Overview
A pilonidal sinus is an abnormal skin condition that occurs in the cleft at the top of the buttocks, near the tailbone. It is characterised by the presence of a small pit or hole in the skin, often containing hair and skin debris, which can become infected, forming a painful abscess or chronic discharging sinus. The condition predominantly affects young adults, particularly males, and is associated with prolonged sitting, excess body hair, deep natal cleft, and poor hygiene. While acute infections are initially managed with incision and drainage, definitive surgical treatment is required to eliminate the sinus and prevent recurrence.
The Procedure
At ILS Hospitals, pilonidal sinus surgery is performed under spinal or general anaesthesia. The surgical approach is selected based on the complexity of the sinus tract and the number of secondary openings. Options include wide excision with open wound healing, excision with primary closure, and flap-based techniques such as Karydakis flap or Limberg flap, which are preferred for complex or recurrent cases as they shift the skin cleft laterally, reducing tension and significantly lowering recurrence rates. All sinus tracts, pits, and secondary openings are excised in their entirety. The wound is meticulously managed to ensure thorough healing.
Recovery
Recovery depends on the technique used. Open wounds heal by secondary intention and require regular dressing changes over several weeks. Primary closure and flap procedures offer faster recovery, with most patients returning to work within 2 to 3 weeks. Patients are advised to keep the surgical area clean, avoid prolonged sitting on hard surfaces, maintain good personal hygiene, and regularly shave or depilate the natal cleft area to prevent hair reaccumulation. At ILS Hospitals, our colorectal team offers the full range of pilonidal sinus procedures, selecting the approach that best balances effective treatment with minimal recurrence risk.
