What You Need to Know About Pilonidal Cyst Surgery
A pilonidal cyst is a sac-like pocket beneath the skin that contains hair and debris. The term originates from the Latin words pilus (hair) and nidus (nest), reflecting its composition. These cysts most commonly develop at the bottom tip of the tailbone, in the upper buttock crease, an area known as the gluteal cleft.
When a pilonidal cyst becomes infected, it fills with pus, causing pain, redness, and swelling. At this stage, it is called a pilonidal abscess. If left untreated, the body may create a small tunnel, or sinus tract, to help drain the infection. This condition is known as pilonidal disease and often requires medical intervention.
Pilonidal cysts can be persistent and painful, making surgery a necessary option for many patients. Below, we explore different pilonidal cyst surgery techniques, from traditional excision to minimally invasive procedures.
Pilonidal Cyst Surgery: Types and Techniques
Traditional Excision
One of the most common methods of pilonidal cyst removal surgery is traditional excision. This procedure involves surgically removing the cyst, along with affected deeper tissue. The incision is typically made along the midline of the gluteal cleft, and the wound may either be left open to heal naturally or sutured closed.
While traditional excision is widely performed, it has been associated with slow healing times and a higher risk of recurrence (Immerman SC, Cureus, 2021).
The Gluteal Cleft-Lift Procedure: A Modern Alternative
An alternative and more effective surgical option is the gluteal cleft-lift procedure. This technique also removes the cyst but places the incision off the midline, which significantly improves healing outcomes. In addition, the procedure reshapes the gluteal anatomy to reduce the risk of future cyst formation. Research suggests this approach leads to faster recovery and lower recurrence rates (Shrager B, Cureus, 2024).
Minimally Invasive Techniques: Laser and Gips/Pit-Picking
Many patients with mild pilonidal disease are interested in smaller surgical interventions. So what of these techniques? Real deal or gimmick? Definitely real deal. The PTCNJ has handpicked a collection of lesser techniques that spares patients the anatomy-altering effect of our gold-standard gluteal cleft-lift but achieves for patients with mild disease a significant period of symptom freedom or disease dormancy. Our Minimally Invasive Pilonidal Treatment (MIPiT) protocol combines the evidence-based Gips procedure to clear the larger gluteal cleft midline pits and any associated pilonidal sinus tract and/or abscess cavities of entrapped hair shafts and diseased inflammatory tissue (Gips M et al, Diseases Of The Colon And Rectum 2008) with the meticulously calibrated thermal energy of the neoV continuous-wave laser system (ForTec Medical – Hudson, Ohio) to ablate the smaller midline pits. Based on the voluminous pilonidal microbiology data only found at a dedicated pilonidal Center such as PTCNJ, we augment the regimen with the judicious use of antibiotic therapy, both in a tailored oral form and a topical form to hasten healing and decrease recurrence risk. While MIPiT does not boast the hefty curative potential of our gluteal cleft-lift procedure, an encouraging period of disease dormancy is reliably achieved, the length of which is currently a focus of study at our Center with a peer-reviewed publication forthcoming. Be a part of this new paradigm!
When Is Incision and Drainage Necessary?
In cases where a pilonidal cyst has developed into a painful abscess, an emergency incision and drainage procedure may be required. This involves making a small cut to release built-up pus, alleviating pressure and reducing pain. While this treatment provides immediate relief, it does not eliminate the cyst itself. Further surgical intervention is often needed to prevent recurrence.
Pilonidal cyst surgery varies in complexity, ranging from minimally invasive techniques to more extensive procedures like excision and gluteal cleft-lift surgery. The right approach depends on the severity of the condition and the patient’s individual needs. While traditional excision remains a common treatment, newer methods, such as the cleft-lift procedure and laser-assisted techniques, offer improved outcomes and faster recovery times.
If you’re experiencing recurrent pilonidal cysts, consulting with Pilonidal Treatment Center of New Jersey can help determine the most effective treatment plan for long-term relief. Contact us today to get started.