Pilonidal disease is a relatively common and usually benign condition where surgery is often the definitive treatment of choice.

A pilonidal sinus is a swollen or inflamed tunnel involving the hair follicles, which can occur anywhere along the cleft between the buttocks. Hair in this area curls over and grows into the skin and fat layers, leading to infection. Pilonidal sinuses are more common in men due to the hair distribution in this region.

Patients can experience a wide variety of symptoms, including:

• Uncomfortable sensations from the pilonidal pits or pores.

• Pilonidal cysts, which form when a hole develops due to an untreated abscess or recurrent abscesses.

• Active pilonidal abscesses, which occur when hair follicles become infected, leading to a pus-filled abscess.

Causes of Pilonidal Disease

Pilonidal disease results from entrapped hair follicles. It is most common in young adults. Three main factors contribute to the development and persistence of this condition: hair (the primary culprit), a force causing the hair to enter the sinus (friction or irritation), and skin vulnerability.

Predisposing factors include:

• Obesity

• Prolonged sitting (sedentary occupation)

• Family history of pilonidal disease

• A deep gluteal cleft (shape and curve of the buttocks)

• Previous irritation or injury, such as skin problems, pressure, or friction in the area

Pilonidal Disease Treatment

Pilonidal disease is primarily managed surgically, especially in cases of infection or abscess formation. Infected abscesses require incision and drainage.

Given the role of hair in the condition’s progression, hair removal through laser treatment may be beneficial when there is no active infection. Self-shaving should only be done with a doctor’s approval. Maintaining hygiene by regularly showering or bathing is also essential.

Types of Surgery for Pilonidal Disease

1. Incision and drainage
   If there is a swollen, painful lump, it may indicate an abscess. An incision is made to drain the pus. General anaesthesia may be needed, depending on the abscess size. Recovery typically takes 4 to 8 weeks, with daily dressing changes. Vacuum-assisted negative pressure dressings may be recommended to speed up recovery.

2. Surgery to remove sinuses

   • Wide excision with open healing
     For large or recurrently infected sinuses, the affected area is removed, and the wound is left open to heal naturally. General anaesthesia is required, and hospitalisation is usually unnecessary. Recovery takes 6 to 12 weeks, with daily dressing changes.
     There is a low risk of recurrence.

   • Surgery with wound closure
     This procedure involves removing the sinus and using a diamond-shaped skin flap to close the incision. It is suitable for non-infected wounds. Stitches are removed 16 to 21 days after surgery. While overnight hospitalisation is typically unnecessary, there is a high risk of infection, and wounds may need reopening for dressing changes.

3. Procedure to clean sinuses and encourage healing

   • Endoscopic ablation
     An endoscope (a thin, flexible tube with a camera) provides a clear view of the affected area. Hair and infected tissue are removed, and the sinus is cleaned with a special solution before being sealed with heat. This procedure is usually outpatient.

   • Plastic surgery
     In cases involving extensive treatment areas, plastic surgery may be used to reconstruct the skin after sinus removal.

What to Do After Your Operation

Do:

• Keep the surgery area clean.

• Wear comfortable, loose-fitting cotton underwear.

• Eat fibre-rich foods to ease bowel movements and prevent straining.

Don't:

• Lift heavy objects.

• Engage in strenuous exercise while the area is healing.