Can a chronic pilonidal sinus be treated without surgery?

Question

Hello doctor,

I am a 26-year-old male. I have a sitting job (mostly eight to 10 hours a day with no exercise). I was diagnosed with a pilonidal sinus a few months ago and was advised to undergo surgery. As it comes with a long recovery time, I never opted for it.

One of the doctors suggested that I just live with it, as it causes no harm if there is not much discomfort and pain. It is situated at the back (tailbone), as shown in the photos attached. It normally pains (drains with pus/ blood) once a month and causes discomfort. So, I just apply betadine ointment till it is cured. It again comes back after a few weeks or a month's time. So, I need your help and have a few questions: What can be the possible cause of it?

Is surgery the only option to cure this, or can I try something that can help me escape surgery? Someone suggested that I use salicylic acid pads to wipe the area twice a day. Will this work? Can you please suggest anything else that can help me get rid of it?

One doctor suggested that he would keep the wound open after surgery, and another doctor suggested using stitches once the surgery is done. Which method is more beneficial in the case of a surgery? Also, is there any chance of recurrence even after surgery?

I want to get a scan done of the area just to know if it is not critical, as it has been more than one or two years since I have been having this problem. What scan is the best for this? MRI or CT scan? I will share the scan results with you in the next query.

Please share your consultation on the same. What do you suggest, please? Any medications, etc.? Can it worsen and damage other parts if delayed? Just worried as it has been long.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through the clinical images (attachment removed to protect patient identity). The reason why this occurs is elusive, although many hypothetical explanations are given. Surgery is the best and only curative option.

The wound can be closed without any problems after surgery. Keeping the wound open is an outdated technique of operation. Generally, no scan is advised. You can get an MRI if you want to get it done, but it will not be of great help.

Do not worry. It is not a life-threatening condition. It will not spread to other parts of the body. It is an easily treatable condition. You should go and get it operated on. I would advise you to reduce weight, check your blood sugar, and BP.

I hope this helps.

Kindly revert in case of further queries.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

MRI is fine. It shows a pilonidal sinus. A surgery is the only curative option. Medicines are not useful except for some antibiotics when there is an active infection.

Postponing may make it worse. The tract can extend in size and length; side tracts can form, especially if there are repeated infections. It is simpler to get operated on when it is small and not infected.

You can sit and work in a few days' time. There will be pain for the first two to three days. Now, there are excellent pain medications. You can go back to work in a week's time and slowly resume your busy schedule. Recovery will take approximately one week. There will be some pain, but it will be tolerable. Pain is a very subjective symptom; it depends on how you react to pain.

It can recur, but if the tract/ cyst is completely removed, the chance of recurrence is very, very low. Do not worry about it. Surgery is the best treatment. Ksharasutra is not for pilonidal sinus as far as I know. It is for fistula-in-ano, a totally different condition. You should not go for Ksharasutra. It is not helpful for this condition, as far as I know. Do not be too anxious about this. It is a common and simple condition to treat. Go ahead with surgery.

I hope this helps.

Kindly revert in case of further queries.

Thank you.

Answer 3

Hello,

Welcome back to icliniq.com.

I am glad that you finally got your surgery done. The doctor has done a perfect job. It is a clean and perfectly fine surgery. For completeness, please ask the surgeon; he will tell you. It was probably a straight tract. So, it looks long, with few side tracts.

Take a high-protein diet. Gradually, you can resume your regular diet. There are no specific precautions. Take some rest for a few days until the wound heals well and the pain goes away. Try to sleep on the sides rather than the back till the wound heals well.

You can go back to work after the wound heals. The wound would heal fast as it is primarily closed with stitches. In 10 to 14 days, the wound heals unless there is an infection. The cushion is fair enough, but the ring seat would have been better.

I hope this helps.

Kindly revert in case of further queries.

Thank you.

Answer 4

Hello,

Welcome back to icliniq.com.

Yes, you can clean it with spirit. It will be fine in a few days' time.
Just keep the dressing changed and wound examined on alternate days. There is no need for spinal suture removal.
If the wound is fine (not infected), then look for a cough or urinary tract infection, which can cause fever. If none, then no need to worry.
Increasing pain, discharge from the wound, and fever are the signs of infection.
Change the wet dressing.

My pleasure to answer your queries. Hope my suggestions were useful.

I hope this helps.

Kindly revert in case of further queries.

Thank you.

Can a chronic pilonidal sinus be treated without surgery?

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