Pilonidal Cyst Surgery

What is a pilonidal cyst?

Pilonidal cyst or sacrococcygeal fistula is a chronic skin infection in the crease of the buttocks near the coccyx (tailbone).The cyst is usually created by the ingrown hair into the skin at the coccyx area. Some doctors think that ingrown hairs are the reason for many of them. Pilonidal means “nest of hair,” and doctors sometimes find hair follicles inside the cyst. However, there is also the possibility to be a congenital disease, i.e. to be caused by a cyst that was developed during foetal (fetal) life.

Pilonidal cyst is a very common condition especially in men from adolescence up to the age of 40, especially in shaggy and overweight people.

What are the symptoms of pilonidal cyst?

Pilonidal cyst is usually appeared as an inflammation in the coccyx area (above the anus). If it’s not treated, a pilonidal cyst can possibly lead to an abscess or a sinus cavity. Those are both signs that the skin infection is getting worse. Most people with a pilonidal sinus do not notice it unless it becomes infected and causes symptoms.

When the pilonidal cyst becomes inflamed, it causes severe pain and is often accompanied by pus or fluid secretions from an opening in the skin (pit). In addition, the inflammation causes, in some cases, fever, extreme tiredness (fatigue) and nausea.

What is the treatment?

The treatment of pilonidal cyst depends on the condition of the disease. An acute abscess is usually checked via incision and drainage, so that pus is released, inflammation is reduced and the patient is relieved from pain. However, this treatment does not definitively cure the cyst. When the situation is improved, then you may need surgery to excise (remove) the cyst entirely.

A chronic pilonidal cyst is effectively treated only with surgery. The traditional surgical procedure aims at completely removing the cyst, together with the accompanying tracts and pits, in order to prevent future recurrence.

In the traditional surgical procedure (open method), the cyst is completely removed along with the accompanying tracts and pits, and the wound is left open to heal naturally. With this surgical procedure, the possibility of recurrence, which is the greater problem in the treatment of pilonidal cyst, is zero.

The regular (daily) dressing changes of the wound are absolutely necessary, at first, by the doctor and then by the patient himself or his/her relative. For these changes, we use special pads so that there is no pain at all and the patient feels comfortable 24 hours a day.

The most modern technique for the treatment of pilonidal cyst is the endoscopic ablation of the cyst using LASER.

This method is a modern, minimally invasive procedure that does not involve incisions and open wounds, minimizing the patients suffering who were subjected with the traditional rehabilitation technique. This laser is not related to the lasers of aesthetic medicine or those that we use for performing surgical incisions. It is a special endoscopic laser unit (a specially designed optical fistuloscope that is inserted through a small circular incision around the pilonidal sinus opening) that emits energy radially at different wavelengths and with different power.

The method is indicated in the uncomplicated types of pilonidal cyst and initially involves the mapping of the affected area and the fistulous ducts with the input of a micro-camera which transfers the magnified image of the inside of the cyst to a high definition 3D screen (EPSiT Endoscopic Technique).

When the sinus tract is cleaned from any material, inflammatory tissues, hairs and hair follicle remnants that are almost always present, an optical fiber (Laser) is inserted and the track is ablated.

The optical fiber emits a laser beam completely controlled, without causing damage to adjacent tissues. The applied radiation on the inner surface of the cyst causes a photothermal process (photocoagulation) that sublimates its walls and results in sterilization of the area and finally the destruction of the cyst as well as the closure of its fistulas, with rapid healing and fast definite recovery.