Excision of Pilonidal Sinus

Introduction

Excision of a pilonidal sinus is the removal of a sinus (track) between the buttocks. The wound maybe left open and may take 2-3 weeks or longer to heal, or a flap repair may be used to close the wound primarily.  

Pre-operative Instructions

You must clip your hairs 5cm around the wound area before surgery.

Post-operative Care

Pain

Post-operative pain is normal but the intensity can differ between individuals. Analgesia will be given to you during your hospital stay and made available to you on your discharge if still required. Please refer to the Medications section below.

Wound / sutures

Keep dressings intact and dry for 7 days. Then leave the wound uncovered. If the wound is open, salt baths need to be undertaken on a regular basis, especially after bowel motion.  It is recommended that you undertake at least two salt baths per day. Salt baths will also assist with the pain. Dissolving stitches are used to close the wound site.

You may develop some swelling, which could take a few weeks to subside. You will be advised to pack the open wound daily with Seaweed packings. This will speed the wound healing. You must clip the hairs around the wound area once the dressing has been removed.

Diet

Normal fluid intake and a light diet is commenced on the day following your procedure. It is important to have a diet high in fibre and drink lots of fluids, as they will help avoid constipation.

Nausea and vomitting

Some people are very sensitive to surgical procedures. Nausea and vomiting may occur as a result of the general anaesthesia, the procedure performed or the medication prescribed.

If you have nausea and vomiting, please do the following:

• Keep well hydrated with frequent small drinks of clear fluids. It is recommended that you drink water, lemonade or diluted fruit juice. Avoid milk.
• Cease your medications, as in most cases the nausea and/or vomiting is related to the antibiotics prescribed. Once these have been ceased the nausea and/or vomiting will usually resolve.
• Contact Dr Daoud’s office at Greenslopes if the nausea and/or vomiting persists.

Activities

24 hours after your surgery you must not drive any motor-vehicle or operate any machinery. You must not undertake any important new projects, make important decision or sign legal documents. You must not drink any alcohol. Alcohol and prescribed medications is a dangerous mix. You should gradually return to normal activities. It is important to include walking in your daily routine and try to avoid standing still for long periods.

No swimming till the wound is completely healed. You are not able to undergo any exercise for 4 weeks.

Medications

You will generally be prescribed pain killers. It is imperative that you notify Dr Daoud’s office of any allergies you may have to any medication. If you are taking medication prescribed by your doctor you need to return to your normal dosage schedule as soon as possible after surgery, unless directed otherwise. If you are having problems with bowel motions you may require an over-the-counter laxative preparation, such as Movicol.

Return to work / school

This will depend on the type of work you do. It is important not to be standing in one place for a long period of time. It is usually 2-3 weeks before you return to your normal work activities. If you require a medical certificate, please contact Dr Daoud’s office after your surgery and one will be arranged. 

Post-operative review

You will need to contact Dr Daoud’s office when you are discharged from hospital, to make a post-operative review for 4 weeks after surgery.

Infection

If you develop a post-operative infection, remember it will not generally appear until 1-2 weeks after your operation. If this does occur, please contact Dr Daoud’s office to book an appointment. You will normally be prescribed a course of antibiotics after your surgery.

It is important that the full course of antibiotics is completed.

Problems

Post-operative complications are uncommon, but if they do occur please contact Dr Daoud’s office for advice.

Special Issues of concern:

• Increasing or persistent pain for 4-5 days.
• Swelling around the wound site.
• Redness or heat around the wound site.
• Persistent nausea and/or vomiting.
• Persistent discharge from the wound site.

Please do not call your referring doctor, or local GP before you contact Dr Daoud’s office. Our office number is 07 3397 8499 and we are open from Monday-Friday 8:30am-5:00pm.

Risks

• The wound may need to be left open and packed regularly until it heals and this could be several weeks.
• The wound, if sutured, may break open and discharge blood or infected material This may need further surgery or daily packings.
• The scar may thicken, redden and be painful.
• The sinus problem may recur. This may need further surgery.
• For obese people, there is an increased risk of wound and chest infections, heart and lung complications and thrombosis.
• For smokers, there is an increased risk of wound and chest infections, heart and lung complications and thrombosis.