What is a pilonidal sinus? Department of Colorectal Surgery Pilonidal Sinus Operation A pilonidal sinus is an inflamed sinus tract (or tracts, as there can be more than one) which leads to a cavity under the skin between the buttocks. How does it occur? It is thought that hairs growing inwards into the skin start the condition. In some people, sinuses form in dents in the skin around hair follicles. The tract and cavity often become infected, causing a discharge. If an abscess forms, this may cause a swelling and can burst. A pilonidal sinus can cause chronic problems, sometimes over several years. Pilonidal sinus is relatively common and often affects young adults, especially men. Risk factors include: obesity, smoking, spending lots of time sitting down, previous skin injury, frequent irritation of the skin and family history of the condition. What are the treatment options? No symptoms: If you have no symptoms, you will normally be advised to keep the area clean and to dry well after washing. Keeping the area free of hair (using hair removal creams, shaving etc.) is also beneficial. As smoking is a risk factor for the development of this condition, stopping smoking is important to prevent further problems. Acute infection (abscess): This usually requires drainage of pus, often under general anaesthetic, though it can occasionally be done under local anaesthetic as well. Chronic infection: This is when infection keeps coming back. Surgery would be considered at this stage. How will the operation help me? The operation removes the layer of skin that lines the sinus tract and removes any infected tissue. There are several different operations that can be done, depending upon the exact nature of your individual problem. Occasionally, the sinus is very small and can be completely removed followed by closure of the skin with stiches (which will later be removed). More often, it is necessary to leave an open wound. Your surgeon will discuss the operation that would best suit you, depending on the complexity of your condition. Available via Trust Docs Version: 2 Trust Docs ID: 11338 Page 1 of 5
What are the risks/complications of surgery? Surgical treatment for pilonidal sinus is generally very safe with few risks but, as with any surgical procedure, complications can occur occasionally: Severe bleeding, needing blood transfusion, is very rare. Wound infection is not unusual and is managed relatively easily by dressing and antibiotics (if the wound has been closed, then some stitches may need to be removed to drain the infection). Temporary difficulty in passing urine, lasting for 12 to 24 hours, is very unusual. You may experience side effects from the anaesthetic, such as feeling sick, but serious complications are rare. These risks/complications will be explained to you when the surgeon asks you to sign the consent form for the operation. What are the alternatives? Unfortunately there are no non-surgical options. Coming into hospital You will be asked to attend the pre-admission assessment clinic 1-6 weeks prior to admission to ensure you are fit for surgery, allowing time for the necessary preoperative tests, which may include blood test, cardiogram (ECG) and a chest x-ray. You will be admitted on the day of surgery, unless there are any medical or technical reasons that may require you to be admitted the day before the operation. The operation is usually carried out under general anaesthetic. The surgeon performing the operation will see you and you will also see the anaesthetist. If you have any questions about your operation, please ask the doctors. Most patients will have the surgery as a day case, but some patients undergoing more complex procedures may need to stay in for 2-3 days. This will be discussed with you. What should I expect after the operation? It is advisable to stay on the ward until the effects of the anaesthetic have completely worn off. You may have an oxygen mask on your face when you wake up. Recovery nurses monitor your pulse, blood pressure and oxygen levels. When you are fully awake you will be able to eat and drink as you wish, and to get up as soon as you feel able. Available via Trust Docs Version: 2 Trust Docs ID: 11338 Page 2 of 5
If your sinus has been layed open (open wound): You will have a dressing in place around the entrance to the sinus. Some discomfort is to be expected. Painkillers or local anaesthetic gel will be available; please ask your nurse if you need something to help with the discomfort. You should be able to go home the same day. Returning home Dressings: You will normally have a bath the next day and this will soak the dressing off (it may need a little gentle pull). It is quite possible that you may bleed a little in the bath (do not be alarmed - this can make the water look very red!). You will be given a telephone number to call if you are concerned. You will probably find that frequent baths are soothing to the area. It is essential that the sinus tract heals from the base upwards towards the skin. When you are ready to go home, your nurse will discuss with you how best to continue your dressings at home. If your wound is in a place that you can reach, the nurses will show you how to dress it yourself. If you cannot reach to do your own dressing, a district nurse may need to be involved, or you may need to go to the nurse at your local surgery. If the wound has been stitched, you will be given information about wound care and removal of any drains (if inserted, to remove any weepage from the site). Often dissolving stitches are used, which do not require removal. It will be necessary to continue daily dressing of your wound until it has completely healed (for wounds left open). Pilonidal sinuses vary a lot in the time that they take to heal. Some can take several months and this can be very frustrating. Sometimes hairs can grow inside the tract, and these will need to be shaved off or they can impair healing. It is important to try to be patient, and to continue the dressings for as long as necessary. Keeping your wound clean: It is important to keep the area clean. While you are in hospital you should take a bath or shower, or use the bidet after each bowel action. After a bowel motion you should wipe toilet paper away from your wound. Women should remember to wipe front to back, away from the vaginal area. Once you are home, taking a bath every time you open your bowels may become less practical, but you should continue to wash after a bowel action if at all possible for 3-4 weeks after the operation. You may find that sitting on the edge of the bath and using a shower attachment (if available) is a convenient way of cleaning the area. Available via Trust Docs Version: 2 Trust Docs ID: 11338 Page 3 of 5
It is very important that hairs do not grow into the healing tract. In some cases it may be necessary to shave any hairs that do grow. The doctor will discuss this with you if it is necessary when you come for your post-operative outpatient check. Returning to activities: The time taken to get back to normal activities varies for different people. Do as much as you feel comfortable doing. You should not drive unless you feel ready and confident to do so; if you need to take painkillers, these may make you drowsy, so you should avoid driving or operating machinery. However, please check with your insurance company as policies vary with individual companies. If lifting causes you discomfort you should avoid it. Try to avoid excessive walking or sitting still until your wound has healed. It would be unwise to go swimming, as chlorine may affect healing and there is a risk of picking up or passing on an infection. You should also try to avoid any friction in the area, as might be caused by tight clothing. You can resume sexual relations as soon as this feels comfortable. Most people need a few days off work, but this will depend on what you job involves. It is important for you to pay attention to your body, and only do as much as you feel able to. If you require a sick certificate for work please ask a member of staff before discharge. If you have stitches and/or a drain, it is important avoid stretching the area and therefore you may be advised not to sit for long periods of time or to stoop forwards. When to seek medical advice In the period following your operation you should seek medical advice on the telephone numbers below if you notice any of the following problems: Severe bleeding; Increased pain; Redness, swelling or discharge this may indicate infection. Please retain this information leaflet throughout your admission, making notes of specific questions you may wish to ask the Doctor and/or Nurses before discharge. Available via Trust Docs Version: 2 Trust Docs ID: 11338 Page 4 of 5
Points of contact Queries or concerns before surgery: If you have any queries prior to the procedure outlined and the implications for your relatives/carers, please contact the Surgical Pre-Admission Assessment Clinic on 01603 287819. Queries or concerns after surgery: Within 24 hours of surgery, please contact the ward from which you were discharged via the main hospital switchboard on 01603 286286. After this time, you should contact your GP, out of hours service or 111. In an emergency, you should attend the Accident and Emergency Department. Further information and support: NHS Choices www.nhs.uk The association of Coloproctology of Great Britain & Ireland Web address: www.acpgbi.org.uk/ For Help Giving Up Smoking: Smoke Free Norfolk 0800 0854 113 This sheet describes a medical condition or surgical procedure. It has been given to you because it relates to your condition; it may help you understand it better. It does not necessarily describe your problem exactly. If you have any questions please ask your doctor. The information within this information sheet is attributed to the Association of Coloproctology of Great Britain and Ireland Available via Trust Docs Version: 2 Trust Docs ID: 11338 Page 5 of 5