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[av_heading tag='h1′ padding='10' heading='Pit-picking: Treatment of coccygeal fistula' colour='custom-color-heading' style='blockquote modern-quote' custom_font='#008dcf' size=" subheading_active='subheading_below' subheading_size='20' custom_class=" admin_preview_bg=" av-desktop-hide=" av-medium-hide=" av-small-hide=" av-mini-hide=" av-medium-font-size-title=" av-small-font-size-title=" av-mini-font-size-title=" av-medium-font-size=" av-small-font-size=" av-mini-font-size="]
Effectively remove hair follicles and fistulas
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Removal of hair follicles is increasingly common method to treat coccygeal fistulas. Pit picking was first described by London surgeon Peter Lord in 1965. In the USA, John Bascom was eventually able to achieve very good healing rates with this procedure. The principles formulated by these two doctors are still valid today:
- All enlarged hair roots filled with ingrown hair must be removed.
- Larger cuts in the midline area must be avoided as wounds in this area will heal poorly.
- Every fistula will heal if it's not stopped by something. These are always hairs that are either ingrown from the side or skewered, loose hairs
- The attempt to close a surgical wound in the midline by suture will in most cases not lead to success.
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Pit-Picking: How it is done
The enlarged hair roots (pits), which look like small black dots or small holes, are cut out only a few millimetres in size. Hair and the so-called granulation tissue (it weeps, is reddish and soft) are removed. The capsule of the fistula, which is often perceived by the patient as a hardened strand, is not removed in this variant of the operation.
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The advantages and disadvantages of pit picking
The advantages of this method of treatment, which is frequently performed in Germany and listed in the medical guidelines for the treatment of coccyx fistulas, are as follows:
- Short treatment duration (15 minutes)
- Can easily be performed on an outpatient basis with local anaesthesia
- Little pain after the operation
- Healing usually in less than four weeks
- Primary success rate 70-80 percent
The disadvantages of this method are:
- In up to 30 percent of the cases, a coccyx fistula is formed again.
- The hardened fistula duct is still noticeable
For which patients can pit-picking be used?
Pit picking is possible for practically all patients who have not yet undergone any major pre-operation. Even if the coccyx fistula recurs after surgery, the cause is enlarged hair roots that have been overlooked or newly formed and can be removed with pit-picking. In our proctological practice, we additionally use laser treatment or fistulectomy in complicated situations and if several previous operations have been unsuccessful.
Coccyx fistula treatment with laser
Laser treatment with FilaC (Fistula Laser Closure) is a supplement to pit picking. For this purpose, a fibre-optic probe is inserted into the fistula duct, which transfers laser energy to the inner layer of the fistula. The deserted tissue can then be scraped out.
The advantage of this method is a better removal of fistula tissue and hair. In this way, success rates can be increased to over 80 percent.
Only a few surgeons have the necessary equipment, because the equipment and laser probes are expensive and have to be maintained regularly. Two of these lasers are available to us in the Proctological Practice in Munich.
If you have any questions about pit picking and laser treatment, please do not hesitate to call our practice. We are happy to be there for you.
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