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● A pilonidal sinus or PNS can be defined as a small hole or tunnel in the skin. It may be filled with fluid or pus, causing the formation of a pilonidal cyst or pilonidal abscess.
● It is also known as a Sacrococcygeal fistula.
● It is formed in the cleft at the top of the buttocks.
● A pilonidal cyst contains hair, dirt, and debris. It is a painful lump and can become infected. When it gets infected, it may ooze pus and blood and have a foul odor ( called a pilonidal abscess ).
● The exact mechanism of formation of pilonidal sinus is unknown but it is supposed to be caused by a combination of changing hormones, hair growth, and friction from clothes or from spending a long time sitting.
● Sometimes the patient may have multiple sinuses that connect under the skin.
● A Pilonidal sinus infection is a condition that mostly affects men and young adults.
● Sedentary lifestyle
● People who sit for long hours like drivers
● Thick, coarse, and curly body hair
● Obesity
● Lack of personal hygiene
● Previous injury in tailbone area
● History of Pilonidal sinus in family
● The deep cleft between the buttocks
● History of Pilonidal cyst or abscess
● PNS is not noticeable other than a small, dimple-like depression on the surface of the skin on top of the cleft in between buttocks.
● However, when it becomes infected, it will rapidly develop into a cyst (a closed sac filled with fluid) or an abscess (a swollen and inflamed tissue where pus collects).
● It can show the following symptoms:
○ Recurring pain or swelling in the area of the tailbone.
○ Foul-smelling yellowish pus-like or bloody discharge from the tailbone area
○ Painful lump under the skin in the tailbone area
○ Pain and discomfort when sitting or standing
○ Swollen, reddened, sore skin around the tailbone area
○ Hair protruding from the lesion
○ Formation of more than one hole in the skin
○ Fever
● The pilonidal sinus is gender-specific. It affects men mostly, especially those who sit a lot.
● If you are experiencing any one of the following symptoms, visit the doctor
○ For pain or swelling in the area of the tailbone with or without foul-smelling discharge
○ Fever with other symptoms of Pilonidal Sinus
○ Lump with swollen red skin around it in the tailbone area
The colorectal surgery or proctology department of Medstar Aesthetics and Multi-specialty Centre is updated with the latest procedures and technologies. We use laser and digital scans for permanent and effective treatment of pilonidal sinus infection.
We provide the service of painless, scar-free, and quick laser treatment of Pilonidal Sinus for our patients in Dubai.
Our proctologists, Dr. Shailesh Matkar and Dr. Ashwin Porwal, are highly experienced and skilled in treating complex and recurrent pilonidal sinus infection cases with an excellent success rate. They specialize in treating the infected pilonidal sinus with Lasers.
● Pilonidal sinus treatment depends on the case presented of the pilonidal sinus. ( if the PNS has been infected or not ).
● Conservative treatment: Non-infected pilonidal sinus is treated conservatively. The doctor will prescribe a broad-spectrum antibiotic to protect it from infections. The doctor will also recommend keeping the area clean and dry, shaving the area, avoiding sitting for long hours, and regular follow up appointments.
● Lancing: In this procedure, the doctor will open the infected pilonidal sinus or pilonidal abscess under local anesthesia. He will clean away hair, blood, and pus from inside the abscess and pack the wound with a sterile dressing and allow it to heal from the inside out. The wound usually heals within four weeks and doesn’t require further treatment.
● Phenol injection: In this procedure, phenol, a chemical compound, is used as an antiseptic. It is injected into the pilonidal cyst under local anesthesia. This results in the hardening of the lesion followed by its closure.
● Surgery: This procedure is recommended for recurring PNS or in cases of multiple sinuses tracts under local anesthesia. The surgeon will open the infected pilonidal sinus, remove all of the pus and debris and stitch the wounds.
● Laser: The most effective and long-lasting treatment option for PNS is the use of a laser to drain and seal it.
● No treatment is necessary in the case of a Pilonidal sinus that lies dormant, which means it is not infected. In this phase, certain precautions are advised which decrease the chances of infection and thereby, the need for surgery.
● The following care should be taken:
○ Keep the tailbone area as clean and dry as possible.
○ Avoid sitting in one place for too long
○ Remove hair from the tailbone area. You could consider permanent hair removal with Laser.
● In cases of pilonidal sinus infection resulting in a pilonidal cyst or pilonidal abscess, treatment is necessary.
● At MEDSTAR, we have multiple options and the patient can freely choose according to his requirement.
● In this procedure, the surgeon does a wide excision of the skin containing the sinus tract resulting in the cavity. This cavity is left open to heal and fill in naturally from the bottom upwards. After this procedure, wound is kept covered with a medicated dressing. The dressing needs to be changed daily.
● The disadvantage of wide excision is that the large size of the wound and healing may take up to 3 months.
● The procedure is safe, with a recurrence rate of 10-15%.
Laser Pilonidoplasty (LPP) is a minimally invasive procedure performed using the Leonardo laser. In this procedure, a small cut is made on the skin and all the pus is drained out. The laser fiber is used to seal the entire tract.
Advantages:
● The patient can go home the same day and can return to routine work by the 5th day.
● Wound healing is faster, in about 6-8 weeks
● The recurrence rate is negligible
● Quick, painless, and stitches free treatment
● In this procedure, the abscess and sinus are surgically removed and the wound is closed with stitches or sutures. The stitch line is placed off the midline, where the tension is less and the chances of healing are better.
● The advantage of this technique is faster healing in about 4-6 weeks.
● The main disadvantage is the infection of the wound post-surgery. In case of such an infection, a revision procedure is done and the wound is left open for healing.
● In Z-plasty, the abscess and sinus are removed and the surgeon loosens triangular flaps on each side of the midline to fill the cavity. These flap points towards the head and foot. When they are closed by the surgeon in a horizontal direction crossing the midline. This converts an N-shaped incision to a Z-shaped closure.
● Z-plasty is not preferred because:
○ The high recurrence rate of pilonidal sinus
○ Risk of flap necrosis and infection
○ High posto-perative pain and discomfort
In this procedure, the surgeon removes all the infected tissues leaving a healthy football-shaped cavity. This cavity lies parallel to the midline but on one side. Then the wound is closed with multi-layered stitches. This procedure aims to change the actual shape of the cleft to a new and more shallow and flatter shape. This new cleft shape allows better healing, fewer chances of hair gathering and less infection.
Limberg flap or gluteal flap surgery is recommended for patients with severe Pilonidal infection or pilonidal infection affecting both sides of the buttock.
In this procedure, the surgeon removes an oblong-shaped plug containing the abscess, skin and fat, leaving a cavity. A flap of skin and thick fat is mobilized from the buttock beside and below the cavity and filled in the wound cavity. In the final step, flaps are sutured towards the midline.
After pilonidal sinus treatment, complete healing is expected in 6 to 8 weeks without the complication of recurrence. Permanent pilonidal sinus treatment with the use of lasers and other surgery options helps our patient to go home happily free from pain and infection.
Yes, all Pilonidal Sinus infection surgeries or treatments are covered under the insurance plan. Consult our office to get detailed information on insurance covers for pilonidal sinus infection treatment and further recommendations. At MEDSTAR, you can also choose freely from several result-oriented and cost-effective treatment options as per your requirements.
Laser treatment option for treating pilonidal sinus infection ensures no risk of infection, hemorrhage, or other common side effects associated with conventional surgical procedures like a recurrence of sinus or swelling.
Other surgical options might have complications due to unhygienic conditions, straining activities, missing post-operative appointments, and medical conditions like diabetes.
Yes, both normal and laser surgery may require local, regional, or general anesthesia according to the severity and spread of the infection. The surgeon decides the type of anesthesia after confirming with the patient. Most of the procedures are performed under local anesthesia. In the case of general anesthesia, the patient is advised to strictly follow pre-operative instructions.
● It is not dangerous if the pilonidal sinus is in a dormant state without any signs and symptoms of infections. Regular shaving of hair and maintaining good hygiene is enough for it.
● When a pilonidal sinus becomes infected resulting in a pilonidal cyst or pilonidal abscess, it needs to be treated medically without any delay.
● If the infected pilonidal sinus is left untreated, it can result in severe painful pus discharging, infection in the buttocks, high-grade fever, and infection might spread in the whole body. Along with these symptoms, the pain will start affecting normal activities like sitting, standing, or driving.
Yes, pilonidal sinus can also affect women. A pilonidal sinus infection occurs due to the entrapment of thick body hair, especially coarse and curly ones. Body hair acts as a foreign particle triggering the reaction of the body resulting in the formation of a pilonidal cyst or pilonidal abscess.
Yes, pilonidal sinus can be treated permanently. The use of lasers has made it possible to get rid of recurring pilonidal sinus infections permanently without post-treatment complications in comparison to other treatment options. The laser treatment option is also safe, quick and the patient can go back home the same day.
Infected pilonidal sinus can show the following symptoms:
● Pain, redness and swelling in the tailbone area
● Foul-smelling discharge
● Fever
● Lump formation in the tailbone area
● Pain while doing normal daily activities like standing, sitting, or walking
Consult the doctor immediately if you notice these symptoms for the treatment before the progression of infection.
The patient can start walking the same day. The patient will probably need time off work, although this depends on how you feel and the type of work you do.
After laser surgery, the patient can join work from the 3rd day. In cases of flap surgery or have stitches, the patient can join the office after 2 weeks.
In any case, strenuous work should be avoided for the first 2 to 4 weeks.
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