A pilonidal cyst is a pocket-like unnatural growth of skin around the tailbone or at the tailbone. The infected area usually looks like a pore in the skin that contains hair and skin. Sometimes, this cyst can become infected and is called a pilonidal abscess.

 

When a cyst becomes infected, it requires surgical drainage because it will not heal alone with antibiotic medicines. If you continuously get infections, you might need to undergo a pilonidal cyst excision. 

 

 

Pilonidal cyst excision procedures

Pilonidal cyst excision is of two types:

 

1) Incision and drainage

Incision and drainage pilonidal cyst surgical procedure is the most common treatment for an infected cyst. The procedures include:

 

• Numbing the skin with local anesthesia.

• A small incision is made to the cyst to drain out the fluid inside. The wound is later packed with gauze and left open.

• The cyst may take 3 to 4 weeks to completely heal. During this time, the gauze is often changed. 

 

2) Pilonidal cystectomy

If you continuously get problems with a pilonidal cyst, it can be surgically removed. Pilonidal cystectomy surgical procedure is an outpatient procedure, so you do not need to stay a night in the hospital. The procedures include:

 

• General anesthesia or regional anesthesia is used to keep you pain-free. However, in some rare cases, local numbing medicine is also used.

• An incision is made to remove the skin with the pores and also the tissue with the hair under the cyst. 

• The area may or may not packed with gause depending on the amount of tissue removed. Sometimes, a tube is placed after surgery to collect the accumulated fluids. Later, the tube is removed when the drainage of fluid stops.  

 

 

Why pilonidal cyst excision is performed?

An excision procedure is performed to remove and drain the pilonidal cyst that does not heal itself. 

 

• Your physician might recommend an excision procedure if you have a pilonidal disease that causes infection and pain.

• A pilonidal cyst with no symptoms does not require treatment.

 

Non-surgical procedure is used if the cyst is not infected.

 

• Laser removal or shaving the hair around the cyst

• Injecting a surgical glue into the cyst.

 

 

Before the procedure

Meet your physician to make sure that medical issues are under good control. This includes high blood pressure, diabetes, and lung or heart problems.

Tell your physician:

 

• What vitamins, medicines, and supplements you are taking including the ones you bought without a doctor’s prescription?

• If you are pregnant.

• If you are drinking alcohol.

• If you are a smoker, you need to stop smoking several weeks before the surgery.   

• If you take blood thinners, such as ibuprofen, aspirin, vitamin E, etc, you need to temporarily stop using them.

 

 

Risks of pilonidal cyst excision

Generally, pilonidal cyst excision surgery is safe. However, you can still get the following complications:

 

• Infection

• Bleeding

• Long healing process

• Returning of pilonidal cyst

 

 

 

Pilonidal cysts are caused when the ingrown hair penetrates beneath the skin. They are more common in men than women and mostly occur during their 20s to 30s. There are two primary procedures to treat a pilonidal cyst. This includes:

 

• Incision and drainage: In this procedure, the doctor will make a small incision and drain the pus or other unwanted materials inside the cyst. 

• Pilonidal cystectomy: In this procedure, the doctor removes the entire cyst and the tissues around it. 

 

 

Suitable candidates for pilonidal cyst removal surgery

1) Incision and drainage

Your healthcare physician will recommend an incision and drainage procedure if:

 

• You have a minor infection

• This was your first treatment for a pilonidal cyst

 

About 60% of the time, an incision and drainage procedure is successful in treating a pilonidal cyst. To maintain the results, doctors often recommend people undergoing the procedure to try hair removal procedures to prevent other infections. This includes waxing, shaving, and laser hair removal. 

 

2) Pilonidal cystectomy

Your healthcare physician will recommend a pilonidal cystectomy procedure if:

 

• You have undergone an incision and drainage procedure but your cyst return

• You have a severe infection

• You have several cysts with sinus tracts

 

 

Potential risks of a pilonidal cyst removal surgery

Incision and drainage is the most common procedure used in treating a pilonidal cyst because it rarely causes serious complications. However, you can experience pain after this procedure but this can be easily relieved by a pain reliever.

 

On the other hand, a pilonidal cystectomy procedure often results in scarring. However, this scar will gradually fade away with time. Like other surgical procedures, incision and drainage and pilonidal cystectomy procedures can lead to infection. The following are some of the symptoms of an infection:

 

• Redness

• Tenderness

• Oozing pus

• Fever or chills 

• Warm to be touch (heat coming from the wound)

 

Other potential complications can include:

 

• Poor healing

• Hematoma (bruise)

• Recurrence of pilonidal cyst

• Seroma (fluid buildup)

 

The recurrence of a pilonidal cyst is higher after treatment. Therefore, you need to undergo more than one procedure to remove the cyst. 

 

 

Preparing for a pilonidal cyst removal surgery

Here’s how you can prepare for each procedure: 

 

a) Incision and drainage 

In incision and drainage procedures, you usually do not need any special preparation. Wearing something that allows your doctor to access the pilonidal cyst easily is a good idea.

 

b) Pilonidal cystectomy

A pilonidal cystectomy procedure is generally performed as an outpatient procedure. This means that you can go home on the same day of the surgery.

 

It is important to follow the doctor’s presurgical instructions to lower the risk of complications. If you are taking certain herbal supplements or medications, your doctor may ask you to stop using them temporarily. Also, you need to stop smoking temporarily, if you are a smoker.  

 

What to expect from pilonidal cyst removal surgery?

Here’s what to expect from a pilonidal cyst removal surgery:

 

i) Incision and drainage

Since the incision and drainage procedure is simple, it is usually performed in the doctor’s office. During this procedure:

 

• The doctor will inject you with local anesthesia to numb the area. 

• The doctor will make a small incision on the cyst to drain the pus inside.

• Once the pus is drained out completely, the doctor will pack your wound with gauze. 

 

The incision and drainage procedure reduces pain and inflammation. So, you do not need antibiotics in this procedure unless it gets infection. 

 

ii) Pilonidal cystectomy

Pilonidal cystectomy procedures are more complex as they involve the removal of the entire cyst and the pilonidal sinus tracts. This procedure is an outpatient procedure and it may take 45 minutes to complete.  

 

Pilonidal cystectomy can be of several types:

 

• Excision with marsupialization: In this procedure, the surgeon removed the upper part of the cyst by performing excision. The fibrous tissue is then stitched. 

• Wide local excision: In this procedure, the surgeon removes the tissues that overly the muscles (the area that goes down to the fascia of the sacrum). The resulting wound is then packed with gauze and left open to heal itself.

• Excision with complex closure: In this procedure, the surgeon removed the entire cyst along with the sinus tracts. The surgeon then uses flap methods to close the wound. That is, the surgeon stitches the flap underside of the skin bridge formed between the midline and incision. This method heals faster and has less risk of recurrence. 

 

 

iii) Recovery period

A pilonidal cyst is a pocket-like unnatural growth of skin around the tailbone or at the tailbone. The infected area usually looks like a pore in the skin that contains hair and skin. Sometimes, this cyst can become infected and is called a pilonidal abscess.

When a cyst becomes infected, it requires surgical drainage because it will not heal alone with antibiotic medicines. If you continuously get infections, you might need to undergo a pilonidal cyst excision. 

Pilonidal cyst excision procedures

Pilonidal cyst excision is of two types:

1) Incision and drainage

Incision and drainage pilonidal cyst surgical procedure is the most common treatment for an infected cyst. The procedures include:

• Numbing the skin with local anesthesia.

• A small incision is made to the cyst to drain out the fluid inside. The wound is later packed with gauze and left open.

• The cyst may take 3 to 4 weeks to completely heal. During this time, the gauze is often changed. 

2) Pilonidal cystectomy

If you continuously get problems with a pilonidal cyst, it can be surgically removed. Pilonidal cystectomy surgical procedure is an outpatient procedure, so you do not need to stay a night in the hospital. The procedures include:

• General anesthesia or regional anesthesia is used to keep you pain-free. However, in some rare cases, local numbing medicine is also used.

• An incision is made to remove the skin with the pores and also the tissue with the hair under the cyst. 

• The area may or may not packed with gause depending on the amount of tissue removed. Sometimes, a tube is placed after surgery to collect the accumulated fluids. Later, the tube is removed when the drainage of fluid stops.  

Why pilonidal cyst excision is performed?

An excision procedure is performed to remove and drain the pilonidal cyst that does not heal itself. 

• Your physician might recommend an excision procedure if you have a pilonidal disease that causes infection and pain.

• A pilonidal cyst with no symptoms does not require treatment.

Non-surgical procedure is used if the cyst is not infected.

• Laser removal or shaving the hair around the cyst

• Injecting a surgical glue into the cyst.

 

Before the procedure

Meet your physician to make sure that medical issues are under good control. This includes high blood pressure, diabetes, and lung or heart problems.

Tell your physician:

• What vitamins, medicines, and supplements you are taking including the ones you bought without a doctor’s prescription?

• If you are pregnant.

• If you are drinking alcohol.

• If you are a smoker, you need to stop smoking several weeks before the surgery.   

• If you take blood thinners, such as ibuprofen, aspirin, vitamin E, etc, you need to temporarily stop using them.

Risks of pilonidal cyst excision

Generally, pilonidal cyst excision surgery is safe. However, you can still get the following complications:

• Infection

• Bleeding

• Long healing process

• Returning of pilonidal cyst

Most people can return to their daily activities within 1 month. Moreover, you still need to follow up doctor’s appointment for about 6 weeks.