Question
I am the mother of an 18 year old son and also I give my time as an expert on the orthopedic section of allexperts.com. I apologize if you are not the one to
direct this question, but I hope you can give me some advice.
My side of the family has a history of pilonidal cysts. My father had one, and I have had one. Two years ago, my 18 year old son had surgery for a pilonidal cyst. The surgery went fine and stitches were used to close the incision.
A month ago, he started to get pain and pressure near the incision site. I took him to his doctor to check the site and the doctor said that he did not see anything to lead him to believe the cyst had returned. My son volunteers for EMS support and he was lifting a heavy stretcher and felt a pull at the time he lifted the stretcher in his lower spine and the doctor felt that his pain may be
due to him pulling something at the incision site.
Today, my son went to the bathroom and as he was finishing up, he noticed blood on the toilet paper. It was coming from near the incision site. He said he felt as if there was a small blister near the site, and it burst and bled. The site was clean with nothing that my husband could see.
The bleeding stopped shortly and my son said he had no pain. I am planning to call his doctor in the morning, but being the "over protective" mother I am, I
was wondering if you could tell me, or direct me to someone who can tell me, what the incidence of a pilonidal cyst returning at the same site is? And if you feel this might be happening.
Thank you for your time
AnswerThis may help,
Dis Colon Rectum. 2007 Nov;50(11):1928-34. Links
Timeline of recurrence after primary and secondary pilonidal sinus surgery.Doll D, Krueger CM, Schrank S, Dettmann H, Petersen S, Duesel W.
Department of Surgery, Bundeswehrkrankenhaus Berlin, Berlin, Germany. ddoll@gmx.de
PURPOSE: This study was designed to evaluate the timeline of recurrence of pilonidal sinus disease after primary vs. multiple surgery. Data of medical military service in Germany were reviewed. METHODS: Telephone interview of 205 patients after pilonidal sinus disease surgery after median interval of 14.8 (standard deviation +/-3.9) years was conducted. A total of 345 patient charts with pilonidal sinus disease recurrence and fully documented previous surgery history were analyzed. RESULTS: Pilonidal sinus disease recurred in 41 of 205 patients (20 percent; actuarial survival 22 percent) after first surgery. Median recurrence-free-interval was 1.8 (range, 0.1-16.5) years. Twenty-nine of 41 of all recurrences (71 percent) were observed within four years after primary surgery. Fifteen of 50 patients (30 percent) treated by primary closure had recurrent disease after a median recurrence-free interval of 2.7 (range, 0.2-13.5) years compared with 24 of 144 patients (17 percent), who experienced recurrence after rhomboid excision and open wound treatment after a median of 1.8 (range 0.1-16.5) years (P = 0.081, long-rank-test). Analysis of 345 recurrent disease charts revealed that recurrence time decreased for multiple recurrences compared with first recurrence (R1 vs. R2: P = 0.07; R2 vs. R3: P = 0.03, Mann-Whitney U test). CONCLUSIONS: Long-term recurrence rate was 22 percent and thus higher than previously reported. This may be attributed to the long follow-up interval. Recurrences up to 20 years after surgery were seen. Our data provide evidence that follow-up after first to the third pilonidal sinus surgery should complete or exceed five years, because the majority of recurrences occur during this postoperative interval. Nevertheless, even a five-year follow-up will still miss 25 percent of recurrences.
