Pilonidal Sinus

 

Pilonidal Sinus Pilonidal sinus is an inflammatory condition involving in-growing hairs in abscess cavities. It occurs most commonly
in the natal cleft (between the buttocks at the base of the spine). The condition usually affects young adults but 
symptoms rarely persist beyond aged 30-40.

The cause is note entirely clear but may involve hereditary or acquired factors. For some reason, the hair follicle
enlarges and allows other hairs to grow in. This leads to a reaction like that of a foreign body with resultant inflammation or infection.

Half of all patients develop an abscess, which may need surgical drainage. Most of the remainder present with an
ongoing inflammation in the natal cleft, some of whom report a previous abscess. Up to a third of patients have very few symptoms, but if present these include pain or discharge.

A simple examination confirms the diagnosis. There are a series of pits in the natal cleft, sometimes associated
with discharge or thick inflamed tissue.

Many pilonidal sinuses do not need need surgical treatment. In some cases, keeping the area hair-free is all that is necessary.

Surgery usually simply involves excision of the diseased tissue with the healthy edges stitched back together. If there is a risk of the wound not healing properly, it may be necessary to leave it open and allow to heal from within. If the abnormal tissue covers a large area, or if the pilonidal has come back following previous surgery, more complex surgery may be required, involving excision of the affected area and reconstruction with flaps of healthy tissue from nearby.

Surgery
You will usually have a pre-op assessment in the week before surgery where blood tests, chest X-ray and an ECG (heart recording) may be taken. You will be admitted a few hours before the approximate planned time of surgery having had nothing to eat for six hours before the start time (you may drink water up to two hours before your proposed time of surgery - with any of your regular medications). You will see your surgeon and the anaesthetist before your operation. After your surgery you will wake up in the recovery room, and then be transferred back to the ward. Later the same day you may have something to eat and drink if you wish. You will normally be discharged on the same day.

You will be provided with painkillers before discharge but it is recommended that you take regular paracetamol and ibuprofen (unless you are sensitive to these) after a few days of these. Stronger painkillers such as cocodamol are occasionally necessary but if so it is important to take a laxative such as lactulose at the same time. You can expect to have some discomfort for up to a week after surgery, but this will gradually subside. It will more uncomfortable for longer if you have had more extensive surgery. You will be able to take gentle exercise but should avoid heavy lifting or strenuous work for 4 weeks. It may be necessary to have sutures removed – usually three weeks following surgery but you will be advised before discharge.

If the wound has not been stitched back together, then regular dressings will be required, daily to start with but then less frequently. These will be arranged between the hospital and your GP practice before you are discharged. You may drive a car when you are able to perform an emergency stop.

You might have some bruising around the wounds and this may take several weeks to settle. If the wounds swell, become more painful and hot, or start to discharge, you should contact the ward or your General Practitioner.

You will be seen for follow-up six weeks following your surgery.

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