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Pilonidal Sinus

Pilonidal sinus disease is acute or chronic infection affecting midline area between buttocks of inter gluteal region.

Small pits appear in midline 4 to 9 cm from anus or a painful abscess appears resulting from infection underneath with hair follicles & necrotic skin debris.

They are of two types

  • Acute Pilonidal abscess
  • Pilonidal Sinus or Cyst

Causes

Most commonly affected are young male population between 15 to 40 years of age esp. With more Hairy Body.

  • Prolonged sitting Eg. Students, drivers, etc
  • Obesity
  • Local Skin trauma or Itching / Irritation

Pilonidal Sinus = Hair(H) x Force(F) x Vulnerability(V)

Symptoms

  • Painful Midline swelling behind the anal region just above the taibone
  • Local redness in between buttocks 
  • Fever 
  • Pus Discharge 
  • Multiple midline pits or holes

Diagnosis

  • Generally it is diagnosed on Physical examination
  • In Complex or Complicated Recurrent Cases, Ultrasound & MRI may be helpful
Pilonidal Sinus
Pilonidal Sinus Photo
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Pilonidal Sinus treatment
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Limberg flap
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Pilonidal Sinus

Treatment

Can it be treated with medicines alone ?

In the earliest stages, it may resolve with antibiotics.
But mainly it is a surgical problem.
Treatment depends on type of presentation to doctor

Surgery

A) Pilonidal abscess

  • Incision & Drainage - Paramedian Approach

B) Pilonidal Sinus / Cyst

  • Limberg Flap - Best Treatment of Choice
  • Laser ablation - Pilonidal Sinus

Excision & Primary suturing

Karydakis Flap

Sinus Laser Therapy (SiLaT)

Video assisted Ablation of Pilonidal Sinus

Endoscopic Pilonidal Sinus treatment (EPSiT) – May need repeated sessions

The current research evidence supports off-midline technique due to 

  1. Low recurrence rates 
  2. Avoiding open wound & hence faster healing

Here are benefits;-

  1. Fast Healing due to closed wound
  2. Short Hospital Stay
  3. Leat recurrence rates
  4. Low Complications
  5. Better Patient Satisfaction
  6. Early return to Work
  7. Minimal Dressing required

It is a good option with its own benefits & concerns.

Advantages:-

Early return to Work

Less Pain

 

Disadvantages:-

Repeated sessions may be required

Discharge present

Repeated Dressing required

More recurrence rates as compared to Limberg Flap

Hospital Stay
1 to 0 Days
Office Work
1 to 5 Days
Medicines
7 to 8 Days
Healing
10 to 0 Days
  • Avoid weight bearing for 2-3 days after limberg flap surgery to avoid skin necrosis & ensure proper blood supply to new skin coverage 
  • Low fiber diet to avoid Stool contamination & decrease chance of infection
  • Stop Smoking for better healing & Avoid Necrosis of Flap
  • Laser Depilation is recommended instead of shaving hair.
  • Get Biopsy report of removed part check with your surgeon

Recurrence rates of 3 to 18 percent depending on the type of disease & Procedure.

Limberg flap has shown very good success rates with least recurrences as compared to Laser Treatment of Pilonidal sinus.

In the best hands, recurrence rates are much lower.

Infection ( 2 – 5 % )

Recurrence ( 7 -18 % )

Bleeding ( 1 – 2 % )

Flap necrosis ( 1 – 5 %)



  • Complication & Recurrence rates should be low
  • Acceptable treatment as per patients comfort level & findings
  • Should return to work & activities as soon as possible

TESTIMONIALS

My pilonidal sinus problem occured twice & then i met dr chintan sir. he explained me all major and minor concerns. now i am doing quite well
Abhijit
Patient

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