Pilonidal sinus surgery

Some pilonidal sinuses don't cause symptoms and you may be unaware that you have one. In some cases, symptoms are mild and may be treated without surgery.

Common symptoms of a pilonidal sinus include:

• Pain and tenderness
• Bleeding
• A red lump between your buttocks
• Yellow or green discharge (pus) that may have a strong, unpleasant smell
• Lower back pain
• Fever

A pilonidal sinus may be treated non-surgically, or surgically. If there is no sign of infection, your consultant may advise you on home treatments and over-the-counter medications to help relieve discomfort.

Non-surgical treatments for pilonidal sinus include:

• Taking over-the-counter painkillers
• Soaking in a warm bath
• Keeping the area around the pilonidal sinus clean and dry
• Using a cushion or pillow to relieve pressure on the area while sitting
• Regular exercise to improve your circulation and aid healing

Surgery to treat pilonidal sinus

If there is an infection present, you may need surgery to drain the pus and, in some cases, remove the pilonidal sinus. Your consultant may also prescribe antibiotics to treat the infection.

The surgery cost for pilonidal sinus removal

Please be aware that the following prices are a guide price. Your final price will be confirmed in writing following your consultation and any necessary diagnostic tests.

Patient pathway	Initial consultation	Diagnostic Investigations	Main treatment	Post discharge care	Guide price
Hospital fees	N/A	Not included	£3,300	Included	£3,300
Consultants fees from	£200	N/A	Included	Included	£200
Guide price	£3,500

At your first consultation, you will typically be seen by a consultant general surgeon or a consultant colorectal surgeon. They will ask you about your symptoms, general health and medical history. They will examine your pilonidal sinus and check for signs of infection.

At Circle Health Group, your first appointment is very important as it's where we get to know you, discuss your symptoms and expectations for treatment and encourage you to ask any questions you may have.

After making a diagnosis, your consultant will discuss possible treatment options with you and decide on the best option based on your symptoms and diagnosis.

Your consultant will tell you everything you need to do to prepare for your surgery. If there's anything you're not sure about, or if you have any questions about how to prepare for your surgery, speak to your consultant or call the hospital for advice. Being well-prepared for your surgery will help to ease any anxiety you may have as well as allow your surgery and recovery to go more smoothly.

Before your surgery, tell your consultant about any medical conditions or allergies you have and any medication you are taking, including over-the-counter medicines. Your consultant may tell you to stop taking some medications like blood thinners before your operation. This is to reduce the risk of bleeding during and after your surgery.

Before your operation, you will have a preoperative assessment to check that you are fit for surgery. This will include a blood test, ECG, and chest X-ray.

You may not be able to eat or drink anything for several hours before your surgery. Check with your healthcare team when you can eat and drink before your operation.

What lifestyle changes can I make before my surgery?

Being as healthy as possible before your surgery can reduce the risk of complications and help speed up your recovery.

To make sure you are as healthy as possible before your surgery:

• Eat a healthy, balanced diet with plenty of fruit, vegetables, lean proteins, and whole grains
• If you smoke, try to stop at least eight weeks before your surgery
• Avoid alcohol for a few days before and after your surgery. Alcohol thins the blood and can increase the risk of bleeding
• Take regular exercise

There are several different types of pilonidal sinus surgery. Which procedure is best for you depends on how severe your pilonidal sinus is, how large it is, and whether you have had an infected pilonidal sinus before.

Incision and drainage

This type of surgery involves making a small incision (cut) into the abscess and draining the pus, before packing the space with gauze. Incision and drainage may be performed under local anaesthetic or general anaesthetic depending on the size of the abscess. It is normally carried out as day surgery, meaning you'll be able to go home the same day.

You'll need to have your dressing changed every day for a few weeks until your wound has healed. Recovery normally takes between four and six weeks.

Wide excision and open healing

If your pilonidal sinus is large, or you have had repeated abscesses, your consultant may recommend a wide excision and open healing. During this procedure, the sinus and some of the surrounding tissue is removed. The wound is left open, and a sterile dressing is applied.

This type of surgery has the lowest risk of your pilonidal sinus coming back, so is ideal for repeat infections. It is normally performed as a day case under general anaesthetic. You will need to have daily dressings in the weeks following your surgery and can expect to recover fully in around six to 12 weeks.

Excision and wound closure

This is another type of surgery to remove the pilonidal sinus. After the sinus is removed, a flap of tissue is formed on either side of the sinus and the two sides are stitched together. It is recommended for large abscesses, or infections that keep coming back. Excision and wound closure is performed as a day case under general anaesthetic. Your stitches are removed around ten days after surgery. This type of surgery has a faster recovery time, but a higher risk of infection than wide excision and open healing surgery.

Endoscopic ablation

During this procedure, a thin, flexible tube with a camera called an endoscope is inserted into the pilonidal sinus. Using images from the camera as a guide, your consultant removes hairs, infected tissue and debris, and washes the sinus out with an antiseptic solution. The sinus is then cauterised (sealed with heat). This procedure is less invasive than other types of surgery and is normally performed as a day case under local or spinal anaesthetic. Endoscopic ablation has a lower risk of complications and a faster recovery time than other procedures. Recovery time is normally within a month.

Plastic surgery

If the affected area is large, plastic surgery may be required to reconstruct the surrounding skin and tissue. Your consultant will advise you if plastic surgery may be needed after your surgery.

Recovery from any type of surgery is different for everyone and depends on factors such as your age, general health and whether or not there were any complications during your surgery or recovery. Your consultant will be able to give you an estimated recovery timeline based on your individual circumstances.

After your surgery, you will be taken to the recovery room where you will be monitored closely until the effects of the anaesthetic have worn off. You will then be taken to your room.

You may have some pain when the anaesthetic wears off after your surgery. Your healthcare team will give you medication to manage this, but please inform a member of the nursing staff if you have pain. You will be given a follow-up appointment to change your dressing and check your wound is healing well.

Dos and don'ts after pilonidal sinus surgery

Do:

• Keep your wound clean and dry after your surgery
• Wear loose-fitting underwear and clothing on your lower half
• Eat a high-fibre diet and drink plenty of water to prevent constipation and straining to have a bowel movement after your surgery. Your consultant may prescribe a mild laxative if needed

Don't:

• Engage in strenuous exercise or heavy lifting for at least the first week after surgery
• Ride a bicycle for six to eight weeks after surgery
• Swim until your wound is fully healed

How many nights will I need to stay in hospital?

Most pilonidal sinus surgery is carried out as a day case, meaning you'll be able to go home later the same day. In some cases, you may need to spend one night in hospital. Talk to your consultant about how long you can expect to stay in hospital after your surgery.

Will I be able to drive home?

You will not be able to drive yourself home from the hospital after your pilonidal sinus surgery. Please arrange for someone to collect you, or we can organise a taxi if you prefer.

How soon can I go back to work?

How soon you can go back to work after your pilonidal sinus surgery depends on the type of procedure you had, the type of job you do, and how well your personal recovery goes. Most people return to work within two weeks of surgery, but you may need longer if your job is very active or physically demanding.

How soon can I drive?

If you had a general anaesthetic, you must not drive for at least 24 hours after your surgery. This is because you may still be affected by the anaesthetic and your concentration and reaction times may be impaired. Do not drive if you are taking painkillers that make you feel drowsy. After this, you can drive when you can sit comfortably, safely control your vehicle, and perform an emergency stop.

When will I be back to normal?

Recovery from pilonidal sinus surgery is a gradual process that is different for everyone. You can help your recovery by taking things at your own pace and listening to your body. Do a little more each day and stop if you feel tired or have pain. Follow your consultant's instructions carefully during your recovery and call the hospital if you have any questions or concerns. Make sure you attend all follow-up appointments during your recovery.

As with all types of surgery, pilonidal sinus surgery carries a small risk of complications. Your consultant will explain all the possible risks and complications before your surgery and answer any questions you may have about your procedure. Being as well-informed as possible about what to expect from your surgery will help put your mind at rest and allow you to make an informed decision so please ask any questions you may have.

Possible complications of any surgery include:

• Bleeding
• Infection
• Blood clots
• Adverse reactions to the anaesthetic

Possible complications specific to pilonidal sinus surgery include:

• Bleeding
• Infection
• The pilonidal sinus may come back

See a doctor straight away if you experience:

• Severe or prolonged bleeding
• Worsening pain
• Redness, swelling or discharge from your surgical wound
• Fever (a temperature above 38C)

We answer some of your most commonly asked questions about pilonidal sinus surgery.

Does everyone have a pilonidal sinus?

Pilonidal sinuses are common, especially in men, but not everybody has one. Some pilonidal sinuses do not cause any symptoms and you may not be aware that you have one. Pilonidal sinuses may be more common if you were born with a dimple or pit in your lower back.

What causes a pilonidal sinus?

The cause of pilonidal sinuses is not fully understood, but they may occur when friction or pressure causes a hair to be pushed inwards. Pilonidal sinuses are more common in men as they tend to have more body hair.

Other factors that may increase your risk of developing a pilonidal sinus include:

• Sitting for long periods
• Trauma
• Obesity
• Lack of exercise
• Excessive sweating
• Wearing tight-fitting clothing

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about pilonidal sinus surgery, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in April 2023. Next review due April 2026.

1. Pilonidal sinus, NHS
2. Pilonidal Cyst Surgery Procedures and Recovery, Healthline
3. Surgery for pilonidal cyst, Medline Plus
4. Pilonidal Cyst and Sinus, NIH