Pilonidal sinus (Coccyx Fistula)


The Pilonidalsinus (Pilus=Hair, Nidus=Nest) is an inflammatory illness situated under the coccyx skin. Altering forces of pressure and tension have an effect on the hair root (follicula) located at the cenral edge of the coccyx bone. This leads to inflammation and skin holes (pits). The inflammation can extend and form tracts as well as bags under the skin. Sometimes abscesses could develop. Hair do not exist necessarily. Secondary collection is possible if hairs pushed forward under the skin by movements of the buttocks. 




- Overweight

- Vast hairs

- Shape of the folliculas

- Construction and shape of the coccyx skin

- Skin effecting activities (Seated occupations, drivers, riders)

- Excessive sweating

- Lack of  hygiene


The illness can run absolutely unnoticed and free of pain. Inflammation of tissue can lead to swelling, redness and abscess, which is very painful. In rare cases malignant change of tissue could be possible.




The healing of the pilonidal sinus is only possible by removing of the infected hair folliculas. There are different operation methods which were developed as open, closed or flap techniques. In case of an abscess only the pus is emptied. If necessary a second operation can be carried out later.

As an alternative to the operation phenol and silver nitrate treatment is performed, which was introduced already decades ago. We do not applicate this method because of low results and high toxicity.

In our clinic an abscess is drained and cleaned via a lateral cut. The small remaining wound stays open and heals by itself. The discomfort after the intervention is minimum and the everyday life is not impaired.

At the operation of a pilonidal sinus, the skin will be opened  in an elliptic shape. The pilonidal sinus is then cleaned completely by the diod laser and skin is closed laterally after shifting (modified Karydakis flap or Cleft lift). This elegant method shows high success and low recurrence rates. Employability is possible after one week.

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