Due to their location, pilonidal cysts often become infected, inflamed, and painful. When these common cysts are diagnosed early, they can often be treated in the doctor’s office and usually heal on their own. Many people, however, put off visiting the doctor until the infection begins to interfere with their daily life.

An experienced colon and rectal specialist is often still able to drain an infected pilonidal cyst in the office with local anesthetic and a small incision. If the infection returns, though, a more invasive procedure may be necessary. Unfortunately, this is a common occurrence, especially among men who are already at an increased risk for developing these cysts. In the event that a previously drained cyst continues to cause problems or recurs after healing, surgery to excise the cyst may be recommended.

What Is Excision Treatment?

In many cases, pilonidal cyst excision can be performed with just a local anesthetic and intravenous sedation. Some doctors, however, prefer general anesthesia. It may also be required in cases where the doctor anticipates a longer or more difficult procedure than usual due to the individual facts of your case.

No matter how your doctor manages your anesthesia, the surgery itself typically proceeds in the same way. The cyst and area around it is removed, and the area is cleaned to remove any remaining infection.

After the excision is complete, there are two ways to manage the surgical incision: open healing and primary closure. Open healing requires packing the wound with a sterile dressing and allowing it to close gradually on its own. Primary closure involves stitching, gluing or stapling the wound closed. Each method has advantages and disadvantages, so it is important to discuss which will be best for your condition with your doctor.

Which Procedure Do I Need?

The key to ensuring your pilonidal cyst excision surgery is done in the most effective way possible with the fewest complications is to choose a surgeon who is well-versed in this surgery and performs them regularly. An experienced colon and rectal specialist can weigh the pros and cons of each type of wound healing, and recommend the one that will offer you the best opportunity for quick and complete healing.

There are advantages and disadvantages to both primary closure procedures and open healing. If your doctor closes the wound with stitches, you will most likely heal much faster. An open wound must be carefully cleaned and packed with gauze regularly, but the risk of the cyst recurring is greatly reduced. In addition, a closed incision is more likely to become infected, either through outside contamination or through previous infection that wasn’t completely removed. About 25 percent of people who undergo a primary closure procedure experience an infection, while only between 5 and 15 percent of people who opt for open healing develop an infection. If an infection does occur, the incision will be reopened and you will begin the healing process again with an open wound.

How Is Open Healing Managed?

During open healing, the surgical site is allowed to heal from the inside outward. This is how the body naturally heals a cavity wound, which means the new tissue is stronger and less likely to erupt into another cyst.

When the incision is left open to heal on its own, wound management often requires frequent follow-ups with the doctor. Some doctors prefer seeing a patient more often than others, but you can expect to visit the clinic regularly for up to eight weeks after a pilonidal cyst excision with open healing.

In most cases, you will receive strict instructions on how to care for the wound between visits. Depending on your doctor’s preference and your unique circumstances, you may be asked to:

  • Carefully flush the cavity several times a day, then pack it with a sterile dressing
  • Clean and irrigate the cavity several times a day, including after bowel movements, and cover the area with gauze or another bandage.

Your doctor may ask you to come into the office for the first few dressing changes, or your insurance plan may cover the fees of a home health nurse to perform wound care. Most people, however, can easily master the aftercare instructions on their own when necessary.

What Happens After An Excision Is Closed?

In general, dealing with the incision after primary closure is much easier than managing an open wound. Your doctor will provide instructions for aftercare that will include:

  • Instructions for regular cleaning and dressing changes
  • How to tell if the surgical site is healing properly
  • Watching for early signs of infection
  • When to have stitches removed, if necessary

Some people require a closed-suction drain inside the cavity after surgery, and your aftercare instructions may also include drain management. Primarily, though, you will need to be aware of your role in reducing your risk of infection. This includes monitoring the surgical incision for swelling, redness, odors or unusual drainage, and reporting any of these signs to your colorectal doctor as soon as possible.

It will take about two weeks before the incision is closed. During that time, you will need to ensure a sterile dressing remains in place and the skin around the surgical site is clean. Your doctor may monitor you during weekly or bi-weekly office visits. In most cases, the stitches can be removed after about two weeks, and you may be released to return to normal activities at that time.