A pilonidal sinus is caused by migration of hairs into the skin leading to formation of a hole which may get filled with fluid or pus there by resulting in a cyst or abscess at the top of the buttocks, where they divide (the cleft). It does not always cause symptoms and only needs to be treated if it becomes infected.
Causes of pilonidal sinus –
Exact cause is unknown. Though excess hair growing around the buttock area, or loose hair shed from the buttocks or elsewhere that gathers around the buttock cleft and enters the pilonidal sinus and later infect them. Pilonidal sinus is seen more in males with excess hair. Sitting for long periods can also increase your chances of getting a pilonidal sinus.
Recurring episodes of pain or swelling in the area of the tailbone.
Yellowish pus-like or bloody discharge from the tailbone area which may be foul smelling
Painful lump under the skin in that area
Certain activities like riding a bicycle, doing sit-ups may be very uncomfortable.
In case of acutely infected sinus,Minor operation to drain pus from sinus will be most helpful before planning conventional surgery.
Incision and drainage- Here small incision is taken to remove pus from infected sinus. Follow up dressing is required and usually wound heals in 4 to 6 weeks.
Surgery to remove sinusOptions
1- Wide excision and open healing- Here the sinus is cut out and some surrounding skin removed. The wound is left open to heal naturally but takes long time to heal.
2- Excision and wound closure, often with flattening of the groove between the buttocks- The sinus is removed and by doing plastic surgery wound is closed. This heals faster and much easier to manage for patient.
3- LASER Ablation (SiLAT)– This is a minimally invasive procedure done using laser. In this procedure, small cut is made on the skin and all the pus is drained out. The entire sinus tract is then sealed with the laser fibre.
Advantages of this procedure includes- Usually patient is discharged on same day and wound heals within4-6 weeks and thus recovery is much faster as compared to conventional Wide excision.
4- MODIFIED KARYADAKIS– Complete sinus is excised andby plastic surgery cleft is flattenedso the gathering of loose hair is less likely, so infection is avoided.Wound is closed and generally wound heals in 6-8 wks.
5- LIMBERG FLAP / GLUTEAL FLAP-This procedure is offered in patients with extensive Pilonidal disease. Here sinus is widely excised a flap of skin and thick fat is mobilised from the buttock beside and below the cavity. The flap is swung into the centre and the edges are sutured.
What to do after your operation ?
keep the affected area cleanand shaved
wear comfortable, loose-fitting cotton underwear
do not ride a bike for 6 to 8 weeks
do not go swimming until your wound has completely healed