Pilonidal Sinus Excision
What is Pilonidal Sinus Excision ?
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Why do you need Pilonidal Sinus Excision ?
Pilonidal sinus disease typically affects young adults (15–30 years), particularly men, and is associated with risk factors like prolonged sitting, obesity, excessive hair, or poor hygiene. Surgery is indicated for:
- Chronic pilonidal sinus: Persistent discharge, pain, or swelling near the tailbone.
- Recurrent infections: Multiple episodes of abscess formation or sinus drainage.
- Acute pilonidal abscess: Severe infection requiring incision and drainage, often followed by definitive excision.
- Failed conservative management: Symptoms not resolving with antibiotics, hygiene, or hair removal.
The procedure aims to remove the sinus tract and surrounding infected tissue, reduce recurrence, and promote healing.
Why Do Costs Vary in Philippines?
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Pilonidal Sinus Excision Procedure
The procedure is tailored to the extent of the disease, recurrence history, and patient preference:
- Before Surgery Evaluation:
- Diagnosis is confirmed via:
- Physical examination: Identifies sinus openings (pits), swelling, or discharge in the natal cleft (area between the buttocks).
- Imaging (rarely): MRI or ultrasound for complex or recurrent cases to map deep tracts or abscesses.
- Blood tests ensure surgical fitness, particularly for patients with comorbidities or active infection.
- Antibiotics (e.g., amoxicillin-clavulanate) are given pre-surgery for active infection or abscess.
- Patients are advised to shave or depilate the area to reduce hair-related irritation.
- Counseling addresses wound care, healing time, and recurrence risk.
- Diagnosis is confirmed via:
- Surgical Techniques:
- Incision and Drainage (for Acute Abscess):
- A preliminary step for infected pilonidal abscesses, performed under local anesthesia.
- The abscess is incised, drained, and packed to control infection, followed by definitive excision after 4–6 weeks.
- Excision with Open Healing (Secondary Intention):
- Performed under general or spinal anesthesia, lasting 30–60 minutes.
- The patient is positioned prone (face down) with the buttocks taped apart to expose the natal cleft.
- The surgeon excises the sinus tract, including all pits and surrounding infected tissue, down to healthy tissue (often to the presacral fascia).
- The wound is left open, packed with gauze, and allowed to heal naturally from the base up, reducing recurrence risk.
- Excision with Primary Closure:
- The sinus is excised as above, but the wound is closed with sutures immediately.
- Suitable for smaller, less complex sinuses with minimal infection.
- Healing is faster, but recurrence and wound breakdown rates are higher.
- Flap Reconstruction (e.g., Bascom, Karydakis, or Limberg Flap):
- Used for complex or recurrent pilonidal disease to reduce tension and recurrence.
- After excision, a flap of nearby skin and tissue (e.g., gluteal flap) is mobilized to cover the defect and flatten the natal cleft.
- The wound is closed with sutures, often with a drain to prevent fluid buildup.
- Takes 60–90 minutes, performed under general anesthesia.
- Minimally Invasive Techniques (e.g., Endoscopic Pilonidal Sinus Treatment, EPSiT):
- A newer approach using an endoscope to visualize and remove the sinus tract through small incisions.
- Offers less pain and faster recovery but is less common and requires specialized equipment.
- Incision and Drainage (for Acute Abscess):
- After Surgery:
- Patients are monitored for a few hours to ensure recovery from anesthesia and pain control.
- Pain medications (e.g., paracetamol, ibuprofen) and antibiotics (if infection persists) are prescribed.
- Open wounds require daily dressing changes and hygiene maintenance; closed wounds need suture care.
- Follow-up visits assess wound healing and recurrence.
Recovery After Pilonidal Sinus Excision
Recovery varies based on the surgical technique and wound closure method:
- Hospital Stay:
- Most patients are discharged the same day (outpatient) or within 24 hours.
- Flap reconstruction may require a 1–3 day stay for drain management and monitoring.
- Post-Surgery Care:
- Pain is moderate for 1–2 weeks, managed with oral painkillers and sitz baths (warm water soaks) 2–3 times daily to promote healing and hygiene.
- Open healing:
- Daily dressing changes are needed for 4–8 weeks until the wound heals completely.
- Patients must keep the area clean and dry, avoiding prolonged sitting.
- Primary closure or flap:
- Sutures are removed after 10–14 days; drains (if used) are removed within 3–7 days.
- Avoid pressure on the wound (e.g., sitting for long periods) for 2–3 weeks.
- Antibiotics are prescribed if infection persists or as prophylaxis for flap procedures.
- Activity and Diet:
- Light activities (e.g., walking) resume within 1–2 days; strenuous activities (e.g., heavy lifting, sports) are avoided for 3–6 weeks.
- A high-fiber diet (fruits, vegetables, whole grains) and 2–3 liters of water daily prevent constipation, reducing strain on the wound.
- Avoid prolonged sitting or tight clothing to minimize pressure on the natal cleft.
- Follow-Up:
- Follow-up visits at 1–2 weeks, 4–6 weeks, and 3 months assess wound healing and recurrence.
- Open wounds heal in 4–8 weeks; closed wounds heal in 2–4 weeks.
- Long-term follow-ups monitor for recurrence, especially in high-risk patients.
Most patients resume normal activities within 2–4 weeks (closed wounds) or 6–8 weeks (open healing). Success rates are 85–95% with flap procedures, though recurrence rates are 5–20% depending on the technique and patient factors.
Risks and Complications
Pilonidal sinus excision is a low-risk procedure but carries potential complications:
- Surgical Risks:
- Bleeding, usually minor but rarely requiring intervention.
- Infection at the wound site, treated with antibiotics or drainage.
- Wound-Related Complications:
- Wound breakdown (5–15% in primary closure), leading to open healing or reoperation.
- Delayed healing, particularly in open wounds or patients with poor hygiene.
- Recurrence:
- Recurrence rates are 5–20%, higher with primary closure (10–20%) than flap procedures (5–10%).
- Risk factors include obesity, excessive hair, and poor wound care.
- General Risks:
- Adverse reactions to anesthesia.
- Scar formation, which may be tender or cosmetically concerning.
- Long-Term Issues:
- Chronic discomfort or numbness near the surgical site, rare with proper technique.
- Persistent sinus tracts if excision is incomplete, requiring reoperation.
Prompt reporting of symptoms like fever, increased pain, or persistent discharge ensures timely management.
Frequently Asked Questions (FAQs)
What causes pilonidal sinus disease?
It’s caused by hair penetration into the skin near the tailbone, often exacerbated by prolonged sitting, obesity, excessive hair, or poor hygiene.
Can pilonidal sinus be treated without surgery?
Early cases may improve with antibiotics, hygiene, and hair removal, but chronic or recurrent sinuses typically require excision for a permanent solution.
Is open healing better than primary closure?
Open healing has a lower recurrence rate (5–10%) but takes longer (4–8 weeks). Primary closure heals faster (2–4 weeks) but has a higher recurrence rate (10–20%). Flap procedures balance both.
How soon can I resume normal activities?
Closed wounds allow activity resumption in 2–4 weeks; open healing takes 6–8 weeks.
Is pilonidal sinus excision covered by insurance in India?
Most insurance plans cover excision for symptomatic or recurrent cases. Confirm with your provider.
What are the signs of complications post-excision?
Fever, increased pain, swelling, or persistent discharge require immediate medical attention.
Can pilonidal sinus recur after excision?
Recurrence occurs in 5–20% of cases, reduced by flap procedures, good hygiene, and hair removal (e.g., laser depilation).
What lifestyle changes are needed post-excision?
Maintain good hygiene, avoid prolonged sitting, remove hair regularly (shaving or laser), manage weight, and follow a high-fiber diet to prevent recurrence.
Conclusion
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Looking for Best Hospitals for Pilonidal Sinus Excision
Note: we are not promoting any hospitals
We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₱) | Maximum Price (₱) |
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Angeles City |
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Antipolo |
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Bacolod |
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Bacoor |
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Baguio |
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Butuan |
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Cagayan de Oro |
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Caloocan |
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Cebu City |
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Dasmariñas |
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Davao City |
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General Santos |
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General Trias |
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Iligan |
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Iloilo City |
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Las Piñas |
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Makati |
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Malolos |
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Manila |
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Muntinlupa |
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Parañaque |
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Pasay |
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Pasig |
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Puerto Princesa |
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Quezon City |
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San Fernando |
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San Jose del Monte |
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Taguig |
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Valenzuela |
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Zamboanga City |
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Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.