A pilonidal cystectomy is a specialized surgical procedure that involves removing an abnormal pocket (cyst or sinus) containing hair and debris that develops in the cleft between the buttocks, near the tailbone. At our practice, we understand that pilonidal disease can cause significant physical discomfort and embarrassment. That's why we're committed to providing compassionate, expert care while helping you understand each step on your path of recovery.
This targeted procedure effectively treats pilonidal disease that has become chronic, causes recurrent infections or abscesses, significantly impacts quality of life, or fails to respond to more conservative measures. Our pilonidal cystectomy approach utilizes several advanced techniques tailored to your specific condition, ranging from simple excision to more complex flap procedures for extensive or recurrent disease. We employ careful surgical planning to remove all affected tissue while creating the optimal wound configuration for your specific anatomy, resulting in effective elimination of the pilonidal disease while minimizing recovery time and recurrence risk through the most appropriate surgical approach for your individual case.
You may need a pilonidal cystectomy if you experience:
Recurrent pilonidal abscesses requiring multiple drainage procedures
Chronic pain or discomfort in the tailbone area
Persistent drainage or discharge from openings in the gluteal cleft
Visible pits or holes in the midline of the upper buttocks region
History of multiple pilonidal infections despite conservative treatment
Significant time lost from work or school due to pilonidal symptoms
Inability to participate comfortably in regular activities
Visible swelling or mass at the base of the spine
Foul odor from the tailbone region
Hair visible in sinus openings or drainage
Bleeding from pilonidal sinus tracts
Extensive or complex pilonidal disease with multiple tracts
Formation of secondary tracts extending from the primary pilonidal area
Significant impact on quality of life from ongoing symptoms
Previous failed or inadequate treatment for pilonidal disease
At Lifetime Surgical, our approach to pilonidal cystectomy combines precision with personalized care. The procedure begins with a comprehensive evaluation of your specific pilonidal disease, including the extent, complexity, chronicity, and any previous treatments. What characterizes us is our expertise in multiple surgical techniques, allowing us to select the optimal approach based on your condition:
Simple Excision and Open Healing: For limited disease, we may perform a straightforward excision of the cyst and sinus tracts, leaving the wound open to heal gradually from the bottom up (secondary intention). While requiring longer healing time and frequent wound care, this approach offers low recurrence rates for appropriate candidates and avoids the tension that can complicate closed techniques.
Excision with Primary Closure: For select patients with minimal disease, we may remove the affected tissue and close the wound immediately. We employ specialized tension-reducing techniques, off-midline closure methods, and strategic suture placement to minimize complications. This approach offers faster initial healing but requires careful patient selection to avoid higher recurrence rates.
Cleft Lift Procedure (Bascom Technique): For more complex or recurrent disease, we specialize in this advanced approach that not only removes the affected tissue but also flattens the gluteal cleft through tissue rearrangement, eliminating the deep, moist environment where pilonidal disease develops. This sophisticated technique creates a shallower gluteal cleft with the incision positioned away from the midline, dramatically reducing recurrence rates.
Karydakis Flap and Rhomboid Flap Procedures: For extensive disease or recurrent cases, we perform these specialized tissue rearrangement techniques that remove all diseased tissue while bringing healthy, hair-free tissue into the affected area and repositioning the incision away from the midline. These approaches are particularly valuable for complex or extensive cases requiring more sophisticated reconstruction.
Throughout your care journey, we emphasize precise removal of all affected tissue, strategic wound management, and comprehensive education about post-operative care and recurrence prevention. Our multidisciplinary approach includes specialized wound care nurses and, when appropriate, plastic surgery consultation to ensure optimal healing and aesthetic outcomes. This comprehensive strategy addresses not only the immediate pilonidal disease but also the anatomical factors that contribute to its development, providing the best opportunity for permanent resolution.
Immediate Post-Procedure (1-7 days)
For Open Technique:
Return home the same day in most cases
Begin wound packing changes as instructed, typically starting 24-48 hours after surgery
Receive detailed instructions on proper wound care technique
Experience moderate pain managed with prescribed medications
Begin sitz baths or gentle showering as directed by your surgeon
Keep the wound clean and follow specific cleaning instructions
Avoid sitting directly on the surgical site
Use a donut cushion or pillow when sitting is necessary
Expect significant drainage from the wound during the initial healing
For Closed Technique or Flap Procedures:
Experience more initial comfort than with open techniques
Keep the surgical site clean and dry as directed
Monitor for any separation of the wound edges
Avoid direct pressure on the surgical site
Take antibiotics if prescribed to prevent infection
Attend your first follow-up appointment for wound check and possible drain removal
Restrict movement that creates tension on the wound
Use pain medication as prescribed, typically requiring less than with open technique
Watch for signs of infection or fluid collection
Short-Term Recovery (1-4 weeks)
For Open Technique:
Attend regular follow-up appointments for wound assessment
Continue wound packing with gradually decreasing frequency as the wound fills in
Expect 4-8 weeks for complete wound closure depending on wound size
Return to work based on your surgeon's recommendation and job requirements:
Sedentary jobs: often possible within 1-2 weeks
Physical jobs: may require 3-4 weeks or longer
Begin gentle walking but avoid strenuous exercise
Monitor for proper wound healing from the bottom up
Continue sitz baths or gentle showering for wound cleansing
Maintain proper hair removal from the area as directed
For Closed Technique or Flap Procedures:
Attend follow-up appointments for suture removal and wound assessment
Monitor the incision for proper healing without separation
Return to work typically within 2-3 weeks depending on job requirements
Begin more normal activities as comfort allows
Continue to avoid prolonged sitting or activities that create wound tension
Follow specific instructions regarding showering and wound care
Watch for any signs of infection or wound breakdown
Protect the incision from excessive moisture or contamination
Long-Term Recovery (1-3 months)
For Open Technique:
Experience gradual filling in of the wound cavity
Notice decreased wound size and drainage
Continue wound care until complete closure
Resume more normal activities as healing progresses
Begin more vigorous exercise once the wound has substantially healed
Monitor for any signs of recurrent disease
Establish ongoing hair removal regimen to prevent recurrence
Observe complete wound closure typically within 2-3 months
For Closed Technique or Flap Procedures:
Experience continued strengthening of the healed incision
Resume normal activities including exercise by 4-6 weeks
Monitor for any signs of late wound issues or recurrence
Maintain proper hygiene and hair control in the area
Notice gradual fading of surgical scars
Observe improved contour of the gluteal cleft with specialized flap procedures
Follow recommendations for preventing recurrence
Long-Term Expectations
For All Techniques:
Complete wound healing with varying degrees of scarring based on the technique used
Recurrence rates vary by procedure:
Open technique: 5-15% recurrence
Simple closure: 10-30% recurrence
Cleft lift and flap procedures: <5% recurrence
Implement recommended preventive measures:
Regular hair removal in the area (laser hair removal may be beneficial)
Maintenance of good hygiene
Avoidance of prolonged sitting when possible
Prompt attention to any early signs of recurrence
Most patients report high satisfaction and improved quality of life
Return to all normal activities including sports and exercise
Minimal long-term lifestyle restrictions
Annual examination during the first few years to monitor for recurrence
For most patients, successful surgery provides permanent resolution
Some patients may notice changes in sensation around the surgical site
Cosmetic appearance varies by technique, with flap procedures often providing the best aesthetic results
Common Side Effects
For Open Technique:
Discomfort during dressing changes
Prolonged healing time (typically 4-8 weeks)
Drainage from the wound during healing
Temporary lifestyle limitations during healing
Discomfort when sitting
Need for regular wound care
Visible scarring after healing
For Closed Technique or Flap Procedures:
Tension or tightness around the surgical site
Seroma formation (fluid collection)
Minor wound separation
Suture discomfort until removal
Temporary numbness around the incision
Visible scarring, though often less than with open technique
Mild swelling during the initial recovery
Less Common Complications
Wound infection requiring antibiotics or reoperation
Complete wound dehiscence (separation) requiring conversion to open healing
Persistent pain at the surgical site
Delayed healing beyond expected timeframes
Recurrence of pilonidal disease
Excessive scarring or keloid formation
Persistent drainage or sinus formation
Inadequate removal of all diseased tissue
Numbness or altered sensation around the surgical site
Need for additional procedures or revision surgery
Chronic non-healing wound
Wound contamination
Poor cosmetic outcome
Rare complications related to anesthesia
When to Seek Immediate Medical Attention
Fever over 101°F (38.3°C)
Excessive bleeding from the wound
Severe, increasing pain not controlled by prescribed medications
Significant redness, warmth, or swelling extending beyond the surgical site
Purulent (pus-like) or foul-smelling discharge
Significant wound separation in closed techniques
Inability to perform proper wound care
Signs of systemic infection including chills or confusion
Significant increase in drainage or change in drainage characteristics
New areas of draining sinuses away from the main surgical site
Complete wound dehiscence in closed techniques
Severe restriction in movement due to pain
Development of new pain in a different location
Significant wound bleeding that doesn't stop with gentle pressure
From your first consultation through your complete recovery, we provide:
Thorough evaluation and explanation of your condition
Clear discussion of all treatment options, including non-surgical alternatives when appropriate
Detailed pre-operative instructions to help you prepare
Compassionate care during your hospital stay or outpatient procedure
Comprehensive follow-up care and support during recovery
Ongoing availability to address questions or concerns
We understand that facing head and neck surgery can be intimidating, but you don't have to navigate this journey alone. Our team is committed to providing expert care with a personal touch, ensuring you feel supported, informed, and confident every step of the way.
Your health and wellbeing are our highest priorities, and we're honored to be part of your care team.
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All our laparoscopic procedures are performed by our highly trained surgical team using state-of-the-art equipment and techniques.
We're committed to providing you with the most advanced, minimally invasive options because we believe you deserve:
Less pain after surgery
Shorter hospital stays
Faster return to work and activities you enjoy
Smaller, less visible scars
Lower risk of complications
Better overall outcomes
Dr. Richard Nguyen is a board-certified General Surgeon with over 20 years of surgical expertise and fellowship training in Minimally Invasive and Bariatric Surgery from Vanderbilt University. Since establishing his practice in San Jose in 2007, he has pioneered innovative surgical techniques, including single-incision laparoscopic procedures and mastery of the da Vinci Robotic Surgical System. Beyond his acclaimed bariatric surgery practice, he has earned national recognition for his specialized expertise in both non-mesh and advanced mesh hernia repairs, while also serving as a critical approach surgeon for anterior spine access procedures. Dr. Nguyen combines technical precision with personalized care across multiple premier facilities throughout the South Bay Area.
I would refer Doctor Nguyen to anyone, in fact I have and they have all had the same experience as me. He is truly great. I owe all my success to Doctor Nguyen and I thank him for all the work he has done for me and continues to do so. He is extremely amazing, and I am very grateful to him.
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At 50, I now have a life I had only dreamed of a year before. My body tells me if I am done eating. This surgery is a tool that I have used to the fullest. It is not an easy way out. It still took work. But I honestly know that I would not be living this amazing new life if I didn’t step forward to embrace this life-saving surgery.
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Dr. Nguyen has changed my life completely. I feel so much better and I also feel like I’ve got control of my life again…I had high blood pressure, diabetes and cholesterol. I took at least 5 different medications for the past 30 years. NOW, after surgery I take no medications only vitamins!
Wondering which surgical procedure might be right for your condition? We're here to help you understand your treatment options and develop a personalized surgical plan. Contact our office today to schedule a consultation.
Your path to improved health may be more achievable than you think—with advanced surgical techniques leading to faster recovery, reduced complications, and a significantly enhanced quality of life.