This page has not been updated for a while. Please visit our new page especially designed for the diagnosis of coccygeal fistula. The manifestations and classification of coccygeal fistula are clearly presented here with example images, sonographic findings and differentiated surgical recommendations.
A coccyx fistula (sinus pilonidalis) can occur in various forms. The appropriate treatment depends on the respective species. For every operation you first need a good plan. This requires careful investigation. To do this, we take a close look at the problem: under magnification with magnifying glasses, it is best to see all the details of a pilonidal sinus. We use ultrasound to look under the surface and thus avoid unpleasant surprises during the operation. We have an individual concept for every situation. The following classification explains how we free you from your coccyx fistula in various starting situations.
There are less than four pits and the fistula duct is less than two centimetres short. Such a coccyx fistula can be removed through a single small opening. The operation is precise and gentle with the RF scalpel. Although this simplest form of coccyx fistula is easy to treat, follow-up examinations should not be neglected.
In this form there are less than four pits - the fistula duct is longer than two centimetres. In this case, it can usually be completely removed via two small accesses at the starting point and end point of the fistula. Also in this case the impairment of the patient is small and a healing is to be expected in over 90 percent of the cases.
Type IIa shows more than four pits and the fistula tract exceeds a length of two centimetres. In this case, too, we aim to peel out the fistula duct as a complete tube. Sometimes, however, it can be more gentle to remove only hair roots, loose hair and fistula tissue and treat the duct with the laser.
There are more than four pits and the fistula duct is also longer than two centimetres in this form. A blindly ending, sack-shaped dilatation of the fistula duct is often the cause of pain radiating to the back, so that patients often consult an orthopaedist because of back pain. The coccyx fistula type II b can be treated with pit picking and laser is less invasive. A fistulectomy offers slightly higher healing rates, but usually requires an additional incision at the end of the fistula.
In these patients, the fistula developed secondary as a result of congenital, funnel-shaped retraction of the skin in the gluteal fold. Such a skin change can be found in many people, most of whom have no impairments. Hair that is bundled by constant rubbing in the gluteal fold can eventually lead to an opening at the lowest point of the funnel and to hair ingrowth. This leads to the formation of a fistula cave. With this form we cut the funnel very sparingly and release the fistula capsule. Shaving the surrounding skin or treating it with laser epilation is particularly important here.
This type of fistula can be seen after conventional pre-operation. Both hair that grows in from below and loose hair that has reached the wound during wound healing are the cause of a new fistula tube. It is not uncommon for a visible opening of the fistula to extend far into the seemingly healthy scar area. In addition to intensive laser epilation, the method of choice is to clean t