Excision of pilonidal cyst or sinus; extensive
CPT4 code
Name of the Procedure:
Excision of Pilonidal Cyst or Sinus; Extensive
Common Name(s): Pilonidal Cyst Removal, Pilonidal Sinus Excision
Technical/Medical Term: Pilonidal Sinus Excision, Pilonidal Cystectomy
Summary:
The excision of a pilonidal cyst or sinus is a surgical procedure to remove a cyst or infection located at the tailbone area between the buttocks. This extensive procedure is performed when the cyst or sinus is large, recurrent, or has multiple tracts.
Purpose:
Medical Condition: Pilonidal cysts or sinuses, which are painful, infected cavities filled with debris, hair, and skin.
Goals/Expected Outcomes: To completely remove the cyst or sinus to alleviate pain, resolve infection, and prevent recurrence.
Indications:
- Chronic or recurrent pilonidal cysts.
- Infection unresponsive to non-surgical treatments (e.g., antibiotics).
- Presence of multiple sinus tracts.
Severe pain or drainage from the cyst site.
Patient Criteria:
- Adults or young adults typically between puberty and age 40, more common in males.
- Patients who have a history of recurrent pilonidal disease.
Preparation:
- The patient may need to fast for 6-8 hours before the surgery.
- Certain medications may need to be adjusted or stopped as directed by the healthcare provider.
- Pre-operative assessment including blood tests and physical examination.
Procedure Description:
- Anesthesia: General or regional anesthesia is administered.
- Incision: A surgical incision is made over the cyst or sinus area.
- Excision: The cyst, sinus tracts, and any infected tissue are carefully removed.
- Cleaning: The area is thoroughly cleaned to remove any hair or debris.
Closure: The incision may be left open to heal from the inside out or closed with sutures, depending on the severity and surgeon’s choice.
Tools/Equipment: Scalpels, scissors, forceps, suction devices, and surgical drapes.
Anesthesia: General or regional (spinal/epidural) anesthesia.
Duration:
The procedure typically takes 45 minutes to 1 hour, but may vary based on the complexity.
Setting:
Performed in a hospital, outpatient clinic, or a surgical center.
Personnel:
- Primary: Surgeon
- Supporting: Surgical nurses, Anesthesiologist, Surgical Assistants
Risks and Complications:
- Common Risks: Bleeding, infection, delayed wound healing.
- Rare Risks: Recurrence of cysts, scarring, complications from anesthesia.
- Management: Follow-up care with antibiotics if needed and wound care instructions.
Benefits:
- Relief from chronic pain and infection.
- Resolution of drainage and discomfort.
- Reduction in recurrence rate with complete excision.
Recovery:
- Post-Procedure Care: Wound care instructions, possible dressing changes, and keeping the area clean and dry.
- Expected Recovery Time: Generally 2 to 4 weeks; patients may need to avoid strenuous activity during this time.
- Follow-Up: Appointment(s) with the surgeon to monitor healing and remove stitches, if applicable.
Alternatives:
- Non-Surgical: Antibiotics, drainage of abscess, hair removal.
- Pros and Cons: Non-surgical treatments may provide temporary relief but are less effective for chronic or severe cases. Surgical excision offers a more definitive solution but involves a recovery period and surgical risks.
Patient Experience:
- During the Procedure: Under anesthesia, so no sensation of pain.
- After the Procedure: Some pain and discomfort are expected, managed with prescribed pain medications. Patients may feel sore in the surgical site and need to rest and follow wound care instructions to ensure proper healing.