A pilonidal cyst is a chronic inflammatory condition of the skin between the buttocks. The condition can cause pain, swelling, and recurrent infections, and in some cases, an abscess may develop. On this page, you can read about surgery for pilonidal cysts, including when surgery is recommended, how the procedure is performed, and what to expect before, during, and after surgery.
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A pilonidal cyst is a chronic inflammatory condition of the skin at the top of the cleft between the buttocks. The condition occurs when hair and skin debris penetrate the skin, triggering a localized inflammatory reaction. It is most commonly seen in younger adults and is more common in men than in women.
A pilonidal cyst may be asymptomatic at times, but it can also develop into a painful abscess accompanied by redness, swelling, and possibly a fever. In some people, the symptoms recur repeatedly if the cyst is left untreated.
Surgery is recommended when a pilonidal cyst causes persistent or recurrent symptoms, or if an acute infection with an abscess develops. In cases of acute inflammation, the initial goal of treatment is to incise and drain the abscess so that the inflammation can subside. In chronic or recurrent cases, surgery may be performed to remove the diseased tissue and reduce the risk of the cyst returning.
There is a risk that the pilonidal cyst will recur after surgery. The risk is approximately 30–40% after treatment of an acute condition and approximately 10–20% after treatment of a chronic condition.
The surgeon always determines which treatment is most appropriate based on your symptoms and the extent of the disease.
Before surgery
To ensure the best possible conditions for the surgery, it is important that you follow the instructions you received prior to the procedure. If the surgery will be performed under general anesthesia, you must arrive having fasted. If you are taking blood-thinning medication or have other medical conditions that may affect the surgery, you will receive personalized guidance prior to the procedure.
It’s a good idea to have pain medication at home and to arrange for transportation home after the surgery. On the day of the surgery, the surgical site must be clean, and you should wear loose-fitting clothing that will be comfortable after the procedure.
During the operation
The surgery is performed under general anesthesia. In the case of an acute infection, the abscess is opened and drained so that the inflammation can subside. In the case of a chronic pilonidal cyst, the inflamed tissue is removed through an incision in the crease between the buttocks, after which the wound is closed with dissolvable sutures. In the case of an acute inflammatory condition, the wound is left open so that it can heal from the bottom up.
Before the surgery, the surgeon will go over the procedure with you and answer any questions you may have so that you feel well-informed about the process.
After surgery
After the surgery, you will be monitored before you can go home. If you were under general anesthesia, you will remain in the hospital until you are sufficiently awake, and you must not drive yourself for the first 24 hours. If the surgery was performed under local anesthesia, you can usually be discharged shortly after the procedure.
It is normal to experience tenderness and moderate pain in the surgical area after surgery. The pain usually subsides within a week. During the first week, you should rest and avoid sitting for long periods or putting any other strain on the incision. Keep the surgical area clean and rinse it according to the instructions you receive upon discharge.
You will receive guidance on pain management, wound care, and the precautions you should follow at home. Upon discharge, you will also be informed about when you can resume your daily activities and how any follow-up care will be arranged.
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