Pilonidal Sinus Drainage in Mumbai: Preparation, Procedure & More

A pilonidal sinus is a small opening or a tunnel found in the skin in the area on the top of your buttocks where they divide. Pilonidal sinus affects both sexes. It is seen frequently in men due to excess hair growth and in people who have to sit for long periods of time, like cab drivers.
Pilonidal sinuses are harmless and do not cause any symptoms. It forms an abscess when infected with hair follicles, dirt, and debris. Fever, swollen and tender areas, and oozing of pus from the sinus are the common symptoms when an abscess develops. Treatment of pilonidal sinus consists of medicines to treat the fever and pain and antibiotics for the infection. These infections tend to recur because of hair follicles in your butt area. In such cases, your surgeon may recommend pilonidal sinus drainage or surgery. Sometimes, the drainage of the pilonidal sinus is done in an emergency setting when the symptoms are severe.

The pilonidal sinus is an opening in the skin on the natal cleft (the place below your lower back where the buttocks divideActivities that cause friction on the skin of the buttock, like sitting for a long time, can cause the hair growing in the area to push back inwards. The body recognizes this hair as a foreign object and launches an immune response to push the hair out, causing pus, fever, pain, and inflammation (abscess symptoms). 
Pilonidal sinus drainage is a conventional surgical approach that involves cutting through the skin overlying the abscess to drain the pus. The surgeon uses a surgical knife known as a scalpel to make a single large incision to cut across the layers of the skin and underlying tissues, thereby exposing the abscess. The surgeon makes an incision, drains, and scrapes the abscess lining. The surgical wound is packed with gauze.

The pilonidal sinus is a small tunnel under the skin at the top of your butt, where the butt divides. It generally does not cause any symptoms. Due to repeated infections or when hair and debris get trapped in the sinus, the abscess develops (collection of pus in the sinus) in a pilonidal sinus.

Pilonidal abscess drainage is the primary treatment modality for an infected pilonidal abscess. Antibiotics alone are ineffective in treating the pain and other symptoms of the abscess. Incision and drainage (I&D) of the pilonidal sinus are recommended if the below symptoms are present:

• Fever- High fever may develop due to the foreign body's immune response.
• Severe Pain -The swelling and inflammation cause pain, making standing, sitting, or lying uncomfortable.
• Pus- A thick, yellow, white, or green-colored, foul-smelling discharge comprising white blood cells, bacteria, debris, and serum may ooze out from the site.
• Swelling -The abscess becomes filled with pus which makes it appear swollen.
• Redness and Soreness - The area will be inflamed and appear reddish and sore.
• Protrusion of hair - Hair will be seen protruding out of the sinus tract.
• Multiple Sinus tracts- More than one sinus tract/ abscess can be present.
• Heat & Sensitivity- The swelling will feel hot and extremely sensitive to the touch.

You must consult your doctor if you have symptoms that are causing discomfort. Your doctor will:

•  Record your medical history to gain information about:
  • Any pre-existing condition like diabetes (increased blood sugar levels), hypertension (high blood pressure), or any blood disorders that may negatively impact your healing and recovery process.
  • Any drug allergies, previous surgeries, or injuries. 
  • Medications being taken such as blood thinners, anti-inflammatory and anti-hypertensive drugs, antidepressants, or other herbal and vitamin supplements.
  • Social habits like smoking and alcoholism may negatively alter your recovery process. This helps the doctor take necessary precautions during and after the surgery to avoid complications.
• Perform a physical examination: Pilonidal sinus is diagnosed mainly by the symptoms and a physical examination. A small pit or a tunnel on the skin at the midline where the butt divides is the hallmark finding seen on examination. Sometimes small hair may be trapped inside the pit, which can be pulled out. In rare cases, the pilonidal sinus may be present below the skin's surface. A gentle pressure on the area will suffice to confirm the diagnosis. 
• Diagnostic tests: Routine tests like complete blood count, Chest X-ray, and Electrocardiogram (ECG) will be advised to evaluate your general health. At times, your surgeon will suggest the following:
  • Sonography (a test that uses high-frequency sound waves to get pictures of the inside of your body)
  • MRI (magnetic resonance imaging, a test that creates high-definition pictures of the inside of your body) may be suggested if the symptoms suggest a deeper pathology like a fistula in ano (a small, abnormal tunnel that develops from the bowel to the skin surface).
• Instructions provided before the surgery- Preparation before open drainage is important to help reduce stress and anxiety for a smoother procedure and optimal healing.
  • You must discontinue medications like blood thinners, etc., and other herbal supplements 2 weeks before the procedure to prevent the risk of bleeding during and after the procedure.
  • You must avoid smoking and alcohol at least a week before the surgery, which may delay the wound healing.
  • You may be started on a course of antibiotics to help treat the infection and prevent any further infection post-surgery.
  • As it is an outpatient procedure, you must arrange for a family member/ friend to drive you home after the procedure, as you will be drowsy from the effect of anesthesia.

Pilonidal sinus drainage is a safe outpatient procedure that takes 10 to 20 minutes and performed under local or general anesthesia. On the day of the procedure, you will be made to sign a consent form that gives permission to the surgeon to perform this procedure on you.

• You will be taken to an operating room where your surgeon will administer either local or general anesthesia (numbing solution to sedate you), depending on the severity of the condition.
• The area to be treated will be cleaned with an antiseptic solution to remove any surface contaminants.
• An incision (cut) will be made over the skin of the abscess with a surgical blade (scalpel).
• Pressure will be applied to drain or squeeze out the pus completely from the abscess.
• The drained pus will be collected and sent to the laboratory to evaluate further the organism causing the infection.
• The wound will then be thoroughly cleaned using a saline solution to remove any remaining debris.
• The wound will be left open and not closed through sutures. A sterile gauze or bandage will be used to pack the wound to allow further drainage. This will also allow healing from the inside out.
• A waterproof surgical dressing will be placed over the packed wound for protection. 
• The entire procedure takes around 10 to 20 minutes, depending on the severity of the abscess. 

You will be kept in a recovery room for an hour or two until the effect of your anesthesia wears off, and then you are allowed to go home. Immediately after the procedure, you may experience mild pain and discomfort, which is normal and easily managed through pain medications. Once you are back home, rest well for a day or two post-surgery.

Medications

• Your surgeon will prescribe antibiotics to treat the infection post-drainage.

Painkillers will be prescribed by your surgeon to reduce pain and soreness.

Laxatives or fiber supplements

• Laxatives will be prescribed to prevent constipation because straining during painful bowel movements may delay healing.
• You will be advised to consume a fiber-rich diet like fresh fruits and green leafy vegetables.
• Avoid spicy and fried foods, citrus fruits and juices, and caffeinated drinks for at least 1 week.

Sitz bath 

• Your surgeon will instruct you about sitz baths to promote healing. 
• A Sitz bath is a method of submerging your anus and genitals region in warm water. 
• This also helps soothe pain and reduces swelling.

Other instructions

• You may shower after a day; however, avoid hot tub baths and do not soak the wound to prevent infection.
• Change your dressing every day to promote quick healing and faster recovery. The packing should be changed every 24 to 48 hours, depending on the amount of the discharge.
• Avoid lifting heavy objects and strenuous exercises for at least 8 weeks. Post-surgery.
• Avoid sitting for a long time at a stretch.
• Wear loose-fitting undergarments that are comfortable..
• Do not go cycling or swimming till the wound has healed completely.

Follow-up appointments

• It is important you attend all the follow-up appointments to prevent abscess recurrence. 

Recovery may take around 4 to 6 weeks for the wound to heal completely from the inside out.

As with other surgical procedures, pilonidal sinus drainage has many advantages and poses a high risk of infections and other complications if not treated on time. 

Benefits

• An abscess surgery helps you eliminate the chronic (long-lasting, persistent) pain caused by the infected pilonidal sinus.
• It provides a permanent solution since the abscess is completely drained to remove pus, and recurrence is rare.
• It provides good accessibility and visibility to the surgeon, unlike other alternative treatment methods.

Risks 

• Wound infection may cause pain, discomfort, or pus discharge from the surgical site.
• Hematoma formation (bleeding under the skin at the surgical site that may cause swelling).
• Mild scarring at the incision site.
• Recurrence of the infection and abscess is the most common complication.
• Re-infection at the scar on the midline is frequently seen.
• Damage to the nearby nerves may cause numbness in the affected area.
• Allergy due to the anesthesia causing skin rash, hives, dizziness, confusion, or shortness of breath.

Surgery can be a daunting aspect, and feeling anxious is absolutely normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty task of finding the best hospital, the finest doctor, and the latest procedure at the lowest cost. Let us take charge while you sit back and focus on your health and recovery. Think surgery! Think Medfin!