Pilonidal Sinus Surgery

Certain factors increase the risk of developing the condition and include:

• A job involving much sitting (a sedentary occupation)
• Being overweight or obese
• A previous persistent irritation or injury to the affected area
• Having a hairy, deep natal cleft
• A family history of the condition
• Being male
• Practicing poor hygiene habits
• Sitting for long periods at a time
• Having thick, stiff body hair

Pilonidal disease is considered an acquired disease resulting from three main factors- the hair or foreign body, a force causing hair deposition into the sinus, and skin vulnerability. The exact cause is not clear. There are various theories. A similar condition can occur between the fingers of hairdressers, caused by customers’ hairs entering moist, damaged skin.

A pilonidal sinus affects the natal cleft. Symptoms vary from mild to severe, depending on the presence or absence of infection

• Small dimples in the skin
• Irritation or discomfort
• Painful mass, which may be an abscess
• Drainage from the area (clear, cloudy, or bloody fluid)
• Red, tender area
• Foul-smelling pus
• Fever

• Wide excision and healing by secondary intention: the sinus and surrounding skin are cut out, and the wound is left open to heal naturally. Healing takes several weeks with regular dressing changes. Recurrence is low with this procedure.
• Excision and primary closure: the sinus area is removed, and the wound is stitched closed. Healing is faster, but the risk of recurrence or wound infection is higher.
• A plastic surgery technique: recommended when the sinus recurs or is extensive, involving reconstructive surgical methods.

• Wide excision and healing by secondary intention: This operation involves cutting out the sinus and a wide margin of skin surrounding the sinus. The wound is not closed but left to heal by natural healing processes. This usually requires several weeks of regular dressing changes until it heals fully. Recurrence is low with this procedure.
• Excision and primary closure: This means taking out the section of skin which contains the sinus and stitching the wound. The advantage of this is that, if successful, the wound heals quite quickly. However, the risk of a recurrence or of developing a wound infection after the operation is higher than with the above procedure.
• A plastic surgery technique: When the sinus recurs or is extensive, plastic surgery may be advised.

You need to keep the wound clean and the surrounding hairy area to be shave regularly to prevent recurrence.
Hair removal techniques : In some cases, hair removal may be the first step in treating a pilonidal sinus if an infection is not present.
Hair removal options may include:

• Shaving
• Waxing
• Laser removal
• Depilation creams