Pilonidal Cyst Surgery: Procedure, Recovery, and Aftercare

A pilonidal cyst is a sac filled with hair and skin debris that forms at the bottom of your tailbone. The recovery time after surgery depends on the procedure type and if you need stitches. In some cases, it could a few months.

Researchers used to think of pilonidal cysts as a congenital disease (formed in utero).

However, it’s now thought that they are acquired from hair from surrounding soft tissue and skin that grows inward and forms a foreign body reaction and thickened tissue.

They are 2.2 times more common in men than in women, and most commonly occur in men in their 20s and 30s.

Initial treatments include sitz baths, warm compresses, and antibiotics. However, if the infection is severe, you may need surgery.

The two primary procedures used to treat pilonidal cysts include:

• Incision and drainage. During this procedure, a doctor will make a cut and drain the cyst.
• Surgical cyst removal. During this procedure, also called a cystectomy, a doctor will remove the entire cyst and the tissues around it.

Read on to learn more about how these procedures are performed, what the recovery process is like, and if a cyst is likely to return.

Incision and drainage

Your healthcare professional will likely recommend an incision and drainage procedure to treat your pilonidal cyst if:

• this is the first time a cyst is being treated
• your infection is minor

An incision and drainage procedure is successful at treating a pilonidal cyst about 60 percent of the time. To maintain results, doctors often recommend that people who have the procedure try to prevent another infection with hair removal procedures, such as shaving, waxing, or laser hair removal.

Surgical pilonidal cyst removal

While an incision and drainage procedure is typically the first surgical option considered for a pilonidal cyst, your doctor may recommend a surgical cyst removal if:

• you’ve already had an incision and drainage procedure but your cyst came back
• your infection is severe
• you have multiple cysts with sinus tracts

Newer procedures to treat pilonidal cysts

Newer minimally invasive surgical treatments are showing promising results in treating pilonidal cysts. These include:

• video-assisted ablation of pilonidal sinus (VAAPS)
• endoscopic pilonidal sinus treatment (EPiST)

Incision and drainage is a common procedure for treating cysts and rarely causes serious complications. Pain is the most common complication.

Pilonidal cyst surgical removal generally causes scarring. The scar will become less noticeable over time.

Like all surgical procedures, incision and drainage and pilonidal cyst surgical removal can lead to infection. Signs of an infection include:

• redness
• oozing pus
• fever or chills
• heat coming from wound (warm to the touch)
• tenderness

Other potentional complications include:

• seroma (fluid buildup)
• hematoma (bruise)
• poor healing
• recurrent pilonidal cyst

Pilonidal cysts also have a high risk of reoccurrence after treatment. More than one procedure may be needed to remove your cyst.

Here’s a look at how you can prepare for each procedure:

Incision and drainage

No special preparation is usually needed before an incision and drainage procedure. It’s a good idea to wear something that allows your doctor to easily access the pilonidal cyst.

Surgical cyst removal

It’s important to arrange a ride before your procedure since you won’t be able to drive after receiving pain medication and general anesthesia. You’ll leave the hospital or surgical center the same day as your operation.

It’s critical to follow your doctor’s presurgical instructions to minimize your risk of complications. Your doctor may tell you to stop taking certain medications or herbal supplements as well as to stop smoking.

They may also give you particular instructions about how soon before your procedure you can bathe and eat. Typically, doctors instruct you to stop eating 8 hours before any procedure that requires general anesthesia.

Bring a photo ID with you to the surgery center as well any insurance documents and other paperwork you may need.

Incision and drainage

Pilonidal cyst incision and drainage is a simple procedure that’s usually done in a doctor’s office, under local anesthesia.

First, the healthcare professional will give you an injection to numb the area. Then, they’ll make a small incision in the cyst to drain the pus. This reduces pain and inflammation.

You’ll be sore after the procedure, so it’s a good idea to have someone drive you home.

Antibiotics aren’t typically required for this procedure unless the infection has spread to surrounding areas.

Surgical cyst removal

This entails a complete surgical removal of the cyst, along with the pilonidal sinus tracts. While this procedure is more complex than an incision and drainage, it’s also more likely to be successful.

Pilonidal cyst surgeries are done under general anesthesia at an outpatient surgical center. The surgery itself takes about 45 minutes to perform.

There are several types of pilonidal cyst removal surgeries:

• Wide local excision. The area removed goes down to the fascia of the sacrum (the tissue overlying the muscles). The wound is packed with medicated packaging and left to heal from the bottom up.
• Excision with marsupialization. The excision is performed and then the roof of the cyst is removed. The fibrous tissue is sutured.
• Excision with closure. The cysts and sinus tracts are removed and the area surgically closed.
• Excision with complex closure. The cysts and sinus tracts are removed, and a flap technique is used to surgically close the wound. The flap is sutured to the underside of the skin bridge formed between the incision and the midline, which aids in faster healing and less likelihood of recurrence.

You’ll probably go home several hours after your procedure. You should arrange to have someone drive you home.

After surgery, your physician might choose to leave the wound open or close it with stitches.

The amount of time it takes for you to recover depends on your surgical procedure and whether you received stitches. In general, it’ll probably take anywhere from 1 to 3 months to completely heal.

Most people can resume their regular activities within a month of surgery. You’ll likely have a follow-up appointment with your doctor about 6 weeks after your procedure. The follow-up appointments depend on whether the wound packing materials need to be changed or if sutures need to be removed.

You may experience some pain or tenderness during the recovery process. This can be managed by:

• taking pain medications prescribed by your doctor
• avoiding strenuous activities
• sitting on a doughnut cushion
• not sitting for long periods of time on hard surfaces

Your doctor will provide you with instructions on how to keep your wound clean. Follow these directions carefully to avoid an infection or recurrence.

If your doctor prescribes antibiotics, be sure to complete the full course, even if you start to feel better before they’re finished.

Call your doctor if you experience:

• a fever
• pus draining from your incision
• increased pain, swelling, warmth, or redness near the incision

Unfortunately, pilonidal cysts can come back after surgery. Within five years of a procedure, recurrence rates ranged from 13.8 percent to 32 percent, depending on the type of surgical removal.
The reccurrence rate after incision and drainage is about 40 percent.

The cysts may return because the area gets infected again or hair grows near the incision scar.

People who have recurrent pilonidal cysts often develop chronic wounds and draining sinuses.

Here are some ways to prevent a recurrence:

• Follow your doctor’s post-surgical instructions carefully.
• Keep the area clean.
• Shave the area, or use a hair removal product every 2 to 3 weeks.
• Keep all follow-up appointments with your doctor.
• Shave or wax hair in the area, or consider laser hair removal, to prevent the cyst from recurring.

Pilonidal cysts can be irritating and painful, and impact affect interpersonal relationships and social activity. But the good news is that there are effective removal options. Your first step should be to see a doctor.

If you need surgery, you and a healthcare professional can discuss the pros and cons of the different options. An incision and drainage procedure is typically easier and can be performed in a doctor’s office. But the risk of recurrence is higher than it is for a surgical cyst removal.

It’s best to seek care early on.

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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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:

1. Observe all rules of personal and intimate hygiene
2. Flush the intergluteal crease
3. Wear loose, clean, environmentally friendly clothing (avoid tight, tight, synthetic clothing)
4. Avoid injury to the coccyx area
5. Avoid prolonged sitting
6. Epilation and (or) depilation in the coccyx area
7. Timely treat and sanitize primary holes, wounds and microtraumas in the coccyx area.
8. 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

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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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:

1. Observe all rules of personal and intimate hygiene
2. Flush the intergluteal crease
3. Wear loose, clean, environmentally friendly clothing (avoid tight, tight, synthetic clothing)
4. Avoid injury to the coccyx area
5. Avoid prolonged sitting
6. Epilation and (or) depilation in the coccyx area
7. Timely treat and sanitize primary holes, wounds and microtraumas in the coccyx area.
8. 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
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