Pilonidal Sinus

Pilonidal sinus or hair follicle fistula is an acute abscess or a chronic inflammation located in the region of the coccyx, between the buttocks. Pilonidal sinus usually occurs at young ages and in a ratio of 4:1 in male patients. In particular, it seems to be more often found in shaggy-haired and obese people. The frequency of the condition is high. More specifically, approximately 30% will develop pilonidal sinus at some point in their lives.

Causes of pilonidal sinus
Even today the causes of the formation of pilonidal sinus are not fully known. The most probable cause is the entry of hairs into the skin of the coccyx area. Hair ingress is mainly caused by the friction of the buttocks.

The hair entry creates a very small hole in the skin through which germs enter and infect and inflame the area. The introduction of germs combined with pressure on the area when we sit creates fistulas in various directions. It should be noted that in extremely rare cases the pilonidal sinus is created during fetal life.


Pilonidal sinus when not inflamed, rarely causes symptoms. It is common that patients may have a chronic pilonidal sinus and have never realized it. It is often found as an incidental finding on clinical examination by a surgeon, where the presence of a fistula in the area is observed episcopally. A chronic pilonidal sinus should be treated as soon as it is diagnosed, even if it has no symptoms.

In the acute form of the pilonidal sinus , the symptoms are intense. The coccyx area becomes red swollen and hard. In detail, the following symptoms may occur:

-Intense pain in the area
-A palpable mass in the area
-Discharge of purulent fluid,
-Discomfort in the waist

Treatment of pilonidal sinus
In the acute condition, the treatment consists of incision and drainage of the abscess by a General Surgeon. The wound is then left open and the wound is healed with daily changes of the dressing.

Pilonidal sinus: How is the surgery performed?

The treatment of chronic pilonidal sinus is surgical and includes the radical excision of the fistulas. The “key” point is the correct identification, mapping, of all fistulas. Then, complete removal of the cyst is recommended. Fistulas can be multiple, cross each other and discharge in a variety of locations.

After excision of the fistulas there is an open wound in the area.
In the previous years this wound was left open and healed with daily changes. However, the whole process can take up to two months, which is undoubtedly a great inconvenience for the patient.
This is also the reason why the open method has now been almost abolished in specialized centers abroad. Instead, the wound is sutured using special techniques avoiding the discomfort of the open method.

Treatment of pilonidal sinus with the EPSiT method

In recent years, the endoscopic method of treatment of the pilonidal sinus EPSiT (Endoscopic Pilonidal Sinus Treatment) has started to be applied. With this method, under local anesthesia, a 1cm incision is made around the entrance of the fistula. With a special tool, the syringoscope, and having a 3D image on a Full HD screen, we identify all the fistulas in the area.

Sections of tissue and pieces of hair are removed endoscopically. The inside of the fistulas is then thoroughly washed with a special washing tool. Finally, the inside of the fistulas is cauterized and destroyed with special forms of energy. This method is the least invasive, is completely painless, does not create an incision and has an excellent aesthetic result.
According to international literature, this method has a success rate of 70-75%.

Pilonidal sinus: Laser treatment

The latest method applied to treat the pilonidal sinus is the laser treatment.. It is a minimally invasive method and the patient quickly returns to his daily routine.

With the help of the laser we destroy the fistula, without resecting it, avoiding incisions. The method is ideal for uncomplicated fistulas, i.e. small pilonidal sinus. The laser treatment method has very good results according to the international literature.

This method is performed in the doctor’s office by a specialized General Surgeon and the patient returns to his daily routine the same day. It is completely minimal invasive and painless and it is the gold standard operation of choice nowadays for the treatment of pilonidal sinus, as it has significant advantages over the other methods.

Finally, regardless of the method we choose after the wound has healed, local permanent hair removal of the area is recommended to prevent the problem from reoccurring.

If you are experiencing symptoms of pilonidal sinus, contact General Surgeon Alexandros Kyritsis. Dr. Kyritsis, having been retrained in laparoscopic and robotic surgery in colon and rectal diseases, he is at your disposal to provide you with a personalized diagnosis.


I have a pain in the back near the coccyx. I definitely have pilonidal sinus?

The answer is no. There is often pain in the coccyx area which is due to strain on the bone. It is a condition called coccygodynia and is not related with pilonidal sinus as it requires a different type of treatment.

Which doctor should I visit if I suspect that I have a pilonidal sinus?

The appropriate specialty is the General Surgeon and in particular the one specializing in proctology.

Should I have the operation even if I have pilonidal sinus without symptoms?

If a pilonidal sinus is diagnosed, then the only treatment is surgical treatment of the condition in order to avoid complications from the disease. There is no conservative treatment of the disease and the only appropriate treatment is surgery. Usually the presence of pilonidal sinus is initially asymptomatic. But at some point it will start to inflame with a high probability of creating an abscess. At the same time, over time the fistula grows and expands. Therefore, it is particularly important that the patient undergo the radical treatment of the pilonidal sinus immediately.

What is the best method of treating pilonidal sinus, l excision or laser?

The laser has significant advantages in terms of the postoperative period. There is no pain, no incisions, and the patient is not bothered with daily constant changes of wound dressing. He quickly returns to his duties and daily life. For uncomplicated fistulas the recurrence rates are similar between the two methods. If the patient’s priority is rapid recovery, then the operation of choice is the use of the laser.

What kind of anesthesia is needed for pilonidal sinus surgery?

The anesthesia we use is local anesthesia. In the case of laser surgery, this can be done in the doctor’s office and the patient can be discharged immediately

How much does pilonidal sinus operation cost?

The cost of the operation is not particularly high compared to other operations. The use of the laser makes the method slightly more expensive than scalpel excision.

I have no hair back in that area. Could I still have pilonidal sinus?

Although the presence of hair in the area is the number one reason for the formation of pilonidal sinus, unfortunately it is not the only one. There are other causes and therefore it is possible for disease to appear in people without hair growth in the area.

What do I need to do after surgery?

When using the laser, you will actually need 2-3 changes of the dressing and permanent hair removal of the area after a period of one month. In the case of scalpel surgery, repeated changes will be done over a long period of time (1-2 months) and then permanent hair removal of the area.

Do I have to do the operation in a clinic?

The answer is no. Pilonidal sinus surgery with laser can also be performed in the doctor’s office as it is minimally invasive.