Hofer - Liebl - Specialists in Visceral Surgery and Proctology

Surgery of the pilonidal sinus

This page got a bit messed up during the relaunch of the website. We are working on it. In the meantime, you can also visit our page specifically set up for the diagnosis of coccygeal fistula.

The way to remove your coccygeal fistula

Pilonidal sinus: From diagnosis to completion of wound healing.

Do you suffer from a coccygeal fistula (pilonidal sinus) and would like to be treated? Then you have come to the right place. Dr. Hofer's proctology practice in Munich specializes in the removal of coccygeal fistulas. Patients from all over Europe come to us to place themselves in our experienced hands. Since the practice was founded in 2013, we have successfully performed over 2000 procedures. We have further developed the pit picking technique and are some of the few specialists in this field working with the new method. This allows us to achieve a 90 percent recovery rate for our patients and minimize their inability to work or play sports. The Karydakis and cleft lift technique can also be used to treat complex fistulas, recurrences (relapses) and non-healing wounds.

For these inquiries it is best to use the contact form. We will then answer your questions by mail and send you a questionnaire to be filled out online. This way, the essential information reaches us in a structured and complete way.

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Establishing contact and making appointments

You can contact us by telephone or e-mail or make an online appointment (only examination appointments, surgery appointments please only by telephone). Normally an examination (clinical examination and ultrasound) takes place first, then we discuss the treatment plan with you and make an appointment for the operation. If you wish, you can send us findings of other doctors or a photo of the region by e-mail (info@darmsprechstunde.de).

Pilonidal sinus treatment: Outpatient or inpatient surgery?

The vast majority of patients can be operated on very well and painlessly under local anaesthesia on an outpatient basis in the surgery room. For this operation the patient lies on his stomach, the average duration of the operation is 30-60 minutes. The anaesthetic is injected to the left and right of the gluteal fold, the drug may burn a little for a short time, after a few seconds the effect starts and the removal of the coccyx fistula can take place painlessly.

If you do not dare to lie down or if the treatment under local anaesthesia means too much stress for you, there is the possibility of an operation under general anaesthesia in the outpatient operation centre of the IATROS clinic or in the affiliated clinic of the Diakonie Maxvorstadt. In this respect, we can act according to your wishes.

I have severe pain from my coccyx fistula.

The best thing to do is to call directly, if there are any difficulties with the accessibility by telephone, dial the direct doctor's extension 089 21546201. An acute abscess is practically always the cause of severe pain. In this case, the first step is to open the abscess through a small cut.

I have a long way to go to Munich

Some of our patients do not come from the greater Munich area. In order to spare these patients the need for repeated travel, pit picking can be carried out in the practice after the examination if desired. Please let us know when you make an appointment if you would like us to make such an appointment. In order to comply with the Patient Rights Act, it is necessary in this case that you have already been advised on this subject by another doctor and/or have obtained information about various treatment options from other, freely accessible sources. After all, you should only decide to undergo surgery if you are well informed.

What happens on the day of treatment?

The procedure is performed under local anesthesia, which is only effective in the surgical area and does not lead to fatigue or drowsiness. Normally no impairment of physical performance is to be expected.

An accompanying person is therefore particularly important if you are prone to circulatory reactions (e.g. syringes or blood samples). Since such reactions are not always predictable, you are always on the safe side with an accompanying person.

When driving a car, you may not be fully concentrated even before the operation and we generally advise not to travel alone.

What preparations are necessary?

For a small procedure such as a pilonid sinus treatment under local anaesthesia, a laboratory examination and an ECG are normally not absolutely necessary. Only if there are known intolerances, allergies or a special bleeding tendency do we ask for findings and statements from your pre-treating physicians. You don't have to be sober, get well sated for surgery. If possible, have the region around the fistula shaved extensively, this will facilitate the operation and laser treatment and dressings will adhere better.

Investigation and clarification

During the examination, the region of the gluteal fold is first inspected with the naked eye and magnifying glasses, then the soft tissues are examined with ultrasound. Special examinations such as MRT are rarely necessary. If you have any findings or such images available, please bring them with you. We will then explain the treatment strategy that we would recommend. Please feel free to ask any questions you may have. We will be happy to answer your questions comprehensively so that you can start the treatment with a good feeling.

Treatment of the coccyx fistula: surgical procedure

The procedure is performed in the prone position. As a first step, a local anaesthetic is injected, we always use a combination with adrenaline. This causes the blood vessels to contract and the likelihood of bleeding is reduced, but any bleeding that occurs is stopped with lasers or high-frequency energy. The syringe is unpleasant for a few seconds, then the remedy begins to take effect. Two punctures are necessary on the left and right side.

To remove the fistula, we use the openings that already exist. They are cut out sparingly with a radio frequency needle or a so-called biopsy punch. Then the fixed gait can be examined more closely with a probe. Hair and inflammatory tissue are scraped out. If it is possible without a significant extension of the procedure, we also remove the fistula tube consisting of connective tissue. In the case of long or very fine fistulae, the laser treatment can be connected with the fibre-optic probe.

At the end of coccyx fistula surgery.

At the end of the operation, hemostasis is achieved by welding all small bleedings with a bipolar forceps or the diode laser. The tamponade with a haemostatic agent provides additional safety. This material stimulates blood clotting and dissolves within a few days with the secretion of a brownish liquid - so it does not have to be removed. The operation is finished with a thick bandage, which can also absorb normal, bloody secretions on the first and second day. Then you can get dressed, get something to drink and a painkiller (ibuprofen) and rest in the waiting room for about half an hour. The final check of the dressing for blood dryness as well as the assessment of the general condition and discharge are then carried out. Let us know if you need a school or university certificate or a certificate of incapacity for work.

After the surgery of a coccyx fistula

On the day of the operation itself, you should take as much care as possible, as physical activity favours post-operative bleeding, especially after the adrenaline has subsided. If post-operative bleeding occurs, it can usually be stopped by simple compression for several minutes, for example with compresses. It can also help to just put something on the wound. There are no large blood vessels in the surgical area that could lead to dangerous secondary bleeding.

The day after a sinus pilonidalis operation you can remove the bandage, shower normally and then use only a small patch or panty liner for the rest of the procedure. You can get these at any drugstore. Physical activity, including sports, showers and bathing are also permitted.

After-treatment of the coccyx fistula

Permanent hair removal with our diode laser improves the long-term chances of healing and can help with non-healing wounds after conventional radical surgery.

We are convinced that practically every healing disorder is based on the renewed penetration of hair into the wound. These hairs can grow from the immediate surroundings into the small openings, or fall as loose hair from the head or back into the gluteal fold and be massaged in by the movements while walking and sitting. We therefore recommend that you shave the area around the wound at least once a week until the wound has healed and for a few weeks beyond, and that you check the wound for penetrated hair with a good light and, if necessary, with a magnifying glass. This can be done without further ado by a relative or also by the family doctor. Many doctors advise against shaving and refer to a study from 2009. In our opinion, the study has significant methodological shortcomings and we definitely recommend shaving.

In our opinion, special dressing techniques or elaborate materials are not necessary. Also the use of disinfectants and ointments is limited, the normal showering with tap water is sufficient for cleaning and leads to a good germ reduction. Complete sterility will hardly be achieved in this region anyway due to the proximity to the intestine and the tightness of the gluteal fold.

There are indications that treatment with low-energy laser beams leads to faster and better wound healing; we offer this as an IGeL service. The probability of a renewed fistula formation can be reduced by hair reduction with the epilation laser. Please feel free to ask us about our offers in this area.

Contact us at any time and ask us your questions about coccyx fistula treatment. We will be happy to advise you on our offers.