Pilonidal Cyst Removal Surgery- What is It? From a General Surgeon turned Pilonidal 

Before reading here , please review my definition of tailbone-area pilonidal disease terms Pilonidal Cyst vs Abscess vs Sinus: What’s the Difference? – Pilonidal Treatment Center of New Jersey

Many understand that “pilonidal cyst” is a misleading term and its use is therefore discouraged by most specialists; so then what is pilonidal cyst removal surgery or, to which it is commonly referred, the “ pilonidal cystectomy”?

In this flawed operation, a nonspecialist surgeon cuts out an ellipse of skin bearing the secondary opening of a pilonidal sinus tract OR approximates the skin where pilonidal abscesses have repeatedly developed and excises a similar ellipse.  Depending on how modern the training of the surgeon, the midline crease skin bearing the pathogenetic pits and associated defunctionalized hair follicles is incorporated into this skin excision.  Then, with  a troubling degree of approximation and uncertainty, a large amount of healthy underlying fat is excised with this skin in an attempt to fully excise the “cyst”, so that further problems from it do not ensue..  More problematic than the inaccuracy and “guesswork” of the technique is the overly aggressive removal of normal underlying fat tissue, all done with the aim of complete cyst removal. As a formal general surgeon, let me assure you that the vast majority of this underlying fat tissue is grossly normal!!

Handling of the resulting wound from this excision is another complete challenge for these nonspecialists and has been extensively written about, so we will not address it further here.

The bottom line is please please avoid the so-called pilonidal cystectomy procedure at all costs!!