Treatment for Pilonidal Sinus
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What is the treatment for Pilonidal Sinus?
There are many treatments that have been described over the years, which imply that none of them work to total satisfaction. Most are surgical treatments. Wide excision (cutting out the sinus but also cutting out a wide margin of skin which surrounds the sinus) has been favoured for many years but this technique often has problems and other operations are now recommended.
About the operations
In Portsmouth, we favour Bascom's operation for simple disease. This is done under local anaesthetic (where you are awake) as a day case. Stitches are placed and there is also an open wound. The wound heals in about 4 weeks, with dressings applied by the patient until this occurs. Stitches are removed in a week. This is a successful operation; however 1 in 10 people may get further trouble in the future.
If this happens or if there is a recurrence or failure of previous treatment, we will do another operation called a Cleft Closure or Lift. This operation creates a flap which partially flattens the groove between the buttocks. This can also be done under local anaesthetic with an intravenous sedative (given via a vein) as a day case, but sometimes needs a general anaesthetic. The wound is stitched with dissolvable stitches and a drain is left in place for a couple of days, after which it is removed. A third of wounds partially break down and heal after a few weeks. After this however, only about 5% of people have further trouble.
Other operations, such as the Limberg flap also have good results but are also fairly extensive operations with poor cosmetic results. We also do these operations, but only when the simpler operations have failed. It is seldom that we cannot treat patients with pilonidal sinus disease to their satisfaction.
It is important in treating pilonidal sinus disease to keep the operation simple, as patients often seem to outgrow this condition. Failure of some treatments may result in more trouble than the disease itself and this should be avoided.
Finally...
At Portsmouth Hospitals NHS Trust we have done many hundreds of these operations and have followed up patients in order to know what happens in the long term. Follow up is essential and we do this rigorously so that if any problems arise, we can deal with them efficiently and effectively.
We have lectured and taught at many meetings and courses and patients have been very generous in their willingness to have their operations photographed and filmed (anonymously of course!).
Consent - What does this mean?
Before any doctor, nurse or therapist examines or treats you they must have your consent or permission.
Consent ranges from allowing a doctor to take your blood pressure (rolling up your sleeve and presenting your arm is implied consent) to signing a form saying you agree to the treatment or operation.
It is important before giving permission that you understand what you are agreeing to. If you do not understand - ask. More detailed information is available on request.
Information about you - The Data Protection Act 1998
Confidential records are kept about your health and the care you receive from the NHS. These records are important; helping to make sure you receive the best possible care from us. The information may also be used to plan NHS services and assist in the teaching and training of health professionals. To make sure that patient confidentiality is maintained a policy has been written informing all staff of their responsibilities.
How to comment on your treatment
We aim to provide the best possible service and staff will be happy to answer any questions that you have. However, if you have any concerns you can also contact the Patient and Customer Services on 0800 917 6039 or E-mail PALS@porthosp.nhs.uk, who will be happy to talk to you.
Author: DSU/AS Produced: Sept 2010 Review: Sept 2012 Ref: DSU/015