Endoscopic pilonidal cyst surgery is a solution for hair cysts that affect the lower back, leading to serious health issues and many complications. Hair cysts affect approximately 26 people per 100,000 per year and are more common in men, particularly in the 15- to 35-year-old age group.
What is a pilonidal cyst, and why does it occur?
A pilonidal cyst is an abnormal pocket in the skin that usually contains hair and skin debris. This cyst often appears near the coccyx bone at the top of the buttocks incision. Pilonidal cysts usually occur when hair penetrates the skin and gets stuck inside. If the cyst becomes infected, it can cause severe pain. The cyst can be drained through a small incision in the skin, and in some cases, surgery may be needed.
Capillary cysts are more common in young adult males. The condition tends to recur, and people who sit for long periods of time are more likely to develop this type of cyst.
Common causes of a pilonidal cyst or capillary fistula
Most capillary cysts are caused by loose hair entering the skin through a wound. The friction and pressure from rubbing the skin, wearing tight clothing, riding a bike, or sitting for long periods of time can push the hair into the skin.
The body forms a cyst around the hair in an attempt to expel it. Most hair cysts form on the coccyx bone, but people who shave or cut hair may develop a cyst between their fingers.
Symptoms and the importance of early diagnosis
A capillary fistula may not cause any symptoms in some cases, but if it becomes infected, the skin around the cyst may become swollen and painful. Symptoms of an infected pilonidal cyst include
- A hole near the top of the buttock fold
- Red, swollen skin and pain
- Pus or blood leaking from an opening in the gel
- Foul odor caused by pus drainage
What is endoscopic hair cyst surgery, and how is it performed?
Endoscopic pouch surgery (EPSiT) is a minimally invasive surgery that uses a very small camera (endoscope) to treat the fistula. The inner lining of the fistula is safely burned (cauterized) and cleaned with a brush, and some people may need more than one EPSiT session to fully heal the fistula. The procedure is often performed as a day procedure under short general anesthesia or spinal anesthesia (conscious sedation by injecting a needle into the back for patients with severe cardiac or pulmonary disease) or under local anesthesia in selected cases.
The surgeon uses a thin, flexible tube with a camera at the end (endoscope) to examine the inside of the capillary fistula. The surgeon uses small instruments with the endoscope to treat and clean the area and may also use heat to stop any bleeding and help the fistula heal. The wounds from this procedure are small and are expected to heal quickly and with less pain, allowing you to return to daily activities and work as soon as possible.
The difference between traditional surgery and endoscopic
There are many differences between traditional surgical pilonidal cyst surgery and endoscopic pilonidal cyst surgery, the most important of which are:
| Element | Traditional surgery | Endoscopic surgery |
| Surgical incision size | Large | small |
| Cyst removal accuracy | Less accurate | high resolution |
| Healing time | Longer | Faster |
| Pain and swelling after the procedure | More | less |
| Possible cyst recurrence | High | Slim |
Advantages of endoscopic pilonidal cyst surgery
Endoscopic pilonidal cyst surgery is preferred because of the low discomfort and quick recovery, and in most cases, there shouldn’t even be a scar after full recovery. Patients can return to work or school within a week, sometimes within just three days after the procedure. On average, the wound is expected to heal completely within a month after the procedure. The technique is completely bleeding and pain-free, and its application with local anesthesia makes it very easy for the patient, and EPSiT does not require incisions, so it offers excellent cosmetic results, while the patient does not need dressing changes or other post-operative recovery procedures.
In addition, thanks to the short recovery time, adolescents can resume their studies, activities, and social life without major interruption. Of course, there are risks in any surgical procedure, but the satisfaction rate of patients who have undergone EPSiT is higher than those who have undergone more invasive or major surgeries. Parents and patients should discuss these risks with the surgeon to understand the best course of treatment for each individual case.
Fast recovery and less pain
This is because the incision is very small, so the skin suffers less damage compared to traditional surgery, and small wounds heal quickly, so there is less swelling of the area and the possibility of infections, which speeds up the healing process. The pain is reduced because the surrounding nerves and tissues are few because of the small incision, so the pain sensation is reduced, and the patient only needs mild painkillers for a short period of time.
Lower recurrence rate compared to traditional methods
Endoscopic pilonidal cyst surgery is characterized by a lower relapse rate compared to traditional methods, mainly due to:
- High-resolution vision: Thanks to the camera, which clearly shows the bag.
- Completely removing the walls of the cyst: This reduces the likelihood of the cyst forming again.
Endoscopic pilonidal cyst surgery tips to speed up recovery
Follow-up after endoscopic pilonidal cyst surgery is important as it speeds up healing and prevents the cyst from recurring. The most important tips are to rest, avoid stress and heavy lifting, especially in the first days of the operation, avoid wetting the wound with water if the doctor does not allow it, take medications regularly, monitor signs of inflammation in terms of swelling, redness and pain, and make sure to visit the doctor to examine the wound and remove the sutures if necessary.
Wound care and when to return to normal life
Care after endoscopic pilonidal cyst surgery involves keeping the wound clean, washing your hands before touching it, changing the dressing regularly as advised by your doctor, and avoiding scratching the wound to prevent infections. It is possible to return to normal life from resuming normal daily activities such as walking within 1 to 3 days after the operation and heavy activities and heavy weights within 2 to 3 weeks, according to the doctor’s recommendation, as well as showering and returning to office work within 2-3 days.
How to prevent hair cyst recurrence
Hair cysts can recur after surgery within five years, with recurrence rates ranging from 13.8% to 32% depending on the type of surgical removal (including laser hair removal). Cysts may recur because the area becomes infected again or because hair grows near the incision scar. Here are some ways to prevent a recurrence:
- Carefully follow your doctor’s instructions after surgery
- Maintain personal hygiene and cleanliness of the surgical area
- Removing hair from the area to prevent cyst recurrence
In conclusion, endoscopic pilonidal cyst surgery has become one of the most important procedures for the removal of capillary fistula due to its modern techniques, low risk, high cure rate with little pain, and low recurrence rate compared to traditional surgery.
Sources:
- University Hospitals Coventry and Warwickshire NHS Trust. (n.d.). Endoscopic pilonidal sinus treatment (EPSiT)
- Giarratano, G., Toscana, C., Shalaby, M., Buonomo, O., Petrella, G., & Sileri, P. (2017). Endoscopic pilonidal sinus treatment: Long-term results of a prospective series. JSLS: Journal of the Society of Laparoendoscopic Surgeons, 21(3), e2017.00043
