Pilonidal Sinus Endoscopic Ablation - Procedure and Recovery

1. The Endoscopic Ablation approach is a notable video-assisted minimally invasive surgical treatment for pilonidal cysts that have shown encouraging outcomes. It offers a viable substitute to typical surgical procedures promising lower complications. 
2. A pilonidal cyst is a small hole or tunnel in the skin at the top of the buttocks. They usually do not cause any symptoms and only need to be treated when infected. 
3. The procedure is performed using a thin, flexible tube attached to a camera better known as an endoscope to get a clear vision during the procedure. 

What if delayed?

Following are the complications that might follow if you take the pilonidal cyst casually and leave it untreated-  

1. The size of the cyst might increase  
2. The symptoms and the severity might enhance  
3.  Accumulation of fluid and pus 
4. Rupturing and recurrence of the cyst       
5. Squamous cell carcinoma might be induced by the untreated cyst

 

Benefits of treatment for Endoscopic ablation for pilonidal Sinus

1. Endoscopic ablation for Pilonidal Sinus offers the possibility of obtaining the complete obliteration of the sinus cavity and sinus tracts and hair removal under direct vision and subsequent closure of the primary sinus with a negligible incision and minimal discomfort.
2. The success rate of 90% is similar to the best reports of the open technique according to a recent metaanalysis

 

Indications for this procedure when your doctor will look for are:  

1. Severe pain  
2. Swelling near buttocks 
3.  Redness near the swelling  
4.  Discharge of pus or blood via the gap in the skin  
5. unpleasant odour from draining pus  
6. The factors that increase the risk of the development of pilonidal cysts are:  
7. Sex: males are more prone to develop pilonidal cysts than females 
8. Age group: People in their 20s are the most likely to develop pilonidal cysts.
9. Obesity 
10. Lethargic Way of living  
11.  Profession demanding constant sitting  
12.  Excessive body hair  
13. Stiff or coarse hair 

 

Procedure Description

Endoscopic ablation of the pilonidal sinus is less intrusive compared to surgery and is usually performed as a day procedure under spinal or local anaesthesia.  

The goal of endoscopic ablation is to target the hair invagination that causes pilonidal sinus illness and stop it from spreading further   down the canal, which heals by secondary intention. 

The process has two phases:  

1. Diagnostic phase: During this, the anatomy of the pilonidal sinus, as well as any collateral routes and/or abscess chambers are identified. 
2. Operative phase: In this, the aim is to ablate and disinfect the infected area. 

The external aperture of the sinus is incised and a Fistuloscope is placed into the sinus tract while the patient is in an inclined posture. 

A continuous flow of irrigation solution is applied, providing for optimal sinus visualisation and assessment. Forceps are utilised to remove hairs, diseased tissue, and any detritus under direct vision. 

The main sinus tract, as well as any subsidiary tracts or abscess chambers, are then cauterised with an electrode passing through the fistuloscope. An endobrush is used to remove necrotic material, and an irrigation fluid is used to clean the sinus tract. 

Key features of the process are: 

1. Direct vision 
2. Removal of debris 
3. Cauterization of inflamed tissue 

What to expect before the surgery

1.  To conduct a proper diagnosis, your doctor will ask you about your symptoms. 
2.  The doctor will ask you about your occupation, lifestyle, family history as well your medical records.  
3. Your doctor will then review the procedure and all the related aspects.  
4.  He might ask you to avoid certain medications or food.  
5.  He might ask you to stop smoking for a certain period.  
6. Your doctor will give you instructions on how to prepare for the procedure. 

What to expect on the day of Surgery

1. The healthcare staff will ask about your medical history, last meal, and will check your other vitals such as blood pressure, blood sugar, body temperature etc.  
2. Before beginning the procedure, the staff will shave and disinfect your lower back area.   
3. The anesthesiologist will give you spinal or local anaesthesia, based upon the severity of the case. 

What to expect during surgery?

1. To begin the procedure, the doctor will ask you to lie down with your legs slightly apart. Two large plasters divide the buttocks. 
2.  After the exterior aperture is excised, your doctor will place a fistuloscope through a 0.5 cm circular cut.  
3. In the diagnostic phase of the process, your doctor will identify hair, debris, and accessory tracts.  
4.  Your doctor will initially use endoscopic forceps to pull out hair and hair follicles under direct view. 
5. Next, your doctor performs electrocautery ablation of the granulation tissue lining both the main as well as the accessory tracts. 
6.  Ultimately necrotic tissues are removed. 

 

What to expect after a surgery?

1.  After a successful operation, you will be kept under observation for a small period. In case there were no complications during the procedure, you might get discharged the same day.  
2. You are likely to feel any pain after the procedure. 
3. Your doctor will suggest you clean the wounded area and shave the hair of the wounded site regularly to prevent a recurrence.  
4.  Your doctor might also suggest you wear loose clothes as well as have a fibrous diet to avoid straining. 
5. The complete healing might take up to 2-3 weeks 
6. The recurrence of pilonidal cysts after an endoscopic ablation is very rare. 
7.  The endoscopic process is preferred over traditional surgical methods because of: 
8. Minimal pain 
9.  Rare chance of recurrence  
10.  Lesser recovery period 

 

First follow up appointment

1. You'll have a follow-up appointment at the outpatient clinic after 1, 2, and 4 weeks post-operation, and later every 6 months for the next 24 months with your specialist. Your doctor focuses on:  
2. Any reaction to anaesthesia  
3. If you still have any bleeding  
4. Any other complication   
5. Healing 
6. Pain  
7.  Recurrence  
8. The doctor will also suggest you some preventive measures to avoid recurrence:  
9.  Keep the area clean  
10. Shave the area often  
11. Get regular checkups  
12. You may consider laser hair removal  
13.  Avoid prolonged   sitting  
14. Maintaining a healthy weight 

 

You should immediately consult a doctor if:  

1. You feel pain which often gets worse when sitting.  
2.  You observe a small dimple or large swelling near the buttocks 
3. You observe an abscess with draining pus or blood.  
4.  You observe nausea, vomiting or extreme tiredness.  
5.  You have a recurrence of pilonidal cysts.  
6.  Your body shows a reaction to anaesthesia after the surgery.