One of the minimally invasive surgical procedures for the treatment of the pilonidal cyst and tailbone fistula is a method from Switzerland, which was reported for the first time in 2012.
The principle consists of a small cut-out ("limited excision") of the fistula. To mark the fistula ducts, a colouring solution is injected over the pits. The pits are cut sparingly and the corresponding fistula ducts in the subcutaneous fat tissue are carefully cut out. This is the difference between the traditional, generous removal of the fistula area in one piece, which leads to large soft tissue defects. Sinusectomy is performed under local anaesthesia in appropriate cases.
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| Immediately after sinusectomy (c) MVZ St. Marien Cologne, Germany |
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| Lord Lucan, Pilonidal cyst and fistula, CC BY-SA 4.0 |
After the surgical procedure, the wounds remain open. They are not sutured, as this often leads to wound healing disorders and increases the probability of new fistulas. The wounds must be showered several times a day until they heal and then treated with a dressing. The wound area must be shaved regularly until it heals. The healing process takes several weeks, an incapacity to work of approx. 1 week must be expected.
It is recommended to perform the sinusectomy only with manageable local findings with a maximum of 3 pits, whereby these should be as close to each other as possible. Occasionally, the fistula ducts cannot be located exactly, which can result in a larger excision than originally planned. In a follow-up study, a relapse rate of 7 % is reported 5 years after the procedure.
Sinusectomy is, therefore, a minimally invasive procedure that is suitable for manageable findings. In suitable cases, it can be done on an outpatient basis under local anaesthetic and leads to good long-term results.
Literature sources:
Soll C, Dindo D et al (2012) Sinusectomy for primary pilonidal sinus: less is more. Surgery 150:996–1001
Mohamed HA, Kadry I et al (2005) Comparison between three therapeutic modalities for noncomplicated pilonidal sinus disease. Surgeon 3:73–77
Oncel M, Kurt N et al (2002) Excision and marsupialization versus sinus excision for the treatment of limited chronic pilonidal disease: a prospective, randomized trial. Tech Coloproctol 6:165–169
