Surgery for pilonidal cysts: What to expect

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Below are two of the main types of surgery for pilonidal cysts.

Incision and drainage

Incision and drainage is the primary treatment for an infected cyst. It is effective in 60% of people with a pilonidal cyst as a primary condition, meaning the cyst does not have links with a past condition.

A person undergoing incision and drainage can expect the following:

• The setting is typically a doctor’s office.
• A healthcare professional applies a local anesthetic (a drug that causes numbness) to the area. This prevents someone from feeling discomfort during the procedure.
• A doctor cuts the cyst to drain pus and fluid. Afterward, the doctor packs the hole with gauze and leaves it open.

Excision

Doctors may surgically remove the cyst using excision techniques if the condition does not resolve after incision and drainage. Surgeons may use one of three types of closures:

• Primary: This means they close the wound completely.
• Secondary: This means they leave the wound partially or completely open.
• Flap: This means they use a skin graft or skin substitute to close the wound.

Below is what someone undergoing an excision can expect:

• The setting is a hospital. A person will not typically need to stay overnight.
• A healthcare professional administers either a general anesthetic to put a person in an unconscious state, or a regional anesthetic to numb the person from the waist down.
• The doctor makes a cut to remove the skin, including the underlying tissue with the hair follicle surrounding the affected area.
• The doctor may or may not pack the area with gauze. Sometimes, a doctor may insert a tube to collect draining fluid and later remove it.

Some reasons a doctor may recommend surgery for a pilonidal cyst are as follows:

• The cyst is not healing.
• The cyst causes infection or pain.
• An infection keeps recurring or is complex.

Pilonidal cysts that are not causing symptoms may not require medical intervention. In some cases, a doctor may recommend a nonsurgical treatment option, such as hair removal.

Some of the risks associated with surgery for pilonidal cyst include:

• infection
• pain
• bleeding
• cyst recurrence
• delayed recovery
• anesthetic-related complications

Preparations are things to do several weeks before surgery and things to do on the day of surgery.

Several weeks before surgery, a person should visit a doctor to disclose:

• any other health conditions, such as type 2 diabetes or high blood pressure
• any medications, vitamins, and other dietary supplements
• if they drink more than one or two alcohol-containing drinks per day
• if they are pregnant or have the possibility of being pregnant

Additionally, people who smoke should stop smoking several weeks before the surgery.

A doctor may ask someone to stop taking the following temporarily:

• vitamin E
• ibuprofen (Advil, Motrin)
• naproxen (Aleve, Naprosyn)
• medications that thin the blood, such as:
  • aspirin
  • warfarin (Coumadin)
  • clopidogrel (Plavix)

How to prepare on the day of surgery

On the morning of surgery, an individual should do the following:

• Take the medications that a doctor has instructed them to take. They can swallow them with a small sip of water.
• Follow instructions about abstaining from food and beverages.
• Take care to arrive at the hospital on time.

People may expect:

• nurses to cover the wound with a bandage
• to receive a prescription for pain medication
• healthcare professionals to demonstrate how to care for the wound at home

What does recovery look like?

Recovery from an excision depends on the type. It may require a hospital stay of a few days and a complete healing time of 8–10 weeks.

Complete healing following incision and drainage may take 1 month if the surgeon removes the dead and infected tissue. Otherwise, it can take around 10 weeks.

The American Society of Colon and Rectal Surgeons recommends the following:

• If the wound is closed, keep it clean, dry, and free of hair until the wound heals.
• If the wound is open, regularly change the dressings that absorb secretions as instructed.
• After healing, keep the skin in the buttocks crease clean and free of hair. Either shave or use a hair removal product every 2–3 weeks until 30 years of age.

A person can ask their doctor when to return to work and what activities to do and avoid doing. Typically, days off work can depend on the type of surgery and the person, but anecdotal evidence indicates that most people return to work in a few days to weeks.

A doctor may recommend the following relating to activities:

• walking daily within toleration limits
• avoiding prolonged sitting or standing
• eating fiber-rich foods to avoid straining during bowel movements
• avoiding baths and instead taking showers, being sure to pat the area dry afterward

Because an infection in the wound is a risk involved in any surgery, a person should contact a doctor if they experience any of the following:

• fever
• drainage from the incision
• discoloration or pain near the incision

Also, other times to call a doctor is if:

• stitches become loose
• pain medication does not relieve discomfort
• a person has any other troubling symptoms or concerns

Pilonidal cysts have a relatively high recurrence rate and may need multiple procedures. The outlook is positive if people receive an accurate diagnosis and make recommended lifestyle changes.

There are rare reports that a cyst may degenerate into cancer. However, in most cases, the condition is noncancerous.

The most common type of pilonidal cyst surgery is incision and drainage, but a surgeon will remove the cyst if it recurs or a person has continuing difficulties with it. Risks can include infection, bleeding, recurrence, and delayed recovery.

An individual having the surgery must follow their healthcare team’s instructions regarding preparations and aftercare. This may include temporarily abstaining from certain medications for a certain time before surgery and keeping the area clean and dry following surgery.

Because infections are possible after surgery, someone should call a doctor if they experience a fever or discoloration near the incision site.