In most cases, a pilonidal cyst excision takes place in a hospital’s outpatient surgical ward or in a surgicenter. The procedure itself only takes between half and hour to an hour, with 45 minutes being about average.
Most patients are required to stay in the recovery area for one hour after the excision, depending on the type of anesthesia that was used. This surgery is frequently done under monitored anesthesia care, although general anesthesia or a spinal block are preferred by some surgeons in certain cases.
A well-trained surgeon, usually a colon and rectal surgeon, also known by the older term, proctologist, will find the best placement of the incision, being careful to avoid creating additional problems by placing it in an area where there may be excessive tension on the line of incision. This usually includes avoiding the midline of the buttocks. Because pilonidal cyst excision wounds are often slow to heal and at an increased risk of infection and breakdown, the placement of the incision is especially important to help avoid complications.
Is There More Than One Type of Procedure?
When the surgeon explains the procedure to you, he or she will most likely tell you if your wound will be left open or will be stitched closed. Both of these techniques have pros and cons, and only your doctor can help you decide which best fits your needs.
The excision itself is carried out the same way, no matter how the post-surgical wound will be managed: the skin is opened near the abscess and sinus and the tissue around them are carefully removed. Once the cyst has been excised, the two procedures go different directions, though.
Most commonly, the wound is sutured closed. However, in some cases, the surgical incision is packed with gauze and left to heal on its own. This is how cavity wounds on any area of the body are typically dealt with. The body heals from the most interior part of the wound outward toward the skin, allowing it to heal more completely. Unfortunately, however, this can often take up to eight weeks. This method is used when the pilonidal area is already infected.
Stitching the wound closed, often called excision with primary closure, offers a much faster recovery process. The risk of infection, however, is slightly higher when the excision isn’t allowed to heal naturally. In fact, as many as one out of four people who opt for primary closure develop an infection. Only between 5 and 15 percent of those with open healing wounds experience an infection.
How Is The Wound Managed After Surgery?
Caring for the wound is key in preventing infection or recurrence after a pilonidal cyst excision. For this reason, your doctor will likely share with you very specific instructions about aftercare and wound management. You will need to follow these procedures very carefully until the wound has healed, or the cyst may return and you will have to repeat the process again.
The patient care packet or verbal instructions given to you by your healthcare provider may include:
- Directions on packing the wound, if required
- Instructions for other dressing changes
- What to look for to ensure the incision is healing properly
- Signs of infection or other complications
Some proctologists handle open healing wounds differently than others. Often, you will be advised to carefully clean the cavity several times each day, and then pack it with gauze. This ensures it stays as clean and protected from bacteria as possible. Other surgeons may not ask you to pack the wound, but may have very specific instructions on how to flush it to ensure it remains clean. But remember, most incisions are closed at the time of the operation. Very few incisions are left open. So, you most likely will not need to take any special precautions after your operation.
Depending on your health insurance provider, you may be able have a home health nurse who will assist you through this process when the wound is left open. Many insurance plans do not cover home visits for surgical wound care, though. While it may be awkward, it is not difficult to perform any of these aftercare requirements on your own.
If you have undergone a primary closure procedure, you will simply periodically change the covering dressing. In addition, you may have a closed-suction drain in place, although a drain placement is very rare. Because a closed wound is more likely to trap bacteria inside and become inflamed, it is important to watch for signs of infection. This may include redness, strange drainage or odors and swelling.
How Long Will Recovery Take?
Recovery, as defined by complete wound healing, may take six weeks or it may require six months, depending on your individual situation and what type of procedure was performed. Uncomplicated primary closure procedures are typically healed within two weeks, while even the most simple open wound procedures often take at least eight weeks.
Patients typically report significant improvement after the first seven days following surgery. Most can resume driving during this time period, and return to work by the second week. Of course, you should check with your colon and rectal surgeon before resuming these activities.
Your doctor will most likely monitor your progress through a series of follow-up visits. Most who undergo excision with primary closure have the stitches removed after two weeks, and may be released from their doctor’s care at that time. Patients with open wounds usually have more frequent follow-ups, and for a longer period of time. The frequency is based on the doctor’s preference, as well as the individual situation.