Proctology

At a glance

Pilonidal is a condition in which hair grows or collects under the skin in the natal cleft, the space between the two buttocks, and a pilonidal sinus is an abnormal track from a deeper infection below to the skin. Laser surgery overcomes the disadvantages of the traditional surgery — minimal scar seen only at the pits, minimal pain, minimal wound management and a quicker return to work — and it is usually combined with Endoscopic Pilonidal Sinus Treatment (EPSiT), leading to a higher success rate.

Pilonidal Sinus & Abscess

Pilonidal is a condition in which hair grows/collected under the skin in natal cleft (Space between two buttocks).

Pilonidal sinus is an abnormal track from deeper infection below to the skin. The track usually travels vertically which may progress with time.

The exact cause of the pilonidal sinus is not known. Some people are born with a pit where hair is trapped between buttocks and with age sinus develops. In some cases the pit may develop with constant pressure.

Some of the conditions which increases the incedence includes

1. A job involving a lot of sitting (a sedentary occupation)
2. Being overweight (obesity)
3. A previous persistent irritation or injury to the affected area
4. Having a hairy, deep natal cleft
5. A family history of the condition
6. Drivers

Treatment options:

LASER in Pilonidal sinus surgery

LASER has now revolutionised treatment of pilonidal sinus. All the treatment options discussed above involve big scar, pain and intensive wound management. In addition they alter ones work/life balance significantly for about 6 -8 weeks.

LASER Surgery overcomes all the disadvantages of the traditional surgery. Advantages are

1. Scar is minimal seen only at pits
2. Pain is minimal compared to other procedures
3. Wound management is minimal
4. One can return to work quicker

Procedure is usually combined with Endoscopic Pilonidal Sinus Treatment (EPSiT) leading to higher success rate.

These advantages make LASER treatment for Pilonidal sinus widely acceptable.

Traditional Treatment for Pilonidal Sinus

1. When the abscess develops in a short span of time (Acute abscess) and pain and infection are not severe then it can be treated with course of antibiotics for 5 days and planned definitive surgery with in 6 weeks.
2. When the abscess develops in a short span of time (Acute abscess) and pain and infection are severe then it can be treated with immediate excision
3. When it's a recurrent chronic condition then planned surgery is done.

I offer the following surgical options depending on the condition

1. If infection is less and there is no contamination of surgical site then excision and primary closure.
2. If surgical site is contaminated then excision and healing by secondary intention.

Both above procedures are simple with no other added complications and will be enough to treat about 90% conditions so I would always prefer to perform simple wide excision +/- primary closure for all the pilonidal conditions as a first choice.

If condition reccurs then a advanced procedure which involves mobilising and closure with flap can be performed.

Pilonidal sinus is minor condition but problomatic because of the place it affects.

Questions patients ask

What is a pilonidal sinus?

Pilonidal is a condition in which hair grows or collects under the skin in the natal cleft, the space between the two buttocks. A pilonidal sinus is an abnormal track from a deeper infection below to the skin, and the track usually travels vertically and may progress with time.

What increases the chance of developing one?

A job involving a lot of sitting, being overweight, a previous persistent irritation or injury to the area, having a hairy, deep natal cleft, a family history of the condition, and drivers.

What are the advantages of laser surgery?

The scar is minimal and seen only at the pits, pain is minimal compared to the other procedures, wound management is minimal, and one can return to work quicker. The procedure is usually combined with Endoscopic Pilonidal Sinus Treatment (EPSiT), leading to a higher success rate.

What are the traditional treatment options?

For an acute abscess where pain and infection are not severe, a five-day course of antibiotics and planned definitive surgery within six weeks; where pain and infection are severe, immediate excision; for a recurrent chronic condition, planned surgery. Excision and primary closure, or excision with healing by secondary intention when the site is contaminated, will be enough to treat about 90% of conditions.