Dr Luigi Sussman - General and Laparoscopic Surgeon

Pilonidal Sinus

This is a condition which generally affects teenagers and young adults, but may occur at any age. Although more common in men it does occur in women too. It is often though not always seen in hairier individuals and may run in families.

It usually presents with pain or discomfort and possibly swelling or a pus-like discharge affecting the natal cleft area (between the buttock cheeks) of the lower back.

A Pilonidal Sinus is a cavity under the skin which may have a few openings visible on the skin surface in the midline of the natal cleft or just off the midline. These openings may have a few hairs protruding from them and may also discharge pus/blood stained fluid. The cavity itself can be quite large (several centimetres) and is often full of hair. The exact cause of these sinuses is not clear. The acute episode may settle with antibiotics, but surgery is required in most people to prevent recurrent problems.

Many operations have been described to deal with this problem.

The surgery involves cutting out the cavity and overlying skin openings. This can leave a sizeable defect which is at times left open to heal with daily dressings required over a period of weeks to months. The hole can be closed directly by pulling the edges together, but often this is under tension and in about 30% the sinus may recur. 

My preference in most people is to remove the sinus and close the resultant defect/"hole" with a flap of skin and tissue from the adjacent buttock. In my experience this will give the best result with the lowest likelihood of recurrent or ongoing problems. It is a more complex operation to perform but worthwhile in view of the superior results. The most common operation I perform is called a Karydakis procedure and on occasion I will perform a modified Limberg Procedure. It takes about 90 minutes to perform under general anaesthetic. A small plastic tube drain is left in place and removed on the ward just prior to discharge home the next day. Skin stitches are removed at 7 to 9 days at a follow-up visit. It is not a particularly painful procedure but strenuous physical activity must be avoided for at least 1 month after surgery to ensure good healing of the wound.

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