Pilonidal cyst: treatments

Treatments in case of abscesses

The treatment of the acute form is surgical with drainage of the abscess in urgency, that is to say that everything is removed in the abscess. This treatment aims to evacuate pus under pressure to relieve pain and stop the progression of the infection.

A very quick appointment should be made with the surgeon or go directly to the emergency department if this is not possible. The incision is made under local anesthesia or not and not necessarily in the operating room. This gesture is painless and will instantly relieve the patient.

The surgeon will then clean and disinfect. However the cyst is still present only the abscess has been treated and therefore there is a risk of recurrence at any time.

It can persist a small flow for 1 to 2 days, requiring to put a protection. Resumption of normal activities is fast, usually 2 to 3 days.

2-stage treatment

In all cases the surgeon will propose a new convocation to treat the cyst and thus avoid recurrences.

Why not do everything at the same time? That is to drain the abscess and remove the cyst on the same operation.

Most of the time, the surgeon prefers to drain the abscess urgently and take care of the cyst afterwards. Because the treatment of abscess and cyst at the same time often leads to a larger wound than when it is performed "cold"; that is once the cyst is no longer infected.

If the wound is larger it will increase the healing time and will hinder the patient in his activities for a certain time.

And antibiotics? It can give a lull of a few days, the time to get an appointment at the surgeon but should not be used as a treatment alone.

Other measures such as alcoholic dressings to "cure" the abscess, local antibiotic ointments are not effective. Some may even be dangerous as NSAIDs (nonsteroidal anti-inflammatory drugs) that will cause a decrease in immune defenses to fight against infection.

The operation of the pilonidal cyst

Here are some explanations on the progress of the operation of a pilonidal cyst:

Most often it is an outpatient surgery the patient enters the morning and gets out at most in the evening.

The patient is completely asleep "under general anesthesia" we remove all the inflammatory fossils, the fistulas responsible for infections.

We then let the skin close gradually with daily care is what is called directed healing. This healing will last 6 to 10 weeks. This phase of healing is quite long but the patient can resume his activities in general after a few days to a week.

However, during this healing phase, there will be nursing every day and every other day, as well as check-ups at the surgeon's office. This surgical technique is the most common and has a recurrence rate of less than 5%

Some practitioners perform sutures or flaps to close the opening. But these are not the most common techniques because associated with the risk of complications or recurrence too high.

Laser Probe Treatment

Recently, a new technique has appeared: the laser probe treatment, we apply a laser probe on the cyst and we will burn its wall.

Healing is rapid, the wound superficial and does not require special care, the patient can resume its activities 2 to 3 days later.

This technique has a lot of advantage and may revolutionize the surgical management of the pilonidal cyst. Attention, there is a risk of failure requiring the transition to the usual surgical drainage.

Treatment of chronic forms

In case of chronic form: the surgical intervention is sometimes inevitable especially if this flow is very old.

If there is only an asymptomatic fossa with no induration, no flow, it should be known that there is a risk of pilonidal cyst but without certainty. There is no preventive treatment to perform. Similarly, it is useless to shave or wax in prevention.

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