A pilonidal cyst is a cyst that grows over the tailbone. Pilonidal Cystectomy is a type of surgery used for the removal of a pilonidal cyst.
The degree of complexity may vary from the relatively straightforward excision of tissue to a complicated procedure involving the rotation of adjacent tissues into the defect after excision.
Pilonidal cystectomy is required when the risk of complications arising out of the developing pilonidal cyst grows high. Risk of complications increases due to increasing skin friction in the area of the cyst, presence of hair and having a deep natal cleft. While it was suspected that the primary cause of a pilonidal cyst was congenital, it is now known to be caused by hair in the natal cleft that results in a reaction from the body’s immune system leading to inflammation and possibly, infection.
The surgery is required for any individual who has a pilonidal cyst that causes pain and discomfort. Sometimes a pilonidal sinus may be the cause of the pain and surgery will have to be deferred until later. Closure of the pilonidal cyst should not be undertaken in individuals with an active infection. In such cases, antibiotics should be administered and the surgery on the abscess performed only after the infection has cleared.
The goal of the surgeon is to remove all the damaged, cystic tissue and to allow the healthy tissue to heal. The surgeon may approach the pilonidal cystectomy with a view to allow open healing. Alternatively, the approach may call for wound closure. There are several different techniques that may be used, including a simple cystectomy, a cystectomy with primary closure and other procedures using flaps and variations thereof. The simple cystectomy and the one involving primary closure are usually performed only on small cysts.
Prior to the cystectomy you will be prepped for the surgery. Hair around the natal cleft will be removed and your buttocks will be taped so as to expose the natal cleft. An iodine solution will be applied to the affected area to create a sterile barrier. The surgeon will then begin to identify the areas that need to be drained.
The procedure begins with anesthesia. For small cysts or for draining the abscess, local anesthesia is usually used. For a simple cystectomy you may be given spinal anesthesia along with local anesthesia while for the more complicated procedures, general anesthesia may be used.
A simple cystectomy uses electro cautery to dissect the tissues around the cyst and the sinus tract. The walls of the wound may have to be debrided further with curettage. In the open technique, the wounds are left open, covered with gauze and left to heal. While this technique requires a shorter operating time, the disadvantage is that recovery takes much longer and the cyst has a 10% chance of recurring. Bacterial infection in the case of larger cysts can be minimized by the use of a negative pressure wound therapy device that will need to be changed once every three days.
Primary closure will involve closing the wound after the simple cystectomy with nylon. Deep wounds may be closed in layers, with absorbable suture used to close the deeper layers.
The surgeon may choose other techniques depending on the amount of tissue to be excised, the contour and tension of the wound and based on personal preferences. These include:
Talk to your surgeon beforehand about which of the techniques will be used on you, and the reasons for choosing it.
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