Background

Pilonidal cystectomy is the surgical removal of a pilonidal cyst or tracts extending from a sinus. It may range from a simple procedure that involves excision of a small amount of tissue to a very complex procedure that may include allowing the wound to heal secondarily or rotating adjacent tissues into the defect after excision.

Risk factors that have been attributed to developing a pilonidal cyst include the following:

Increased friction or abrasion in the area
Increased hair
Deep natal cleft

A pilonidal cyst is believed to be an acquired condition caused by the presence of hair in involuted epithelial tissue in the natal cleft. Some clinicians have theorized that this condition is a congenital one, but it is more generally accepted that the presence of hair in the natal cleft causes a foreign body–like reaction that leads to inflammation and possibly infection.

Medical management may reduce the severity of disease. Proper hygiene is paramount. Local hair control by laser epilation has been shown to be an effective therapy that decreases recurrence.^{[1, 2, 3]} Lifestyle changes to reduce repetitive trauma or friction to the area have also been encouraged. Rare cases of squamous cell carcinoma have been reported in the pilonidal sinuses,^[4]which are similar to carcinomas arising in chronically inflamed areas.^[5] Thus, pilonidal cysts that are not amenable to medical management should lead to surgical referral for further evaluation.^{[6, 7]}

Indications

Pilonidal cystectomy is indicated for any patient who has pain or discomfort from the presence of the pilonidal cyst. Occasionally, a pilonidal sinus is encountered on physical examination that is not causing any deficits. Surgery may be deferred in these instances.

Contraindications

The pilonidal cyst may become infected. Closure after pilonidal cystectomy is contraindicated in any patient with an active infection. In these cases, antibiotics should be prescribed and the procedure deferred until the infection has been cleared. In certain cases, drainage of an abscess is performed, and a formal cystectomy is deferred until the infection has cleared.

Periprocedure

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