What is a pilonidal sinus
A pilonidal sinus, also known as sinus pilonidalis or tailbone cyst, is a chronic change of the skin and subcutaneous tissue in the tailbone area, more precisely in the cleft above the end of the spine. In this area a channel or cavity forms beneath the skin in which hairs, skin cells and fluid accumulate. On the surface one or more tiny openings are often visible, from which content occasionally drains.
The basic cause is the penetration of hairs into the skin and subcutaneous tissue, where they act as a foreign body and cause constant irritation and inflammation. Predisposing factors are pronounced hairiness, prolonged sitting, increased sweating and friction in that area. For this reason the condition appears more often in younger adults and in those who spend most of the day sitting.
A pilonidal sinus in its course alternates between quiet periods and episodes of inflammation. In the quiet phase it may cause only mild discomfort or occasional discharge, while in the phase of inflammation pain, redness and swelling appear, and sometimes a collection of pus that requires urgent drainage. Without appropriate treatment the change most often recurs and spreads over time.
Conservative measures, such as hygiene and hair removal, can reduce the symptoms, but with a pronounced or recurrent sinus the lasting solution is surgical removal of all the diseased tissue together with the channels. The goal of surgery is to remove the source of the constant inflammation and reduce the possibility of recurrence.
When surgery is indicated
Pilonidal sinus surgery is recommended when the change causes repeated symptoms, when it frequently flares up or when there is a permanent channel with discharge. With a pronounced and recurrent disease, surgical removal is the most reliable way to break the cycle of constant inflammation.
In the case of a sudden, painful inflammation with a collection of pus, urgent drainage is often done first to calm the acute phase, and the definitive operation is planned later. The decision on the type and timing of the procedure is made by the surgeon after an examination, taking into account the state of the skin and the extent of the change.
- Repeated painful inflammation in the tailbone area
- A permanent opening in the skin from which fluid or pus leaks
- Swelling, redness and tenderness in the cleft above the buttock area
- Pain when sitting, driving or standing for longer
- Occasional leakage of clear or cloudy content
- An unpleasant odor or moisture in that area
- A collection of pus that requires urgent drainage
- Recurrence of the change after earlier treatment
How pilonidal sinus surgery is performed
The goal of surgery is to completely remove the diseased tissue with all channels and openings, because only in this way is the source of constant inflammation broken. The surgeon first assesses the extent of the change and its borders, and then removes the entire sinus in healthy tissue together with the surrounding altered part of the skin and subcutaneous layer.
After removal there are several ways of managing the wound. In one approach the wound is left open to heal gradually, from the depth toward the surface, with regular dressing changes. In another approach the wound is closed with sutures, sometimes with special techniques of shifting the skin so that the incision line is moved out of the cleft itself, thereby reducing the possibility of recurrence. The choice depends on the size of the change, the state of the tissue and the surgeon's assessment.
Regardless of the chosen technique, it is key that the diseased tissue is removed completely and that the wound is cared for properly during healing. Tidy wound care and hair removal from that area during the recovery period contribute significantly to a lasting result.
Preparation
Preparation for pilonidal sinus surgery begins with an examination at which the surgeon assesses the extent of the change, the state of the skin and any inflammatory phase. If the area is actively inflamed, the acute condition is sometimes calmed first, and the definitive operation is planned when the conditions for healing are more favorable.
Good preparation of the skin and hygiene of that area are also important for a successful outcome. It is useful for the doctor to know everything about your earlier episodes, therapies and general health, so the technique and the way of managing the wound can be planned.
- Tell the doctor how often and how long you have had symptoms
- State earlier interventions or drainage in that area
- Report chronic illnesses, especially diabetes, and medications you take
- Follow the instructions on fasting if wider anesthesia is planned
- Maintain tidy hygiene of the area and prepare for regular dressing changes
- Arrange help at home for the period of wound care and limited sitting
The procedure, anesthesia and duration
Pilonidal sinus surgery is, depending on the extent of the change and the chosen technique, performed under local, spinal or general anesthesia. The most suitable form is decided before the procedure, in agreement between the surgeon and the anesthesiologist, taking into account your condition.
The procedure itself most often takes a shorter time, usually up to an hour, depending on the size of the sinus and the way of managing the wound. During the operation you feel no pain, and the team monitors your condition the whole time. When finished, the wound is dressed with an appropriate bandage, adapted to whether it was left open or closed with sutures.
For most patients this is a procedure after which you go home the same or the next day. Before leaving you receive detailed instructions on wound care, the way of dressing, the position when sitting and follow-up appointments.
Recovery
Recovery after pilonidal sinus surgery requires patience, because the wound in this area, due to its position and movement, heals more slowly than in other places. With an open wound, healing proceeds gradually, from the depth, with regular dressing changes that are a key part of success. With a closed wound, care is taken of the sutures and straining of the incision line is prevented.
During recovery it is important to reduce pressure on that area, avoid long sitting on a hard surface and maintain tidy hygiene. Hair removal from that area and proper care further reduce the possibility of recurrence. The return to usual activities is gradual and agreed with the surgeon at the follow-ups.
- Change the dressing regularly exactly according to the team's instructions
- Avoid long sitting and pressure on the wound area
- Keep the area clean and dry and follow the instructions on bathing
- Remove hair from that area in the way the doctor recommends
- Do not strain the area with sudden movements and lifting
- Report increased pain, redness, pus or a raised temperature
Possible risks
Pilonidal sinus surgery is safe and routine, but like any intervention it carries certain risks. Because of the position of the wound and the tendency of this area toward irritation, proper care and patience during healing are especially important. An open conversation with the surgeon helps you understand the possible outcomes and recognize the signs that require contact.
- Slower wound healing due to the position in the cleft
- Wound infection with redness, pain and discharge
- Bleeding or a collection of fluid in the procedure area
- Separation of the wound edges when closed with sutures
- Recurrence of the sinus despite removal of the tissue
- A tender or more prominent scar in that area
Why Medical Time
At the Medical Time center in Belgrade we resolve the pilonidal sinus thoroughly, with the aim of removing the source of constant inflammation and reducing the possibility of recurrence. The entire journey, from assessment to guiding recovery, is followed by an experienced surgical team with clear wound care instructions.
- An experienced surgical team and thorough removal of the diseased tissue
- A choice of technique adapted to the extent of the change and the state of the skin
- A clear plan of wound care and regular dressing changes
- Careful monitoring throughout the healing period
- Advice for reducing the risk of recurrence
Price — pilonidal sinus
The price of pilonidal sinus surgery depends on the extent of the change, the chosen surgical technique, the type of anesthesia and the course of wound care, so the final amount is determined only after an examination and assessment of the condition.
For an accurate and individual estimate it is best to come for a consultation, where you will receive a proposed operation plan, the way of managing the wound and all the necessary information in advance.
- Examination and surgeon's assessment before the operation
- Pilonidal sinus surgery with removal of the tissue
- Dressing changes and follow-up examinations during recovery
For an individual estimate and an appointment, call 062-399-888.
Frequently asked questions
The main cause is the penetration of hairs into the skin and subcutaneous tissue in the tailbone area, where they act as a foreign body and cause constant irritation and inflammation. Prolonged sitting, pronounced hairiness and increased sweating further contribute to its formation.
Hygiene and hair removal can reduce the symptoms, but with a pronounced or recurrent sinus the change most often returns. The lasting solution is surgical removal of all the diseased tissue.
The procedure itself is performed under anesthesia, so during the operation you feel no pain. After the procedure tenderness in the wound area is possible, which is eased with prescribed therapy.
In one approach the wound is deliberately left open to heal gradually from the depth, with regular dressing changes. Such a way sometimes reduces the possibility of recurrence, and the choice of technique depends on the surgeon's assessment.
Recovery requires patience because the wound in this area, due to its position and movement, heals more slowly than elsewhere. The duration depends on the size of the change and the way of managing the wound, and the course is monitored at the follow-ups.
Tidy hygiene, regular hair removal from that area in the way the doctor recommends and avoiding prolonged pressure on the area significantly reduce the possibility of the sinus recurring.
In the first period it is recommended that you avoid long sitting and pressure on the wound area. The manner and duration of the restriction are agreed with the surgeon, because they depend on the chosen technique and the course of healing.