Pilonidal Sinus Surgery
I specialises in the treatment of Pilonidal Sinus problems. I am a Consultant General Surgeon and Colorectal Specialist at Mid Cheshire Hospital, BMI Alexandra Hospital and South Cheshire Private Hospital. I am also the Lead Consultant for Enhance Recovery Programme in Colorectal Surgery and Colorectal Multi Disciplinary Team at the Mid Cheshire Foundation Hospital.
A pilonidal sinus is a small opening or tunnel in the skin, usually at the very top of the natal cleft between the buttocks. Dents or pits in the skin can easily become filled with bits of skin and hair, and infected with bacteria. If the pits become blocked, it can get bigger, eventually forming a tunnel under the skin, filled with pus. This is known as a draining sinus or abscess.
The word pilonidal means containing a nest of hair. Doctors are not sure what causes pilonidal sinuses. Patients may be born with the problem that may surface in later part of their life. They often seem to form around hair follicles, the tiny holes in the skin that hairs grow out of. Pilonidal sinuses are most common in young adults, and are rarely seen in children or people over 40 years old. They happen slightly more often in men rather than women, and seem to occur most frequently in people with a lot of body hair. The condition is more common in obese individuals.
Patients may be asymptomatic with the condition. Symptoms manifest when the tract gets infected. You may note a painless or painful bump between your buttocks. Infected sinus can get painful, tender, red and swollen. If an abscess develops the swelling enlarges, the area throbs and pus discharge may appear from the sinus tract.
The diagnosis is by examination of the effected area by your GP or your specialist.
If you have pilonidal dents in your skin but no symptoms, treatment is not required. To avoid infection, keep the area clean and dry well after washing. Sometimes removal of excessive hair from the surrounding area prevents problems. When symptoms develop your GP may start you on antibiotics that may resolve the acute inflammation.
When symptoms develop quickly and severely, in an acute infection, you will usually need an emergency operation to drain the abscess.
For infections that keep coming back, your GP will usually advise an operation and refer you to a general or colorectal surgeon.
Surgical Modalities for Treatment of Pilonidal Sinus
Wide excision – removes of sinus and some healthy skin around the sinus, and allows it to heal without stitches. This method may need 6-8 weeks to heal, and dressings need to be changed regularly by your district nurse.
Excision and stitching – which only removes the skin that contains the sinus, and stitches the edges back together. This method is quicker to heal, but there is more chance of re-infection or wound break down.
Plastic surgery techniques and Flaps – which remove the sinus and rebuild the skin. This is usually used if the sinus keeps coming back, or if it covers a large area.
Bascom’s operation the operation is done under general anaesthetic as day case or overnight stay. Results are favourable with low short term recurrence