Pilonidal Sinus Surgery in Ankara, Turkey

Pilonidal sinus surgery is the surgical removal of hairs that have penetrated under the skin and infected tissues. If left untreated, it can lead to chronic infections and a decrease in quality of life. Early surgical intervention provides a permanent solution by reducing the risk of recurrence.

Among the most commonly used methods in the treatment of pilonidal sinus are open surgery, closed techniques, and minimally invasive procedures. The choice of method is determined according to the extent of the disease and the patient’s general health condition.

After pilonidal sinus surgery, wound care and maintaining hygiene affect the success of treatment. Paying attention to sitting position, keeping the wound area clean, and performing regular dressings accelerate the healing process.

To prevent recurrence after pilonidal sinus surgery, hair density in the area can be reduced with methods such as laser hair removal. In addition, regular exercise and weight control also reduce the risk of recurrence and protect the patient’s long-term health.

You can contact Prof. Dr. Ebru Soy, one of the doctors performing Pilonidal Sinus Surgery in Ankara, to get information about Pilonidal Sinus Surgery prices, the process, and the hospital where Pilonidal Sinus Surgery is performed.

What Is Pilonidal Sinus?

Pilonidal sinus is a skin condition, especially seen in the coccyx area, in which hairs accumulate under the skin and cause infection. Factors such as poor hygiene, excessive sweating, prolonged sitting, and wearing tight clothing play a role in the development of the disease. It is more common in men. If left untreated, it may recur and become chronic. Treatment is possible with surgical or non-surgical methods.

What Causes Pilonidal Sinus?

Pilonidal sinus generally occurs due to the accumulation of loose hairs that penetrate under the skin in the coccyx area. These hairs can lead to inflammation and abscesses under the skin. The main causes of pilonidal sinus are:

• Dense body hair
• Prolonged pressure due to sitting (desk work)
• Poor hygiene and sweating
• Tight clothing that causes friction
• Being more common during adolescence and in young men
• Genetic predisposition
• Excess weight (obesity)

These factors may cause hairs to be directed into the skin and lead to infection there. Early diagnosis and hygiene measures are effective in preventing recurrence.

What Are the Symptoms of Pilonidal Sinus?

Pilonidal sinus usually occurs in the coccyx area and causes noticeable complaints when it becomes infected. While it may present with mild discomfort in the early stage, abscesses and discharge may be seen in advanced stages. The most common symptoms are:

• Swelling, tenderness, or redness at the coccyx
• Pain when sitting or walking
• One or more small holes in the skin (sinus openings)
• Foul-smelling purulent or bloody discharge
• Occasional fever and fatigue (in abscessed cases)
• Hair and foreign bodies coming out

When these symptoms are seen, surgical evaluation is recommended to prevent the spread of infection.

What Is Pilonidal Sinus Surgery?

To better understand pilonidal sinus surgery, it is necessary to know the source of the problem first. Contrary to popular belief, pilonidal sinus is not a congenital problem; it is a completely acquired, almost mechanical failure. Hard and sharp hairs shed from our body (especially those coming from the nape, back, and scalp) accumulate in the deep and narrow cleft at the coccyx. With friction and a vacuum effect that occur when sitting and standing, these hairs drill into the skin like a drill bit and penetrate inward. The body immediately recognizes this and perceives the hair fragment as a “foreign body,” trying to isolate it within a capsule. Over time, this defense mechanism forms an inflamed, draining sinus—namely a hair nest.

This is exactly where the core philosophy of pilonidal sinus surgery comes into play. The surgery has two fundamental and indispensable goals. The first is to completely eliminate the existing problem. This means removing the hair mass under the skin, all surrounding inflamed and diseased tissue, any abscess if present, and all the fine tunnels connected to the abscess, leaving no residue behind.

The second, and perhaps the most important goal, is to prevent the problem from recurring, namely recurrence. This is where modern surgery focuses. Cleaning alone is not enough. Because as long as the anatomical structure in that region—the deep cleft that causes hairs to accumulate and penetrate into the skin—remains, the problem can potentially continue. For this reason, current surgical techniques aim to make that deep cleft shallower and flatter, essentially changing the “geography.” At the same time, they aim to move the postoperative scar away from the problematic midline to the side of the buttock, where blood supply is better and friction is less.

In short, pilonidal sinus surgery is much more than a cleaning operation; it is a repair and reshaping procedure aimed at eradicating the root cause. The choice of method is carefully planned depending on the stage of the disease and whether there is an abscess or chronic discharge.

In Which Cases Is Pilonidal Sinus Surgery Performed?

Not every case diagnosed as pilonidal sinus requires immediate surgery. The decision for surgery is made according to the stage of the disease and the severity of the patient’s complaints. Situations in which surgery becomes inevitable are generally as follows:

• Acute Abscess
• Chronic, Draining Disease
• Incidentally Detected, Asymptomatic Condition

To elaborate a bit; an acute abscess is the situation in which the patient typically rushes to the doctor in pain. There is sudden onset, throbbing severe pain, swelling, and redness in the coccyx. This occurs when the opening of the hair nest becomes blocked and microbial pus accumulates inside. This is a surgical emergency, and its treatment is to drain the abscess through a small incision. This relieves the patient’s immediate suffering but does not treat the pilonidal sinus itself. In more than half of patients, after the abscess heals, the condition becomes chronic and a definitive surgery needs to be planned.

Chronic disease is the condition that requires a permanent solution. There is continuous or intermittent, foul-smelling, bloody, or purulent discharge. There is discomfort and pain when sitting, during long trips, or when lying on the back. This significantly disrupts quality of life, causing constant soiling of underwear, hygiene issues, and social concerns. At this point, a definitive pilonidal sinus surgery is planned to resolve the problem at its root. The asymptomatic condition is noticed when a few small holes are seen at the coccyx during an examination for another reason. Follow-up is usually sufficient, but these holes are also a sign that they can cause a problem at any time.

What Are the Risks of Pilonidal Sinus Surgery?

Yes, like any surgical intervention, pilonidal sinus surgeries have certain risks. Knowing these risks helps you have realistic expectations and makes you more aware of what to pay attention to in the postoperative period. We can divide these risks into general risks and risks specific to pilonidal sinus.

There are general risks that can be seen in every surgery:

• Infection
• Bleeding
• Anesthesia complications

There are also some risks more specific to pilonidal sinus surgery that should be known.

• Recurrence of the disease (Recurrence)
• Wound healing problems
• Fluid accumulation (Seroma)
• Permanent pain or numbness

Among these risks, the most important one to emphasize is recurrence, meaning the disease coming back. The risk of recurrence is directly related to the surgical technique used. While this risk can reach 40% after surgeries performed with an incorrect or outdated technique, it can be reduced to an extremely low level such as 1–5% with a modern and correct technique. Therefore, when you decide to have surgery, the most important point is to discuss in detail with your surgeon which technique will be applied. Wound healing problems are also technique-related; especially in wounds closed under tension in the midline, suture dehiscence is more common. Seroma is the accumulation of fluid under the tissue, especially after flap surgeries, and to prevent this, a thin tube called a drain is usually placed in the surgical area for a few days. All these risks can be minimized with correct surgery, good postoperative care, and the patient’s adherence to instructions.

How Is Pilonidal Sinus Surgery Performed?

There are many different techniques in pilonidal sinus surgery, and the success rates of these techniques can differ dramatically. We can examine these methods in three groups: outdated methods, modern gold standards, and minimally invasive approaches.

First, let’s talk about an old method that should now be abandoned: excising the diseased area and closing the wound by suturing it right in the midline. Although this seems like the simplest method in theory, it is the most problematic in practice. Because this method preserves the deep and moist cleft structure that causes the disease, and even deepens it further with sutures. This suture line is continuously exposed to tension and also creates an ideal environment for hairs to accumulate again. The result? High rates of infection, wound dehiscence, and most importantly, recurrence risks reaching 40%. Rather than solving the problem, it essentially invites it back, and it should have no place in today’s surgery.

Another old method is wide excision of the area and leaving the wound open. In this method, the wound is not sutured and is left to heal on its own from the bottom to the surface. The recurrence rate is lower than midline closure. However, the biggest cost is that the patient is subjected to months of extremely demanding and often painful daily dressings. It can take 2–3 months, or even longer, for the wound to close completely. This process significantly delays the patient’s return to normal life and greatly reduces quality of life. Therefore, it is now considered only as an option in very special and complicated cases.

Now let’s move on to flap (tissue advancement) surgeries, which are the gold standard of modern surgery. The basic logic of these methods is excellent: do not just close the wound—change the anatomy that causes the problem! In techniques such as Karydakis or Limberg flap, after the diseased tissue is removed, a healthy, well-vascularized skin and subcutaneous tissue segment from the side of the buttock is advanced like a cushion to close the defect. With this maneuver, two excellent results are achieved: First, the deep and problematic cleft is flattened. Second, the surgical scar is moved away from the risky midline to the more protected and better perfused lateral buttock area. In this way, the risk of recurrence drops to an incredibly low rate of 1–5%. Recovery is much more comfortable and faster. Especially in recurrent or complex pilonidal sinus cases, these methods are the most reliable solutions.

Finally, there are minimally invasive approaches. These are modern techniques that aim to solve the problem from within through small openings rather than large incisions. Pit-picking, endoscopic (EPSiT), or laser (SiLaC®) treatments fall into this group. The biggest advantages of these methods are almost no postoperative pain and the patient returning to normal life within 1–2 days. The cosmetic results are also excellent. However, there is another side to the coin. These methods do not correct the underlying anatomical problem, namely the deep cleft. Therefore, especially in complex cases, their recurrence rates are significantly higher compared to flap surgeries. This is like a trade-off: very fast recovery, or the lowest long-term recurrence risk? The best approach is to make this decision together with the surgeon, according to the condition of the disease and the patient’s priorities.

Postoperative Process After Pilonidal Sinus Surgery

The period after the surgery is at least as important as the surgery itself and follows a completely different roadmap depending on the technique chosen.

Things to pay attention to after flap (tissue advancement) surgeries are as follows:

• Drain use
• Sitting restriction
• Wound care and bathing
• Time to return to normal life

After these types of surgeries, a drain that prevents fluid accumulation under the wound usually remains in place for 1–2 weeks. Avoiding sitting directly on the wound for the first 2–4 weeks is critical for the health of the stitches. Generally, showering is possible after 2–3 days, and returning to desk work is possible within 2–3 weeks. For heavy activities, it is necessary to wait 4–6 weeks.

In the open wound healing process, the situation is very different.

• Daily mandatory dressings
• Long healing period
• Activity restriction

In this method, daily and demanding dressings that can take months are required to allow the wound to fill in from the bottom. During this process, the patient’s return to normal life takes quite a long time.

After minimally invasive procedures, the healing process is quite comfortable.

• Simple dressing
• Fast return to activity
• Short healing time

Since there is no large wound, a simple dressing is sufficient for a few days of minor leakage from the small entry openings. Patients can usually return to their normal lives and work within a few days. It takes 2–4 weeks for these openings to close completely. As a general rule after any surgery, it is very important to eat a fiber-rich diet to avoid constipation, keep the area clean and dry, and consult a doctor immediately if there are any signs of infection (increasing pain, bad odor, redness, fever).

What Should Those Who Have Undergone Pilonidal Sinus Surgery Pay Attention to?

Thinking that everything is over once you have surgery and your wound heals is one of the biggest mistakes you can make. Pilonidal sinus is a condition that requires care and attention even in the postoperative period. There are some golden rules you should follow so that the disease does not come back:

Important habits you should add to your life to prevent recurrence are:

• Laser hair removal
• Area hygiene
• Weight control
• Avoiding prolonged sitting
• Not missing doctor follow-ups

Among these, the most important and scientifically proven one is laser hair removal. After the surgical area has completely healed, having regular laser hair removal sessions across the entire coccyx and intergluteal region permanently destroys hair follicles and eliminates the risk of new hairs penetrating into the skin. It should be especially noted that shaving this area with a razor is definitely not recommended; because a razor can make hairs harder and sharper, facilitate their penetration into the skin, and increase the risk of recurrence.

Area hygiene is also vital. The area should be washed daily with soapy water and must be dried very well. A moist environment causes both bacterial growth and increased skin sensitivity. Wearing loose, cotton underwear reduces friction and allows the skin to breathe. Weight control is important, especially because it reduces the depth of the intergluteal cleft. Excess weight both creates a deeper cleft and increases sweating in that area. If your job requires prolonged sitting, standing up and walking for a few minutes every hour increases blood circulation in the area and reduces pressure. Finally, never miss the follow-up appointments recommended by your doctor. Remember, the success of pilonidal sinus treatment is a combination of good surgery and the patient’s attention to postoperative lifestyle. As long as you follow these rules, your chance of eliminating this problem from your life permanently is very high.

Common Misconceptions About Pilonidal Sinus

False! Pilonidal sinus is only seen in young men.
Although pilonidal sinus is more common in men, it can also occur in women and in different age groups. Factors such as prolonged sitting, dense hair structure, and skin characteristics can be effective for any individual.

False! Pilonidal sinus is caused by a lack of personal hygiene.
Pilonidal sinus is not only related to hygiene. Mechanical factors such as the tendency of hair to grow under the skin, friction, and pressure play an important role.

False! Pilonidal sinus will definitely heal on its own.
In some mild cases, complaints may decrease; however, in most cases the disease may progress and inflammation may develop. Therefore, evaluation and appropriate treatment may be required.

False! Pilonidal sinus is a very dangerous disease.
Pilonidal sinus is generally not a life-threatening condition. However, if left untreated, it can lead to problems such as pain, discharge, and infection, reducing quality of life.

False! The only treatment for pilonidal sinus is surgery.
There are different treatment options depending on the stage of the disease. In the early stage, non-surgical methods or more limited procedures may be sufficient; the same approach is not required for every patient.

False! Pilonidal sinus does not recur after surgery.
Despite appropriate treatment, it may recur in some patients. Regular care, recommended measures, and follow-up visits are important in reducing the risk of recurrence.

False! Pilonidal sinus occurs only at the coccyx.
Although it is most commonly seen in this region, rarely pilonidal sinus can also develop in different areas such as the navel, armpit, or between the fingers.