Pit Picking Procedure
The "all-in-one" appointment: From registration to follow-up care
Have you decided to finally address your pilonidal sinus? A wise decision. You are not alone—and you are in the right place. At our specialized center, we offer pit picking as a minimally invasive outpatient procedure under local anesthesia. On this page, we guide you step by step through the treatment process, explaining how pit picking is combined with a targeted sinusectomy to effectively remove the diseased tissue while preserving healthy skin.
If you would like to learn more about the surgical technique and its variations, you can find additional details on our Pit Picking page. Most importantly, however, our experienced team will take the time to listen to your concerns, answer your questions, and explain the procedure in a clear and reassuring way. Our information materials will help you understand what to prepare for and what the treatment journey looks like—from start to finish.
One of the key advantages for our patients: consultation, examination, and surgery can all be performed on the same day. This makes pit picking under local anesthesia an especially convenient option if you want effective treatment without long waiting times. The procedure is carried out on an outpatient basis in our practice, allowing you to remain relaxed and return home shortly afterward. Pit picking is a particularly gentle method with a fast recovery. Should symptoms recur at a later stage, all further surgical options remain available, including flap procedures such as the Karydakis technique. In most cases, however, healing proceeds smoothly, and patients are able to return to everyday activities quickly.
With our clearly structured and transparent process, we ensure that you feel well informed, safe, and supported—from your first consultation to your recovery.
Take the next step now and schedule your consultation.
Step 1: Diagnosis of pilonidal sinus
Has your doctor already confirmed that you have a pilonidal sinus? Perfect, then you are ready for the next step—and we are here to help.
If you are still unsure or would like to classify your symptoms more precisely, we have compiled some helpful information for you: Find out which symptoms indicate a pilonidal cyst and take a look at our picture gallery to see what such a cyst looks like.
Our modern diagnostics and treatment methods make all the difference – and we make sure that you feel well cared for with us.
Step 2: Find an appointment online
The easiest way to find an appointment is in our online calendar:
- The diagnosis is clear and you would like to have pit picking surgery immediately after the examination and consultation? Then the appointment category “Examination/Treatment Coccyx Fistula All-in-one” is made for you. This allows you to book a 2-hour appointment with treatment option – a great relief for anyone who wants to avoid a second trip.
- If you are still unsure or want to take your time to consider your decision, we recommend choosing “Special consultation for pilonidal sinus/sinus pilonidalis.” This will give you a 20-minute appointment for examination and consultation. We will then arrange an appointment for the operation according to your wishes. Such a consultation appointment is also essential if an operation under general anesthesia is to be planned, whether at your request or for medical reasons.
All information on the procedure for acute pain can be found on the pilonidal abscess page.
Please note that examination or treatment for other diagnoses (hemorrhoids, anal fistulas, etc.) is not possible during these appointments. A requested appointment will be confirmed if the patient has already been examined by us or if image documentation has been submitted.
Step 4: Preparation for the appointment
Please inform us before your appointment if you have any relevant pre-existing conditions (e.g., heart, lung, or coagulation disorders), known allergies or intolerances—especially to local anesthetics or antibiotics—or if you are taking anticoagulant medication.
If you require special pre-treatment (e.g., antibiotics for heart valve disease or Minirin for congenital bleeding tendency), please let us know in good time.
We recommend that you do not drive yourself home. Circulatory reactions are rare, but can never be completely ruled out—and immediately after the procedure, you may not be the most focused person on the road. It is best to arrange for someone to accompany you or plan an uncomplicated journey by public transport.
Please also take the following into account when planning your schedule: Sitting for long periods of time may be uncomfortable for the first one to two weeks after the procedure. You should avoid long days at the office, long car journeys, or air travel during this time if possible.
Schritt 4: Stressfreie Anreise
You will find the Dr. Hofer / Liebl practice at Brienner Straße 13 on the 4th floor above Café Luitpold in the center of Munich. The entrance is located between the café and the Flor & Decor flower shop; there is, of course, an elevator.
The subway stops right in front of the building (Odeonsplatz station). The parking garage at Salvatorplatz is located behind the Luitpoldblock building, accessible via Amiraplatz.
Please note that during rush hour, heavy city traffic and short-term detours due to numerous construction sites are to be expected. Therefore, please allow sufficient time—a relaxed start is the best preparation for your appointment.
We work with a full, well-organized schedule. Therefore, please arrive “just in time” if possible – if you arrive about 5–10 minutes before your appointment, you will be perfectly on time. Due to our fixed schedule, it is usually not possible to start treatment earlier.
Step 5: Don't come on an empty stomach, and ideally have showered and shaved.
Unlike surgery under general anesthesia, you do not need to fast before sinusectomy under local anesthesia. Eat and drink normally and sufficiently. Especially on warm days, staying well hydrated helps prevent circulatory reactions.
Diabetics should take their meals and medication as usual. If you are unsure, please contact us in advance.
Please shower on the morning of the procedure. If possible, shave the buttocks generously in the area of the buttock crease. This makes it easier for us to perform the procedure and makes changing the bandages later on more comfortable for you, as the plasters will not stick to the hair.
We recommend wearing comfortable clothing on the day of the treatment. Unlike with many other procedures, tight-fitting underwear is more suitable than loose boxer shorts: slight compression helps to secure the bandage and provides additional support.
Step 6: The procedure is performed with the patient lying comfortably on their stomach and under local anesthesia.
During the procedure, you will lie comfortably on a specially padded gel mattress with an adjustable headrest and armrests. This allows you to remain relaxed in a prone position. Before the operation begins, we recommend that you visit the restroom once more so that you can relax during the procedure. After any necessary shaving, local anesthesia will be administered. The procedure usually takes between 30 and 60 minutes.
We perform the operation under what is known as tumescent anesthesia. Local anesthetics have been used in medicine for over 140 years and specifically block the transmission of pain in the nerves. This allows for pain-free treatment while the patient is fully conscious. Many patients fear that local anesthesia will not be effective enough. The effectiveness and safety of tumescent anesthesia have been proven by numerous studies, including those conducted by Prof. Bussen at the University of Würzburg. Tumescent anesthesia (tumescent = swelling) was developed in 1985 by cosmetic surgeon Dr. Jeffrey A. Klein in the USA and has since been used successfully in many specialist fields. It offers many advantages:
- even larger areas can be reliably anesthetized
- the tendency to bleed and bruise is reduced
- the long duration of action ensures lasting pain relief after the procedure
- the procedure is easy to control and puts significantly less strain on the body than general anesthesia
Which types of procedures can be performed responsibly in this outpatient setting? We explain the details of the surgical techniques on the corresponding subpages:
Step 7: What happens to the wound?
Open wound treatment
We usually leave small wounds up to 1 cm open. Conventional wound suturing is often ineffective in the midline, as shear forces, bacteria, and regrowing hair impair healing. However, under optimal conditions, it is possible to deviate from this principle, with a success rate of around 80% under the following conditions:
- Good tissue consistency
- Exclusion of an abscess
- Laser hair removal before the procedure to reduce hair growth as much as possible in the first two weeks after the procedure
Is the wound sutured or glued?
Two different techniques are used:
- Wound gluing: The edges of the wound are brought together and sealed with a type of “super glue.”
- Eversion suture: The eversion suture is a suture technique that offers a larger contact area and better blood circulation and thus stability than a standard suture. In addition, the direction of hair growth is directed away from the wound.
Step 7: Could there be bleeding or post-operative bleeding?
A clear overview during the procedure is crucial for precision and protection of the surrounding tissue. That is why we place great importance on careful and controlled hemostasis.
We use additives such as adrenaline and tranexamic acid, which reduce the tendency to bleed, even during local anesthesia. During the procedure, we use modern bipolar coagulation and, if necessary, laser coagulation to ensure very targeted and gentle hemostasis.
In order to reliably prevent post-operative bleeding, we insert a special absorbable fleece into the wound cavity. This so-called hemostatic agent supports natural coagulation, offers additional protection against post-operative bleeding, and promotes wound healing. The material dissolves completely on its own over time. Hemostatic agents are usually made of collagen or gelatin of animal origin. If you have any concerns, for example for ethical or religious reasons, please let us know in advance—cellulose-based medical devices can be a plant-based, vegan alternative.
The wound is protected externally with a thick, absorbent dressing. Especially in the first few days, the wound may secrete increased amounts of fluid; the dressing reliably absorbs this and protects your clothing.
Step 8: After the operation
After the procedure, we ask you to sit in our reception area for about 15 minutes. You can relax with a pretzel and a bottle of water. Sitting also provides gentle, desirable compression in the area where the operation was performed.
If necessary, you can take an ibuprofen tablet as a precaution so that the pain-relieving effect begins as soon as the local anesthetic wears off.
Finally, there will be a brief medical check-up. If everything is normal, you can then leave the practice.
You can generally stand up independently and move around normally. There is no reason why you cannot walk to your car, the subway, or the train station, or go out for something to eat.
However, we recommend that you take it easy on the day of treatment. You should avoid long city tours, extended shopping trips, or strenuous physical activity in order not to unnecessarily increase the risk of post-operative bleeding.
Step 9: On your way home
A quiet journey home and a relaxed end to the day are the best conditions for uncomplicated healing.
The local anesthetic usually lasts for several hours after the procedure. You can therefore sit in the car or train without feeling any pain; light pressure on the wound is even desirable and reduces the already low risk of post-operative bleeding.
However, we advise against driving a motor vehicle yourself. After a procedure, you are often not yet fully focused on the road, and slight circulatory reactions can also impair your ability to drive.
Normal everyday movements are permitted. However, we ask you to refrain from long walks, sporting activities, or strenuous physical activity on the day of the operation.
If bleeding does occur, apply several compresses or absorbent cellulose material to the wound and apply even pressure for about 15 minutes. It may also be helpful to sit carefully on the wound and wait. Postoperative bleeding is usually not dangerous. If you are unsure, please contact our practice or the emergency number below.
The first week after surgery
You can remove the large bandage applied after the operation yourself. Afterwards, it is possible and advisable to shower with normal tap water at a comfortable temperature. Although an aseptic procedure is generally recommended for wound care, sterility cannot be achieved in the area of the buttock crease. Washing or showering, possibly using a bacteria filter, has been proven to reduce the bacterial load in this highly contaminated area of the body by 99% and therefore represents a sensible cleaning method with a very low empirical risk of wound infection (Federal Center for Health Education). Extreme spreading of the buttocks to examine the wound should be avoided in the first 2 days.
Everyday activities are permitted as far as possible; working from home for a few hours would be possible, but a long day at the office or a business trip would not yet be advisable. Exercise is permitted as soon as the wound pain allows.
We recommend wearing close-fitting underwear with a standard panty liner. This type of wound care is more comfortable than an adhesive bandage. The wound secretes bloody discharge. The wound pain is more severe on the second day than on the first and subsides over the course of the week. Treatment with ibuprofen as needed is almost always sufficient.
We will issue a certificate of incapacity for work if required, usually for 1-2 weeks depending on the requirements of your job.
The hemostatic agent or tamponade dissolves. Depending on the material used, Tabotamp® appears brownish and mushy, while Lyostypt® looks like white foam. Mild irritation and swelling are normal during this phase.
Fibrin, a natural “wound adhesive” made from blood components, forms yellowish coatings resembling pus, but this is nothing to worry about.
Ointments or powders are not normally necessary. If wound healing is delayed, we prescribe ointments containing metronidazole, mupirocin, or iodine (Betaisodona®), which you apply to the wound twice a day.
Once a week, it is essential to shave the edges of the wound with a disposable razor and examine the wound for any ingrown hairs. This can be done by us, relatives, or your family doctor. The wound is examined in good light and with good visibility (possibly using a magnifying glass or reading glasses), and any hairs are removed with tweezers. After the wound has closed, shaving should be continued for another 2 months.
We have various options for promoting wound healing:
- Low-level laser therapy (“LLLT, soft laser”) once or twice a week stimulates the body’s self-healing powers through cellular activation.
- Treatment with cold plasma (CAP) provides highly effective disinfection while improving microcirculation.
- Laser treatment for hair removal is performed every 4-6 weeks and is a preventive measure against relapses (recurrences). If necessary, the treatment can be performed painlessly under local anesthesia. However, due to the wavelength mix and integrated cooling of modern lasers, this is usually no longer necessary.
Any questions? FAQ Pilonidal sinus Pit picking surgery
How can you tell if you have a fistula on your tailbone (pilonidal sinus)?
Typical symptoms include pain, swelling, small openings, and discharge of blood or pus in the area of the buttock crease.
Which appointment should I choose—all-in-one or special consultation?
If the diagnosis is clear, i.e., usually confirmed by a medical examination, you can generally choose the appointment with the treatment option. This is particularly advantageous if you live further away from Munich.
Do I really have to send photographic documentation?
Sending a photo of the affected area in advance has many advantages: The image documentation usually allows the diagnosis to be confirmed and a possible treatment and follow-up plan to be outlined. You save yourself a long journey if a different differential diagnosis is made or if it is obvious that (in exceptional cases) outpatient surgery under local anesthesia is not possible.
My doctor did not take any photographs. What should I do?
You don’t need professional documentation—a selfie taken with your cell phone is sufficient. Here are some tips for taking useful photos.
I am in severe pain and there are no appointments available at short notice in the online appointment calendar?
Then raise the alarm—using the emergency button or by sending a short email to [email protected].