Surgical procedure for pilonidal sinus disease in the tailbone region. It can be performed with flap techniques aimed at preventing recurrence.
Indication
- Recurrent pilonidal sinus abscesses
- Chronic discharging or inflamed pilonidal sinus disease
- Cases not responding to conservative treatment (hair removal, hygiene)
- Wide or multi-pit pilonidal sinus
- Recurrent pain and cases affecting quality of life
- Need for definitive treatment after abscess drainage
- Acute pilonidal abscess (elective surgery after emergency drainage)
Preparation
- No food for 6-8 hours before the procedure
- Blood thinners are adjusted with physician approval
- Shaving of the surgical area (sacral region)
- Blood tests and ECG if needed
- If active infection is present, drainage and antibiotic therapy first
How it's performed
- The patient is placed in the prone position and the sacral area is sterilized
- General, spinal, or local anesthesia is administered by the anesthesiologist
- The sinus tract and the hair tufts within it are excised together with their capsule
- Reconstruction is performed off-midline using techniques such as Karydakis or Limberg flap (to reduce recurrence)
- The surgical area is closed in layers; a drain is placed if needed
- A sterile dressing is applied
Post-procedure
- Hospital stay of 1-2 days (varies with surgical technique)
- Avoiding prolonged sitting in the first week
- Regular dressing changes and wound care; drain removal if applicable
- Keeping the area continuously hair-free (laser hair removal may be recommended)
- Follow-up examinations at 1 week, 1 month, and 3 months
Risks
- Surgical site infection
- Wound dehiscence or delayed healing
- Hematoma or seroma formation
- Recurrence of the pilonidal sinus (rates are lower with off-midline flap techniques)
- Sensory changes or scar tissue discomfort
FAQ
Can it recur after surgery?
Compared with classical midline excision, off-midline techniques such as Karydakis or Limberg flap have markedly lower recurrence rates. Keeping the area clean and hair-free further reduces the risk of recurrence.
How much bed rest is needed after the procedure?
Prolonged sitting is restricted in the first 1-2 days. Light activities are usually possible within 1 week and desk-based work within 1-2 weeks.
Does laser hair removal prevent recurrence?
Reducing hair density in the area is considered effective in preventing recurrence. Your physician may recommend laser hair removal once healing is complete.
When are stitches removed?
Stitches are typically removed at 10-14 days, or if absorbable sutures were used, they dissolve on their own and are followed accordingly.
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