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Pilonidal Cyst

The pilonidal cyst is a cystic lesion in the coccyx area. There are several theories about how it arises. It may be silently present in the human body since birth or may be due to penetration of hairs into the skin (pilonidal sinus) resulting in a cystic envelope around the penetrating hairs.

The pilonidal cyst usually occurs in males aged 15 to 25, in people with obesity, increased hair growth, and people who lead a sedentary life. The ratio for it to occur in men and women is 3:1, whereas women with a light skin are not particularly at risk for this disease.

Symptoms of Pilonidal Cyst

Symptoms of the pilonidal cyst are numerous and depend on the chronicity of the inflammation and the phase in which it is found. The phases are two, the chronic phase, where there is a small swelling in the coccyx area with minimal pain and the acute phase, with severe pain, in which a very painful inflammatory mass is created, resulting in redness, swelling and the outflow of pus. The symptoms, in more detail, are:

  • Swelling in the coccyx (“tailbone”)
  • Hοt mass – Abscess
  • Redness –
  • Outflow of pus (discharge)
  • Pain and discomfort in the waist
  • Fever
  • Fatigue
  • Nausea

Diagnosis of pilonidal cyst is straight and fast as it is made by a detailed medical history and thorough clinical examination of the area. There are some measures which can help reduce symptoms, such as healthy nutrition, weight loss and the use of a pillow when sitting.

Treatment of Pilonidal Cyst

Treatment is surgical and there are several methods.

The method of Bloodless Field Surgery is usually applied under local anesthesia. In case of an abscess, incision and drainage of the pus is carried out first and definitive surgery is required later on.  In the absence of an abscess, three methods are usually applied:

  1. The open one (without any stitches), which requires more time dealing with wound care but has low relapse (recurrence) rates,
  2. The closed one (with stitches) which needs less wound care, but shows higher rates of relapse,
  3. The semi-closed one, which constitutes an average solution.

From the most recent studies, however, it appears that the current global trend is turning to another method, the FISTULOTOMY, which is a BLOODLESS, simple, quick (3-5min) method, convenient for the patient, who returns home or to work promptly, possibly driving himself, with a low rate of relapse, with rapid recovery, without any stitches and with an excellent aesthetic result. Unfortunately, as usual, in Greece, most physicians remain faithful to the previously mentioned techniques, and this technique is rarely applied, resulting in this very common benign condition to continue to unnecessarily trouble thousands of patients.

Yet, a safe, painless and successful treatment is with the use of Laser technology surgery. Some of the advantages of using Laser techonology are:

  • Painless surgery
  • Local anesthesia
  • Definitive solution to the problem
  • Immediate return to work
  • No hospitalization
  • It takes 5 to 7 days for complete healing

LASER Treatment of Pilonidal Cyst

Laser therapy lasts from 20 to 30 minutes, depending on the situation, and it is initially performed using a mapping technique so that the physician can accurately chart the problem and check the inside of the cyst and associated fistulas.

Using a specific methodology, continuous washing is performed with a specific solution while the cyst and its branches (fistulas) are mapped. Next, the hairs causing the problem are cleansed and removed. When the cyst and fistulas are cleansed from the inflammatory tissues, exudates, and hair tufts, then a LASER optical fiber is introduced through the same opening.

The radius of the optical fiber being emitted is of specific (depending on the case) strength, intensity, wavelength and with an absolutely determined depth and extent, without causing any damage to adjacent tissues.  The applied light radiation provides a significant antiseptic and anti-inflammatory effect and at the same time sublimates the walls of the lumens created by the inflammation process.

Once surgery has been completed, the area has been fully sterilized and the cyst, along with the fistulas, has been closed (through photocoagulation) with rapid healing and final treatment within approximately 7 days.