Part of the TeachMe Series

Consent: Pilonidal Sinus Repair

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Original Author(s): Ollie Jones
Last updated: February 14, 2019
Revisions: 5

Original Author(s): Ollie Jones
Last updated: February 14, 2019
Revisions: 5

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This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.

Overview of Procedure

Pilonidal sinuses often present acutely infected and therefore require incision and drainage. However, in patients with recurrent symptoms, elective wide excision or excision and primary closure may be undertaken to reduce recurrence. Overall it is a low-risk procedure.

Many different techniques have been described; all have relatively similar peri-operative risks and, unfortunately, similarly high risks of wound breakdown and recurrence.

Complications

Intra-Operative

Complication Description of Complication Potential Ways to Reduce Risk
Haemorrhage Significant bleeding is a rare but documented occurence
Anaesthetic risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms a part of the anaesthetist assessment before the operation

Early

Complication Description of Complication Potential Ways to Reduce Risk
Pain The pain is likely to be minimal, the patient will likely only require simple analgesics only
Infection Superficial wound infection is possible.
Wound breakdown Delayed or non healing wound.  This is the most common complication (10 – 20%) as these wounds are notoriously difficult to heal.
Scarring Wide excision and healing by secondary intention will result in a significant scar.
Blood clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate.
Stroke, MI, Kidney Failure, Death Although small, this is always a risk in any surgery

Late

Complication Description of Complication Potential Ways to Reduce Risk
Recurrence Recurrence or incomplete excision of the sinus is common, reported in 25-30% of cases.