What Are The Options For Pilonidal Cyst Excision?

Medically reviewed by: Gary H. Hoffman, MD

Pilonidal cysts are infected abscesses that most frequently occur in the midline between the sides of the buttocks, near the top of the crease. Because of their location, these cysts often become a chronic condition. If conservative treatment or less invasive procedures cannot reliably eliminate the infection, surgery may be required.

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When is Incision and Drainage Used?

Incision and drainage is typically used to drain the infection from a pilonidal abcess, in order to clear the infection and help the cyst close faster. As the name insinuates, this procedures requires cutting a small opening in the cyst and draining the infection from it.  However, this is not curative.

While some colon and rectal specialists do this in the clinic with only local anesthetic, others prefer using a local hospital or surgical center where general anesthetic can be used. During the procedure, the surgeon uses a scalpel to make a small opening in the skin, allowing the pus and other material inside to drain.

After surgery, the small incision is covered with a dressing, and you can typically return to work the following day. Your doctor will offer guidance on dressing changes and keeping the wound clean while it heals.

Many pilonidal abscesses clear completely after an incision and drainage procedure. Those that recur often require more invasive surgery to prevent chronic problems from ongoing pilonidal disease.

When is Surgery Necessary?

Your colon and rectal specialist may recommend pilonidal abscess excision surgery when:

  • Other treatments fail to clear the infection from a pilonidal cyst
  • The issue becomes chronic, with infections that recur
  • The infection is especially bad and needs to be addressed immediately

During a pilonidal cyst excision procedure, the infection is drained, the entire cyst is removed and the resulting wound is washed with antibacterial cleanser. The goal of this invasive procedure is to ensure all infection is removed and prevent future abscesses from developing.

This procedure is typically performed as a day procedure or outpatient surgery, either at a local hospital or surgical center. In most cases, general anesthesia is administered, although a nerve block or local anesthesia may be used for patients who cannot have general anesthesia.

What Do I Need to Know About the Excision Procedures?

There are two ways a pilonidal cyst excision is performed. An incision is made in the abscess

  • The cyst is drained completely
  • The surgeon removes the entire section of skin surrounding the cyst
  • The wound is rinsed clean using special antibacterial treatments to prevent infection

Once this excision and cleaning process is complete, however, there are two options. Many surgeons prefer to leave the wound open, packing it with gauze and other dressings. This allows it to heal from the inside out. This reduces the chance of recurrence, but it also takes much longer to heal. If your doctor recommends this type of procedure, you will need regular dressing changes and the wound must be repacked daily until it is healed.

What is an Excision with Primary Closure?

The other possibility for a pilonidal cyst excision is known as an excision with primary closure. As this name indicates, this procedure requires the surgeon to remove the cyst and some surrounding tissue then utilize staples or stitches to close the surgical wound.

In some cases, the surgeon must create a flap of your own skin to close the wound, instead of simply being able to stitch it closed. If your doctor decides an excision with primary closure is the best option for you, the two of you will likely discuss the method of closure based on the circumstances of your case.

The biggest advantage of using primary closure after an excision is that the wound heals much faster. However, the cyst is more likely to recur, although the recurrence rate is not very high.  At the same time, there is an increased risk of infection in the surgical wound. If this occurs, your surgeon will need to reopen the incision and pack it with gauze. At this point it will be treated like an open incision.

Are Complications Common After Excision Procedures?

Clean dressings are important to reduce the risk of infection, and to aid healing. Dressing changes can be especially difficult to manage on your own if your wound was left open, so you may need to return to the clinic for dressing changes for a few days. Having a loved one around to help you is also a good idea.One of the reasons wound care is so important after an excision surgery is because of the high risk of infection in the incision. Keep an eye out for any of these symptoms, and notify your doctor as soon as possible if you experience:

  • Unusual swelling, warmth or redness at the incision site
  • Pain in excess, especially several days or weeks after surgery
  • Symptoms of a fever of 100F or more
  • Any unusual drainage from the wound

Depending on the specific details of your condition and if your wound is closed or remains open, it may take you as few as two weeks or as long as eight weeks to fully heal from your pilonidal cyst excision procedure. If complications occur, recovery can take even longer.

Most people however, return to work and many of their regular activities within a few days of the surgery. You will leave the hospital or surgery center with paperwork about what to expect as you heal, and how to handle dressing changes.

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