This is a procedure whereby the pilonidal sinus (or sinuses) is surgically removed in an elliptical excision. The wound is then closed off the midline after a flap of skin and subcutaneous tissue is mobilised. This has the effect of flattening of the natal cleft. The procedure is performed under a general anaesthetic (completely asleep) in the prone position (face down). The natal cleft (top of the buttocks) is shaved and the buttocks taped apart. The procedure is performed, a drain is usually left in the subcutaneous tissues and a pressure dressing is placed.
Most people spend one night in hospital and can be discharged in the morning following the surgery. Smaller pilonidal sinuses can be done as a day case procedure.
Local anaesthetic will be injected into the wound at the end of the operation and therefore you should be comfortable when you wake up. The pain post-operatively is usually manageable with The drain (Panadol) 1g (2 tabs) every 4-6 hours (max 8 tabs per day) and an anti-inflammatory such as ibuprofen (nurofen) 400mg every 4 – 6 hours. Occasionally a stronger pain-killer such as tramadol or endone is needed. After 48 hours, use the painkillers only if needed.
The wound will be closed with stitches. A pressure dressing will be placed over the wound. There will be a dressing over the drain as well. Leave the pressure dressing on for 48 hours. Once the pressure dressing is off, the wound is covered by a smaller dressing which you can leave on until review and removal of the stitches in 10 – 14 days.
The drain usual stays in for 1 week before removal. At home, once the drain bottle is full, it can be emptied and then reconnected to the drain.
Most people recover well and reasonably quickly and feel almost back to normal within 2 – 4 weeks. Usually, people require 1 – 2 weeks off work but this can be longer if one has a physical job.
Don’t do any strenuous activities for 4 weeks. Don’t lift anything over 1-2kg during this time. Walking and normal activities around the house is encouraged if you feel comfortable enough. After 4 weeks, you can start doing more strenuous activities if there is no pain or discomfort and the wound has healed completely.
Wound infection – This can occur in up to 10% of cases. It is usually treated by opening part of the wound to allow drainage and antibiotics.
Wound breakdown – This is when the wound comes apart either partially or in its entirety. If this occurs, the wound is usually packed with a dressing. This can be done by district nurses or at a general practice.
Recurrence – In < 5% of cases, the sinus can recur in the future.