Pilonidal sinus surgery at Shrewsbury Hospital

What is pilonidal sinus surgery?

Pilonidal sinus surgery treats a pilonidal sinus, a small opening in the skin, typically found where the buttocks meet, where hair and skin fragments can gather and become infected. Rather than simply draining an abscess, the operation works towards clearing away the tissue actually behind the problem.

What conditions does pilonidal sinus surgery treat?

A pilonidal sinus doesn't always cause bother, and treatment tends only to come into play once infection sets in. Signs worth watching for include:

• soreness and redness where the buttocks meet, often with visible puffiness too
• a pus-filled abscess, which can appear surprisingly quickly
• oozing pus or blood, sometimes carrying an unpleasant smell
• more than one opening showing up in the same patch of skin

The exact reason someone develops a pilonidal sinus isn't entirely settled, though ingrown hairs, friction and skin pressure are all thought to play a role. It tends to show up more in men, in younger adults, and in those with plenty of body hair, with carrying extra weight, long stretches of sitting, and heavier sweating all raising the odds too.

What are the benefits of pilonidal sinus surgery?

Surgery clears out the infected tissue driving your symptoms, addressing what's actually causing the problem rather than offering temporary relief alone. This can ease pain and discomfort considerably, and, depending on which technique gets used, can cut the chances of things flaring up again down the line.

Are there different types of pilonidal sinus surgery?

• draining the abscess through a small cut, a minor procedure that also clears out any hair, generally reserved for a first occurrence
• wide excision leaving the wound unstitched, taking away the sinus along with a margin of surrounding skin, then letting the area heal on its own over time. This route carries the smallest chance of things returning, though full healing can take a good few months to complete
• excision followed by stitching, removing the sinus and bringing the skin back together with sutures. Healing tends to move faster this way, though infection or recurrence become somewhat more likely than with the open approach
• Limberg flap reconstruction, taking out the entire sinus plus affected surrounding tissue, then patching the area with healthy skin brought across from close by. An inpatient stay of a couple of nights typically follows this approach
• endoscopic treatment, sometimes called EPSiT, working through a thin camera and a small opening to clean and treat the area, generally bringing less discomfort and a swifter return to ordinary activity

Your surgeon will run through which approach fits your particular symptoms and the size of your sinus.

What happens before pilonidal sinus surgery?

Your doctor or nurse looks over your general health and asks through your medical background beforehand. A separate pre-assessment visit sometimes gets arranged roughly a fortnight ahead of the operation itself, where your circulation and weight get checked, alongside blood work, imaging, or a heart tracing where relevant.

You'll receive clear guidance on cutting out food and drink ahead of your operation, and following this precisely genuinely matters. Compression stockings might also be provided, worn as protection against clots developing.

What happens during pilonidal sinus surgery?

1. You're taken through to theatre and given an anaesthetic, general or occasionally spinal, so you don't feel anything during the procedure itself.
2. Equipment tracks your circulation, breathing and oxygen levels the entire time.
3. Your surgeon clears away the infected sinus tissue, following whichever method was agreed on beforehand.
4. Depending on the approach taken, the wound is either left unstitched to heal by itself, brought together with sutures, or covered using a graft of healthy skin.

The whole thing generally happens as a day case, so most people go home the same day.

What does recovery look like?

You'll wake in a recovery area before moving back to a ward shortly after, a drip providing fluids until managing food and drink on your own becomes possible again. You will be encourage to get moving as soon as it's manageable.

Some tenderness as the anaesthetic fades is entirely normal, generally settling as time passes, with painkillers sent home with you to help. Attending to hygiene, keeping things dry and clear of stray hair, supports proper healing and can reduce the odds of a repeat episode.

• steer clear of anything physically demanding, or lifting more than roughly a bag of shopping's weight, for the first few weeks
• hold off on swimming until the wound's sealed over completely
• rinsing off in the shower the morning after surgery is generally fine
• expect somewhere around a fortnight off work, though this shifts depending on your job and personal recovery pace

A check-up will be arranged further down the line to see how the wound and healing are coming along.

What are the risks and complications?

Possible risks of pilonidal sinus surgery include:

• infection settling into the wound, sometimes needing antibiotics to clear
• bleeding, or a pooling of blood (haematoma) beneath the skin, occasionally calling for a further procedure to drain it
• clots forming in the leg veins or travelling to the lungs, tied to surgery itself and reduced movement while recovering
• the sinus or its symptoms making a comeback, sometimes needing further treatment down the line
• a wound that ends up taking longer than hoped to heal properly
• the standard risks tied to anaesthesia, something your anaesthetist will run through with you directly

Get in touch with your care team if you spot signs of infection, redness, swelling, a raised temperature, or discharge from the wound that smells off.