A pilonidal cyst is a painful lump found at the base of the spine. Filled with hair and skin debris, it can become inflamed and cause chronic discomfort.

Surgical treatment is often recommended as other treatments are usually not sufficient. This article offers a complete guide to pilonidal cyst surgery. (1)

What is Pilonidal Cyst Surgery?

Pilonidal cyst surgery is a surgical procedure to remove a cyst containing hair that develops near the tailbone. It's often performed to prevent recurrent infections and alleviate the significant pain and discomfort associated with the cyst, which can disrupt daily life. (1)

Indications

Surgery is needed to drain and remove a pilonidal cyst that is causing pain or infection, while non-surgical treatment may be used if the area is not infected. (1)

Risks

While pilonidal cyst surgery is generally safe and effective, as with any surgical procedure, there are potential risks, including: (2)

• Infection.
• Bleeding.
• A hematoma that may require drainage.

Specific risks for this surgery include: (2)

• Recurrence of pilonidal cyst.
• Slow wound healing.
• Pain and numbness.
• Scarring.

It is important to discuss these risks with your surgeon before the procedure.

Preparations

Before surgery, you will undergo the following: (4)

• Physical Examination and Medical History Review: To assess the cyst and your overall health.
• Blood Tests: Blood tests may be required before surgery.
• Hair Removal: The surgical area will need to be shaved.
• Antibiotics: You may be prescribed antibiotics to prevent infection.
• Smoking Cessation: Your doctor may recommend that you stop smoking for several weeks before and after surgery.
• Fasting: Overnight fasting may be required prior to your surgery.

Surgery Steps

Pilonidal cyst surgeries can vary in complexity depending on the specific method used.  

These methods include: (2)(3)

1. Incision and Drainage
   
   • Incision and drainage is a simple procedure used for small pilonidal cysts. Usually performed at the doctor's office without needing to schedule a separate appointment. 
   • Local anesthesia is used to numb the skin, then is made in the cyst to drain fluid and pus. You can usually go home the same day.
2. Surgical Excision
   
   • This is the most common treatment option for recurrent or large pilonidal cysts that haven't responded to other treatments, as it reduces the risk of cyst recurrence.
   • The procedure is typically performed under general or spinal anesthesia. It involves removing the entire cyst and surrounding inflamed tissue. The wound may be closed with stitches (removed after about 10 days) or left open to heal gradually.
   •  You can typically go home on the day or day after surgery.
   • Sometimes, a drainage tube is placed to remove fluids after surgery, which is later removed when fluid drainage stops. 
   • Complete cyst removal can be challenging, and there's a chance of recurrence.. (4)
3. Limberg Flap Surgery
   • This is a more complicated surgery that involves excision of the cyst and surrounding infected tissue. This is followed by repair—Reconstruction of skin around the area using a flap of healthy skin to cover the wound—in order to avoid recurrence and infection. (5)
   • Hospital stay is typically 2 days, and the stitches are removed in about two weeks. (5)
4. Other Procedures
   • Some surgeons operate using a laser, endoscopy, or other techniques. (3)

Recovery

Carefully following your doctor's post-surgery instructions is crucial for optimal healing and minimizing complications. Recovery time can range from several weeks to a few months, depending on the specific surgical procedure and individual factors. General guidelines include: (3)

• Wound Care: Follow your doctor's instructions for cleaning and dressing the wound to prevent infection.

• Pain Management: It is common to experience pain, swelling, and discomfort in the surgical area for the first few days. This can be managed with pain relievers prescribed by your doctor. The pain may seem to worsen before it starts to improve.

• Rest and Avoid Strenuous Activities: It is important to get plenty of rest and gradually return to normal activities, limiting physical exertion for several weeks to prevent wound reopening. 

• Sitz Baths: Soak the area in warm water to minimize discomfort.

• Follow-Up Appointments: Be sure to attend your scheduled doctor appointments to monitor healing progress.

Frequently Asked Questions

How can I prevent a pilonidal cyst from recurring?

While surgery is often effective in treating pilonidal cysts, preventing recurrence is crucial.

Although there is no guaranteed way to prevent recurrence, maintaining cleanliness and shaving the area, avoiding prolonged sitting, and maintaining a healthy weight may help reduce the risk. (1)

What are the signs of a recurring pilonidal cyst?

Common signs include: (2)

• Redness: The skin around the cyst may become red and inflamed.
• Pain or redness: Dull pain or a burning sensation in the infected area.
• Swelling: A visible swelling near the top of the buttocks.
• Discharge: Pus or blood draining from the cyst.
• Fever: In some cases.

Pilonidal Cyst Surgery at Dr. Soliman Fakeeh Hospital

Book an appointment today for pilonidal cyst surgery with one of our general surgery or colorectal surgery specialists at Dr. Soliman Fakeeh Hospital. Consult our top surgeons with extensive experience in performing pilonidal cyst surgery.

References

1. Pilonidal cyst, Mayo Clinic
2. Surgery for pilonidal sinus, healthdirect
3. Pilonidal sinus, NHS
4. Surgery for pilonidal cyst, MedlinePlus Medical Encyclopedia‍
5. Pilonidal sinus surgery - Types of surgery, Guy's and St Thomas' NHS Foundation Trust