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
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
- Low recurrence rates
- Avoiding open wound & hence faster healing
Here are benefits;-
- Fast Healing due to closed wound
- Short Hospital Stay
- Leat recurrence rates
- Low Complications
- Better Patient Satisfaction
- Early return to Work
- 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
- 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
Get OPD Appointment
Book OPD appointment with Dr. Chintan B Patel at Kiran Hospital, Surat, Gujarat, India
Opening Hours
Monday – Saturday
Morning10.00 AM – 12.30 PM
Evening04.30 PM – 06.00 PM
