If you are wondering: What is the best pilonidal sinus surgery? You came to the right place.
Next, we will analyze the main surgical options available to treat pilonidal sinus, advantages, disadvantages, and how to choose the best technique for each case.
Let’s start…
What is the best pilonidal sinus surgery?
There are several surgical techniques for pilonidal sinus, and the choice of procedure depends on multiple factors, such as the extent of the disease, the characteristics of the cyst, and the preferences of the patient and surgeon.
The techniques that you will see below are some of the most effective and in which we specialize at Innova Cirugía .
1. En bloc removal leaving the wound open
En bloc excision leaving the wound open is one of the oldest and most widely used techniques for the treatment of pilonidal sinus.
In this procedure, all affected tissue is removed, including the cyst and fistulous ducts, leaving the wound open to heal by secondary intention.
Advantages:
- It is effective in completely eliminating diseased tissue and reducing the risk of recurrence.
- It allows natural drainage of any discharge, which can reduce the risk of postoperative infection.
Disadvantages:
- Healing can be slow, taking 6 to 12 weeks or more, which may require prolonged postoperative care and multiple doctor visits.
- During healing, the wound requires intensive care, such as regular dressings and protection against contamination.
2. En bloc removal with primary suture
En bloc removal with primary suture is a variation of the above procedure, in which the wound is closed immediately after removal of the cyst.
This is achieved by suturing the edges of the wound, allowing for faster healing.
Advantages:
- Healing is faster, usually within a couple of weeks, allowing for a shorter recovery.
- Postoperative care of the pilonidal sinus is less intensive compared to the open wound.
Disadvantages:
- There is an increased risk of the wound becoming infected or fluid collecting under the skin, which can lead to the formation of a new cyst or the need for a second surgery.
- It is not suitable for all patients, especially if the cyst is very large or very infected.
3. Pit-Picking (Gips intervention)
The Pit-Picking is a minimally invasive procedure in which the pores and small fistulous tracts of the pilonidal sinus are eliminated without removing large amounts of tissue.
Also known as a Gips procedure, this procedure is a less invasive option than en bloc removal techniques.
Advantages:
- It is a minor intervention, with less pain and a faster recovery.
- It is performed on an outpatient basis, and the patient can return to their daily activities in a short time.
- There is a lower risk of complications and more aesthetic healing.
Disadvantages:
- May not be suitable for large or complex pilonidal sinuses.
- There is a risk of recurrence, since not all affected tissue is removed.
4. Laser sinus treatment / SiLaC (Sinus Laser Assisted Closure)
The pilonidal sinus laser treatment, also known as SiLaC, is a modern, minimally invasive technique that uses laser energy to close the pilonidal cyst from the inside.
The laser destroys the lining of the cyst and seals the fistulous tracts, promoting healing.
Advantages:
- It is a minimally invasive technique, with less postoperative pain and a faster recovery.
- The procedure is outpatient and is performed under local anesthesia.
- It offers excellent aesthetics, with minimal or non-existent scars.
Disadvantages:
- It may not be suitable for large or heavily infected cysts.
- It is a relatively new technique, so it may not be available in all medical centers.
Recommended reading: Debunking myths about the pilonidal sinus
5. EPSiT (Endoscopic Pilonidal Sinus Treatment)
The EPSiT (Endoscopic Pilonidal Sinus Treatment) is another minimally invasive technique that uses an endoscope to visualize and treat the pilonidal cyst from the inside.
During the procedure, the cyst is cleaned, fistulous tracts are removed, and the cyst lining is destroyed to facilitate healing.
Advantages:
- It offers excellent visualization of the affected area, allowing precise removal of diseased tissue.
- It is minimally invasive, with rapid recovery and minimal scarring.
- It can be done under local anesthesia.
Disadvantages:
- May not be suitable for very large or extensive pilonidal sinuses.
- Like other minimally invasive techniques, there is a risk of recurrence.
Recommended reading: How many times can a pilonidal cyst appear and what to do if it occurs?
6. Modified Karydakis Flap or Bascoms Cleft Lift Procedure
The modified Karydakis Flap, is an advanced surgical technique in which a flap of skin and subcutaneous tissue is used to close the wound after removal of the cyst.
The goal is to flatten the intergluteal fold to reduce pressure and prevent hair accumulation in the area.
Advantages:
- It is highly effective in preventing the recurrence of pilonidal sinus.
- It offers good postoperative aesthetics, with scars that can be hidden in the intergluteal fold.
- It is suitable for complex or recurring cases.
Disadvantages:
- It is a more complex surgery and requires an experienced surgeon.
- Recovery may be longer compared to minimally invasive techniques.
Recommended reading: Pilonidal cyst in women, how common is it?
Other Flaps (Limberg Flap, Z-Plasty, Rotation Flaps)
There are other flap techniques that can be used in the treatment of pilonidal sinus, such as the Limberg flap, Z-plasty, and rotation flaps. These techniques are generally used in complex cases or when other surgeries have failed.
Flaps allow good wound coverage and reduce tension in the operated area, which can promote healing.
Conclusion: What is the best surgery for pilonidal sinus?
Determining the best pilonidal sinus surgery depends on many individual factors, including the size and complexity of the cyst, history of recurrences, patient preference, and surgeon experience.
While some minimally invasive techniques offer rapid recovery and minimal scarring, other more invasive techniques may be necessary to ensure complete removal and prevent recurrences .
At Innova Cirugía, we are specialists in the surgical treatment of pilonidal sinus and we are committed to offering the best surgical option for each patient, based on a thorough and personalized evaluation.
If you are dealing with a pilonidal sinus and need advice on the most appropriate treatment, we invite you to schedule a consultation with us.
