Following basic investigations:
Anesthesia: Local anesthesia with sedation or regional anesthesia
Position: Prone i.e. patient lying on the stomach
Procedure: An elliptical incision is taken around the pilonidal sinus involving the midline pits. The sinus is excised upto the base and sent for histopathology. The unhealthy tissue is scooped and wash is given. Based on the status of the wound, it may be left open or primary closure in layers may be done. For bigger wounds, flap is done for the closure of the wound. If left open, the cavity is packed. If closed, dressing is done.
Post op: Patient is given antibiotics, painkillers for management of the wound.
If the wound is kept open, regular dressing is required which is done during follow up. Patients can start working immediately on day 2. Wound dressing is painful initially and the wound takes around 6-8 weeks to heal.
If primary closure is done, then the patient needs bedrest in a prone or side position for 5 to 7 days. Dressing is done at follow up. Sutures are removed on 12th or 15th day. Once the wound is healed the patient can get back to work and routine.
If flap closure is done, then the patient needs bed rest in prone or side position for 4-5 days. Dressing is done at follow up. Sutures are removed on 12th or 15th day. Once the wound heals, the patient can get back to work and routine.
Follow up: Patient is followed up on 3rd or 4th day and then weekly till wound heals.