At Texas Pilonidal Center, we offer the most advanced and innovative treatments for pilonidal disease in a state-of-the-art facility.
Pilonidal disease is traditionally thought to be due to a congenital cyst, but we now believe that it is due to microtrauma. Hair from the neck and upper back fall in between the cleft above the buttocks. Friction then causes the hair to erode into the skin and soft tissue. This area is moist, void of air, and make healing difficult, so it can then turn into an abscess with tracts that can lead to the tissue around the midline cleft.
Signs and Symptoms
The signs and symptoms of pilonidal disease can vary, but most commonly it presents as pain, discomfort, redness, and possibly purulent (pus-like) discharge from the pre-coccygeal (tail bone) region. Patients usually become aware of pilonidal disease after an abscess has formed, which may or may not have required drainage. Topical antibiotics are not effective and not necessary. The most obvious external sign of pilonidal disease is an opening which can be pinpoint or a little larger. It may sometimes have hair sticking out of it, but not always. This is what we call a sinus tract. Very rarely, patients require hospitalization because of infection resulting from pilonidal disease.
Treatment
When an abscess forms as a result of pilonidal disease, it usually requires drainage. Topical antibiotics are not helpful, and oral antibiotics are helpful in a few instances. The abscess usually requires drainage because the symptoms are so severe that many times the patient cannot walk properly, or even sit down. Draining the abscess will resolve the symptoms, but will not cure the pilonidal disease. The disease may lie quiescent for some time, but almost always flares up at some point in the future. The best option to prevent future episodes is surgery.
Surgery for Pilonidal Disease
There are several operations performed for pilonidal disease, but the one we usually recommend is a cleft lift procedure. We believe that this is the best treatment option because it addresses the anatomical issues that we feel lead to pilonidal disease. In this operation, unlike traditional methods, we actually strive to minimize the amount of tissue that we excise. The thought is that leaving empty space behind actually leads to complications and recurrences, so the idea with the cleft lift procedure is to leave as much tissue as possible, and ”lift the cleft” so that there is nowhere that hair can get trapped and erode into the skin. We flatten out the cleft above the buttocks. Because the thought is that it is micro trauma that leads to this disease, we eliminate the anatomical reasons why the disease happens in the first place.
The cleft lift procedure, as are all procedures for pilonidal disease, is usually an outpatient procedure. It usually takes about 1.5 to 2.5 hours. There is about 2 to 3 weeks restriction period after surgery, and usually all sutures are dissolvable. There is a drain that is placed at the time of surgery which stays in for a minimum of eight days. Antibiotics are prescribed for 14 days after surgery.
Traditional methods involve excision of this area with either leaving it open and packing it, or closing it off the midline. With the excision and leaving it open method, there is a wound that needs to be packed daily, which usually takes 6 to 8 weeks to heal. There is minimal activity restriction with this operation. Patients are usually referred to wound care a few days after surgery to begin caring for the wound. With the excision and off midline closure, there is empty space left behind and at best a 30% chance of complications or recurrence. There is about a 2 to 3 week restriction. Stitches are usually removed at this time. Sometimes there is a drain left in place.
There is also a newer treatment modality which involves minimally invasive removal of the pilonidal disease. A small scope is introduced into the diseased area and the tissue are cleaned out. We do not offer this type of procedure as we feel it does not address the cause of pilonidal disease.
Recovery
Almost all surgeries for pilonidal disease are performed at an outpatient surgery center. Patients go home the same day and will need somebody to drive for them on the day of surgery.
Most patients start feeling better after a few days after surgery. Patients are able to walk, sit, lie down, but we do restrict heavy lifting, sports, running, swimming, or any other strenuous activity for 2 to 3 weeks after surgery. Showering is okay two days after surgery, but we do restrict soaking the incisions underwater for at least two weeks.
We see patients about 8 days after surgery to evaluate if the drain is ready to be removed. We then see patients at the 14-16 day period.
