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Falls Canyon Surgical Associates

Pilonidal Cystectomy: What You Need to Know

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What is a Pilonidal Cystectomy?

A pilonidal cystectomy is a surgical procedure to remove a pilonidal cyst, a chronic skin condition that occurs near the tailbone at the top of the buttocks. These cysts often contain hair, debris, and infected material and can cause pain, swelling, and drainage. Surgery is commonly recommended for recurrent or persistent cases to prevent ongoing infection and discomfort.

This page will guide you through what a pilonidal cystectomy is, why it’s done, what to expect, and how to recover.

Why a Pilonidal Cyst May Need to Be Removed

Pilonidal cysts can become repeatedly infected or fail to heal with conservative treatment. Surgical removal helps eliminate the source of infection and reduce the risk of recurrence.

Your healthcare provider may recommend a pilonidal cystectomy for:

  • Recurrent pilonidal abscesses
  • Chronic drainage or non-healing wounds
  • Persistent pain or swelling
  • Formation of sinus tracts under the skin
  • Failure of prior treatments (such as incision and drainage)

Common symptoms include:

  • Pain near the tailbone, especially when sitting
  • Redness or swelling in the upper buttock crease
  • Drainage of pus or blood
  • Foul odor from the area
  • Fever (in cases of infection)

Before the Procedure

Acute Pilonidal Abscess (Urgent Treatment)

If the cyst becomes infected and forms an abscess:

  • Evaluation/Diagnosis: Physical exam; imaging is rarely needed
  • Treatment: Incision and drainage may be performed to relieve infection
  • Timing: Definitive cyst removal is usually scheduled after the infection resolves

Elective Pilonidal Cystectomy

For chronic or recurrent disease, surgery is planned electively. Preparing for a pilonidal cystectomy includes:

  • Initial Consultation: Where you meet with the surgeon who will be performing the surgery and discuss treatment options.
  • Pre-Op Tests: Some patients may require blood tests and an EKG before surgery. Please complete all blood tests and EKGs within 30 days of surgery, and no later than two weeks before, to allow time for any needed repeats.
  • Imaging: CT/CAT scans, ultrasounds, or an MRI may be performed to determine the best and most safe surgical approach.
  • Medications: Inform your doctor about all medications and supplements, especially blood thinners.
  • Smoking: Stop smoking before surgery to promote better healing. Some insurances may require this step in order to authorize surgery. Check with your healthcare provider if you have questions about this.
  • Prep the Night Before:
    • Use the provided antibacterial soap to wash the area the night before and morning of the surgery. This excludes hemorrhoid procedures.
    • Clean clothes and clean sheets gets you prepared for surgery.
  • Fasting: Do not eat or drink anything for at least 6–8 hours before surgery.
  • Transportation: It is required that you arrange for someone to drive you home after the procedure.

Proper preparation is important to reduce infection risk and support healing. Please visit our Preparing for Surgery Page for more detailed instructions.

What to Expect During Surgery

  • You will receive general anesthesia or sedation, depending on the surgical approach
  • The surgeon removes the cyst along with any sinus tracts and infected tissue
  • The area is cleaned thoroughly to reduce recurrence risk
  • The wound may be:
    • Closed with sutures, or
    • Left open to heal gradually from the inside out (common in some cases)
  • A dressing is applied, and sometimes packing is placed in the wound

Procedure time: Typically 45 minutes to 1.5 hours

Types of Pilonidal Surgery

1. Excision with Open Healing

  • The cyst is removed and the wound is left open
  • Allows healing from the inside out
  • Lower risk of recurrence
  • Requires regular wound care and dressing changes
  • Longer healing time

2. Excision with Primary Closure

  • The cyst is removed and the wound is closed with sutures
  • Faster initial healing
  • Less daily wound care required
  • Slightly higher risk of recurrence or infection

3. Flap Procedure (Advanced Cases)

  • Tissue is repositioned to close the area and flatten the cleft
  • Used for complex or recurrent cases
  • Helps reduce recurrence by minimizing hair and moisture buildup

After the Procedure

Recovery

  • Most patients go home the same day
  • Return to light activity within a few days
  • Return to work typically within 1–2 weeks (longer if wound is left open)
  • Full healing:
    • Closed wounds: ~2–4 weeks
    • Open wounds: May take several weeks to months

What to Expect

  • Pain or tenderness near the surgical site
  • Drainage from the wound (especially if left open)
  • Daily dressing or packing changes (if applicable)
  • Instructions on hygiene and wound care

Keeping the area clean and dry is essential for proper healing.

Contact your doctor if you experience:

  • Fever over 100.4°F (38°C)
  • Increasing redness, swelling, or drainage
  • Severe or worsening pain
  • Foul-smelling discharge
  • Bleeding that does not stop

Potential Risks and Complications

While generally safe, pilonidal cystectomy carries some risks:

  • Infection
  • Bleeding
  • Delayed wound healing
  • Recurrence of the cyst
  • Wound separation (if closed)

Your surgical team will review these risks and how to minimize them.

Life After Pilonidal Surgery

Proper hygiene and hair management are important to prevent recurrence. Your provider may recommend:

  • Keeping the area clean and dry
  • Avoiding prolonged sitting during early recovery
  • Regular hair removal (shaving or other methods) around the area
  • Wearing loose-fitting clothing

Most patients recover fully and return to normal activities without long-term issues.

Frequently Asked Questions (FAQs)

Will the cyst come back after surgery?
Recurrence is possible but less likely with proper wound care and hygiene.

Is the procedure painful?
You will not feel pain during surgery. Some discomfort afterward is expected and manageable with medication.

How long will I need wound care?
It depends on the surgical method. Open wounds require daily care for several weeks, while closed wounds need less maintenance.

When can I sit normally again?
You may sit carefully within a few days, but prolonged sitting should be avoided initially.

Will I have a scar?
Yes, but the appearance depends on the surgical technique and healing process.

Can I shower after surgery?
Usually within 24–48 hours, but follow your provider’s specific instructions.

When can I return to work?
Typically 1–2 weeks, but longer if healing is prolonged.

Do I need antibiotics after surgery?
Not always. Your provider will determine if they are necessary.

How do I prevent recurrence?
Good hygiene, keeping the area dry, and hair removal can help reduce risk.

Can this condition happen again even after surgery?
Yes, but proper care significantly lowers the chances.

Have Questions or Concerns?

Your care team is here to support you. If you are dealing with a pilonidal cyst or recovering from surgery, please contact us with any questions about your care or recovery.