Surgery for Pilonidal Cyst

A pilonidal cyst is a pocket filled with fluid that also contains body hairs found at the natal cleft just right below the coccyx.

It could either be symptomatic presenting with pain due to infection or an inflammation or asymptomatic. It most commonly occurs in men of the Caucasian race.

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Surgery for Pilonidal Cyst

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A pilonidal cyst is a pocket filled with fluid that also contains body hairs found at the natal cleft just right below the coccyx.

It could either be symptomatic presenting with pain due to infection or an inflammation or asymptomatic. It most commonly occurs in men of the Caucasian race.

Other risk factors include deep natal clefts seen in obese people or people with big buttocks, very hairy people are predisposed as well as a positive family history of pilonidal disease is a contributory factor.
It comes about when an ingrown hair through an enlarged hair follicle stimulates an immune response that leads to inflammation around the area especially when pressure or trauma is applied, a cyst is then formed.
Intense pain, lower back swelling, reddening of the affected region are some of the inflammatory signs associated with the pilonidal cyst. If severe, leaking pus can be seen from the affected site, this is usually due to trauma to the area. With any infection comes fever but it is very uncommon in this case.
Asymptomatic cases generally require no immediate treatment because the quality of life is not affected. Symptomatic cases, however, need urgent management due to the intense dysfunctional pain and swelling around the affected region.

Indications

Surgery is recommended for these symptomatic cases for faster symptomatic relief and easier management. There are two ways in which surgery can be applied; incision and drainage and pilonidal cystectomy. Surgery is required because once a cyst has become infected it will not be responsive to any antibiotics. The cyst is removed if the infection has been recurring.

How is the procedure done?

  • Incision and drainage

Incision and drainage is the procedure of choice for a first time pilonidal cyst. It is a very
simple procedure that can be done in an outpatient setting with very few complications. The
length of the procedure is short if compared to cystectomy; besides, it takes a short time for
the wound to heal. However, the recurrence rates have been reported to be high with this
procedure thus a pilonidal cystectomy is advised. The patient is counseled about the
procedure before it is carried out. The affected area is sterilely readied for the procedure and
a local anesthetic is administered around the region, lidocaine is the preferred choice. An
incision is made on the cyst and drainage ensues. The wound is thoroughly washed with an
antiseptic and packed with gauze and strapped with a sterile dressing. The patient is put on
antibiotics to prevent or manage infection and painkillers for the pain. The wound remains
strapped for at least 2 days after which the dressing can be removed. Healing generally takes
approximately about 2 weeks depending on the extent of infection and size of the cyst.
Complications of incision and drainage may include wound infection, poor wound healing,
especially in diabetics and cyst recurrence.

  • Pilonidal cystectomy

Pilonidal cystectomy is the preferred choice of management for recurrent infected pilonidal
cysts or a chronic pilonidal disease. It is done in theatre under general or regional anesthesia
as an outpatient procedure. It involves complete removal of the cyst with or without the
surrounding skin, highly dependent on whether the cyst is infected or not. If the cyst is not
infected, an incision on the skin is made, the cyst is removed and the incision is stitched into
place. If infected, the incision is made, the cyst together with a part of the surrounding structures are excised. The wound is then packed with sterile gauze and left open for
continuous drainage of the fluids that collect after surgery.

Risks

Some of the risks of this procedure may include infection, bleeding at the site, cyst recurrence if it was not fully removed. If the wound was not fully packed with gauze, the wound tends to heal superficially and this might lead to the formation of an abscess.

Recovery

The stitches are to be removed in two weeks, meanwhile; the patient is put on antibiotics and painkillers and can be discharged from the hospital on the same day or in two days depending on the procedure. The wound takes a minimum of 8 weeks to fully heal to as close as 6 months. The patient is discharged and advised on good wound care to minimize the risk of infection.

Outcomes

The wound heals and forms a scar that fades off with time. Patients can go back to work or their usual activities in about 2 weeks. A diet rich in fiber is advised as constipation is a common occurrence during recovery usually because of the pain medication. Regular showers are advised to keep the wound clean. High success rates have been recorded with this procedure.