal surgery is the most widely recommended treatment option for permanent removal of the cyst. To remove the cyst completely and to lower its risk of recurrence, the surgeon may choose one of the following surgical approaches:

Incision And Drainage

As the cysts are typically filled with pus or fluid, to cut open the cyst and drain it is the standard line of action. This is done after numbing the area. A small cut is made in the infected part to drain out the debris. The patient will feel immediate relief from pain and pressure. 

The choice to leave the wound open or close it with sutures will depend on how big the cut or the incision was. But whatever is the case, it is important to follow post-operative guidelines fully. For a quick and complete recovery, the surgeon will prescribe antibiotics, painkillers, and instructions for proper wound care along with do’s and don'ts to follow in this phase. 

Removing The Pilonidal Cyst

For hard-to-treat cysts or where the symptoms are dreadful, the complete removal of the cyst becomes necessary.  The excision will involve the removal of the cyst, surrounding skin tissue and the sinus tract. The surgery is absolutely invasive and aims at complete removal of the infected portions. It may include one of the following:

• Wide Local Excision - The skin tissue surrounding the cyst and the overlaying muscles and sinus area is removed. The wound is not closed and is simply covered with a sterilized gauze. The healing happens bottom upwards and takes almost four weeks in total for complete recovery.  
• Excision With Marsupialization - Once the excision of the cyst is done as explained above, the wound is closed. For closing the wound, the edges of the cyst are stitched together. The sutures close the wound cavity. The wound site is nicely sealed and packed with dressing. Healing will happen in six weeks. Following the instructions is important to minimize the infection.  
• Rhomboid Flap Technique - For chronic cases of pilonidal cyst, a more comprehensive surgical procedure is required. It is called the rhomboid flap technique. In this the surgeon will remove the entire infected area. Once the wound cavity appears clear, it is packed with healthy skin taken from another part of the body. The skin grafting leaves no hollow space in the wound and therefore minimizes the risk of infection to regrow. The wound is sealed with sutures and packed with medical dressing. The healthy skin tissue will slowly fuse into the hollow cavity. This healing phase is long and can take up to six months. It is a major surgery and will require complete adherence with the after-care and  follow-up schedule.

Final Thoughts

It is advised to proceed with the surgical operation if the cyst is compromising daily activities and influencing quality of life. Before suggesting a treatment course, the colorectal surgeon will assess the degree of infection and the intricacy of the illness. Expert colorectal surgeon Dr. Allen Kamrava MD MBA Many of his patients have found respite from the difficult and taxing illness.