What Is Pilonidal Disease?
A pilonidal cyst is a pocket of skin and hair that forms near the tailbone (sacrum), at the top of the cleft between the buttocks. It can become infected, forming a painful abscess. Pilonidal disease most commonly affects young adults, men more often than women, and is associated with prolonged sitting, excess body hair, and friction in the area.
Pilonidal cysts and abscesses tend to recur without definitive surgical treatment. Dr. Kakarla performs excision with primary closure and flap technique — the diseased tissue and any sinus tracts are completely removed, and the wound is closed using a tissue flap for optimal healing and the lowest recurrence rate.
Symptoms
- Pain and swelling near the tailbone, especially with sitting
- Redness and warmth in the area
- Drainage of pus or blood from a small opening in the skin
- Recurrent infections in the same area despite drainage or antibiotics
- Foul-smelling discharge
When to seek care
Call our office first if you have a new or worsening pilonidal flare-up — we can often see you quickly. For an acutely infected, tense abscess causing severe pain and fever, urgent drainage may be needed.
The Procedure
Surgery is performed under general anesthesia at Gwinnett Surgery Center. The entire pilonidal cyst, abscess cavity, and any sinus tracts are excised. The wound is closed with a flap technique (tissue advancement) that shifts the closure line away from the midline cleft — this promotes better healing, reduces tension on the wound, and significantly lowers the recurrence rate compared to midline closure.
The procedure takes approximately 30–60 minutes. You go home the same day. All tissue is sent to pathology.
Preparing for Surgery
You will receive a phone call from the surgery center 1–2 days before with your arrival time.
- No solid food after midnight. Clear liquids may be permitted up to 2 hours before
- Medications: Dr. Kakarla will specify which to take and which to hold
- Blood thinners and antiplatelet medications: If you take any blood-thinning or antiplatelet medication, you will receive specific stop and restart instructions from our office. Common medications and typical guidance:
- Warfarin (Coumadin) — typically stopped 5 days before surgery; INR checked the day before
- Eliquis, Xarelto, Pradaxa, Savaysa — typically stopped 1–3 days before depending on kidney function
- Plavix — stopped 5–7 days before; Brilinta — 3–5 days; Effient — 7 days
- Aspirin — may be continued or stopped depending on why you take it
- No need to shave the surgical area
- Transportation: You must have someone to drive you home and stay with you the first night
Recovery
- Wound care — specific instructions provided at discharge. Keep the area clean and dry
- Activity — avoid prolonged sitting for the first 1–2 weeks. Walking is encouraged. Most patients return to work within 1–2 weeks depending on the nature of their job
- Pain — moderate discomfort, especially with sitting. Prescription and over-the-counter pain medication provided
- Follow-up — visit with Dr. Kakarla within 1–2 weeks to check wound healing
- Long-term prevention — keeping the area clean, managing hair growth (shaving, laser hair removal, or depilatory creams), and avoiding prolonged pressure on the area help reduce recurrence risk
When to call after surgery
Call our office first for: fever · increasing redness, swelling, or drainage · wound opening or separation · severe pain not controlled by medication.
Frequently Asked Questions
Why a flap technique instead of just stitching it closed?
Simple midline closure (stitching the wound directly in the crease) has a higher recurrence rate because the closure sits in the area of friction and moisture that caused the problem. A flap technique shifts the wound away from the midline cleft, promoting better healing and significantly reducing the chance of recurrence.
Can pilonidal cysts come back after surgery?
The flap technique has a low recurrence rate, but no surgery guarantees zero recurrence. Long-term prevention includes keeping the area clean, managing excess hair (shaving, laser hair removal, or depilatory creams), and avoiding prolonged sitting or pressure on the tailbone area.
How long until I can sit normally?
Most patients can sit with a cushion or donut pillow within a few days and comfortably without it by 1–2 weeks. Avoid prolonged sitting on hard surfaces during the first 2 weeks.
Will I be asleep during surgery?
Yes. Pilonidal surgery is performed under general anesthesia.
Do I need a referral?
No. Call our office directly unless your specific insurance plan requires a referral.
