Pilonidal Sinus Surgery: Causes, Symptoms, and Treatments

Pilonidal Sinus Diagnosis

Proctologists primarily diagnose a pilonidal sinus with a physical examination alone. During the exam, the doctor will check the tailbone and the buttocks for signs of pilonidal sinus, which may present as a pimple or an oozing sinus. To understand the full extent of your condition, they may ask questions like: 

• Has the sinus changed in appearance?
• Is the sinus oozing any liquid?
• Do you have pain when sitting?
• What are other symptoms you’re experiencing?

Although rare, the surgeon may order tests like MRI and CT scans to confirm if any sinus cavities have developed under the skin. 

Pilonidal Sinus Treatment 

Pilonidal Sinuses require surgical intervention as they do not heal on their own in most cases. During the procedure, the proctologist uses a high-intensity laser to ablate the entire sinus tract so that the condition doesn’t recur. Laser pilonidal sinus surgery imparts a higher level of precision and promotes higher healing rates.

While there is no special preparation required for the surgery, do keep in mind the following:

• Follow the doctor’s pre-surgery instructions diligently to minimize the risk of complications.
• If you’re allergic to anesthesia or any other medications, let the surgeon know well in advance.
• Avoid smoking and drinking in the days leading up to the surgery.
• Stop eating 8 hours before the procedure.

It takes about 30-45 days to heal from laser pilonidal sinus surgery completely. We recommend you follow all the post-surgery instructions to ensure minimum risk of post-surgery issues. In addition, keep in mind the following: 

• First, ensure that you keep the surgery site clean to avoid infection.
• Take sitz bath regularly.
• Avoid lifting heavy weights as that adds additional strain to the surgical site.
• Be diligent about taking medications and applying ointments/creams prescribed by your doctor.
• Avoid exercise and strenuous activities during the recovery period.
• Avoid sitting for long periods on hard surfaces

The following are the benefits of laser surgery for pilonidal sinuses.

• Minimal Bleeding & Pain: There is minimal blood loss during laser surgery and reduced pain post-surgery since the laser only targets a specific area.
• Minimal Scarring: The laser procedure results in minimal scarring at the surgery site, most of which fades as you recover.
• Improved Precision: Laser surgery imparts precision by targeting smaller areas without damaging the surrounding tissues.
• Day Care Surgery: Anal fistula laser surgery is a day care surgery, i.e., you will be discharged the same day unless the doctor deems otherwise.
• Shorter Recovery Time: Since it is a minimally invasive procedure, the recovery time is much lesser.

Like any other surgical treatment, you may suffer from the following after pilonidal sinus laser surgery:

• Infection: Infections can develop at any point during pilonidal sinus surgery. The chances of the surgical site getting infected are higher in case of open surgery or in cases where the patient does not allow the site to heal properly.

• Reaction to anesthesia: Several patients report experiencing side effects of anesthesia. If the effects of anesthesia remain for longer than usual, the patient should consult with the doctor.

Here are the Alternative Treatments For Pilonidal Sinus:

• Home Remedies: To get relief from symptoms, you can use home remedies like the following:
  • Warm Compress: A hot, wet compress on the sinus a few times a day can help drain the discharge from the pilonidal sinus. This method can also help relieve pain and itching.
  • Sitz Bath: Sitting in a tub with water up to the hips helps relieve discomfort and pain. This method is also known as a hip bath.
• Non-surgical: If there are no signs of inflammation or infection, the doctor may prescribe antibiotics to help manage the symptoms. You will be asked to maintain proper hygiene and keep the area hair-free.
• Surgical: Alternative surgical methods to treat pilonidal sinus are as follows:
  • Lancing: This treatment is done under the influence of local anesthesia and alleviate abscess symptoms. The doctor then uses a scalpel to open the abscess and cleans the dirt, blood, hair, and debris. Once the cleaning is done, the doctor would cover the wound with a sterile dressing to heal from the inside.
  • Incision & Drainage: Incision and drainage is an open surgery under local anesthesia. The surgeon makes an incision in the sinus to drain the discharge, which is then packed with gauze and left open to heal. The gauze is changed regularly, and the sinus takes about 4-6 weeks to heal.
  • Pilonidal sinusotomy: A pilonidal sinusotomy is the surgical removal of the entire pilonidal sinus. This procedure is generally performed for a recurring pilonidal sinus under local or spinal anesthesia.
  • Z-Plasty: This method is used to treat multiple pilonidal sinus tracts. It involves the creation of 2 triangular flaps of equal dimensions. Z-plasty has a low recurrence rate.

An untreated pilonidal sinus can cause a plethora of complications like the following:

1. Abscess Formation: When the sinus is left untreated, it gets infected, and an abscess filled with pus is formed at the site. The discharge can be foul-smelling and ooze out from the sinus tract.
2. Multiple Sinus Tracts:  An untreated sinus can become chronic and lead to a higher risk of multiple tracts forming.
3. Squamous Cell Carcinoma: If a person leaves pilonidal sinus untreated or does not treat recurrent pilonidal sinus, they are at an increased risk of skin cancer, also known as squamous cell carcinoma.
4. Pilonidal fistula-in-ano: Untreated pilonidal sinuses can lead to the formation of a fistula, a condition known as a pilonidal fistula-in-ano. However, it is considered a rare complication.

Note: Patient details changed for privacy

Mr. Naman was a 33-year-old from New Delhi diagnosed with pilonidal sinus about a year ago. His doctors informed him that the sinus needed surgical removal for long-lasting relief. But Naman felt that surgery was an intimidating process and was scared to go for it. 

To feel more comfortable with the process, he researched online and came across Pristyn Care, which advocated for laser pilonidal sinus surgery. Naman knew laser surgery resulted in minimal pain and blood loss. So, he contacted Pristyn Care and spoke with his medical care coordinator Dr. Shubham. After a lengthy discussion, Dr. Shubham suggested visiting Pristyn Care Clinic in Dwarka and consulting their in-house proctologist, Dr. Nikhil. Naman decided to get admitted the same day.

When he reached the hospital, all the paperwork and insurance were already taken care of by the Pristyn Care team, and he was relieved he didn’t have to run around. His laser pilonidal sinus surgery went smoothly, and he was discharged within 24 hours. 

He was back on his feet within 2-3 days and could resume work. Within a month, he completely recovered from the surgery. He was pleased with his experience with Pristyn Care and extended his gratitude to Dr. Shubham and Dr. Nikhil.

Pilonidal sinus surgery cost generally ranges between Rs. 40,000 to Rs. 55,000. But, the actual cost can differ based on some factors like the city you’re getting treated in, etc. Therefore, it is advisable to discuss the total Pilonidal sinus surgery cost with the hospital beforehand. Some factors that can cause a variation in the cost of your Pilonidal Sinus Surgery include:

• Choice of the hospital (government/private)
  
• Fees of the proctologist
  
• The total cost of preoperative diagnostic tests
  
• Cost of preoperative and postoperative medicines
  
• Nursing charges
  
• Hospitalization charges (if required)
  
• Transportation charges