Pilonidal cyst

What is a pilonidal cyst?

Pilonidal cyst is a chronic inflammation at the bottom of the tailbone, or coccyx. This cystic formation is usually caused by the penetration of hairs into the skin, but it may also be due to a cyst formed during fetal life.

The condition is more common in men than women and occurs mainly between puberty and the age of 40. Aggravating factors are obesity and intense hair growth.


How can it be prevented? What are the root causes?

Unfortunately, there are no medical guidelines for the prevention of a pilonidal cyst. Less sedentary life and maintaining an ideal weight can be helpful.

Main causes of pilonidal cyst include, among else, hormonal disorders, intense hair growth in the area, friction, inflammation.


What are the symptoms of a pilonidal cyst?

The symptoms vary, from a small swelling to a large and painful inflammatory mass-abscess. In its initial stage, a pilonidal cyst may not show any symptoms. Often, fluid or purulent material discharges from a skin opening (fistula) in the area. Upon inflammation the area gets red, swollen and hard, and pus may also flow out, usually with an awfully unpleasant smell.

In addition, the inflammation may cause, in some cases, fever and exhaustion.

An uncomplicated pilonidal cyst causes little discomfort. Often patients realize its presence by signs of serous-bloody fluid on their underwear. When acute a pilonidal cyst is characterized by strong pain, abscess formation and even fever. In such cases surgical intervention is recommended. In chronic pilonidal cysts continuous or even intermittent fluid secretion is observed.


How is a pilonidal cyst treated?

The indicated treatment depends on the condition of the disorder. An acute abscess is usually managed by opening and draining to release the pus, reduce inflammation, and relieve the patient of pain. Antibiotics are administered before surgery, which is basically the only solution to the problem.

Also, a chronic pilonidal cyst can only be treated effectively with surgery and not with conservative means (ointments etc.). Surgery is intended to remove or completely eliminate the cyst, along with accompanying ducts and fistulas, to ensure a low chance of recurrence.


Pilonidal cyst treatment: Laser or open method?

There are various surgical techniques for the treatment of pilonidal cysts, including “open”, “closed” and laser treatment. Patients discuss with their surgeon the best method of treatment for their case.

During surgery, the entire affected area is removed, leaving a significant gap/deficit.

Whether the wound is left open, semi-closed, or closed on purpose with or without a flap is at the discretion and training of the surgeon.

In the open method, daily dressing changes are required for at least 45 days, while this period can reach up to 2-3 months.

In our clinic we mainly apply two methods for the treatment of pilonidal cysts:

  • The innovative circular diffusion Laser catheter (FiLaC method). This type of treatment does not involve an incision, stitches or daily dressing changes. The catheter is inserted into the cyst through a tiny hole, and after the cyst is cleaned, the laser causes photothermal degradation of the mucosa and closure of the cyst. The operation can be carried out with local anesthesia, it is completely bloodless and the patient returns home within two or three hours. Although a novel technique it has excellent results and huge acceptance by patients due to the simplicity of the procedure and the avoidance of discomfort compared to classical methods.
  • For complicated cases such as recurring pilonidal cysts with large wounds and multiple fistulas, we use plastic reconstruction of the area along with the Karydakis & Bascom cleft lift procedure, an off-midline closure technique based on the transfer of tissue from the buttock to the midline. This approach provides a definitive cure and virtually minimizes the chances of recurrence. This technique and its success is confirmed at international conferences.


Recovery time and healing

After the operation patients return home and to their daily activities the same day. On the third day, the surgeon removes the gauze and drainage and immediately after patients can shower. Stitches are removed after 10 days.


How much does pilonidal cyst surgery cost?

The cost for pilonidal cyst treatment varies from patient to patient and depending on the choice of treatment method. Contact the doctor to make an appointment and discuss everything that interests you.