Miss Patricia Boorman

Consultant Colorectal Surgeon


Pilonidal Disease Treatment

Pilondal disease excision & Limberg flap procedure information.

What does pilonidal surgery procedure involve?

Incision and drainage – If you have formed an abscess, your surgeon will make a small incision over the infected area and washout the infection, your surgeon may then pack your wound with an absorbent dressing, that will need changing by your practice nurse at regular intervals – your surgeon will advise you of this.

Excision of pilonidal sinus – If you have suffered from reoccurring infection then your surgeon will cut around the affected area and remove both the involved skin and the sinus. At times it is not possible to close the skin with stitches due to the amount of tissue removed; in this case your surgeon will pack your wound with an absorbent dressing that will need changing by your practice nurse at regular intervals.

In extreme cases, especially if you have experienced reoccurring sinuses your surgeon may need to remove the affected tissue, and then rotate an area of skin and tissue near the area to cover the wound.

What about the anaesthetic?

You will receive a general anaesthetic for your surgery; you will see your anaesthetist on the day of surgery who will discuss your anaesthetic further with you.

What happens before the operation?

Prior to your admission you will have seen the consultant to discuss the surgery and its risks and benefits.

You will have a pre-operative assessment where you are likely to be examined by a practitioner, have bloods taken and be asked about your past medical history, previous surgeries and asked about any medications you may be taken. At times you may be asked to stop taking certain medications prior to surgery, these may impose an added risk to surgery such as blood thinning medications.

You will receive a letter detailing the date of your surgery, time and ward to report to for your admission. You will also be advised on what to bring to hospital with you.

Upon admission on to the ward you will be shown where to sit, where you will be see a number of different people. You will be seen by a nurse who will take some information from you and will attach patient identification bands around your wrists or ankles. You will be given a gown to wear for theatre and white stockings to wear to help prevent blood clots. You will also be seen by the consultant who will go through the consent form for your procedure with you, an anaesthetist who will discuss your anaesthetic.

When your theatre team is ready for you, a member of the team will walk to the ward to collect you; they will check a few details with you and then walk you to theatre (if you are able). You will then be taken into the anaesthetic room where you will be met by your anaesthetist. A member of the theatre team will ask you to lie on a theatre bed, and will attach a blood pressure cuff to your arm; a probe onto your finger to measure your oxygen levels and three stickers attached to wires will be placed onto your chest to monitor your heart. You will also have a needle placed into a vein on the back of your hand or arm; this allows the anaesthetist to administer the medications required for your anaesthetic.

What happens after the operation?

After your surgery you will be taken into recovery where you will receive individual specialist care whilst you are waking up from the anaesthetic. When you are awake and feel ready you will be given something to eat and drink. You will be encouraged to get up and mobilise to reduce the risk of developing blood clots.

You may feel sore after surgery; you will have been prescribed some painkillers for you to take as required.

Discharge from hospital.

With both types of surgery you are likely to be able to go home that day or the following day. In rare cases you may need to stay in for longer.

Please ensure that you have somebody who can bring you home from hospital as you will not be able to drive. You will also need to have somebody to stay with you for 24 hours following surgery whilst you recover from the anaesthetic.

If you have had the sinus excised it is likely that you will need to have some time off work depending on your job, it is important to avoid strenuous exercise for at least 4 weeks.

If your wound has been packed, your surgeon will have advised you how often this will need changing.

If your wound has been closed with stitches, these will usually need to be removed after 10-14 days following surgery by your practice nurse.

We expect you to make a rapid recovery after your operation and to experience no serious problems. However, it is important that you should know about minor problems, which are common after this operation, and also about more serious problems that can occasionally occur.

What problems can occur after the operation?

Bleeding – it is common for you to experience some bleeding from the wound; this should be a small amount and decrease or stop by the next day. If you experience heavy bleeding or notice large blood clots please contact your GP or the ward you were discharged from.

Wound problems – although rare, it is possible that the wound doesn’t heal and breaks down, if this happens you may need to go to theatre to have it washed and closed.

Infection – if after surgery you find your pain is worsening and/or you start to feel unwell it is possible that you are developing an infection. Please contact your GP as you may require antibiotics. In extreme cases you may need to go to theatre to have your wound cleaned.

Deep vein thrombosis (DVT) - Deep vein thrombosis is a possible problem, but is uncommon. If you are at particular risk then special precautions will be taken to reduce the risk. Moving your legs and feet as soon as you can after the operation and walking about early, all help to stop thrombosis occurring.

Recurrence – it is possible that despite surgery the sinus reoccurs, this may require further antibiotics or surgery.

The risks of a general anaesthetic

General anaesthetics have some risks, which may be increased if you have chronic medical conditions, but in general they are as follows:

Common temporary side effects (risk of 1 in 10 to 1 in 100) include bruising or pain in the area of injections, blurred vision and sickness, these can usually be treated and pass off quickly.

Infrequent complications (risk of 1 in 100 to 1 in 10,000) include temporary breathing difficulties, muscle pains, headaches, damage to teeth, lip or tongue, sore throat and temporary problems with speaking.

Extremely rare and serious complications (risk of less than 1 in 10,000). These include severe allergic reactions and death, brain damage, kidney and liver failure, lung damage, permanent nerve or blood vessel damage, eye injury, and damage to the voice box. These are very rare and may depend on whether you have other serious medical conditions.

What should you do if you develop problems?

Please contact your GP, your GP will then decide on the most appropriate treatment for you, they will be able to contact the hospital if necessary.

Do you need to return to hospital for a check?

You will be sent an appointment to see one of the surgical team in the outpatients clinic in 6-8 weeks following surgery

Who should you contact in an emergency?

Please attend your local accident and emergency department or if your condition is life threatening please call for an ambulance.

Book a consultation with Miss Boorman today.