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Pilonidal Cyst Removal

Last updated Feb. 11, 2019

Approved by: Krish Tangella MD, MBA, FCAP


Microscopic pathology image showing a benign pilonidal cyst.

Background Information:

What are the other Names for the Procedure?

  • Pilonidal Cystectomy
  • Surgery for Pilonidal Cyst

What is the Pilonidal Cyst Removal surgical procedure?

  • A Pilonidal Cyst Removal procedure involves the surgical removal of the pilonidal cyst
  • The pilonidal cyst is a benign cyst filled with hair and skin debris, located close to the tailbone in the upper part of the buttock
  • The cyst can be very painful, which is usually caused by the cyst becoming infected

What part of the Body does the Procedure involve?

The Pilonidal Cyst Removal procedure involves the surrounding parts of the tailbone (lower back region).

Why is the Pilonidal Cyst Removal surgical procedure Performed?

  • A Pilonidal Cyst Removal procedure is performed for the following reasons:
  • Relieve pain associated with an infected pilonidal cyst
  • Prevent an infection from spreading

What are some Alternative Choices for the Procedure?

There are no alternative choices for the procedure.

What are the Recent Advances in the Procedure?

The use of laser to remove hair present in the region and thus treat the condition is a recent development.

What is the Cost of performing the Pilonidal Cyst Removal surgical procedure?

The cost of a Pilonidal Cyst Removal procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding a Pilonidal Cyst Removal procedure and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

Prior to Pilonidal Cyst Removal surgical procedure:

How is the  Pilonidal Cyst Removal surgical procedure Performed?

The Pilonidal Cyst Removal procedure maybe performed under local anesthesia.

  • The patient lies face down on the operating table. The buttocks are held gently separated to expose the pilonidal cyst
  • After numbing the area with local anesthetic, a probe is passed to find the extent of the sinus (a sinus is a space that is formed in the tissue)
  • After identifying the cyst and sinus, the diseased tissue is removed
  • The wound may then be either sutured or left open to heal slowly

Where is the Procedure Performed?

Pilonidal Cyst Removal is usually performed in an out-patient surgery center facility, a physician’s clinic/office, or a hospital.

Who Performs the Procedure?

A general surgeon or a proctologist performs a Pilonidal Cyst Removal procedure.

How long will the Procedure take?

The procedure may take up to an hour to perform.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Pilonidal Cyst Removal procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

  • A physician will request your consent for the Pilonidal Cyst Removal procedure using an Informed Consent Form.
  • Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
  • You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the  Pilonidal Cyst Removal surgical procedure?

Before a Pilonidal Cyst Removal, the patient has to undergo certain tests such as:

  • Routine blood and urine analysis
  • Chest X-ray
  • Sigmoidoscopy

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Pilonidal Cyst Removal surgery?
  • What does the removal procedure involve?
  • How will this procedure help?
  • Will the procedure in anyway impair my mobility?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • Are there any complications after the procedure or during recovery?
  • How long will it take to recover? When can I resume normal work?
  • Are there any lifestyle restrictions or modifications required after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
  • How many such procedures have you (the physician) performed?
  • What are the costs involved?

During the Pilonidal Cyst Removal surgical procedure:

What kind of Anesthesia is given, during the Procedure?

An injection of local anesthesia is administered for this procedure.

How much Blood will you lose, during the Procedure?

There is hardly any significant blood loss during a Pilonidal Cystectomy procedure.

What are the possible Risks and Complications during the Pilonidal Cyst Removal surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

  • Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
  • Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders and chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Pilonidal Cyst Removal surgery are:

  • Excessive bleeding
  • Infection surrounding the surgical wound
  • Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Pilonidal Cyst Removal surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Pilonidal Cyst Removal surgical procedure:

What are the possible Risks and Complications after the Pilonidal Cyst Removal surgical procedure?

The possible risks and complications that may arise after a Pilonidal Cyst Removal surgery are:

  • Excessive bleeding
  • Slow healing
  • Recurrence of the cyst
  • Infection within the surgical wound

What is the Prognosis after the Surgery?

A complete recovery from Pilonidal Cyst Removal procedure is usually achieved, without any serious complications being noted.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Worsening pain and swelling of the surgical wound
  • Bleeding or fluid drainage from the surgical wound
  • Signs of an infection
  • Headache, muscle aches
  • Fever, feeling sick
  • Dizziness
  • Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Pilonidal Cyst Removal surgical procedure?

At home, the following post-operative care is recommended after a Pilonidal Cyst Removal procedure:

  • Slowly resume regular/daily activities as early as possible, which aids in faster recovery
  • Avoid all activities that are physically strenuous for up to 6 weeks after the surgery
  • Wash the surgical wound with a mild soap while bathing and keep it dry thereafter
  • Avoid drying the area surrounding the surgical wound with a towel
  • Replace dressing often, if the surgical wound is left uncovered to heal
  • Sit on a padded cushion to help relieve any discomfort
  • Complete the course of prescribed medication as advised by your physician
  • Take stool softeners to prevent constipation, per the physician’s advice
  • Take antibiotic medication to help combat or prevent infection, per your physician’s advice
  • Resume driving 1 week after being discharged from the healthcare facility or, when advised by your physician
  • Avoid sex till a complete healing has taken place (under advise by the physician)
  • Individuals are advised to have to clear liquids immediately after surgery, until the gastrointestinal tract begins properly functioning. They may then proceed to have a well-balanced diet, which can aid in a faster recovery
  • Also, one’s fluid intake may be increased to prevent constipation and stress during bowel movements and urination

How long does it normally take to fully recover, from the Procedure?

It usually takes approximately 2 weeks to fully recover from this procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision
  • Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Pilonidal Cyst Removal surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility, a physician’s clinic/office, or a hospital
  • An anesthesiologist (if anesthesia was administered)
  • A pathologist (if the tissue was sent for analysis)
  • General surgeon or a proctologist

The patient is advised to inquire and confirm the type of billing, before the Pilonidal Cyst Removal procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: June 21, 2015
Last updated: Feb. 11, 2019