Pilonidal sinus surgery

An operation to treat a pilonidal sinus — a small tunnel containing hair and debris in the cleft at the top of the buttocks — by draining infection or removing the sinus, sometimes closing the wound to one side to reduce the chance it comes back.

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

A pilonidal sinus is a hair-containing tunnel in the cleft of the buttocks that can become repeatedly infected.
Operations differ mainly in whether the wound is left open to heal slowly or closed (often off the midline) to heal faster — each has trade-offs.
Wound healing here can be slow, and the sinus can come back, so aftercare and keeping the area clean and hair-free matter a lot.
A non-infected sinus that is not causing problems often does not need surgery at all.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeSurgical procedure (usually day case)

AnaestheticUsually general anaesthetic; sometimes spinal or local

How long it takesAbout 30–60 minutes, depending on the technique

Hospital stayUsually day case

Time off workOften around 1–2 weeks; longer if the wound is left open to heal

When you'll see resultsOpen wounds can take weeks to a few months to heal; closed or flap wounds usually heal faster

On the NHS?Commonly treated on the NHS, especially when infected; private care is sometimes used for speed or choice

A general guide. Your surgeon will give you advice for your situation.

Best fit

Drains a painful pilonidal abscess and relieves infection

Pause if

A pilonidal sinus that is not causing symptoms often does not need surgery, just good hygiene and hair control.

Main recovery point

Expect soreness, especially when sitting. Take painkillers, keep dressings in place as advised, and avoid putting prolonged pressure on the area.

Good aftercare

Clear written instructions on wound care, dressings and washing.

First few days

Expect soreness, especially when sitting. Take painkillers, keep dressings in place as advised, and avoid putting...

First 1–2 weeks

Many people return to non-physical work within a week or two. Avoid heavy lifting and strenuous activity. Open...

Weeks to months

Open wounds heal gradually from the bottom up; this can take a couple of months. Closed and flap wounds usually...

Cycling, swimming and sport

Avoid cycling for around 6–8 weeks and swimming until the wound has fully healed, or as your surgeon advises.

Medical line illustration of lower rectum and anal canal treatment anatomy for Pilonidal sinus surgery. — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What is pilonidal sinus surgery?

A pilonidal sinus is a small hole or tunnel in the skin of the cleft between the buttocks, near the tailbone. Hairs and skin debris collect in it, and it can become infected, forming a painful abscess or discharging pus and blood. It is most common in younger adults, more often men, and in people who sit for long periods.

Surgery is used either to drain an acute infection or to remove the sinus so it stops causing trouble. There is more than one way to do this, and they differ mainly in how the wound is managed afterwards: some are left open to heal slowly from the bottom up, while others are closed with stitches — often off to one side of the midline — to heal faster and reduce the chance of the sinus coming back.

No operation guarantees a cure: pilonidal sinuses can recur, and wound healing in this area can be slow and frustrating. The choice of operation, careful aftercare and keeping the area clean and hair-free all affect how things go. A simple, non-infected sinus often needs no surgery at all.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Incision and drainage (for an abscess)

A small procedure to release pus from an infected pilonidal abscess, often under local or general anaesthetic. It relieves the acute infection but does not remove the sinus, so further treatment may be needed later.

Wide excision, left open to heal

The sinus and surrounding tissue are removed and the wound is left open to heal naturally from the bottom up. This has a low chance of the sinus returning but the wound takes longer to heal and needs regular dressing.

Excision with primary (midline) closure

The sinus is removed and the wound stitched closed in the midline. Healing is quicker, but a midline wound in this area has a higher chance of breaking down or the sinus coming back than an off-midline repair.

Karydakis flap

The sinus is removed and the wound closed off to one side of the midline, flattening the cleft. This off-midline approach tends to heal faster than a midline-open wound and has a low recurrence rate.

Bascom cleft lift

A technique that lifts and reshapes the skin to move the scar off the midline and reduce the deep cleft where hair gathers. It is often used for difficult or recurrent disease and aims for reliable healing and low recurrence.

Open healing versus off-midline closure

Approach	Healing time	Coming back
Excision left open	Weeks to a few months	Low, but wound care is demanding
Midline closure	Faster	Higher chance of breakdown or recurrence
Off-midline flap (Karydakis/Bascom)	Usually faster than open	Low recurrence in studies

There is a trade-off between how long the wound takes to heal and how likely the sinus is to come back. Off-midline techniques aim to get the best of both.

Preparing for your surgery

See a surgeon who examines the sinus and explains which technique they recommend and why.
Ask how long the wound is likely to take to heal and how much dressing or wound care will be needed.
If there is active infection, this may need draining or settling before definitive surgery.
Tell the team about all medicines, including blood thinners, and about diabetes or anything affecting healing.
Stop smoking if you can, as it slows wound healing in this area.
Arrange a lift home and time off; you may not be able to drive after a general anaesthetic.
Plan for managing dressings, sitting comfortably and keeping the area clean at home.

What happens

Most operations are done under general anaesthetic as a day case, with you lying face down. The surgeon either drains an abscess or removes the sinus and surrounding affected tissue.

The wound is then either left open to heal naturally, or closed with stitches — often off to one side of the midline to encourage healing and reduce recurrence. The choice is made with you beforehand based on the extent of the disease and whether it has come back before.

You wake up in recovery and, once comfortable, most people go home the same day with dressings in place and instructions on wound care, sitting and washing.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

A pilonidal sinus that is not causing symptoms often does not need surgery, just good hygiene and hair control.
Surgery may be deferred during active, spreading infection until it has been drained or settled.
People who smoke heavily or have poorly controlled diabetes heal less well; optimising these first improves results.
Closed or flap repairs may be less suitable where there is heavy contamination or extensive disease.

Delay surgery if…

There is an active abscess or spreading infection that should be drained or settled first.
Diabetes or another condition affecting healing is poorly controlled.
You are on blood thinners that need managing before surgery.
You cannot arrange the dressing care and time off that recovery needs.
You are still smoking and able to stop or cut down beforehand to aid healing.

Alternatives to discuss

Conservative management (hygiene and hair removal) for a sinus that is not causing problems.
Simple incision and drainage for an acute abscess, with definitive surgery only if it recurs.
Minimally invasive options (such as sinus laser treatment or pit-picking) in selected cases.
Laser hair removal to reduce recurrence, used with or instead of more major surgery.
Watchful waiting after a single episode that settles.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

General anaesthetic

Most common for excision and flap repairs.

Spinal anaesthetic

Numbs the lower body while you stay awake; used in selected patients.

Local anaesthetic

May be enough for simple drainage of an abscess or small procedures.

Benefits

Drains a painful pilonidal abscess and relieves infection
Removes the sinus so it stops discharging and getting infected
Off-midline techniques aim to heal reliably and reduce the chance of recurrence
Can end a cycle of repeated infections and time off
Allows the area to be kept clean and hair-free more easily once healed

Risks & complications

More common

Pain and discomfort, especially when sitting, for the first days to weeks
Slow wound healing — open wounds can take weeks to months
Discharge, oozing or bleeding from the wound while it heals
Regular dressing changes and disruption to sitting and activity

Less common

Wound infection
A stitched (especially midline) wound breaking down and needing to heal open
The sinus coming back, sometimes needing further surgery
Delayed healing needing extra clinic visits

Rare but serious

A wound that does not heal for a long time
Bleeding needing further treatment
Problems related to the anaesthetic
Very rarely, long-standing pilonidal disease can change in nature, so non-healing wounds should be reviewed

The two things that frustrate people most are slow wound healing and the sinus coming back. Midline-closed wounds heal faster but break down or recur more often than off-midline (flap) repairs; open wounds rarely recur but take longest to heal. Smoking, obesity and a deep, hairy cleft all worsen the odds. Ask your surgeon which technique they recommend for your situation and what the realistic healing time and recurrence chance are.

Published figures to discuss

Healing time and recurrence depend heavily on the technique and on patient factors such as smoking, weight, and how deep and hairy the cleft is. Studies use different definitions and follow-up lengths, so figures vary. The clearest pattern is that off-midline closures tend to heal faster than midline-open wounds and recur less than midline closures.

Figure	Reported range	How to interpret it	Source / confidence
Recurrence after off-midline flap (Karydakis/Bascom)	Low in the first 1–2 years in pooled studies	A large meta-analysis reported recurrence well under 1% at 12–24 months for these techniques; longer-term figures are less certain.	Bascom cleft lift versus excision with secondary healing — PMCpmc.ncbi.nlm.nih.govPublished figure
Recurrence after midline primary closure	Substantially higher over the long term	The same meta-analysis reported long-term midline recurrence rising to a large proportion of patients over many years.	Guide sourcesClinical context
Wound healing time	Faster after off-midline closure than after open or midline-suture wounds	A randomized trial reported a median healing time of about 2 weeks for a Karydakis flap versus about 7 weeks for midline suture.	Bascom cleft lift versus excision with secondary healing — PMCpmc.ncbi.nlm.nih.govSource-linked context

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery depends heavily on the technique. Most people go home the same day. A closed or flap wound often heals within a few weeks, while a wound left open to heal can take from several weeks up to a few months and needs regular dressing.

First few days

Expect soreness, especially when sitting. Take painkillers, keep dressings in place as advised, and avoid putting prolonged pressure on the area.

First 1–2 weeks

Many people return to non-physical work within a week or two. Avoid heavy lifting and strenuous activity. Open wounds will need regular dressing changes, sometimes by a nurse.

Weeks to months

Open wounds heal gradually from the bottom up; this can take a couple of months. Closed and flap wounds usually heal faster but still need care to avoid breakdown.

Cycling, swimming and sport

Avoid cycling for around 6–8 weeks and swimming until the wound has fully healed, or as your surgeon advises.

Follow-up

You may be reviewed to check healing. Slow or non-healing wounds should be reassessed.

What's normal — and not a worry

Pain when sitting that eases over the first weeks
Ongoing discharge or oozing from an open wound
A wound that takes longer to heal than expected
Needing help with dressings you cannot reach yourself

Aftercare

Keep the wound and area clean as instructed; gentle showering is usually allowed, with careful drying.
Attend dressing changes — open wounds often need a nurse to pack or dress them regularly.
Take painkillers as needed, especially before sitting for periods or opening your bowels.
Once healed, keep the cleft clean and hair-free (by shaving, hair-removal cream or laser) to reduce recurrence.
Avoid prolonged sitting, cycling and heavy exercise in the early weeks.
Keep follow-up appointments so healing can be checked.
Know who to contact if the wound becomes more painful, red, smelly or stops healing.

Before-surgery checklist

Dressings and a plan for changes (district or practice nurse if needed)
Painkillers at home
A cushion or way to sit comfortably
Loose clothing
A hair-removal plan for once the wound has healed
Time off work arranged
Lift home after a general anaesthetic
Clinic contact number saved

Scars and how they heal

Surgery in this area leaves a scar near the cleft of the buttocks. A wound left open heals from the bottom up and leaves a scar where it closes over. Off-midline closures (Karydakis, Bascom) deliberately place the scar to one side of the midline, which can heal more reliably. Scars usually fade over months but may remain visible in the cleft.

⚠ Get urgent help if…

Increasing pain, redness, swelling or heat around the wound
Pus, a bad smell or discharge that increases (signs of infection)
Fever, chills or feeling generally unwell
A stitched wound opening up
Heavy or persistent bleeding
A wound that is not healing or keeps breaking down over weeks

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result is a healed wound, no more infections, and the sinus not coming back. Off-midline techniques such as the Karydakis flap and Bascom cleft lift are designed to heal reliably and keep recurrence low, while wounds left open recur rarely but take longest to heal. Midline closures heal faster but break down or recur more often.

Even after successful surgery, pilonidal disease can return, particularly if the cleft remains deep and hairy. Keeping the area clean and hair-free afterwards is an important part of staying healed. A wound that will not heal should always be reviewed.

How long it lasts

Many people are cured by surgery, but recurrence is a recognised problem, especially after midline closure or if the cleft stays deep and hairy. Studies suggest off-midline (flap) techniques have low recurrence over the first couple of years, whereas simple midline closure has a much higher long-term recurrence. Good hair control and hygiene after healing help keep the sinus away.

Combining with other procedures

If you have an active pilonidal abscess, this may be drained first and definitive excision planned later once the infection has settled. Hair-removal measures (including laser hair removal) are often recommended alongside or after surgery to reduce the chance of recurrence.

Follow-up & long-term care

You will usually be reviewed to check the wound is healing, particularly if it has been left open and needs regular dressing. Slow healing, breakdown of a stitched wound, or any recurrence should prompt reassessment rather than simply waiting.

Keep the cleft clean and dry.
Keep the area hair-free by shaving, hair-removal cream or laser hair removal.
Avoid prolonged sitting where you can, particularly while healing.
Report any new swelling, pain or discharge promptly so recurrence is caught early.

Revision and secondary surgery reality

Recurrent or non-healing disease may need a more complex flap procedure such as a Bascom cleft lift.
A stitched midline wound that breaks down often has to be left to heal open.
Repeated drainage of abscesses is common before definitive surgery is offered.
A wound that will not heal over a long time should be reviewed, including to exclude other causes.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

Clear written instructions on wound care, dressings and washing.
Arranged nurse-led dressing changes for wounds left open.
A named contact route for infection, bleeding or slow healing.
Advice on hair removal and hygiene to reduce recurrence once healed.
Follow-up to check healing, with reassessment of any wound that will not heal.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

The surgeon's fee and the technique used (drainage, excision left open, primary closure or a flap).
Anaesthetic fee (general, spinal or local) and theatre or facility charges.
Whether the disease is simple, extensive or recurrent.
How much wound care and how many dressing changes are needed afterwards.
Whether hair-removal treatment such as laser is recommended and included.
Follow-up appointments to check healing.
What is included if the wound breaks down or the sinus recurs.

Make sure your written quote includes

The surgeon's fee and which technique is planned
Anaesthetic and theatre or facility fees
Dressings and any nurse-led wound care
Follow-up appointments to check healing
Whether hair-removal treatment is included or extra
Cancellation policy
What happens, and what it costs, if the wound does not heal or the sinus recurs

On the NHS? Pilonidal sinus surgery is commonly provided on the NHS, especially for infected or recurrent disease; some people use private care for faster access or to choose their surgeon.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Choosing a surgeon safely

Check your surgeon is on the GMC Specialist Register for this area.
Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Questions to ask your medical professional

Take this to your consultation. A good surgeon will welcome every one of these.

Which operation do you recommend for me, and why?
Will the wound be left open or closed, and how long is it likely to take to heal?
What is the realistic chance the sinus comes back with this technique?
How much dressing or wound care will I need, and who will do it?
What can I do — including hair removal — to reduce the chance of recurrence?
What should I watch for, and who do I contact if the wound does not heal?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the surgeon who carries out my operation, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this operation not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

Will my wound be stitched closed or left open?

It depends on the technique. Some wounds are left open to heal slowly from the bottom up (low recurrence but slow), while others are stitched — often off to one side of the midline — to heal faster. Your surgeon will explain which they recommend for you and why.

How long will it take to heal?

A closed or flap wound often heals within a few weeks. A wound left open can take from several weeks up to a few months and needs regular dressing. Healing in this area is often slower than people expect.

Can a pilonidal sinus come back after surgery?

Yes. Recurrence is more likely after midline closure or if the cleft stays deep and hairy. Off-midline techniques aim to reduce recurrence. Keeping the area clean and hair-free afterwards helps.

Do I need surgery if it's not infected?

Often not. A pilonidal sinus that is not causing symptoms usually needs no treatment — just good hygiene and avoiding hair build-up. Surgery is mainly for infected or troublesome sinuses.

Will hair removal help?

Keeping the cleft hair-free reduces the chance of the sinus forming or coming back. Options include shaving, hair-removal cream and laser hair removal. Ask your surgeon what they advise after your wound has healed.

Is the surgery available on the NHS?

Yes — pilonidal sinus surgery is commonly provided on the NHS, especially for infected or recurrent disease. Some people use private care for faster access or to choose their surgeon.

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Pilonidal sinus Royal College of Surgeons of England — Day-care surgery for pilonidal sinus (Annals) Common surgical procedures in pilonidal sinus disease: meta-analysis and recurrence — Scientific Reports Midline excision versus Karydakis flap: randomized clinical trial — BJS Open Bascom cleft lift versus excision with secondary healing — PMC

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.