Pit picking, sinusectomy, laser surgery (SiLaC)

By definition, the pit-picking operation can only be performed if "pits", also called primary fistula or porus, are found, i.e. primarily in the case of a pilonidal fistula that has not yet been operated on. However, such a "pit" can also have been overlooked during the initial operation or have newly developed and thus cause a relapse (recurrence). And finally, the basic idea of pit-picking, the healing of the fistula by eliminating a port of entry, can also be implemented in the frequent type IV pilonidal fistulas.

In classic pit-picking as described by Lord and Bascom, the fistula tube is not removed, but only cleaned of the trapped hairs. By removing this inflammatory stimulus, the tissue may normalise to a certain extent in the course of the procedure, but the hardening does not usually disappear completely. This is another reason why we combine pit-picking with sinusectomy, i.e. peeling out the fistula tract under the skin.

In principle, this risk can indeed not be completely ruled out if no histological examination can be carried out. Malignant coccygeal fistulas are fortunately extremely rare and usually conspicuous by other findings.

This procedure is currently offered exclusively by specialised specialists, predominantly from the field of general and visceral surgery, but also dermatology. When choosing a doctor, the question should also be allowed as to how often the colleague performs such minimally invasive procedures.

The classic pit picking operation can always be performed under local anaesthesia. General anaesthesia would only be preferred in exceptional cases with very young or particularly anxious patients.

Yes, you do not need to stay in hospital for this operation.

Yes, with our pit picking technique, the fistula is surgically removed via the small openings. This "excision" of a Pilonidal Sinus belongs to the services of the statutory health insurance in Germany.

Private patients and self-payers should expect to pay between 700 and 1200 € for outpatient treatment under local anesthesia. The costs depend on the complexity of the fistula and the time required. For an overview of reimbursement, please see our Treatment Costs page.

Yes, if the surgeon has experience with local anaesthesia and takes some time, there is no pain during the operation. We use the so-called tumescent anaesthesia, which can also be used to reliably anaesthetise large surgical areas.

The "picking of the pits" (sparingly cutting out the enlarged hair roots) and cleaning of the fistula tract sometimes takes only 10-15 minutes. If the fistula tract is also to be treated with laser (SiLaC) or removed (sinusectomy), surgery times of between 30 and 60 minutes can be expected.

 Yes, you may assume any position that is comfortable for you. Especially directly after the operation, this is even helpful, as gentle compression has a preventive effect against post-operative bleeding.

Serious complications are not to be expected. Postoperative bleeding is possible on the day of surgery, but very rarely requires medical hemostasis. Wound healing disorders, wound infections and the recurrence of a fistula after healing (recurrence) affect about 10 % of patients (with pit picking and sinusectomy) to 30 % (with pit picking alone).

After pit picking and sinusectomy, all activities are generally permitted from the day following the operation. Healing is not impaired by sport or occupation. 

Mild to moderate pain while sitting in the office or car can justify an inability to work, rarely longer than 2 weeks.

The time it takes for all wounds to heal naturally depends very much on the initial findings. On average, you should expect 6 weeks. If the wounds have not healed after 8 weeks, a check-up with us is recommended.

Externally, all wounds should be closed, and the color of the scars should no longer be purple but skin-colored to white. Slight hardening in the former course of the fistula is normal, more severe swelling is suspicious of a problem. Significant pain should no longer be present. The best assessment allows an ultrasound examination.

Yes, physical activity has no negative influence on wound healing.

There are many opinions on the subject of bathing and showering. The official guidelines of the Robert Koch Institute would advise against it and recommend the use of a bacteria filter (e.g. Germlyser® D) when showering. However, we have never seen any negative consequences when our patients shower with water of drinking quality or go swimming in the sea, lake or swimming pool (Europe).

The most common problem after all operations at Pilonidal Sinus is the penetration of hair into the wound. Care should therefore be taken to shave the area around the wound. Loose, broken hairs from the head should also always be removed immediately. For long-term prognosis, laser epilation offers advantages. 

It has proved useful to place a dressing of folded or rolled 10 x 10 ES compresses in the fold of the buttocks and to fix it with a tape strip, for example Fixomull®. For smaller wounds, a ready-made plaster or a commercially available panty liner that absorbs the wound secretion is sometimes sufficient. Elaborate dressing material (silver, alginate, hydrocolloid) is only occasionally useful if there are problems during the healing process.

If the course is normal, this is not absolutely necessary. You can find an overview of ointments and antiseptics on our page on conservative treatment.