Pilonidal Cystectomy

What is a pilonidal cystectomy?

A pilonidal cystectomy is a procedure in which your healthcare provider opens or removes a cyst near your tailbone.

When is it used?

A pilonidal cystectomy may be done to open and drain an infected pilonidal cyst. A pilonidal cyst is an abnormal saclike structure in the skin. It usually happens in the crease between the buttocks, near the tailbone. It often contains hair and small pieces of skin. It can get infected and cause an abscess, which is a pocket of infected fluid (pus) with a thick wall around it. The cyst may become painful, leak pus, and smell bad.

This procedure may also be done even if the cyst isn’t infected. The procedure can relieve pain caused by the cyst and keep it from getting infected.

How do I prepare for a pilonidal cystectomy?

Plan for your care and recovery after the operation, especially if you are to have general anesthesia. Arrange for someone to drive you home after the procedure. Allow for time to rest and try to find other people to help you with your day-to-day duties.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow any other instructions your provider gives you. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

You will be given a local or general anesthetic. A local anesthetic is a drug that should keep you from feeling pain during the operation. A general anesthetic will relax your muscles and put you to sleep. It will prevent you from feeling pain during the operation.

If the cyst is infected, your healthcare provider may just make a cut in the skin, remove the hair, and drain any pus that has formed. Your provider may try to remove the whole cyst or may just leave the cyst open to allow it to drain completely. If there is no infection, the provider may remove the whole cyst and close the cut in the skin with sutures (stitches).

What happens after the procedure?

You may go home that day or stay in the hospital for 1 to 2 days, depending on the procedure and your condition. Keep the area as clean as possible. It may take as long as 6 months or more for the area to fill in completely with scar tissue if it was left open. If it was closed with stitches, they may stay in as long as 2 to 3 weeks.

Make sure that you follow all of your healthcare provider's instructions. To help prevent or postpone getting another cyst:

• Keep the area clean.
• Shave the area or use a hair removal cream every 2 to 3 weeks.

Check the area for signs of infection, such as redness, pus, or pain. Ask your provider what other steps you should take. Keep all follow-up appointments for dressing changes and checks of the wound.

What are the benefits of this procedure?

You no longer have a painful, draining cyst.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• A local anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia.
• You may develop another cyst.
• The cyst could get infected again if it was not removed.
• You may need another operation to try to control the problem.
• You may have infection or bleeding.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You develop a fever over 100°F (37.8°C).
• You have uncontrollable pain.
• You notice extensive drainage from the operation site.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.