Pilonidal Cyst Surgery (Pilonidal Cystectomy)

Pilonidal cyst surgery is a medical procedure performed to remove an infected pilonidal cyst and prevent recurrence. Surgery is often recommended when the cyst becomes painful, recurrent, or leads to complications.

A pilonidal cyst is a fluid-filled sac that typically develops at the base of the tailbone (coccyx), near the cleft of the buttocks. It forms when hair, dirt, and debris become trapped beneath the skin, leading to an infection. This condition is more common in young adults, men, and people who sit for prolonged periods. If left untreated, a pilonidal cyst can lead to complications such as abscess formation, severe infection, or, in rare cases, skin cancer, making early diagnosis and treatment essential.

Diagnosing a pilonidal cyst begins with a thorough clinical evaluation by experienced specialists. At Max Hospitals, the diagnostic process includes:

• Medical History & Symptom Assessment: The doctor will ask about symptoms. Common symptoms of pilonidal cyst include:
• A painful lump near the tailbone
• Redness and swelling around the affected area
• Drainage of pus or bleeding from pilonidal cyst 
• Foul-smelling discharge
• Tenderness and discomfort while sitting or moving
• Physical Examination: A detailed examination of the affected area helps identify swelling, tenderness, and any visible sinus tracts or abscess formation.
• Advanced Imaging (if needed): In some cases, an ultrasound or MRI may be recommended to assess the depth of the cyst and rule out complications like abscesses or sinus tracts.

Early and accurate diagnosis at Max Hospitals ensures that the right treatment approach—whether conservative management or pilonidal cyst removal surgery—is selected for the best patient outcomes.

While the exact cause is not always clear, certain factors increase the likelihood of developing this condition.

Causes of Pilonidal Cyst

1. Ingrown Hair: Loose hair can penetrate the skin, causing irritation and inflammation, leading to cyst formation.
2. Friction and Pressure: Activities such as prolonged sitting, cycling, or wearing tight clothing can create friction, pushing hair and debris into the skin.
3. Infection: Bacteria entering the blocked hair follicle can lead to abscess formation and a painful cyst.

Risk Factors for Pilonidal Cyst

Certain individuals are more prone to developing pilonidal cysts due to specific risk factors, including:

• Prolonged Sitting: People with desk jobs, truck drivers, or students who sit for extended hours are at higher risk.
• Excess Body Hair: Thick or coarse hair increases the chances of ingrown hairs.
• Poor Hygiene: Lack of proper cleaning in the affected area can lead to hair and debris buildup.
• Obesity: Excess weight increases friction in the tailbone region.
• Family History: A genetic predisposition can make some individuals more susceptible.
• Age and Gender: Young adults, particularly men, are more commonly affected.

Since pilonidal cyst recurrence is common, understanding these risk factors can help prevent pilonidal cysts and reduce complications.

Surgery is recommended for pilonidal cysts because they can become recurrent, infected, and increasingly painful over time. While some cysts may drain on their own, they often return or form abscesses, leading to severe discomfort and complications. Surgical removal helps eliminate the cyst completely, reduces the risk of recurrence, and promotes faster healing, improving the patient’s overall quality of life.

Pilonidal cyst surgery is typically recommended for individuals experiencing persistent or severe symptoms that do not respond to non-surgical treatments. Candidates for pilonidal cystectomy include:

1. Recurrent or Chronic Pilonidal Cysts

• Patients who experience frequent flare-ups, infections, or cyst recurrence despite previous treatments.
• Those with a history of multiple pilonidal cyst abscesses require drainage.

2. Severe Pain and Infection

• Individuals experiencing intense pain, swelling, redness, or pilonidal cyst bleeding due to infection.
• Patients with pus or foul-smelling drainage from the cyst.

3. Complications from an Untreated Cyst

• If left untreated, a pilonidal cyst can lead to abscess formation, deep tissue infection, or sinus tract formation.
• In rare cases, chronic cysts may increase the risk of pilonidal cysts becoming cancerous, making surgery necessary.

4. Failure of Non-Surgical Treatments

• Patients who have tried conservative treatments such as antibiotics, warm compresses, or drainage but continue to experience symptoms.
• Those who require a permanent solution to prevent pilonidal cyst recurrence.

5. Individuals with a High Risk of Future Cysts

• People with excessive body hair, prolonged sitting habits, or poor hygiene may benefit from surgical removal to prevent future complications.
• Those with deep gluteal clefts or a family history of pilonidal cysts.

At Max Hospitals, specialists assess each patient's condition to determine the most suitable pilonidal cyst removal technique, whether traditional excision or laser pilonidal cyst surgery, ensuring optimal results and a smooth recovery.

If left untreated, a pilonidal cyst can lead to several complications, ranging from mild discomfort to serious infections. While some cysts may remain small and manageable, others can worsen over time, requiring medical intervention.

Infection and Abscess Formation

A pilonidal cyst infection can cause swelling, redness, pain, and the formation of an abscess filled with pus. This may lead to pilonidal cyst bleeding, foul-smelling drainage, and fever.

Chronic or Recurrent Pilonidal Cysts

Many individuals experience pilonidal cyst recurrence, even after treatment. If not fully healed, the cyst can return, requiring surgical procedures like pilonidal cystectomy or pilonidal cyst laser surgery.

Open Wound Healing Challenges

After surgery, some patients experience slow healing, especially if the wound is left open. The pilonidal cyst open wound healing stages can take weeks to months, requiring regular dressing changes and hygiene maintenance.

Spread of Infection

If a pilonidal cyst infection is not treated in time, bacteria may spread deeper into the tissues, causing cellulitis or, in severe cases, sepsis.

Development of Sinus Tracts

Chronic pilonidal cysts can form sinus tracts—tunnel-like passages under the skin that continuously drain fluid. This condition may require more extensive surgical intervention.

Rare but Serious Risks

In rare cases, long-standing or repeatedly infected pilonidal cysts can lead to squamous cell carcinoma, a type of skin cancer. However, this occurs only in severe, untreated cases over many years.

There are different surgical approaches available at Max Hospitals for pilonidal cyst treatment, including:

• Lancing: Lancing is a minor surgical procedure used to drain an infected pilonidal cyst. A surgeon makes a small incision to release pus and reduce swelling, providing immediate relief. However, it may not prevent recurrence, and further treatment like cystectomy may be needed.
• Incision and Drainage (I&D): A minor procedure where the cyst is opened and drained to relieve infection and discomfort. However, this does not eliminate the cyst completely, and recurrence is common.
• Pilonidal Cystectomy: A more definitive procedure where the entire cyst and affected tissue are surgically removed to prevent future infections.
• Pilonidal Cyst Laser Surgery: A minimally invasive option that uses laser technology to remove the cyst, reduce scarring, and promote faster healing.

The choice of procedure depends on the cyst’s severity, size, and recurrence history. After surgery, proper post-operative care is crucial for successful healing and to reduce the risk of pilonidal cyst recurrence.

Before the Procedure

At Max Hospitals, patients undergo a thorough preoperative evaluation to ensure a smooth pilonidal cyst surgery experience. Here's what to expect:

• Preoperative Consultation: The doctor will discuss the pilonidal cystectomy procedure, assess medical history, and explain surgical options, including traditional excision or pilonidal cyst laser surgery.
• Pre-Surgery Instructions: Patients may be advised to:
• Avoid certain medications that increase bleeding risk.
• Maintain hygiene in the affected area by keeping it clean and shaving if necessary.
• Follow fasting guidelines if general anaesthesia is required.
• Anaesthesia Planning: Depending on the severity of the cyst, local or general anaesthesia will be used for a pain-free experience.

After the Procedure

Recovery after pilonidal cyst removal depends on the surgical technique used. Here’s what to expect post-surgery:

• Immediate Post-Surgery Care:

• Patients may experience mild discomfort, swelling, or drainage from the wound.
• Pain management with prescribed medications is provided.
• If pilonidal cyst open wound healing is required (open technique), regular dressing changes will be necessary.

• Pilonidal Cyst Recovery Time After Surgery:

• Closed-wound techniques heal within 2-4 weeks, while open-wound healing may take longer (up to 6-8 weeks).
• Patients should follow wound care instructions to prevent pilonidal cyst recurrence.

• Activity & Lifestyle Adjustments:

• Avoid prolonged sitting for the first few days.
• Refrain from strenuous activities until full recovery.
• Maintain hygiene and consider hair removal to prevent reoccurrence.

Regular follow-ups at Max Hospitals ensure proper healing and help address any pilonidal cyst complications such as infection or recurrence.

Pilonidal cyst surgery is typically recommended for individuals experiencing persistent or severe symptoms that do not respond to non-surgical treatments. Candidates for pilonidal cystectomy include:

• Recurrent or Chronic Pilonidal Cysts

• Patients who experience frequent flare-ups, infections, or cyst recurrence despite previous treatments.
• Those with a history of multiple pilonidal cyst abscesses require drainage.

• Severe Pain and Infection

• Individuals experiencing intense pain, swelling, redness, or pilonidal cyst bleeding due to infection.
• Patients with pus or foul-smelling drainage from the cyst.

• Complications from an Untreated Cyst

• If left untreated, a pilonidal cyst can lead to abscess formation, deep tissue infection, or sinus tract formation.
• In rare cases, chronic cysts may become cancerous, making surgery necessary.

• Failure of Non-Surgical Treatments

• Patients who have tried conservative treatments such as antibiotics, warm compresses, or drainage but continue to experience symptoms.
• Those who require a permanent solution to prevent pilonidal cyst recurrence.

• Individuals with a High Risk of Future Cysts

• People with excessive body hair, prolonged sitting habits, or poor hygiene may benefit from surgical removal to prevent future complications.
• Those with deep gluteal clefts or a family history of pilonidal cysts.

At Max Hospitals, specialists assess each patient's condition to determine the most suitable pilonidal cyst removal technique, including traditional excision or laser surgery, ensuring optimal results and a smooth recovery.

Like any surgical procedure, pilonidal cyst surgery carries certain risks. While most patients recover without complications, it is essential to understand the potential risks associated with pilonidal cyst surgery before undergoing the procedure.

1. Infection

• The surgical site is prone to infection due to its location near the buttocks, where moisture and bacteria can accumulate.
• Signs of infection include redness, swelling, warmth, pain, pus drainage, and fever.

2. Recurrence of the Cyst

• Pilonidal cyst recurrence is a common concern, especially if hair follicles continue to grow in the affected area.
• Proper wound care, hygiene, and hair removal techniques can help reduce the risk of recurrence.

3. Poor Wound Healing

• Some patients experience delayed healing, particularly if the wound is left open to heal naturally.
• Smoking, diabetes, and poor circulation can further slow the healing process.

4. Bleeding and Fluid Accumulation

• Pilonidal cyst bleeding may occur after surgery, especially if stitches are placed under tension or if the wound is irritated.
• In some cases, fluid buildup (seroma) or blood accumulation (haematoma) may develop, requiring drainage.

5. Pain and Discomfort

• Pain is expected after surgery but can usually be managed with prescribed medications.
• Prolonged or severe pain may indicate complications such as infection or poor healing.

6. Scarring

• Depending on the surgical technique used, scarring may occur at the site of pilonidal cyst removal.
• Laser-assisted procedures, such as pilonidal cyst laser surgery, may minimise scarring compared to traditional excision.

7. Allergic Reactions to Anaesthesia

• Some individuals may have an allergic reaction to anaesthesia or medications used during the procedure.
• Surgeons and anesthesiologists take necessary precautions to minimise this risk.

For effective treatment and long-term relief from pilonidal cysts, timely medical intervention is essential. At Max Hospitals, our expert surgeons provide advanced pilonidal cyst surgery with personalised care to ensure a smooth recovery. Book a consultation today and take the first step towards a pain-free life.

1. Is a pilonidal cyst contagious?

No, a pilonidal cyst is not contagious. It is a non-infectious skin condition caused by hair and debris trapped under the skin, leading to inflammation or infection.

2. How to prevent pilonidal cysts?

To prevent a pilonidal cyst, keep the area clean, dry, and free of excess hair through regular hygiene and hair removal. Avoid prolonged sitting and wear loose-fitting clothing to reduce friction and irritation.

3. Is pilonidal cyst surgery done under anaesthesia?

Yes, pilonidal cystectomy is usually performed under local, regional, or general anaesthesia, depending on the severity of the cyst and the chosen surgical technique.

4. Can a pilonidal cyst come back after surgery?

Yes, there is a risk of pilonidal cyst recurrence, especially if proper hygiene and hair removal are not maintained. Following post-surgical care can help prevent recurrence.

5. Can a pilonidal cyst be cured without surgery?

Small or mild cases may be managed with antibiotics, drainage, and hair removal, but pilonidal cyst removal via surgery is often needed for a permanent solution.

6. Can you sit after pilonidal cyst surgery?

Sitting may be uncomfortable for a few days after surgery, but using a cushioned seat or doughnut pillow can help reduce pressure and discomfort.

7. Can I poop after pilonidal cyst surgery?

Yes, you can have a bowel movement after surgery. Keeping the area clean and using stool softeners if needed can help avoid straining.

8. Who does surgery for a pilonidal cyst?

A general surgeon or a colorectal surgeon typically performs pilonidal cyst surgery, ensuring proper removal and wound care.

9. How long do stitches stay in after pilonidal cyst surgery?

Stitches are usually removed within 10 to 14 days, but if the wound is left open, it may take longer to heal naturally.

10. How long does pilonidal cyst surgery take to heal?

Healing time varies, but pilonidal cystectomy recovery generally takes 4 to 8 weeks, depending on whether the wound is closed with stitches or left open.

11. Is pilonidal cyst surgery recovery painful?

Some discomfort is expected, but pain can be managed with medications. Pilonidal cyst laser surgery may cause less pain than traditional methods.

12. What to eat after pilonidal cyst surgery?

A fibre-rich diet with fruits, vegetables, and plenty of fluids helps prevent constipation and promotes healing. Avoid processed or greasy foods that may cause digestive discomfort.

Reviewed by Dr. Atul Wadhwa, Principal Consultant - General Surgery, Bariatric Surgery/ Metabolic, Department of General Surgery and Robotics, on 09-April-2025.