Types of Surgeries

Pilonidal Cystectomy - Pilonidal Cyst Surgery

Overview

What are pilonidal cysts? Pilonidal cysts are the name we give specific cysts that are usually located near the tailbone at the top of the cleft of the buttocks. These abnormal pockets usually occur when an ingrown hair punctures the skin and becomes embedded under the skin. If the abscess becomes infected it can be incredibly painful for the patient.

Why?

There are two ways to treat infected pilonidal cysts – drainage or surgical removal. If the cyst is left untreated, it risks developing into a type of skin cancer called squamous cell carcinoma. Thus, if you think you may have a pilonidal cyst, it is best to consult your doctor immediately.

The complete removal of a pilonidal cyst is called a pilonidal cystectomy. While this procedure is a fair bit more complicated that an incision and drainage, it is considered more likely to be successful in the prevention of future recurrence. A doctor may recommend a pilonidal cystectomy over drainage if you’ve already had a drainage procedure before and your cyst came back, or if your infection is very complex or severe. Talk with your doctor to see if a pilonidal cystectomy is right for you.

All surgeries, whether they be big or small, carry risks. For pilonidal cystectomy surgery, these typically include:

Risks

Risks of Surgery

  • Common complications include nausea, vomiting, urinary retention, sore throat, and headaches.
  • More severe complications include heart attack, stroke, pneumonia, and blood clots.
  • Infection of the surgical site.
  • Development of keloids (a thickened scar).
  • Excessive bleeding.
  • Pain, swelling, itchiness or tenderness at the site of incision.
  • Loss of sensation surrounding the surgical area if nerve endings need to be cut. This may be temporary or permanent depending on the damage.
  • Recurrence of the pilonidal cyst after surgery.

What to expect prior to your surgery

You may need to take antibiotics before surgery. Routine blood work is usually not needed but may be ordered prior to surgery based on the patient's age and the presence of any existing medical problems. You may be advised to stop smoking or go off certain medication before your surgery.

A pilonidal cystectomy is done on an outpatient basis (you will be able to go home after the surgery is completed). Before your surgery, a nurse or doctor will plan the site, clean the affected area, and consult with you for any questions you may have. Then, you will be brought to the operating room and be put under general anesthesia by our anesthetist.

The procedure itself usually takes around 45 minutes to perform. Typically, your doctor will give you a heads up on how long the procedure should last. 

The procedure

The procedure starts with the surgeon taking a scalpel and using it to cut and excise the cyst and sinus, including the surrounding skin, pores, and underlying tissue around the infection. The area will be cleaned and all liquids will be suctioned away. If a lot of tissue has been removed, the surgeon may pack the wound with gauze. Moreover, if the wound is large, the surgeon may opt to close it up using stitches.

After the procedure

Recovery time for a pilonidal cystectomy will vary, but you should feel back to normal within a few days to weeks depending on whether or not you received stitches. Be sure to keep the area clean and dry to avoid the possibility of infection. Itchiness or soreness is common, however let your doctor know if you experience swelling or excessive pain.

You will need to arrange for a ride home the day of your surgery and we recommend someone stay with you for the first 24 hours at home. When you leave the facility after surgery, we will want you to go home and rest. Avoid making any other plans on the day of your surgery. Starting the following day, you can increase your activity as you feel up to it.

You will likely be given a prescription for pain medication following your surgery. The recovery nurse will discuss a pain control plan following surgery specific to you and your needs including activities like ice applied over incisions and a medication regimen. Oftentimes we will recommend taking Tylenol and Advil (same as Motrin, Ibuprofen) or Aleve in addition to the narcotic pain medication.

Unfortunately, there is always a chance that pilonidal cysts come back after surgery. Studies show recurrence rates can be as high as 30 percent. In such instances, it is best to keep all follow-up appointments with your doctor.

Did you know we have a support group?

Your questions and concerns have most likely been asked and answered in our support group. Moderated by our dietitian's, nurses, and staff. We provide you with reliable patient education and resources to help you throughout this life-changing process.