Pilonidal Sinus Treatment Kompally, Hyderabad

What is pilonidal sinus?

The pilonidal sinus, also referred to as sacrococcygeal fistula, is a small tunnel or hole in the skin or a sac formed over the tailbone at the upper part of the buttocks’ cleft.

An infected pilonidal sinus is called a pilonidal cyst or abscess and usually has dirt, debris, and hair. Multiple cysts or abscesses can develop and these are connected by under skin tunnels. For pilonidal sinus treatment in Hyderabad, the surgeons at Sree Nandaka Advanced Surgery Hospital, Kompally, will examine you and advise a treatment that suits your condition.

Causes of Pilonidal Sinus

Pilonidal sinus or cyst is likely to develop in:

Males
Obese people
Individuals who earlier had an injury in the area
Those who have thick, coarse, and curly body hair
Those who have deep cleft between the buttocks
People who have pilonidal sinuses running in their family
Individuals who have records of pilonidal cyst
People with sedentary lifestyles or those having long-sitting jobs.

There is no definite reason behind the occurrence of an infected pilonidal sinus. However, it is believed to be caused by a combination of factors like hormonal changes, hair growth, and friction from tight underwear or prolonged sitting.

Symptoms of Pilonidal Sinus

Pilonidal sinus usually isn’t much noticeable unless it gets infected. At first, the pilonidal sinus appears as a small, dimple-like depression on the skin surface. However, when it gets infected, it quickly turns into a cyst (a fluid-filled sac) or an abscess (an inflamed tissue where pus collects).

The signs or symptoms of pilonidal sinus (usually an infected one) include:

A painful lump under the skin in the tailbone area
More than one sinus tract or holes in the skin
Frequent pain, swelling, or red, sore skin in the tailbone area
A pus-like yellow discharge or bloody discharge from the tailbone area which may have a bad odour
Hair coming out of the lesion
Feeling discomfort while riding a bicycle or doing sit-ups
Low-grade fever (less common).

Treatment of Pilonidal Sinus

A dormant pilonidal sinus needs no treatment. To abate the chances of it getting infected or requiring surgical intervention, certain precautions are advised to be taken by an anorectal specialist. For infected pilonidal sinus, surgical management becomes a necessity.

Surgical management can be done by two approaches: Open or Closed. All these procedures are available at Sree Nandaka Advanced Surgery Hospital, in Hyderabad.

Open surgery

Conventional Wide Excision- This surgery involves making a local, wide-bore cutting of the skin having the sinus tract. The excision creates a cavity that is allowed to heal and naturally fill from the bottom upwards. This surgery has a reported recurrence rate of about 10-15%, but the wound created is large, needs repeated dressing changes, and heals in up to 3 months.
Laser Pilonidal Plasty- Pilonidal Sinus Laser Treatment in Hyderabad involves making a small skin incision in the tailbone area to drain out pus and then using laser fiber to seal the entire sinus tract. The procedure is minimally invasive; recovery usually takes about 6 weeks, and your surgeon will explain the risk of recurrence.

Close Surgery

Excision with Primary Closure- This surgery involves surgical excision of the pilonidal sinus and abscess and wound closure with sutures. The sutures are placed preferably away from the midline where there is minimal tension and better healing chances. The procedure allows shorter healing time for many patients, in around 4-6 weeks but it has a high infection rate (almost 20-25%).
Flap Closure- It involves either of the three surgical approaches associated with lengthy recovery.

Z-Plasty - Following the pilonidal sinus and abscess removal, the surgeon makes loose the triangular flaps on either side of the midline to fill the cavity with a flap pointing towards the head and foot. When closing, the surgeon converts N shaped incision to Z shaped closure by crossing the flaps and making it horizontally cross over the midline.
This procedure has many drawbacks including very high recurrence rates, high post-operative pain and discomfort, and flap necrosis.
Cleft lift/Cleft Closure/ Modified Karyadakis- This procedure involves the removal of all diseased areas and ensuring healthy wounds. The removal creates a football-shaped ellipse or cavity that one-sidedly parallelly lies to the midline. Next, the surgeon slightly frees up the skin edges, and wound closure is done with multilayered stitches. In cleft lift, the actual shape of the cleft is made more shallow for better healing. This makes the gathering of loose hair less likely and less probability of anaerobic bacteria growth in the cleft.
Limberg Flap/Gluteal flap- This surgery is preferred in cases where the pilonidal disease is affecting both sides of the buttocks and is extensive. It involves the removal of an oblong-shaped plug having the skin, fat, and abscess, thereby creating a cavity. The cavity is filled with a thick fat and skin flap which is shifted from the buttocks on either side and below the cavity. The flap is kept free to swing at the centre while its edges are stitched.

For more details on Pilonidal Sinus Surgery Cost in Hyderabad, India, consult the surgeon at Sree Nandaka Advanced Surgery Hospital.

Dos and Don’ts Following Pilonidal Sinus Treatment

Do keep the treated area clean and dry
Do wear comfortable, loose-fitting underwear
Do have dietary fibres in meals to keep your stool soft and avoid straining during defecation
Do not indulge in any vigorous physical activities including heavy weight lifting for the first week or so
Do not go bike, horse, or cycle riding for a few months
Do not go swimming unless your treated area fully heals.

Frequently Asked Questions About Pilonidal Sinus Treatment in Kompally, Hyderabad

Does a pilonidal sinus always need surgery?

Not always. A pilonidal sinus that causes no symptoms may only need care at home, such as keeping the area clean and dry, removing hair from the area and avoiding long periods of sitting, along with check-ups as the doctor advises. An infected sinus, an abscess or a sinus that keeps coming back usually needs a procedure. The surgeon will assess your condition and explain the options.

What is flap surgery for pilonidal sinus?

In flap surgery, the surgeon removes the sinus and the affected tissue and then closes the wound by moving a flap of nearby healthy skin and fat over it. Examples described on this page are the Limberg flap, the cleft lift (modified Karydakis) and Z-plasty. Flap surgery may be considered for larger, complicated or repeated pilonidal sinus. Recovery usually takes longer than after a smaller procedure, and the surgeon will explain what to expect.

What is laser pilonidal plasty?

Laser pilonidal plasty is a minimally invasive procedure. The surgeon makes a small opening, cleans out the sinus tract and uses a thin laser fibre to close the tract from the inside. It may suit some patients, depending on the size and type of the sinus. The surgeon will assess whether laser treatment or flap surgery is more suitable for you.

When can I get back to my usual routine activities following pilonidal sinus surgery?

On the day of your surgery, you can get back on your feet and start walking at normal speed. Probably, you need to take a few days leave from your job. Your leave period will depend on the nature of your job and how you feel. Following laser surgery, recovery usually takes about 6 weeks, whereas after flap surgery where you get stitches, you would need to stay home for about 2 weeks. For the first few weeks, you should avoid strenuous workouts and if having stitches, you would need to stay away from activities that could disrupt your stitches. Recovery varies from person to person, so please follow your surgeon's advice.

Can a pilonidal sinus come back after treatment?

Yes, a pilonidal sinus can come back after any type of treatment. The chance depends on the type of sinus, the procedure used and how the area is cared for afterwards. Keeping the area clean and dry, removing hair from the area as advised and avoiding long periods of sitting may help. Attend your follow-up visits and see your doctor if pain, swelling or discharge returns.

Schedule an Appointment

Feeling as if there is a small tunnel in your anal area? You might be having a pilonidal sinus or cyst. Our pilonidal sinus surgeons in Kompally, Hyderabad can help diagnose your condition and provide you with an appropriate treatment plan, all at reasonable prices. All you need to do is step forward and contact the hospital for an appointment.