Reducing the Risk of Recurrence After Pilonidal Cyst Surgery

Medically reviewed by: Gary H. Hoffman, MD

Pilonidal cysts can be extremely painful, and often require surgery to fully heal. Unfortunately, even when surgery is performed and the cyst is fully removed, the recurrence rate is high. This is especially true for young men with excessive body hair. There are steps that can be taken to reduce the risk of recurrence, however.

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What Causes Pilonidal Cysts To Develop?

Many pilonidal cysts are asymptomatic, meaning you will experience no symptoms from their development. In other cases, though, the cyst becomes inflamed and infected, causing considerable pain. For many, an infected cyst can be lanced and drained by an experienced doctor and the drainage site will heal quickly. Others experience numerous recurrences, and require ongoing treatment for the chronic disorder.

While the exact cause of pilonidal cyst development is often debated among medical professionals, they are more likely to occur and become infected in some people than in others. They are most common in young men who have large amounts of body hair, as well as in people who live in hotter climates. Those who wear tight clothing and people who sit for more than six hours a day are also at an increased risk. This means truck drivers, bicycle riders and other occupation and lifestyle choices may increase a person’s risk of developing symptoms of a pilonidal cyst. Finally, a lack of personal hygiene such as infrequent bathing and obesity may also play a role.

What Type Of Surgery Is Used To Treat Pilonidal Cysts?

While most doctors will initially try draining the cyst during an office visit and prescribe broad-spectrum antibiotics, surgery often becomes necessary to completely heal a pilonidal cyst. This surgery cuts around the area where the infection occurred, removing both the cyst and a small amount of surrounding tissue. It is usually performed in a hospital or surgery center, and often requires general anesthesia.

After surgery, some surgeons prefer to stitch the wound closed while others leave it open, allowing it to heal from the inside out. This decision may be made based on both the preference of the surgeon and your individual medical needs. Both types of surgery have both advantages and disadvantages.

If the wound is left open:

  • It must be packed with gauze or other sterile dressing, and changed regularly
  • It will have an extended healing time
  • There is a lower risk of recurring infection

If the wound is closed:

  • Healing time is greatly reduced
  • Greater risk of infection
  • Possibly increased likelihood of recurrence

Infection in the surgical wound is a very real risk after surgery, no matter if the incision is left open or closed. You will need to follow aftercare instructions carefully, and change the dressings regularly. Your doctor may have you come into the office the first few times to have a nurse assist you, or you may be left to manage the process on your own. Either way, it is important to watch for signs of infection and call the doctor immediately if you see any.

How Likely Is It That The Pilonidal Cyst Will Recur?

The recurrence rate of a pilonidal cyst depends on a number of factors, including how the original cyst was treated and the depth of follow up treatments. Some studies have found that as many as half of all cysts recur and become a chronic problem.

Some pilonidal cyst recurrences happen almost immediately after surgery.  Working with an experienced Los Angeles proctologist who regularly works with pilonidal cysts can help detect this.

When a recurrence occurs six or more months after surgery for the initial pilonidal cyst, this is a true recurrence. The cyst has redeveloped, perhaps even in a new area. This is caused by the same conditions that led to the first infection, and may require another surgical procedure.

Are There Ways To Reduce My Risk Of Recurrence?

Infected cysts in the anal region have been occurring for centuries, but it wasn’t until 1880 that they were named pilonidal cysts. The word “pilonidal” comes from the Latin words for “hair” and “nest.” Knowing this, it should come as no surprise to you that much of the preventative measures necessary to keep the cysts from recurring center around keeping coarse body hair from growing into the skin.

Some researchers, doctors and other experts believe that shaving the area around the cyst regularly can reduce the risk of recurrence.  If your doctor recommends shaving the area, it is best to follow the instruction you are given or to ask about alternative hair removal methods.

Some studies have shown that laser hair removal in the area where the cyst was removed is highly effective. This is because laser methods of hair removal reduces the number of hairs, as well as reduces the coarse nature of individual hair.

It is important to also wash the area daily with soap and water, being careful to ensure all of the soap has been removed. The area should be allowed to dry completely before getting dressed. Exercising regularly, reducing the amount of time spent sitting and other lifestyle changes may also be recommended.

With attention to hygiene, your chances of a complete recovery are bettered.  Your doctor will be able to instruct you in the post-operative care of the excision site.

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