If a pilonidal sinus keeps becoming infected, you may be recommended to have surgery to remove the sinus and to prevent further infections.
There are two different surgical methods used - ‘wide excision’ or ‘excision and primary closure’ - and your consultant will advise the most appropriate treatment for you. There is also a relatively new treatment involving fibrin glue.
Excision of a pilonidal sinus is usually carried out in hospital under a general anaesthetic, so you’ll be asleep during the operation. It's a relatively minor procedure so you should be able to go home within a couple of days.
Wide excision of a pilonidal sinus
Wide excision involves cutting out the section of skin containing the sinus and leaving the wound open and packed with a dressing. The chances of an infection returning are low using this method; however, the wound takes a long time to heal and you’ll need daily dressing changes for two to three months.
Excision and primary closure
This procedure involves cutting out the affected skin and then stitching the wound closed. While the wound heals more quickly with this method, there is a greater chance of the infection returning.
Some pilonidal sinuses can be treated by scraping away debris from the infected area before sealing the sinus with fibrin glue. You won’t need any dressings and pain is minimal; the risk of reinfection is similar to the ‘excision and primary closure’. Fibrin glue treatment can be carried out under general or local anaesthetic, depending on your preference.
You may have some discomfort after your operation which we’ll help relieve with painkillers. You may have a small plastic drain in place, which is normally removed after 24 hours. If the wound has been left open, it will have a dressing that needs changing each day; this may be uncomfortable. More often the wound will be stitched and covered with a light pad; this is not usually painful.
You’ll usually go home after two days. If you still have a dressing in place, this will still need to be changed daily. If you have a stitch it will need to be removed at around 10-12 days after your operation. All of these arrangements will be made before you go home.
You’ll probably need time off work, depending on how you feel and the type of work you do. Any strenuous work or exercise that could disrupt the wound should be avoided.
Whatever type of operation you have, it is important to keep the site of the wound clean. Depending on the procedure, it may be necessary to keep the area completely dry. You’ll probably be more comfortable wearing loose-fitting cotton underwear and, to reduce any straining when you go to the toilet, a high-fibre diet may be suggested to help soften your stools. Your consultant will tell you what’s required.
There is a risk that a pilonidal sinus returns after treatment (recurrent pilonidal sinus). Additionally, surgery for a pilonidal sinus can lead to an infection at the site of the wound. You contact your GP immediately if you have any signs of infection such as pain; red, swollen skin; a high temperature; a feeling of heat at the site of the wound; fluid, pus or blood leaking from the site of the wound or an unpleasant smell coming from the site of the wound.
Treatment may not be necessary for a pilonidal sinus if it's not infected.