Pre-operative and post-operative care for Laparoscopic Hernia surgery
Pilonidal disease and sinus
Pilonidal disease is a chronic infection of the skin in the region of the buttock crease. The condition results from a reaction to hairs embedded in the skin. The sinuses are infected tracts below the skin that connects to the surface with one or more small openings predominantly occur at the end of tail bone.
Although less common, a pilonidal sinus can also occur between fingers and in belly button area.
The exact reason of pilonidal sinus is not known. Ingrown hairs, hormonal changes, friction because of lot of sitting and infection may contribute to pilonidal sinus.
Pilonidal sinus is found more commonly in young adults and occurs most often in men.
Signs and symptoms of pilonidal sinus
A pilonidal sinus may be asymptomatic at first present as a small dimple or a small painless lump. Once it is infected, it may become a painful cyst and acute abscess. Once abscess ruptures patients may develop an opening/ pilonidal sinus.
Some patients have recurrent infections and inflammation of these sinus tracts if not treated.
- Few symptoms
- Pain, redness, and swelling
- Blood or pus drainage
- Protruding hair from the cyst
- Fever & malaise in few
Diagnosis of Pilonidal Sinus
A medical history of symptoms and detailed physical examination is usually enough to diagnose pilonidal sinus.
Visual examination to check for signs of infection and blood test to check for increased white blood cells may be ordered. In rare cases, CT scan may be recommended.
Pilonidal sinus should be differentiated from other conditions such as a dermoid cyst.
Treatment of pilonidal sinus in Mumbai
Incision and drainage of Acute Abscess:
In acute abscess formation, the Sinus tract is cut open and accumulated pus is drained out. This is a minor outdoor procedure under local anaesthesia so you will be able to return home on the same day or the day after. Daily dressing is required till healing occur.
For chronic sinus or recurrent infections of your pilonidal sinus, your surgeon will recommend surgery to remove the sinus with any of the following procedures:
Excision and Reconstruction with local advancement flap:
A section of skin along with infected sinus tract is removed by the surgeon. Direct suturing will cause excessive tension on the suture line and wound may breakdown causing a delayed wound healing or chronic wound sinus.
Wound is closed with the mobilization of a skin flap from the healthy skin of surrounding area. This helps in healing.
Advantage of local advancement Flap surgery:
- Day care procedure,
- Postoperative pain is very less
- Fast recovery after surgery (usually within a week).
EPSIT (Endoscopic Pilonidal Sinus Treatment):
EPSIT is a new technique to treat pilonidal sinus which facilitate endoscopic visualization of inside of the sinus tract and ablation of tract by cautery through endoscope.
Advantages of EPSIT
Minimally invasive procedure
can be done under local anaesthesia
Day care procedure so same day return to home
Dr Nitish Jhawar is General, laparoscopic and colorectal surgeon with 17 years extensive experience in the field. He has fellowship of Association of Colorectal Surgeons of India (FACRSI) and Fellowship in colorectal surgeries from US.
He has received advance training in proctology and training EPSIT endoscopic treatment of pilonidal sinus from Berlin, Germany.
Post-Operative Care after pilonidal procedure
What to expect after the procedure?
Patients can go home same day
Pain Medications to control postoperative pain are prescribed.
Patient can lie on his back but should change position regularly.
Light physical activity and showering is allowed.
Full physical activity can generally be resumed after 2 weeks.
Patients are generally able to resume work after few days or in one week
No external stitches are present and there is no need to remove any suture.
Area is to be kept clean and dry.
After healing, the skin in the buttocks crease must be kept clean and free of hair.