Your Pilonidal Surgery FAQ

Pilonidal Surgery - What you need to know about Pit Picking & Co.
Details of the course of treatment of a Pilonidal Cyst at the Pilonidal Center.
Behandlungsablauf Steißbeinfistel.pdf
PDF-Dokument [159.9 KB]

Before surgery

  • Consider sufficient time for your arrival since traffic and parking in the city of Munich are time consuming. You will find a parking structure (“Am Salvatorplatz”) behind Luitpold building and the subway station “Odeonplatz U4/5” is directly located in front of our entrance. If your travel time exceeds 3 hours or if you need to catch a specific train or flight, please let us know when you schedule your appointment.
  • Usually the surgical procedure involves a local anesthesia. Please inform us if you do not tolerate the agent Prilocain (Xylonest®).
  • In the case your surgery uses local anesthesia, we ask you not to fasten, but you should take enough food and liquid. If your circulation tends to respond (e.g., shots, blood drawing or surgeries), please come along with a companion.
  • If possible, please shave the area of your natal cleft and sufficiently shower off this area.
  • Avoid ointments, which limit the laser treatment procedure because of the dark color (iodine or blistering ointment).

On the day of pilonidal surgery

  • After we examined you and after we performed ultrasound diagnostics, we explain to you the results and offer options for a surgical treatment. On your explicit request and if appropriately scheduled, we are able to perform the surgery immediately after this initial evaluation. In this case, we waive your right to re-consider and to obtain a second opinion.
  • The surgery will be performed in the abdominal ("prone") position and takes 20 to 90 minutes. Please use the restroom once more, before the beginning of the procedure.
  • We then perform shaving and local anesthesia, which acts only in the surgical area. You will not become tired and the nerves of the legs and closing muscle are not affected. The needles used cause only a minimal distress by the prick. The local anesthesia causes an aching sensation for a few seconds and then it starts to act and after 10 minutes the area is completely numb.
  • The next step involves – if desired – the laser treatment of the natal cleft. As a result, the pits will be deactivated and the number of hair will be reduced in the region of interest.
  • Now, the surgery starts: the pits (the hair roots as well as the fistula opening lined with skin) will be removed in form of tiny skin cylinders of 0.08 - 0.2 inch (2 - 5 mm) Ø in size. Above the opening, the fistula path can be cleaned, laser treated or enucleated.
  • Finally, it will be carefully evaluated whether all fistula portions are completely removed and in using radiofrequency forceps possible bleeding will be stopped. Lastly, a solvable tamponade will be usually inserted, which reduces in addition the risk of after-bleeding. It does not need to be removed. After providing a thick and cushioning bandage, the surgical procedure is completed.
  • Please get up slowly form the surgery couch that your circulation remains stable. You will receive a bottle of water and a pain killer and relax in the waiting room for 15 minutes.
  • In context of the final examination, we evaluate whether the bandage remained dry. If you need a medical certificate with respect to sick leave or for your school, please let us know. 

Going Home, at the Evening of the Procedure

  • You should go directly home after the surgical procedure. At best, someone will drive you home, but public transportation usually works, too. However, long walks need to be avoided.
  • However, if it starts bleeding again: Put several compresses or sheet material on the wound and apply for 15 minutes a persistent pressure. It can also help to sit on the wound and to wait a little bit. Serious hemorrhage is not possible.

Day 1 and 2 after Pilonidal surgery

  • You may remove the bandage and as usually you can shower, take a bath and move around. During the first two days you should avoid to spread the buttocks for the purpose of checking the wound so that bleeding can be avoided.
  • We recommend wearing tight underpants with a customary panty liner. This kind of wound treatment is more comfortable than a tightly bonded bandage. The wound discharges bloody secretion. 
  • The wound pain is stronger at day 2 than at day 1 and then it declines after one week. The use of ibuprofen (or comparable agents) is sufficient.

Since day 3 after Pilonidal surgery

  • The inserted tamponade resolves completely by discharging a brownish mass or fluid. Slight irritation and swelling can occur. This can be considered as normal.
  • By the end of the first week, the secretion color changes to yellow. This is no pus, but fibrin, a protein forming in the wound area.
  • Usually, no ointment or powder is required. In the case of delayed wound healing, we prescribe ointment with metronidazole and/or mupirocin, which you apply once a day to the wound.
  • It is once a week required to shave the edges of the wound with a disposable razor and to examine the wound for penetrating hair. This can be performed by us, by a dependent or by your primary care physician. 
  • The wound will be evaluated in good light and with good vision (possibly magnifier, reading glasses) and hair will be removed with tweezers. After the wound closed, shaving should continue for about 4 weeks.
  • Wound healing will be supported once per week by a Low Level Laser Therapy (LLLT, soft laser), which can occur here along with the wound follow-up examination.
  • A laser epilation treatment can occur every 4-6 weeks and is a meaningful preventive measure against relapse (recurrence). In considering that a treatment lasts only if a sufficient energy dose is used, applying local anesthesia (gel or shot) before the treatment is appropriate. We obtain a portion pack of an effective product from a pharmacy and sell it at cost.

Closure of Wounds, Signs of successful Pilonidal surgery

  • Usually, the wound should be closed and dry after six to eight weeks.
  • After this period, swelling or discharge of fluid indicates that hair may have penetrated or ingrown and this should be examined by us.
Dr. Hofer Facharzt für Chirurgie, Viszeralchirurgie, Proktologie und Spezialist für Steißbeinfisteln in München Dr. Bernhard Hofer, Chirurg und Proktologe. Leitender Arzt des Behandlungszentrums für Steißbeinfisteln.

2044 Patienten

mit Steißbeinfistel haben die Behandlung in unserer Praxis gewählt (Stand 11.04.17).

European Pilonidal Center

Zentrum zur Behandlung der Steißbeinfistel

Dr. B. Hofer

Brienner Str. 13

80333 München


Allgemeine Chirurgen
in München auf jameda

Warum ein "Zentrum" zur Behandlung der Steißbeinfistel?

In Deutschland werden im Jahr etwa 20.000 Patienten an einer Steißbeinfistel operiert.

Die herkömmliche Therapie der Steißbeinfistel ("Metzger-Methode") führt nicht selten zu einem Monate bis Jahre langen Krankenstand.

Die meisten Patienten sind im jungen Erwachsenenalter, so daß Schule, Ausbildung, Studium und Start ins Berufsleben leiden können. Auch (Leistungs-) Sportler können und wollen sich eine Trainingspause nicht leisten.

Seit 2001 haben wir uns als einer der wenigen Ärzte in Europa auf die Behandlung des Sinus pilonidalis spezialisiert und in über 1200 Operationen seit Gründung der Praxis in München 2013 die Technik des Pit Picking weiterentwickelt. Nach Pit Picking, Laser-OP (FiLaC) und minimal tubulärer Exzision (Fistulektomie) wird Arbeits- und Sportfähigkeit wenige Tage nach einer Operation erreicht. Die Rate primärer Heilung liegt über 90 %.

Die OP des Pilonidalsinus ist schmerzfrei in örtlicher Betäubung möglich.

Die Nachbehandlung nach Pit Picking - OP ist einfach, Duschen, Baden und Schwimmen sind ohne Einschränkung möglich ab dem zweiten Tag nach der OP.

Dr. Hofer Spezialist für Steißbeinfisteln in München Dr. Hofer, Facharzt für Viszeralchirurgie und Proktologie
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