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What Is a Pilonidal Cystectomy?

By B. Chisholm
Updated Feb 19, 2024
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Pilonidal cystectomy is a small operation, usually done on an outpatient basis, to remove a pilonidal abscess. This is a small cyst usually found on the coccyx or tailbone at the top of the buttocks. The operation involves the attending doctor making a small incision and removing the cyst. The wound is either packed with sterile material and left to heal or stitched.

The cyst is often referred to as a pilonidal sinus, due to the fact that it is basically a cavity or sinus, usually filled with hair and skin debris. They are more common in men than women, possibly due to the greater amount of hair on men. Even with treatment, they commonly recur. The exact cause is unknown but is thought to be due to an ingrown hair that becomes infected. Due to their position on the coccyx, sweat, pressure and rubbing when sitting or moving may exacerbate the cyst.

Pilonidal cysts can be unsightly and painful and may require pilonidal cystectomy. This is a minor procedure that can be done in the doctor's rooms or emergency room and does not usually require a stay in hospital. In some cases the cyst may infect the skin around it, requiring antibiotic treatment after the pilonidal cystectomy, but this is not common.

Before starting, the area on which the pilonidal cystectomy will be performed is cleaned with an antiseptic such as povidone-iodine to ensure sterility. Local anesthetic will be injected around the entire area to ensure that no pain is felt during the procedure. A small incision is then made over the cyst, and the hair and any debris is removed. In some cases, phenol may be injected into the cavity.

After the pilonidal cystectomy is completed, there are two courses that may be followed. Some doctors prefer to pack the wound with sterile gauze while others prefer to stitch the wound. Which route is followed is purely a clinical decision, and in general the outcome is good with either.

Following the procedure, antibiotics may be given if it is an infected pilonidal cyst. Mild painkillers may be prescribed for analgesia. The wound should be kept clean, and the area should be kept free of hair. If severe pain, redness or heat is experienced, medical attention should be sought.

The wound may take up to six weeks to heal completely, and good hygiene is essential during this period. In the case of more severe or deeper and recurrent pilonidal cysts, the procedure may involve a bigger incision and perhaps an overnight stay in the hospital. In this case, wound healing may take a bit longer.

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