Pilonidal Cystectomy

Pilonidal Cystectomy

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Pilonidal cystectomy is the surgical removal of a pilonidal cyst or tracts extending from a sinus. It may range from a simple procedure that involves excision of a small amount of tissue to a very complex procedure that may include allowing the wound to heal secondarily or rotating adjacent tissues into the defect after excision.

Risk factors that have been attributed to developing a pilonidal cyst include the following:

A pilonidal cyst is believed to be an acquired condition caused by the presence of hair in involuted epithelial tissue in the natal cleft. Some clinicians have theorized that this condition is a congenital one, but it is now more generally accepted that the presence of hair in the natal cleft causes a foreign body–like reaction that leads to inflammation and possibly infection.

Medical management may reduce the severity of disease. Proper hygiene is paramount. Local hair control by laser epilation has been shown to be an effective therapy that decreases recurrence. [1, 2, 3]  Lifestyle changes to reduce repetitive trauma or friction to the area have also been encouraged. Rare cases of squamous carcinoma have been reported in the pilonidal sinuses, which are similar to carcinomas arising in chronically inflamed areas. [4]  Thus, pilonidal cysts that are not amenable to medical management should lead to surgical referral for further evaluation. [5, 6]

Pilonidal cystectomy is indicated for any patient who has pain or discomfort from the presence of the pilonidal cyst. Occasionally, a pilonidal sinus is encountered on physical examination that is not causing any deficits. Surgery may be deferred in these instances.

The pilonidal cyst may become infected. Closure after pilonidal cystectomy is contraindicated in any patient with an active infection. In these cases, antibiotics should be prescribed and the procedure deferred until the infection has been cleared. In certain cases, drainage of an abscess is performed and a formal cystectomy is deferred until the infection has cleared.

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Giarratano G, Toscana C, Shalaby M, Buonomo O, Petrella G, Sileri P. Endoscopic Pilonidal Sinus Treatment: Long-Term Results of a Prospective Series. JSLS. 2017 Jul-Sep. 21 (3):[Medline]. [Full Text].

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Suárez Valladares MJ, Rodríguez-Prieto MA. Laser Nd:YAG to treat primary pilonidal cysts: an alternative treatment. Br J Dermatol. 2017 Sep 2. [Medline].

[Guideline] Steele SR, Perry WB, Mills S, Buie WD, Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of pilonidal disease. Dis Colon Rectum. 2013 Sep. 56 (9):1021-7. [Medline].

Mahdy T. Surgical treatment of the pilonidal disease: primary closure or flap reconstruction after excision. Dis Colon Rectum. 2008 Dec. 51(12):1816-22. [Medline].

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Favuzza J, Brand M, Francescatti A, Orkin B. Cleft lift procedure for pilonidal disease: technique and perioperative management. Tech Coloproctol. 2015 Aug. 19 (8):477-82. [Medline].

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Bascom J, Bascom T. Utility of the cleft lift procedure in refractory pilonidal disease. Am J Surg. 2007 May. 193(5):606-9; discussion 609. [Medline].

Ramon A Riojas, MD, PhD Staff Surgeon, Department of General Surgery, Keesler Medical Center

Ramon A Riojas, MD, PhD is a member of the following medical societies: American College of Surgeons, American Medical Association

Disclosure: Nothing to disclose.

Brian D Layton, DO, FACS Staff Surgeon, General Surgery Residency Program, Department of General Surgery, Keesler Medical Center, Keesler Air Force Base

Brian D Layton, DO, FACS is a member of the following medical societies: American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons

Disclosure: Nothing to disclose.

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

The views expressed in this material are those of the authors and do not reflect the official policy or position of the U.S. government, the U.S. Department of Defense, or the U.S. Department of the Air Force.

Pilonidal Cystectomy

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