Pilonidal Cysts and Abscesses
Pilonidal cysts occur in the cleft that exists between the two buttocks. When a pilonidal cyst becomes infected, it is called an abscess. These cysts may be congenital (present at birth) or may result from hairs penetrating the skin and accumulating beneath the skin. This condition occurs in this area because of the cleft between the buttocks allows hair to accumulate. There are usually one or more dimples or small holes overlying the cyst called pilonidal sinuses. Often there are hairs protruding from these small openings.
Pilonidal cysts are four times more common in men than women. This condition may be present form birth, but is not usually noticed until adolescence or later. The disease has been referred to as “jeep-driver’s disease”, and it is thought that bumpy driving aggravates previously existing disease.
External appearance varies from a barely visible dimple at the upper end of the buttock crease to an obvious opening into the cyst. The cyst gradually enlarges and becomes susceptible to infection. When an abscess is present, there is a painful, swollen area with surrounding redness and often pus leaking from the sinuses. A sinus may chronically drain. Infection is more common in the warmer months when the area becomes moister and the bacterial count on the skin increases.
If the cyst is abscessed, the only treatment is to open and drain the pus. Antibiotics are generally not helpful. The procedure can usually be accomplished under local anesthesia in the office. The open wound is packed with gauze which is then removed in a day or two.
Once the infection is cleared, the entire cyst must be removed in order to prevent further infection. This is usually scheduled for a week or two after the drainage of the abscess.
Surgery for Pilonidal Cyst
Not too many years ago, the only accepted operation for pilonidal cyst was to completely excise the area, leaving a defect 4-5 inches long by 2-3 inches wide. This was packed open with gauze that was changed daily. The wound was allowed to heal in from the sides, a process that takes several weeks. This still might be the
operation of choice if infection is encountered during the operation or if the cyst keeps recurring.
More recently, we have found that with the use of a suction drain to remove fluid accumulation, the wound can be closed with sutures. The drain remains in place until the drainage subsides (usually about a week). It is removed at a follow-up visit in the office. The skin sutures are removed two weeks after the surgery.
This surgery can be done under intravenous sedation or general anesthesia. In either event, the surgery can be done as an outpatient.
After recovery from the anesthetic, the nurses will instruct you in the care of the drainage tube. You will need to keep it clean to prevent infection. The easiest way to clean the drain tube is to remove all dressings and shower with soap and water. The surgical site is then carefully dried with a clean towel. A gauze dressing should be applied over the drain. You will be asked to empty the drainage reservoir daily and record how much drainage is present.
You probably will not want to return to work or other normal activity for the first few days. It is OK to walk, sit, and lay on your back, but you should avoid strenuous activity. It is helpful to use a pillow for extra padding when sitting.
Pilonidal cysts have a relatively high risk of recurrence – about 15%. Wound infections, wound separation, and wound drainage is also fairly common. These problems can sometimes be treated with dressings, but repeat surgery can also be necessary. Other risks include, but are not limited to: bleeding, infection, scarring, and complications related to anesthesia.