Piles/Hemorrhoid

Pilonidal sinus is a small hole or tunnel in the skin. It may be filled with fluid or pus forming an abscess. It is seen in the cleft between the top of buttocks. The sinus usually contains hairs and other debris. It causes recurrent pain and discharge due to repeated infections. Occasionally it may ooze foul smelling pus and blood. The disease is seen more often in men, usually young adults who have prolong sitting jobs. Although the exact cause is not know but activities like prolong sitting which involves local friction result in hair breakdown and deposition with cyst formation around hairs. These then get recurrent infections with multiple openings.

Usual complains of the patient is local swelling with pain while sitting. They may also give history of recurrent pus or blood discharge. On examination one can see multiple skin holes around the cyst in the cleft.

Although surgical treatment is the mainstay for permanent cure of the disease, medical treatment in the form of broad spectrum antibiotics and analgesics may be needed in the acute phase to control infection and relieve pain. Once the infection is controlled surgery should be performed for complete cure. Different surgical procedures have been described but the principle of surgery remains wide and complete excision of the sinus and its tracts. After complete excision the wound / wide defect is closed by one of the various described techniques. Post-operatively, patients need regular dressing and the wound usually heals by around 4 weeks time.

Commonly performed Pilonidal Sinus procedures by Dr.Ankur Bansal are

• Sinus Ecxision Surgery
• Flap Rotation
• EPSIADS
• Rhomboid Excision and Limberg Flap
• Multiple Z-plasty