Definition & Overview

Pilonidal cyst excision is the process of surgically removing a pocket of tissue that abnormally grew around a hair follicle. The cyst is typically located near the tailbone, at the top of the buttocks crease.

A pilonidal cyst contains both hair and skin debris that accumulates after the hair punctures and embeds itself in the skin. When hair burrows back into the skin, inflammation occurs as the body identifies it as a foreign body that needs to be attacked. Over time, cyst forms around the base of the hair, resembling that of a small pit or pore in the skin with a dark spot in the centre.

Who Should Undergo and Expected Results

Patients with pilonidal cyst may undergo this procedure, particularly if:

  • It is a recurring condition
  • If the abnormal growth is causing severe discomfort and impacts the patient’s daily activities
  • It causes the formation of sinus tract or a small abnormal channel

However, this procedure is usually deferred if there is an active infection and if pus has already formed. This condition, termed pilonidal disease, has to be resolved first by opening the cyst to drain the pus and other fluids. Once the infection is cleared through antibiotic therapy, the patient can go ahead and undergo pilonidal cyst excision.

The procedure has a high success rate, though it may take several weeks for the wound to heal. The patient is usually allowed to go home immediately but would be advised to rest for several days. Care should be taken not to put any stress on the wound and strenuous activities are usually avoided for several weeks.

How is the Procedure Performed?

For the procedure, the patient is administered with anaesthesia before the hair is shaved off or clipped from the affected area. The nasal cleft is then exposed and the sinus tracts identified and probed using a lacrimal duct probe. In a simple pilonidal cyst excision, electrocautery is used to remove the tissue growth and seal the wound at the same time.

For more complex excision techniques, the surgeon typically removes the cyst and designs a flap from the surrounding skin to cover the wound. This promotes healing by keeping the wound away from the midline. Examples of these techniques include the Karydakis flap, the Limberg flap, the Z-plasty, and the Bascom procedure.

In rare cases wherein the primary pilonidal cyst excision failed and had led to the recurrence of the condition, the more complicated myofasciocutaneous gluteal flap is performed. This involves the isolation of some parts of the gluteal muscles and its blood vessel. The flap is then rotated into the wound once the recurrent cyst has been removed. The procedure is highly specialised and is performed as the last resort for removing the cyst.

In removing a small cyst, the surgeon may use sutures to close the wound. However, bigger cysts may require open wound technique where sterile gauze is used as cover while the wound heals. The dressing has to be replaced regularly to prevent bacterial infection and promote healing.

Possible Risks and Complications

Pilonidal cyst resection carries the risks of:

  • Bleeding
  • Adverse reaction to anaesthesia
  • Wound infection
  • Delayed healing of the wound
  • Recurrence
  • Wound dehiscence, in which the wound ruptures along the incision line



References

  • Steele SR, Perry WB, Mills S, Buie WD, Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of pilonidal disease. Dis Colon Rectum. 2013 Sep. 56 (9):1021-7.

  • McCallum IJ, King PM, Bruce J. Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis. BMJ. 2008 Apr 19. 336(7649):868-71

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