Pilonidal Cystectomy

A pilonidal cystectomy is a surgical procedure aimed at removing a pilonidal cyst, a fluid-filled sac that mostly occurs near the tailbone at the top of the buttocks. The cyst typically appears as a swollen, tender lump located near the tailbone, at the top of the buttock’s crease. The overlying skin may exhibit redness and warmth, and in cases of infection, there can be drainage of pus or blood, sometimes accompanied by a foul odor. Multiple pilonidal cysts can develop simultaneously, especially if the condition progresses, leading to the formation of interconnected sinus tracts beneath the skin

Pilonidal cysts can cause significant discomfort and may lead to infections if left untreated. The primary goal of a pilonidal cystectomy is to excise the cyst and any associated sinus tracts to prevent recurrence and alleviate symptoms.

Why Cuba

Pilonidal cystectomies in Cuba are performed by experienced general surgeons who prioritize effective symptom management, patient safety, and favorable long-term outcomes. The nation’s healthcare system is acclaimed for its high standards, offering comprehensive preoperative assessments, advanced surgical methods, and meticulous postoperative care to ensure smooth recoveries and minimize potential complications. Surgeons in Cuba adopt personalized treatment plans, often opting for minimally invasive techniques when appropriate, to enhance patient comfort, reduce postoperative discomfort, and expedite healing for those undergoing pilonidal cyst removal.

Causes of Pilonidal Cysts

Pilonidal cysts are believed to form when loose hairs penetrate the skin, leading to an inflammatory response. Several factors contribute to their development:

• Hair Insertion: Loose hairs can become embedded into the skin, particularly in the natal cleft (the crease between the buttocks), leading to an inflammatory reaction and cyst formation.

• Mechanical Factors: Activities that involve prolonged sitting or repetitive trauma to the sacrococcygeal region can increase pressure and friction, facilitating the insertion of hairs into the skin.

• Congenital Predisposition: Some individuals may have a congenital pilonidal dimple, a small pit or sinus at birth, which can predispose them to developing pilonidal cysts later in life.

• Excessive Sweating: Moisture from excessive sweating can fill a stretched hair follicle, creating a low-oxygen environment that promotes the growth of anaerobic bacteria, often found in pilonidal cysts.

Understanding these contributing factors is essential for both prevention and effective management of pilonidal cysts.

Types and Classification of Pilonidal Cysts

Pilonidal disease is categorized based on its clinical presentation:

• Acute Pilonidal Abscess: This presents as a sudden, painful, swollen area in the sacrococcygeal region, often accompanied by erythema and tenderness. Patients may also experience purulent discharge from the affected site.

• Chronic Pilonidal Sinus: This is characterized by persistent or recurrent drainage and inflammation in the intergluteal fold. Patients may have visible sinus tracts or pits in the midline of the gluteal cleft, which can lead to ongoing discomfort and discharge.

• Recurrent Pilonidal Disease: This refers to the reappearance of pilonidal disease after previous treatment, indicating a relapse of the condition.

Symptoms of Pilonidal Cysts

Common symptoms of a pilonidal cyst include:

• Pain or discomfort near the tailbone.
• Swelling and redness in the affected area.
• Drainage of pus or blood from an opening in the skin.
• Foul odor from the draining pus.
• Fever, in cases of infection.

Pre-Surgical Diagnosis of Pilonidal Cysts

Accurate pre-surgical diagnosis of pilonidal cysts is essential for effective treatment planning and optimal patient outcomes. The diagnostic process encompasses:

• Patient History: A thorough medical history is obtained to identify symptoms such as pain, swelling, or discharge near the sacrococcygeal region. Risk factors, including prolonged sitting, obesity, and family history, are also assessed.

• Physical Examination: A detailed inspection of the gluteal cleft is performed to detect signs of pilonidal disease. Findings may include:

• Midline Pits or Openings: Small depressions or sinus openings in the midline of the gluteal cleft.
• Swelling or Tenderness: Indications of an underlying abscess or active infection.
• Discharge: Presence of purulent or bloody drainage from sinus tracts.

• Imaging Studies: While pilonidal disease is primarily diagnosed clinically, imaging modalities can be utilized in specific scenarios to delineate the extent of the disease or to differentiate it from other conditions:

• Ultrasound: Used to visualize subcutaneous abscesses, sinus tracts, and fluid collections, aiding in the assessment of the extent of the disease.
• Magnetic Resonance Imaging (MRI): MRI offers detailed visualization of the soft tissue structures, enabling precise mapping of complex or recurrent pilonidal disease. It is particularly useful in identifying deep extensions of the sinus tracts and their relationship to adjacent anatomical structures, which is crucial for surgical planning.

Surgical Options for Pilonidal Cysts 

Surgical intervention is recommended when:

• The cyst causes significant pain or recurrent infections.
• There is a risk of complications, such as abscess formation.
• Non-surgical treatments have failed to provide relief.

Surgical Procedures: Traditional vs. Minimally Invasive

Several surgical options are available for treating pilonidal cysts, each tailored to the patient’s specific condition and the cyst’s severity. These procedures range from minimally invasive techniques, which often involve shorter recovery times and less postoperative discomfort, to more extensive surgeries that may be necessary for recurrent or complex cases.

The choice of surgical method depends on factors such as:

• The size of the cyst.
• Complexity of the cyst.
• Presence of infection.
• Patient’s overall health.

Types of surgical intervention include:

• Incision and Drainage (I&D):

This procedure involves making an incision to drain the cyst, providing immediate relief from pain and pressure. Typically performed under local anesthesia whereby the cavity is often packed with gauze to facilitate healing, requiring regular dressing changes over several weeks. While effective for acute infections, I&D addresses the immediate issue but may not prevent recurrence without further intervention.

• Excision (Traditional Surgery):

This method entails the complete removal of the cyst and surrounding tissue to reduce the risk of recurrence. Conducted in an operating room under local or general anesthesia, the wound may be left open to heal naturally or closed with sutures, depending on the surgeon’s assessment. Open healing can result in a longer recovery period but may lower the chance of recurrence.

• Minimally Invasive Techniques:

Procedures such as endoscopic pilonidal sinus treatment (EPSiT) and laser therapy aim to remove the cyst with less tissue damage. Utilizing specialized equipment, these methods involve small incisions and are often performed under local anesthesia, leading to faster recovery times and reduced postoperative pain.