What is pilonidal sinus?

A sinus is a blind ending tract with an opening on the skin, pilonidal sinus is usually seen in the natal cleft between the buttocks as an opening with occasional pus discharge from same and at times you might see some hair coming out of it. Rarely seen at other sites in the body.

How will I know that I have pilonidal sinus?

Most common symptom is that you feel a small pimple or a swelling in the groove between your buttocks just near the tail bone area which has something leaking from it which can be pus, blood or watery.

Sometimes before leaking the swelling becomes painful and once it bursts the pain stops an it may heal for a few days to come back again after some time.

If you have any of these symptoms you should consult a doctor who would do a local examination and will suggest an MRI of the local area to diagnose.

What are the treatment options for pilonidal sinus?

Conventional treatment options were excision of pilonidal sinus where the entire tract was excised which leaves behind a wound that heals with regular dressings. This process takes a long time extending fro weeks to months

Advancements in treatment have led to minimally invasive methods for treatment.

​One is excision with flap closure where the part from where the sinus is removed is covered with a skin flap named LIMBERG flap

Other treatment option is DIODE LASER where the treatment does not lead to any wound, there are no stitches and no dressings needed.

I had pain/pus discharge which was diagnosed as pilonidal sinus but it resolved with medications. Now I don’t have any pain. What should I do?

It is true that many times pus discharge and pain of pilonidal sinus resolves with medications. One must seek medical examination by a surgeon to assess the extent of sinus as it does not heal with medications it is only the infection which gets healed and you get relief from symptoms but the sinus tract stays there and keeps growing with time. The cycle of pain and swelling which bursts with relief keeps repeating again and again. If you leave the problem unattended gradually you might end up with complications.

What are the possible complications of pilonidal sinus?

If untreated sinus tract can keep growing and extending to multiple branches and it might develop into such an extent as it might reach the bone and such that sometimes complete excision becomes very difficult and more the delay in treatment more are the chances of recurrence.

What are the preparations required before surgery and what should I expect during hospital stay and after discharge?

the preparation for surgery will be started from the outpatient department (OPD). You will be advised to undergo a few tests to assess your body functions and a pre-anaesthetic check-up (PAC) will be done by an anaesthesiologist (a specialist doctor) who will assess your fitness for anaesthesia.

Most likely you will be admitted on the day of surgery unless you have some specific concerns which warrant some extra stay before the surgery.

You will be advised not to eat or drink anything from midnight of the day prior to surgery and not to eat or drink anything on the morning of admission as well. If you take some medications regularly in the morning than please do not forget to discuss regarding them with your doctor so that he advices you on which medicine to take and which not to take.

Upon admission some paper work will be done and you will be asked to sign consent forms for anaesthesia and surgery.

You will be asked to change in to hospital clothing, shaving of the area will be done and you will be given some intravenous medications.

Once the preparations are done you will be wheeled into the preoperative area where nursing staff and doctors will confirm your identity and then you will be shifted to the operating room.

Your anaesthetist will put you under spinal or general anaesthesia and then surgery will start. Usually it takes about one hour for the surgery to be over and then you will be shifted to post-operative recovery area in conscious state. You will be kept there for couple of hours and then you will be shifted to your designated room.

A drain might be put if you have undergone flap closure but if laser surgery is done there is no drain. You will be discharged to home the day after the surgery. You will be advised some medications on your discharge.

You will be advised to take liquid diet at home for five days and then gradually you can start having normal diet.

Usually if all goes well you will be called for a visit to OPD two days after discharge for a change of dressing

How soon can I resume work after surgery? How much bed rest is advised? Is there any specific season of year when I should opt for surgery?

If flap closure surgery is done you will be advised to rest for two weeks and after that for a month you will not be allowed to drive on your own and not to use to wheeler. You will be advised to use western toilet. You can resume normal household work two days after surgery. Climbing stairs will not be a problem but should be restricted. You will be advised to lie on your stomach as much as possible or on sides.

Considering that almost all hospitals and households have air conditioning the season has become irrelevant so you can plan surgery as per the need and convenience anytime round the year.