General Surgery

Pilonidal Sinus Excision

OPERATION: Excision of Pilonidal Sinus
ANAESTHETIC: General / spinal anaesthesia. Local infiltration.
POSITION: Prone jack-knife. Buttocks taped apart.

INDICATION:
Symptomatic pilonidal sinus disease [acute abscess / chronic discharging sinus].

PROCEDURE:
WHO Checklist performed. Disease extent assessed by probing sinuses and identifying all secondary lateral tracks.

[FOR ACUTE ABSCESS: Incision and drainage — incision over most fluctuant point. Pus evacuated. Curettage of cavity. Wound packed and left open.]

[FOR CHRONIC SINUS — WIDE EXCISION]: Elliptical incision around all midline pits and secondary openings with adequate clearance. Excision carried down to post-sacral fascia, ensuring complete removal of all sinus tracks and granulation tissue. All hair-containing cavities curetted.

[HEALING BY SECONDARY INTENTION: wound packed with ribbon gauze / foam dressing.]
[OR PRIMARY CLOSURE: wound edges undermined and closed in layers — subcutaneous absorbable sutures, skin closed with vertical mattress sutures / staples taking tension off the midline.]
[OR FLAP REPAIR: Bascom / Karydakis / rhomboid flap — describe technique used.]

Haemostasis confirmed.

FINDINGS:
Midline pits [number]. Lateral tracks [describe extent]. Granulation tissue-lined cavity identified and excised.

EBL: Minimal. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Wound care and dressing management explained. Regular outpatient wound review. Antibiotics [if prescribed]. Shaving / laser depilation of natal cleft recommended to reduce recurrence.