Pilonidal cyst complications after surgery: Pilonidal Cyst Surgery – Paul E. Savoca

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Pilonidal Cyst Surgery – Paul E. Savoca

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Consent Form For Pilonidal Cystectomy

Paul E. Savoca, MD, FACS, FASCRS

The doctor has explained that I have the following condition:
PILONIDAL CYST

The following procedure will be performed:
Removal of a sinus (track) between the buttocks

There are some general risks and complications of the procedure, which include:
(a) Small areas of the lungs may collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
(b) Clots in the legs (deep vein thrombosis or DVT) with pain and swelling. Rarely part of this clot may break off and go to the lungs which can be fatal.
(c) A heart attack because of strain on the heart or a stroke.
(d) Death is possible due to the procedure.
There are specific risks and complications of the procedure which include:
The wound may need to be left open and packed regularly until it heals and this could be several weeks or even months.
The wound, if sutured, may break open and discharge blood or infected material. This may need further surgery.
The scar may thicken and redden and be painful.
The sinus problem may recur. This may need further surgery.
Increased risk in obese people of wound infection, chest infection, heart and lung complications and thrombosis.
Increased risk in smokers of wound and chest infections, heart and lung complications and thrombosis.

SIGNIFICANT RISKS AND RELEVANT TREATMENT OPTIONS
The doctor has explained any significant risks and problems specific to me, and the likely outcomes if complications occur. The doctor has also explained relevant treatment options as well as the risks of not having the procedure.

PATIENT CONSENT
I acknowledge that:
The doctor has explained my medical condition and the proposed procedure. I understand the risks of the procedure, including the risks that are specific to me, and the likely outcomes.
The doctor has explained other relevant treatment options and their associated risks. The doctor has explained my prognosis and the risks of not having the procedure.
I was able to ask questions and raise concerns with the doctor about my condition, the procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction.
I understand that if organs or tissues are removed during the surgery, that these may be retained for tests for a period of time and then disposed of sensitively by the hospital.
The doctor has explained to me that if immediate life-threatening events happen during the procedure, they will be treated accordingly.
I understand that no guarantee has been made that the procedure will improve the condition, and that the procedure may make my condition worse.

On the basis of the above statements,
I REQUEST TO HAVE THE PROCEDURE.

Name of Patient:_______________________________________
Signature/Date__________________________________________

DOCTOR’S STATEMENT
I have explained the patient’s condition, the need for treatment, the procedure and the risks as well as all relevant treatment options and their risks, the likely consequences of those risks as well as the significant risks and problems specific to this patient.

I have given the patient/ substitute decision-maker an opportunity to ask questions about any of the above matters and raise any other concerns which I have answered as fully as possible. I am of the opinion that the patient/ substitute decision-maker understood the above information.

Name of Doctor: Paul E. Savoca, MD, FACS, FASCRS
Signature/Date___________________________________

Discharge Instructions for Pilonidal Cystectomy

PAUL E. SAVOCA, MD, FACS, FASCRS / CHS COLORECTAL SURGERY / SAINT CATHERINE OF SIENA MEDICAL CENTER / SAINT CHARLES HOSPITAL

You will be given a prescription for pain medication. Follow the directions given by your doctor for taking this medication. To avoid upset stomach, take your pain medication as prescribed with food in your stomach.
Take these drugs exactly as directed. Never take more than the recommended dose, and do not take the drugs more often than directed. If the drugs do not seem to be working, consult your physician.
Do not share these or any other prescription drugs with others because the drug may have a completely different effect on the person for whom it was not prescribed. Some people experience drowsiness, dizziness, lightheadedness, or a false sense of well-being after taking prescription pain medications. Anyone who takes these drugs should not drive, use machines, or do anything else that might be dangerous until they know how the drug affects them. Nausea and vomiting are common side effects, especially when first beginning to take the medicine. If these symptoms do not go away after the first few doses, check with the physician who prescribed the medicine. Side effects may include: dizziness, lightheadedness, nausea, sedation, vomiting, if these side effects occur, it may help if you lie down after taking the medication.
- Don’t drive while you are taking narcotic pain medication.
- Don’t lift anything heavier than 15 pounds until your doctor says it’s okay.
- Don’t mow the lawn, use a vacuum cleaner, or do other strenuous activities until your doctor says it’s okay.
- You may walk indoors, outdoors, up and down stairs.
- Expect to be off from work/school for at least one to two weeks following this surgery. Your surgeon will give you more guidance on return to normal activities.
- Avoid constipation:
  - Eat fruits, vegetables, and whole grains.
  - Drink 6–8 glasses of water a day, unless otherwise instructed.
  - Use a fiber supplement and a stool softener twice a day. This is particularly true while taking narcotic pain medications.

Wound Care:
For comfort take pain medication prior to dressing change. The basic principle is to shower the wound twice a day and reinsert a fresh gauze in the wound after each shower.

Leave the dressing from surgery in place until the day after surgery.
The morning after surgery, remove the tape and outer dressing from the wound, getting in the shower and allow the rest of the dressing that is packed in the wound to be soaked with water and then pull it out. Unfortunately, this does hurt a bit.
When the dressing is removed, you may see a small amount of bleeding. This is normal.
Vigorously irrigate your wound in the shower for 5-10 minutes, using a hand-held shower head, it you have one. Aim showerhead directly at the wound. Bending forward helps open the wound. Let the water clean the area thoroughly.
Wrap a thin, clean wash cloth or 4×4 plain cotton gauze around your finger and clean gently, but thoroughly, the inner surface of the wound, removing any surface covering to expose clean, healthy pink tissue. Don’t scrub.
After shower, pat the skin around the wound edges dry.
The repacking of the wound is what usually requires help from another person. Wash hands. You may use gloves, but this is not necessary.
Moisten a fresh 4×4 inch plain cotton gauze with tap water. Squeeze out excess water.
(The dressing should be damp, not wet).
Pack the wound gently but not tightly with the moist gauze. Use a Q-tip or your finger to ensure that the gauze reaches the bottom of the wound and place it so that all inner wound surfaces are in contact with the moist gauze.
Cover with a dry outer dressing and secure with tape or elastic bandage.
Dispose of the old dressing in plastic trash bag with twist tie.
As your wound heals, it will close from the bottom and sides, and you will need less and less gauze to pack it.
Shave the skin at least 2 inches around the wound at least once weekly. Use adhesive tape to pick up loose hair.

Follow up appointments are essential to ensure the wound is healing normally. The doctor will tell you how soon they need to see you back for the first follow up appointment.

When to Call Your Doctor:
Call the office if you have any of the following:

Excessive Bleeding
Increasing pain
Increased redness or drainage of the incision
Fever 100.5°F, or higher

Pilonidal Sinus Disease: Risk Factors for Postoperative Complications and Recurrence

Int Surg. 2012 Jul-Sep; 97(3): 224–229.

doi: 10.9738/CC86.1

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Author information Copyright and License information Disclaimer

The aim of this study is to analyze the risk factors for complications and recurrence in pilonidal sinus disease. The prospective study consisted of 144 patients with pilonidal sinus disease who were operated on at Dicle University Medical Faculty, Department of General Surgery, between February 2008 and December 2010. Patients receiving the Limberg flap totaled 106 (73.6%), while 38 (26.4%) had primary closure. Postoperative complications developed in 42 subjects (29.2%), and recurrence occurred in 19 (13.2%). The Limberg flap method was statistically considered as a risk factor for postoperative complications (P = 0.039). Regarding recurrence, family tendency (P = 0.011), sinus number (P = 0.005), cavity diameter (P = 0. 002), and primary closure (P = 0.001) were found to be risk factors. Postoperative complication rate is higher in the Limberg flap method than primary closure method. The risk of recurrence is related to family tendency, sinus number, cavity diameter and anesthesia type and is also higher in primary closure.

Keywords: Pilonidal sinus disease, Postoperative complication, Recurrence

Pilonidal sinus disease (PSD), diagnosed by the penetration of hair follicles into one or more sinus walls, attacks younger subjects more frequently and chronically develops with acute and subacute instances of infection.1 Frequently seen in the midline of the sacrococcygeal region,1 it limits the patient’s lifestyle and results in loss of productive power.2 For treatment, various noninvasive3 and surgical methods (simple incision and drainage, lying open, marsupialization, excision and primary closure, or rhomboid excision and Limberg flap) have been performed.4–,6 Despite these methods, the disease often leads to postoperative complications and recurrence. Male gender, obesity, smoking, family tendency, poor body hygiene, sinus size, and the surgical procedures performed have been confirmed in a number of studies as primary risk factors for postoperative complications and recurrence.1,7–,13 In this study, we aimed to analyze the risk factors for postoperative complications and recurrence in PSD.

The prospective study included 144 consecutive patients with PSD who underwent surgery between February 2008 and November 2010. Physical signs and patient’s history were reviewed. In terms of postoperative complications and recurrence, age, gender, time from the onset of the symptoms, systemic and congenital diseases, skin color (fair-skinned or dark-skinned), family tendency, body mass index (BMI), smoking habits, duration of the disease, abscess formation and number (if any), drainage type (closed-suction drain or not), sinus number, hematocrit value, type of anesthesia (local or spinal), surgical method (primary closure or Limberg flap), necessity of drainage, extent of the excised cavity, pathologic results, hospital stay, and duration of wound healing were studied. The patients with recurrent pilonidal sinuses and diabetes mellitus, and who had previously received phenol treatment were excluded from the study. The BMI for each patient was calculated based upon their height and weight [weight (kg)/height (m)²]. Depending on the BMI range, 20–25.9, 26–29.9, and over 30, patients were classified as normal range, overweight, and obese, respectively. The patients in which infection or an abscess was detected underwent surgical operation 8 weeks after having received simple drainage and antibiotic treatment.14

The classification of patients into 2 groups was made arbitrarily and without any bias as follows: group 1 (primary closure group) and group 2 (Limberg flap group), according to the surgical procedures.

In the primary closure group, the patients were placed in the jackknife position; the area to be excised was marked on the skin, and a rhomboid incision to the presacral fascia including the sinus and its extensions was made longitudinally, from superior to inferior. A closed-suction drain was then placed in several patients. The skin edges were approximated without tension using interrupted sutures of absorbable 3/0 suture or liquid skin adhesive.

In the Limberg flap group, the patients were also placed in the jackknife position, and the area to be excised, as well as the Limberg flap, was marked on the skin. This was followed by a rhomboid incision, including the sinus and its extensions, made to the presacral fascia. The flap was then constructed, extending the incision laterally and inferiorly to the gluteal fascia. The flap was transposed, and the defect was covered. A closed-suction drain was placed, and the skin was closed with nonabsorbable, monofilament, interrupted sutures.

Family tendency about PSD

Presence of PSD in one or more family members is a possible occurrence in the patients with family tendency. Complete healing date was determined by the date of removal of the suture in primary healing or epithelization of the sacral wound in healing by secondary intention, sick leave, and clinic visit.

The postoperative complications in the first month included wound infection signs such as pain, tenderness, and erythema, along with hematoma, seroma, and wound separation.15 The patients were followed and evaluated for recurrence in a median period of 27.5 months.

Statistical method

All statistical analysis in this study was performed using SPSS software (Version 13.0, SPSS Inc, Chicago, IL). For group comparisons, Student t test was used for parametric data, while Mann-Whitney U test was used for nonparametric data. Chi-square test was used for comparing 2 categorical variables. Risk factors for complications and recurrence were evaluated by multivariable logistic regression analysis. For all P values, P = 0.05 was considered to indicate statistical significance, and odds-ratios (OR) were calculated for each variable.

The demographic characteristics of the patients are given in . Also, demographic characteristics and findings according to the groups are given in . The presence of symptom duration, the number of sinuses, the diameter of the cavity, the length of hospital stay, the healing time, and the rate of postoperative complications were higher in group 2, but the recurrence rate was significantly lower in group 2 compared with group 1. The most common complication was wound infection, and it was detected in 12 (26.2%) subjects as shown in , together with other morbidities and treatment protocols. No patients developed a complication that required surgical intervention. Recurrence occurred in 19 (13.2%) patients during the median follow-up period of 27.5 months. The pathologic results revealed basal cell carcinoma in one patient, and the remaining 143 subjects were reported as benign.

Table 1

The demographic characteristics of the patients

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Table 2

The demographic characteristics and findings according to the treatment groups

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Table 3

Postoperative complications and treatment

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Following univariate analysis, wound healing time was assessed as 24. 17 ± 11.65 days for the patients without postoperative complications, while patients with complications displayed a wound healing time of 34.93 ± 17.54 days (P = 0.001). Performing Limberg flap and closure methods upon postoperative complications was found as a risk factor by univariate analysis (P = 0.039). Regarding recurrence, family tendency (P = 0.011), sinus numbers (P = 0.005), the cavity diameter (P = 0.002), application of local anesthesia (P = 0.010), and primary closure (P = 0.001) were assessed as risk factors.

Multivariate analysis proved the Limberg flap method as an independent risk factor for postoperative complications (P = 0.004). As for recurrence, cavity diameter (P = 0.001), primary closure (P = 0.007), and family tendency (P = 0.008) were found as independent risk factors.

PSD is an important disease that seems simple but leads to high rates of postoperative complication and recurrence. However, there is not a consensus on the ideal treatment type for PSD despite many alternatives. It has a high incidence rate of 26 to 700 of 100,000 people. It is more common in male subjects between the ages of 20 and 25 years.16 The disease was seen 4.1 to 8.1 times more in males than in females.17,18 The reason that higher frequency exists in puberty and lower frequency exists for those over 40 years of age could be explained by the effect of more active sex hormones during puberty on pilosebaceous glands. The affected girls were younger than the boys, likely because of the earlier onset of puberty in females.19 Among the patients in the present study, males had a rate of 94.4% with an average age of onset of 26.9 years, while females displayed a rate of 5.6% with an average age of onset of 27.9 years. The ratio of females versus males was 1:17. In our study, age and gender were not proven as risk factors for postoperative complications and recurrence. However, the ratio between female and male PSD patients in Turkey is reported to be lower than ratios in Western countries. Also, the mean age for females is found to be older, which could be associated with the notion that our female patients, as with other anorectal diseases, refrain from seeing a doctor for PSD until the discomfort becomes unbearable and partially because of social bias. In the etiology, PSD was previously believed to result from postcoxygeal cells or remnant glands, whereas acquired factors are considered to play the greatest part today. Karydakis attributed the hair insertion process to 3 main factors: the invader, the force which causes the insertion, and the vulnerability of the skin to the insertion of hair at the depth of the natal cleft.9 Family tendency is also an important factor. Sondenaa et al20 have reported it to be 38%, and Doll et al7 reported that family tendency accelerates the development of PSD, causing higher risk of recurrence, while suggesting that the positive patients should be closely followed up. Family tendency was evident in 15.9% of our patients. Despite the lack of significance for postoperative complications, it was evident as an important risk factor for recurrence. This could be due to the results presented by similar body types and hair characteristics as well as similar hygienic conditions. PSD is reported to be more common in hirsute people with dark skin and dark hair, with a smaller frequency in black and Asian people.3,7 Nonetheless, 119 (82.6%) of our patients were dark skinned, but they did not present a significant distribution in terms of postoperative complications and recurrence.

Obesity has been reported as an important risk factor and to be related to higher rates of postoperative complication and recurrence in PSD.8,20–,22 Cubukcu et al23 did not detect a statistical significance between BMI and PSD. Because of the deeper structure of the intergluteal cleft and the fragility with wetness as a result of oversweat, obese people are more vulnerable to PSD. Indeed, the softness of the surface structure in intergluteal region in obese people raises this vulnerability. However, in terms of etiology, PSD is not confined to the obese alone but is also a concern in those with excessive pilosity, oversweat, poor body hygiene, irregular presacral shaving, and unsuitable diets.9,10,24 Sixty-eight (47.2%) of our patients were overweight, yet they did not correlate with postoperative complication and recurrence.

Smoking leads to hypoxia development in peripheral structures, causing the proliferation of bacteria in the wound area. This also triggers separation in the wound area, reducing the restraining capacity of sutures while promoting the impairment of collagen synthesis. Further, it weakens oxidative killing by neutrophils.11,12 In our study, patients who smoked developed postoperative complications with a rate of 32.7%, although this did not provide a statistical significance.

In connection with its shape and follow-up duration, the diameter of the sinus is an important matter for recurrence.25 Another possible reason for recurrence includes inadequate excision of the sinus tract. 13,26 It was found that there was a positive correlation between an elevated number of sinus tracts and recurrence. It was believed that curative surgery becomes undoable when some sinuses remain as residues as a result of higher numbers of sinuses during surgery. The diameter of the cavity in PSD is concerned with the width and depth of the wound as well as the number of sinus tracts opening to the cavity. Definitive treatment in PSD is achieved through complete removal of infected tissues in one block.27 The cavity extent in the nonrecurrence group was significant, convincing the investigators that no residual tracts occurred in the study.

There was a statistical significance between the groups that had spinal anesthesia and those that had local anesthesia in terms of the cavity extent. It was noted that the use of local anesthesia did not enable effective surgery because of the pain in the wound area and the discomfort experienced by the patient and the surgeon, and that it limited the surgical area of operation, all of which influenced the recurrence rate.

The basic step in PSD treatment is surgical excision. However, there is no consensus on an ideal method for excision. This is owing to the conviction that there is a direct relationship between closure method and the risk of recurrence. Primary closure method is more popular because it accelerates wound healing, shortens the times of surgery and hospitals stays, and has proven to be practical.22 Recurrence rates of 7% to 42% have been reported with this method.20,28 Possible reasons among postprimary recurrence include scar formation in gluteal cleft and tension.29 A number of studies have reported a recurrence rate of zero to 3% after rhomboid excision and Limberg flap repair.5,30,31 In the present study, the flap method led to higher postoperative complications, while primary closure resulted in a higher recurrence rate. Drainage in PSD is used not only to prevent postoperative complications and hematoma but also to eliminate the potential cavity following excision.19,32 In this study, drainage was not correlated with postoperative complication or recurrence. Postoperative healing time for PSD ranged between 13 and 30 days.18,32 The group with postoperative complications in the present study had a healing period of over 1 month. Though rare, malignant formation is also possible during long-term PSD follow-ups. The formations are generally squamous cell carcinomas.33 Only one patient in this study was diagnosed with basal cell carcinoma.

In PSD, postoperative complication is a rare development when using primary closure, yet it is frequent in the Limberg flap method. The recurrence rates are also significantly higher in primary closure than in Limberg flap. Additionally, family tendency, sinus number, cavity diameter, and local anesthesia are among the risk factors for recurrence.

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Coccyx cyst (epithelial coccygeal duct)

Coccyx cyst (epithelial coccygeal tract)

Delicate and complex problem

Coccyx cyst (epithelial coccygeal passage) is one of the most delicate and complex health problems. Those who have dealt with it understand what it is about. Tailbone cyst occurs in both men and women. According to statistics, the stronger sex suffers three times more often.
The delicacy lies in the localization of the pathological focus. The formation is located in a fairly intimate place (the area of the coccyx, sacrum and intergluteal fold) not far from the anus. Not everyone easily wants to share this with others, even with relatives and close people. Not everyone is ready to immediately show a sore spot, discuss their complaints and discomfort, even with doctors.

With a complication of the epithelial cyst of the coccyx (abscess formation, suppuration, relapse), in most cases a person is deprived of the opportunity to maintain his usual way and quality of life. Annoying pain, excruciating discomfort, serous or purulent discharge, an unpleasant odor appear, linen gets dirty, additional hygiene procedures become necessary. Often it is simply impossible to sit normally. And this is not the whole list of inconveniences.

Many in this situation are forced to abandon their usual activities, sports and even intimate life. All this is depressing. The delicacy is added by the fact that the coccyx cyst clinically manifests itself more often in adolescence or puberty. Teenagers are known to be especially sensitive to such problems, although they will try their best not to show it. Wise advice, understanding, help and timely consultation of a surgeon are especially important for them.

The complexity of this pathology lies in the fact that very often there are relapses (repetitions) after improper preparation for surgical intervention, an insufficiently radical operation (incomplete removal of cysts, fistulas and streaks), inattentive management in the postoperative period, failure to follow the doctor’s recommendations, ignoring elementary hygienic procedures and other reasons. Some have to undergo surgery for a coccyx cyst not once, not twice, but many times. Believe it or not, there are still people who suffer all their lives because of relapses. This reduces the quality of life and this is certainly a tragedy. It shouldn’t be like this!!!

It is necessary to take this disease and the primary operation very seriously from the very beginning. Agree, no one wants to be operated on repeatedly. However, no less seriously, and possibly more, should be taken to a second surgical intervention, if, nevertheless, the clinical situation recurred. It is very important to prevent chronization and continuation of a sluggish process. A coccyx cyst is not quite a common and not at all an ordinary problem. The choice of clinic and doctor is extremely important in order to minimize the risk of relapse. A consultation and operation with a qualified specialist surgeon who has experience in the treatment of this pathology is necessary.

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Make an appointment with a surgeon by phone +7(495)755-79-18

Tailbone cyst. What is it? What is the cause? Classification

Coccyx cyst (epithelial coccygeal tract, pilonidal cyst, ECX) is a closed small cavity (tube-shaped canal), which is located subcutaneously in the region of the upper part of the intergluteal fold. It has no direct connection with the coccyx and sacrum. The cavity of the cyst is covered from the inside with a special epithelial lining, in which there are ordinary hair follicles, hair, sweat and sebaceous glands.

According to the main generally accepted version, the coccyx cyst is a kind of congenital pathology. An unusual defect (anomaly) in the region of the intergluteal fold is formed in the prenatal period. As a result, a cavity (channel or passage) with a special internal epithelial lining remains in a person under the skin in the upper part of the intergluteal fold in the coccyx area.
According to another version, a cyst (epithelial passage) is formed as a result of hair growing into the skin due to improper growth inward with invagination (immersion). Often, the appearance of education is associated with an injury to the sacrococcygeal region or prolonged sitting (professional drivers often suffer). The cause of suppuration, most often is the attachment of a specific infection (present in the anus).

In childhood, the coccygeal cyst practically does not make itself felt, since there is no infection in the formation cavity, there is no active hair growth and gland secretion. Clinical manifestations of the disease usually occur at 13-30 years of age. As a rule, during these years of life there is increased hair growth, active secretion of sweat and sebaceous glands, including inside the cyst. Hair grows in the cyst, and the glands secrete their secret into the formation. All this accumulates.

When the cavity overflows, unpleasant discomfort appears, excruciating pain, weeping, itching and other symptoms may appear. Then, between the buttocks in the coccyx area, one or more primary serous holes (serous fistulas) open. The contents of the formation (serous discharge, tufts of hair) are released to the outside. When holes appear, microorganisms actively colonize the cavity (infection) in which they were not previously present. If for some reason the communication with the external environment is closed, there is a delay in the evacuation (removal) of the separated from the formation. There is overflow, tension, acute inflammation and abscess formation (suppuration).

It so happened that this pathology has many different names. This is sometimes confusing or can be misleading. If there is no inflammation, the formation is called an uncomplicated coccyx cyst, dermoid cyst, or epithelial coccygeal tract. In the English-language literature, a pilonidal cyst or pilonidal sinus (pylonidal cyst, pylonidal sinus, hairy or hairy cyst, “hair nest”) is more common due to the presence of hair inside. Holes or holes that occur primarily or secondarily are called coccyx fistulas. When acute inflammation appears and an exacerbation of chronic inflammation occurs, suppuration and abscessing occur, the diagnosis sounds like an abscess, a festering coccyx cyst or a festering epithelial coccygeal passage. All these names describe different stages or features of the same process.

However, the following classification is most commonly used in clinical practice:

Coccyx cyst uncomplicated by inflammation (without clinical manifestations)
Acute or exacerbation of chronic inflammation of the coccyx cyst
Chronic inflammation (slow process) of coccyx cysts
Remission of the inflammatory process (cold period)

Prevention.

How can complications and recurrence be avoided?

If you have an uncomplicated cyst, you must do everything to avoid inflammation, suppuration and try not to develop clinical manifestations.

Basic preventive measures:

Observe all rules of personal and intimate hygiene
Flush the intergluteal crease
Wear loose, clean, environmentally friendly clothing (avoid tight, tight, synthetic clothing)
Avoid injury to the coccyx area
Avoid prolonged sitting
Epilation and (or) depilation in the coccyx area
Timely treat and sanitize primary holes, wounds and microtraumas in the coccyx area.
See a surgeon immediately at the first signs of discomfort and inflammation

If there are clinical manifestations or recurrence, then the only correct preventive measure will be surgical treatment.

What worries with a coccyx cyst? Symptoms

If the coccyx cyst is not complicated or is in the “cold period” after inflammation, then in the vast majority of cases it does not manifest itself and is asymptomatic. Periodically, there may be some discomfort in the coccyx, serous discharge or moisture above and between the buttocks. Sometimes anal itching can disturb. Small points (retractions) of the skin in the coccyx and intergluteal folds are visually determined.

When an infection enters the cavity, discomfort increases significantly, inflammation, pain in the coccyx and sacrum occur. Primary openings (holes, fistulas) may appear from which serous, sanious or purulent discharge is released. With suppuration and abscess formation, secondary purulent fistulas may form.

In the absence or delay of discharge from the cyst through the holes, a painful infiltrate (swelling, edema, tumor, lump) appears with clear contours in the coccyx and intergluteal folds, which interferes with movement and walking. When the contents of the cyst are infected, acute inflammation develops. There is pain, swelling, redness in the infiltrate area. An increase in body temperature (fever). Abscess formation occurs (the formation of a cavity with suppuration).

After the abscess of the coccyx cyst drains on its own or as a result of the operation (outflow of pus), relief comes. Pain, swelling and redness disappear, inflammation subsides. The fistula gradually closes, and the postoperative incision wound heals. There comes a period of imaginary well-being (cold period). It is not worth waiting for a complete cure, since the focus of a dormant chronic infection (substrate of chronic inflammation) remains, which aggravates or re-inflames under certain conditions favorable for this.

If you do not do a radical operation, then periods of exacerbations and remissions (the interval between exacerbations) can alternate for months, and sometimes years. With remission, edema and hyperemia, as a rule, are not present. Periodic dull pains or discomfort in the coccyx area may disturb. Discomfort occurs when sitting and in the presence of scant discharge from the holes, fistulas. Fistulas can function, open and close. With prolonged remission, pigmentation and cicatricial tissue changes appear around the holes.

Treatment of coccyx cyst (preoperative examination, preparation, operations)

Treatment of a coccyx cyst is surgical. To clarify the diagnosis and exclude other pathologies (fistulas of the rectum, presacral teratoma, osteomyelitis), it is necessary to examine the rectum, in some cases X-ray, colonoscopy or irrigoscopy may be required. Before surgery, a thorough depilation of the surgical field is very important and cleansing enemas are required.

In case of an abscess of the cyst of the coccyx (suppurated epithelial coccygeal passage), acute inflammation or exacerbation of a chronic process, the first step is to drain the purulent contents of the cyst (open, drain). The abscess is opened urgently with a small incision under local anesthesia. The cavity is emptied, sanitized with antiseptic solutions and drained. After the outflow of pus comes relief. Dressings are applied with ointments on a water-soluble basis (levomekol). The pain disappears, the inflammation subsides, the postoperative incision wound heals. There comes a period of imaginary well-being (a complete cure does not occur). The center of a dormant chronic infection remains. Without the second stage – a radical operation (complete excision or removal of the coccyx cyst), as a rule, suppuration repeats again and again. With a long delay in radical intervention, inflammation can go into a chronic stage with the formation of new infiltrates and secondary fistulas.

Primary radical operation (coccyx cyst uncomplicated) or the second stage of treatment after subsiding of acute inflammatory phenomena during remission (“cold period”) is carried out in a planned manner. The operation is performed under local infiltration, spinal anesthesia or under intravenous anesthesia. Surgical intervention consists in the removal (excision) of the pathological formation (cyst, canal, passage) along with the internal lining, the contents of the cavity, the surrounding tissues changed after repeated inflammatory processes to the fascia. All primary and secondary holes (holes, fistulas) are also excised. To minimize the risk of recurrence, all moves, fistulas must be stained with a special dye. After excision of the coccyx cyst, the postoperative wound, as a rule, is sutured tightly. Sutures are applied according to Donati, which provide a good stop of bleeding and accurate comparison of the edges of the wound.

In a number of clinics, the postoperative wound is left open or the edges of the wound are sutured to its bottom for secondary healing (marsupilization). In our opinion, this tactic of postoperative wound management has a lot of disadvantages:

injury
decrease in the patient’s quality of life
possible secondary infection
high probability of recurrence
vicious postoperative scars after secondary healing

postoperative period. Dressings after surgery

In the postoperative period, during the first day after the operation, it is necessary to observe bed rest. You can get up and walk the day after surgery. You can sit down for 5-6-7 days. Fully sit for 8-9 days. It is very important to exclude stress on the seams. It is necessary to avoid traumatization of the postoperative wound, and later on the scar. In the postoperative period, antibiotic therapy is prescribed if the process was accompanied by acute inflammation and abscess formation. Painkillers are used in the presence of pain. A modern breathable aseptic bandage with an absorbent pad is applied to the seams. Dressings are done daily. On the 4th-5th day, in the absence of discharge from the wound, it can be bandaged every other day. With primary healing, the sutures are removed 12-14 days after the operation.

If the postoperative wound is open, then the secondary healing takes a fairly long period. In such a situation, it is best to use modern medical dressings and fixation devices for dressing and care. In the postoperative period, the quality of life of the patient should not suffer. We can select special dressings for the care of an open wound, even if you have been operated on at another clinic.

Rehabilitation. Prevention of relapse. Forecast

To prevent recurrence after surgery, the supervision of a surgeon and periodic depilation of hair in the area of the postoperative wound are necessary. How to do depilation should be explained by the surgeon. It is very important to strictly observe the basic preventive measures (see above). The prognosis after radical surgical treatment of the coccyx cyst is favorable. The ability to work is fully restored.

Complications and consequences

With a severe course of the process, the following complications may develop:

relapse
osteomyelitis of the coccyx (purulent lesion of the bone)
pyoderma fistula (purulent skin lesions)
fungal infection
multiple communicating purulent fistulas and pathological passages with epithelial lining (sacrococcygeal region, perineum, scrotum, inguinal folds, anterior abdominal wall, anus)

Recurrent ECX

Complications require painstaking, long-term, often multi-stage treatment. Competent prevention, the right choice of clinic and doctor, timely treatment, radical surgery, compliance with all recommendations will help you avoid such problems.

Price of services. Cost

Service	Cost
Surgeon appointment. Consultation of a candidate of medical sciences	1800
Operation opening and drainage of abscess	from 3500
dressing	1600

Referral for a planned radical operation in a hospital to the best specialist in Moscow

Appointment and consultation by phone: +7(495)755-79-18

Surgeon, candidate of medical sciences Garmaev Alexander Shagzhiyevich

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