Is Pilonidal Cyst Surgery Painful?

The gluteal cleft-lift at PTCNJ is not painful!   Patients will almost universally agree that this curative surgery, although requiring a relatively long incision, brings less pain than a pilonidal abscess occurrence and certainly less pain than the emergency drainage of such an abscess.  How is this so?  There are 2 factors that explain this phenomenon. 

One factor is our trimodal approach to postoperative pain.  After the patient is asleep, even before the surgery begins, we inject a long-acting local anesthetic into the planned surgical site.  To optimally administer this agent, we use ultrasound guidance to identify the space where the nerve endings live.  This alone gives 48 to 72 hours of numbness to the surgical area, making the patient quite comfortable for the first several days after surgery.  Second,  we use an oral anti-inflammatory agent around the clock to decrease the typical postsurgical inflammation that causes the healing pain.  Third, we make a light oral opiate analgesic available to the patient for any breakthrough pain that may occur.  This regimen has proven highly effective for our cleft-lift patients, as evidenced by the observation that few patients actually take any of the as-needed opiate pills.

The second factor that explains the low reported pain after cleft-lift is our surgical technique, which brings the incision well off of the midline and to the side of the tailbone.  This allows for comfortable sitting and sleeping.  We encourage patients to sit the day of and the day after the surgery, and they always do this without difficulty.