When to Consider Pilonidal Cyst Excision Surgery

“When you are down with a pilonidal cyst, looking at immediate relief is the only focus. Conservative treatment options help, but pilonidal cyst excision is seen as an effective measure. But does the surgical option fit every scenario?”

Dr. Allen Kamrava MD, MBA offers both non-surgical and surgical treatment for pilonidal cyst. However, there are specific points that require careful consideration when choosing the treatment style. 

One is more likely to witness cases of pilonidal cyst among people who are in their late teens to early middle age. This is because of their hairy disposition. The cyst will start to form in a hair follicle at the end of the tailbone. Due to pus buildup, the cyst becomes infected and the area turns sore and painful. Removal of the cyst is the only way to treat the condition. This can be done through conservative approach or an aggressive pilonidal cyst excision. Let’s understand the best course of action and when to consider a surgical removal. 

The Growth Stages Of Pilonidal Cysts

At the starting point, the hair follicle traps the roots of the body hair. Dead skin cells and debris also get trapped if proper hygiene is not maintained. This pimple-like growth is not painful and largely asymptomatic.

At the second stage, the pus formation will make the area red and sore. Mild symptoms like pain, pus discharge, and movement difficulties become prominent.  

Draining the pus offers instant relief. But the cyst is likely to recur. Over time the area of infection grows wider and deeper. The cyst gets to infect the sinus tract. This is the final stage. The movement becomes challenging and the pain is extremely excruciating. 

Conservative Treatment Options

The patients in their stage 1 and 2 of pilonidal cyst are often managed through non-surgical options. The use of antibiotics, pain relievers are most common. Using warm compress and Sitz Bath offer relief. Draining the acute abscess releases pus and pressure. Regular hair removal to keep the area hair-free is a helpful approach. 

When to Consider Pilonidal Cyst Excision Surgery

Unfortunately, conservative treatments will not help most patients. The cyst will keep returning and the condition will become more complex. 

Excision of pilonidal cyst aims to remove the entire cyst and the infected skin tissue that surrounds the pilonidal cyst. It is considered in the following cases. 

1. Frequency Of Occurrence

Excision pilonidal cyst becomes necessary if there is repeated infection. If the cyst returns every 2-3 months, the colorectal surgeon will look at avenues to ensure long-term and permanent relief from the pain and other symptoms. 

2. Degree Of Pain

Chances are that the patient feels persistent pain due to the awkward location of the cyst. Also, the size of the cyst may be big to trigger movement difficulties. If the presence of the cyst begins to interfere with the daily chores and activities, it gets difficult to sit, stand or lie down comfortably, pilonidal cyst excision surgery may provide relief. 

3. Size And Complexity

Pilonidal cysts gradually grow from a pimple-like growth on the surface of the skin to a deep and large abscess infecting one or multiple sinus tracts. Large and complex cysts do not settle with conservative treatments alone. Therefore, a surgical route is the only option available to find relief in the long run. 

4. Complications

Skin infection, cancerous growth are rare complications of the pilonidal cyst. But if the infection spreads to extensive levels, surgical removal is the last resort. Cellulitis, a bacterial skin infection, or other complications will need extensive surgeries to eliminate all of the affected portions of skin to find relief and prevent further spread of the infection.

5. Cosmetic Reasons

Many patients are conscious about the scarring that may happen with a pilonidal cyst. If this is a major concern for the patient, the colorectal surgeon may consider operating upon and removing the cyst at an early stage. Minor surgeries leave less noticeable scars.  

6. Permanent Relief 

The rhomboid flap technique is the most complex of all surgical removals for pilonidal cyst. In cases where the cyst recurs time and again, it is the only option for long term relief. But the healing is very slow and one has to seek help from family and caregivers during this healing period. 

Final Thoughts

Pilonidal cyst removal surgery is an effective way to find relief from painful cysts. Dr. Allen Kamrava MD MBA, visits the case closely to check if it is suitable for a simple approach or if it requires wide excision. Flap closure surgeries are the most complex and are recommended for large and bad cases. It is important to leave the cyst untreated. Medical intervention is important at the earliest as managing the cyst at an early stage is easier and with high chances of positive treatment outcomes. 

Just like any other surgical procedure, pilonidal cyst excision also requires careful consideration. This is why experience and skill of a colorectal surgeon are extremely important. If the surgery is not performed well or the after-procedure wound management is not up to the mark, the cyst will resurface again. This will require another set of surgical excision.