Pilonidal sinus fistula – minimally invasive therapy instead of major surgery

A coccyx fistula (medically pilonidal sinus(also known colloquially as “coccyx abscess” or “hair fistula”) is a chronic inflammation in the gluteal fold that is usually caused by ingrown hairs. It typically affects young adults (often men) between the ages of 15 and 35. In Germany, around 48 out of every 100,000 people are newly diagnosed with coccyx fistula every year – and the trend is rising.

Initially, the disease often goes unnoticed or is underestimated, but if left untreated it can lead to severe pain, recurring abscesses and persistent discharge. Many sufferers ask themselves, whether a major operation is really always necessary or whether there are also gentler, minimally invasive treatment methods are available.

At the VenaZiel Proctology Center Berlin (DayClinic) we specialize in the diagnosis and treatment of coccyx fistula. We offer modern, gentle therapy methodsso that you can recover quickly.

In the following you will learn how you can recognize a Pilonidal Sinusthe causes behind it, how the diagnosis is madewhat treatment options – from conventional to minimally invasive – are available and why you are in the best hands with us in Berlin.

What is a Pilonidal Sinus?

A coccyx fistula is an inflammation of the subcutaneous fatty tissue in the gluteal fold in which a small cavity forms under the skin. This cavity usually contains Hair, dead skin cells and dirt particleswhich the body perceives as foreign bodies.

The name Pilonidal sinus means “hair nest cavity” – a reference to the fact that ingrown or penetrated hairs play a central role in its formation. From this cavity, fine Fistulous tracts (small tubular connections) that lead to the surface of the skin.

Visible are often small punctiform openings or pores in the gluteal fold, from which hair or secretions can escape when pressure is applied.

Although the term coccyx fistula suggests that it is a fistula on the coccyx, in fact only the skin and underlying only the skin and underlying tissue are affectednot the bone itself. Typically, the fistula occurs above the coccyx in the buttock crack. In rare exceptional cases, similar hair nest fistulas have also been observed in other parts of the body (e.g. in the navel, in the groin region or between the fingers in hairdressers). However Over 90 % of all pilonidal cysts occur in the gluteal foldwhere hair can penetrate the skin particularly easily due to friction and pressure.

Causes and risk factors

The exact cause of coccyx fistula is ingrown hair or the penetration of hair into the skin of the gluteal fold. The hair bores into the skin through mechanical friction (e.g. when sitting) and triggers a Foreign body reaction from: The body recognizes the hair as an intruder and reacts with inflammation in order to encapsulate it.

A chronic inflammatory duct (fistula) develops under the skin, which can fill with more hair and sebum. An older theory assumed that this was a congenital malformation, but today the Acquired development through hair “nest” as the main cause. The following factors favor the development of a coccyx fistula:

• Heavy body hair: Dense, strong hair growth in the buttock region increases the risk of hair growing into the skin. In fact, most patients have strong hair growth in the buttocks area. (However, people with rather fine body hair can also be affected – but the hair factor often plays a role).
• Young age and male gender: Young men between puberty and around 35 years of age are most frequently affected. Overall, men are affected around 2 to 4 times more frequently than women. Hormonal differences (e.g. testosterone, hair growth distribution) probably contribute to this. However, women can also develop coccyx fistula, especially if they are predisposed to it.
• Prolonged sitting and friction: People with predominantly sedentary jobs (office work, frequent drivers such as truck drivers or students) are disproportionately often affected. Sitting for long periods of time Pressure and friction in the fold of the buttocks, making it easier for hair to be rubbed into the skin. During the Second World War, an unusually large number of American Jeep drivers suffered from pilonidal cysts, which is why the disease is also known colloquially as ” Jeep disease“Today, however, we know that driving alone is not the cause, but rather the general mechanism of hair and friction.
• Sweating and hygiene: Moist, softened skin favors the penetration of hair. Heavy sweating in the crease of the buttocks and insufficient ventilation of the skin (tight clothing) create an environment in which hair and skin flakes stick. Poor hygiene is controversially discussed as a direct risk factor – scientifically, lack of hygiene is not considered to be the main cause. However, good anal hygiene can help to reduce the risk, while very poor hygiene can promote the development or recurrence of a fistula (empirical value).
• Overweight: Many patients with coccyx fistula are overweight. A higher weight leads to a deeper gluteal fold and increased sweating, which in turn promotes hair breakage and skin irritation. Excess weight also puts more pressure on the skin fold. This increases the risk of fistulas.
• Familial predisposition: Occasionally there appears to be a genetic component There is a family history of pilonidal sinus. It is possible that certain skin or hair conditions are inherited that are more susceptible to ingrown hairs.
• Smoking: Although smoking is not a directly proven trigger for coccyx fistulas, nicotine worsens blood circulation and wound healing. blood circulation and wound healing. Smokers have a higher risk of healing disorders and possibly also recurrences after surgery. It is therefore better to avoid nicotine, especially before and after surgery.

The main cause is a combination of hair and mechanical stress. The more risk factors come together (e.g. young, very hairy man with a sedentary job and sweaty skin), the greater the likelihood of developing a Pilonidal Sinus.

Symptoms: How can you recognize a coccyx fistula?

The symptoms of a coccyx fistula can vary greatly – from almost unnoticed to highly acute. There are basically three different forms:

• Asymptomatic fistula: In the early stages, the coccyx fistula often causes no pain and goes unnoticed. Small Skin dimples or punctiform openings (pits) may be visible in the gluteal fold, which you notice by chance when washing or showering. As long as there is no inflammation, there are no acute symptoms. However, even an asymptomatic fistula can develop into an acute or chronic form at any time.
• Acute pilonidal sinus (abscess): This acute form – often referred to colloquially as coccyx abscess – is characterized by sudden severe pain noticeable. A painful, reddened lump above the coccyx, which reacts very sensitively to pressure. Often occurs Pus from one or more openings, the skin is warm and swollen. The pain intensifies when sitting or sitting down/standing up. Sometimes it comes to Fever and fatigueif the inflammation is severe. An acute abscess is a urgent situation – medical help is needed quickly to relieve the pus (see treatment).
• Chronic coccyx fistula: In many cases, the disease progresses to a chronic stage. Typical symptoms are then Persistent or recurring complaints over weeks, months or years. Patients report a Feeling of pressure or pulling pain in the breech area, which occurs particularly when sitting. There is often Constant discharge of secretions: From small fistula openings a clear yellowish clear-yellowish fluid secretion, blood or or pus in small quantities, which can lead to soiling of the underwear. The skin around the openings is often reddened and itches or burns easily. Chronic courses occur in phases – in between there may be phases with little discomfort, but without treatment the inflammation flares up again and again. In contrast to acute abscesses, the pain is usually less intense, but can affect the quality of life for a long time.

Note: If left untreated, a chronic coccyx fistula can repeatedly become inflamed and encapsulated. Over time more and more ducts (fistulas) branch outsometimes also laterally outside the gluteal fold. The surrounding skin becomes increasingly scarred. In very rare cases – In the case of chronically inflamed fistulas that have existed for years, it can even lead to malignant changes in the skin (development of squamous cell carcinoma). A coccyx fistula should therefore be never be trivialized or postponed forever, but treated at an early stage.

Diagnosis: How is a Pilonidal Sinus diagnosed?

The diagnosis of a coccyx fistula is usually uncomplicated and is made by a specialist (e.g. proctologist or surgeon) based on the typical clinical signs. typical clinical signs. This is often a Visual diagnosisThe doctor will already recognize the characteristic small fistula openings in the midline, possibly scars from old inflammations, swellings or leaking secretions when examining the gluteal fold. In addition, a thorough Medical history The patient reports their symptoms (pain, discharge, swelling, fever), the duration of the symptoms and any previous episodes. Questions are also asked about professional activity (prolonged sitting?), hair growth, family history and previous treatments.

During the physical examination the doctor looks for the following features:

• Fistula openings (pits): There are usually one or more small holes or pores right in the buttock crease on the midline. Light pressure can sometimes push out secretions or a tuft of hair. Laterally displaced openings also indicate branched fistulas.
• Swelling or hardened lump: A bulging, painful swelling can be felt just above the coccyx, especially in the case of an acute abscess. In chronic fistulas, scarred strands can be felt under the skin.
• Pressure pain and redness: The area is usually sensitive to pressure. Redness and overheating indicate active inflammation.
• Secretion: Purulent, bloody or watery secretion at the openings or in the underwear is a clear sign of an open fistula.

Imaging procedures are not always necessary in uncomplicated cases not always necessary. In complex or unclear cases however, a sonography (ultrasound) can be helpful to visualize the extent of fistula tracts and any abscess cavities in the tissue. Particularly before surgical interventions for recurrent fistulas, some centers also use MRI-examinations in order to obtain a more precise “map” of the fistula tract. Imaging is particularly useful if there is a suspicion of Recurrences (repeated fistulas after previous operations) or if very extensive courses are suspected. In most cases, however, a clinical examination is sufficient: The coccyx fistula can – for the experienced proctologist – be recognized quite clearly.

Differentiate differential diagnoses

It is important to rule out other diseases that can cause similar symptoms in the coccyx region:

• Anal fistula: A fistula originating from the anal canal (e.g. as a result of an anal abscess) can sometimes be confused with a coccyx fistula. However, openings are typical for anal fistulas near the anus (not on the coccyx) and a connection with rectal complaints. In the case of lateral fistula tracts near the coccyx, the doctor will always check whether an anal fistula is present, as this requires a different treatment.
• Hidradenitis suppurativa (acne inversa): This is a chronic skin disease that causes recurring painful lumps and abscesses in body folds (armpit, groin, buttocks). In the chronic stage, fistulas can also develop here. In contrast to coccyx fistula, however, these are usually several jobs and bilateral changes are present and it is a systemic skin gland disease.
• Abscesses of other causes: An abscess in the gluteal region could theoretically also be caused by a penetrating foreign body injury or a skin infection. However, the classic coccyx fistula is characterized by the typical pori in the midline mentioned above.
• Cracked skin or fungus: Small tears in the skin (rhagades) or psoriasis can cause superficial inflammation and redness in the buttock crease, but without the deep ducts and abscesses of a coccyx fistula. These more harmless findings usually do not require surgical treatment.

The specialist will consider all these possibilities. However, in the vast majority of cases Medical history and clinical findings clearly the diagnosis pilonidal sinus. Once the diagnosis has been established, the optimal treatment plan must be determined – the extent of the fistula and the stage (acute vs. chronic) play a decisive role here.

Treatment: What therapies are available?

Basically: A pronounced coccyx fistula does not heal by itself. Without adequate treatment, the disease usually progresses – the inflammation remains active and new abscesses can form again and again. Conservative measures such as ointments, antibiotics or sitz baths can at best provide temporary relief, but do not eliminate the actual cause (the fistula tract). The therapy is therefore in most cases involves a surgical procedure. The good news is that today there are various Surgical methodsThe treatment options range from classic to minimally invasive and can be selected depending on the findings. Even an acute abscess requires a minor surgical procedure before definitive treatment is carried out.

In the following we present the different treatment steps and methods – from short-term measures for acute abscesses to the modern minimally invasive techniques that we use in our clinic as a gentle alternative. gentle alternative to major operations.

First aid for acute abscess

If the coccyx fistula is in an acute acute inflammatory episode with abscess formation, the first priority is rapid relief in the foreground. A bulging pus-filled abscess is treated in a minor procedure under local anesthesia incised (cut open) and drained. The surgeon opens the abscess with an incision (preferably to the side of the midline to promote wound healing) and drains the pus. The severe pressure pain immediately subsides and the healing process can begin. The resulting cavity is rinsed and, if necessary, treated with a small drainage or gauze strip so that it remains open and can continue to heal. This Intervention for emergency relief is relatively small and can usually be performed on an outpatient basis. However, this only the acute danger is avertedthe actual fistula initially remains. Without further treatment, an abscess would soon form again in most cases. For this reason, definitive surgery on the fistula is planned after the abscess has been relieved – as soon as the acute inflammation has subsided and the tissue has calmed down (typically after around 4-6 weeks).

Important: Antibiotics are usually not a permanent solution for coccyx fistulas not a permanent solution. In the case of a large abscess, antibiotics hardly penetrate the area of pus; at most, they can temporarily contain the surrounding infection. Antibiotics are therefore only used Short-term bridging (e.g. if immediate surgery is not possible). However, complete healing can only be achieved by removing or destroying the fistula tract.

Conservative measures and prevention

In early or very mild cases – e.g. if an asymptomatic coccyx fistula is discovered by chance that is not (yet) causing any symptoms – conservative measures can be tried first. These are aimed at Minimize risk factors and prevent further inflammation:

• Hair removal: To reduce the “regrowth” problem, the hair in the crease of the buttocks can be removed regularly. This is traditionally done by shaving or trimming. However, caution is advised: Daily shaving can irritate the skin and even promote new hair growths. In fact, constant shaving of the coccyx region is nowadays no longer generally recommendedas studies have shown no lasting benefit and rather increased recurrences have been observed. An alternative is the Laser hair removal (laser epilation), which has a more permanent effect. However, there is no clear scientific evidence of an improvement in success here either. Some specialists still rely on laser epilation for recurring fistulas because it reduces hair regrowth in the long term, but statutory health insurance companies do not usually cover the costs in Germany. All in all: careful hair removal can be part of prevention (especially in the healing phase after surgery, it is often recommended to keep the wound edge shaved), but should not be exaggerated. Important: If shaving is carried out, only wet and carefully to avoid skin irritation or consider professional hair removal methods. 
• Hygiene and skin care: A thorough anal and buttock hygiene is the simplest preventative measure. Daily washing of the buttock crease with water (and mild, pH-neutral soaps) keeps the pores free of hair and sebum. The crease should then be dried well (careful dabbing, no rough rubbing). Powder or ointments containing zinc can help to reduce moisture if heavy sweating is a problem. Overall, good hygiene reduces the germ load on the skin and could therefore prevent inflammation. Although this will not cure an existing fistula, it will help to prevent new abscesses as far as possible.  
• Weight reduction: Overweight patients benefit from weight lossas this reduces the mechanical stress and moisture in the gluteal fold. A slimmer figure can reduce the recurrence rate and also makes any upcoming operations and wound care easier.  
• Behavioral changes: Prolonged, uninterrupted sitting should be avoided or interrupted more often. If you sit a lot at work, you should take regular breaks to stand up or work standing up in between. Special Seat cushion (donut cushions with a hole) relieve pressure on the coccyx. You should also avoid wearing very tight-fitting clothing that could chafe. Although these measures are no guarantee, they do reduce mechanical irritation.  
• Stop smoking: As mentioned, smoking worsens wound healing. A Abstaining from nicotine is particularly advisable before and after surgical treatment to ensure optimal healing.

Important: Conservative measures can possibly slow down the progression or keep smaller, not yet inflamed fistulas stable. Healing However, they cannot correct an established coccyx fistula, as the duct remains deep. Sooner or later, surgery is therefore usually necessary, especially if symptoms occur. Nevertheless, hygiene, hair removal and co. Accompanying measures – both to prevent recurrence after surgery and to generally reduce the risk of inflammation.

Minimally invasive proceduresModern procedures such as pit-picking surgery or endoscopic fistula therapy make it possible to remove a coccyx fistula via tiny incisions or using camera technology. The patient can often be treated on an outpatient basis in a comfortable supine position. The procedures cause Less wound pain and heal faster, allowing patients to return to their everyday lives more quickly. The picture demonstrates how a gentle proctological procedure is prepared in our clinic – the focus is on putting as little strain as possible on the tissue.

Surgical treatment methods: classic vs. minimally invasive

Coccyx fistulas have been treated surgically since time immemorial, but the surgical procedures have developed significantly in recent years. There are conventional operationsin which the diseased tissue is generously excised, and modern minimally invasive techniqueswhich manage with very small incisions. Which method is used depends on the extent of the fistula, the stage and the surgeon’s experience. The following often applies: As radical as necessary, as gentle as possible. Below we compare the most important procedures:

Conventional surgical procedures (excision)

For a long time, the classic standard treatment for coccyx fistula was excisionThis is the complete surgical excision of the fistula system including all inflammatory tissue. In the process – usually under general anesthesia – a oval area around the fistula. There are two basic procedures after excision:

• Open wound healing (secondary healing): Here the wound is left openwithout suturing it. The wound cavity heals from the bottom upwards as new tissue grows in. The advantage of this method is that the risk of recurrence is relatively low, as all fistula tracts have been removed and there is no tension on a fresh suture. Studies show that with open wound healing, the recurrence rate can be less than 10 %. can be less than 10%.
  The disadvantage is the long healing timeDepending on the size of the wound, it can take 4-8 weeks (sometimes longer) for the wound to completely heal. During this time, daily wound care is necessary (irrigation, dressing changes) and the patient must take it easy. Many people find the open wound psychologically stressful. Nevertheless, this procedure is recommended above all for complex, extensive fistulas because it heals most reliably.  
• Primary wound closure (direct suturing): In this case, the wound is sutured shut immediately after the fistula has been excised. This closes the wound cavity and healing is faster (often in 2-3 weeks). Patients are able to return to work more quickly and care is easier as no deep open wound needs to be treated. However, with this procedure the Higher risk of relapse – Depending on the study, fistulas recur in up to 15-20% of cases. In particular, an occlusion exactly in the gluteal fold (in the middle) is considered unfavorable, as high tension and moisture prevail there, which favors healing disorders. Important: Modern guidelines advise against treating a coccyx fistula with a central suture to close. Instead, techniques have been developed in which the closure laterally offset to relieve the load on the loaded pore tip. 
• Plastic flap procedure (off-midline closure): In order to combine the advantages of rapid healing and a low recurrence rate, many surgeons now use plastic surgery methods. After the excision, a Tissue flap to close the wound, leaving the new scar outside the gluteal fold. outside the gluteal fold comes to rest. Examples are the Karydakis operation or the Limberg flap surgery. The wound is closed diagonally or asymmetrically, sometimes with the removal of a small skin spindle, so that the former buttock furrow is flattened. The result: better ventilation, less hair accumulation and less tension on the scar. Off-midline procedures show in studies excellent healing rates and significantly shorter wound healing times compared to open healing.
  In a meta-analysis, the healing time according to Karydakis/Limberg was significantly shorter, and these techniques are used especially for larger findings or after recurrences. larger findings or after recurrences recommended. The recurrence rates are usually less than 5-10%, depending on the technique. The disadvantage is, of course, a somewhat more extensive procedure with general anesthesia and the need for a certain amount of bed rest until the flap sutures have held securely. Overall, however, plastic coverings are considered State-of-the-art for recurring or severe cases to achieve a permanent solution.

In summary, conventional operations are sometimes unavoidable – especially if the fistula is very extensive or has already occurred several times (recurrence) and is scarred. They offer the Highest probability of successbut are sometimes accompanied by prolonged healing and scarring. Fortunately, there are now suitable cases less invasive alternatives.

Minimally invasive techniques

In recent years, several minimally minimally invasive procedures have been developed with the aim of treating the coccyx fistula with as little trauma as possible to treat. These methods are particularly suitable for Smaller fistulas that have not yet been operated on often very successful. The advantages are obvious: Minor woundsless pain, shorter downtimes – many patients can be treated with virtually no interruption to work. However, studies show that minimally invasive procedures tend to have a Slightly higher relapse rate than radical excision. Nevertheless, they are an attractive option due to their gentleness and repeatability. The most important techniques include:

• Pit-picking (also known as “sensory clearing”): This method goes back to the surgeon John Bascom. It involves local anesthesia only the small visible fistula openings (pits) together with the fistula tract behind them punched out or scraped out. Only a few Tiny incisions (approx. 5 mm)through which the surgeon removes the tufts of hair and inflammatory tissue. The resulting mini-holes are left open to heal or sutured with 1-2 stitches. Pit picking can usually be performed on an outpatient basis.
  The wounds heal in 1-2 weeks and the patient has hardly any pain or restrictions – they can often walk, sit and work normally again the very next day.
  Disadvantage: Pit picking is only suitable if the fistula tracts are superficial and not very branched are present (ideally only a few pits). In the case of very extensive or chronic findings, it is often not enough. It is also important to know that the recurrence rate is higher with pit picking; studies indicate recurrence rates of around 20-30%. However, in the event of a recurrence, pit picking can be treated relatively easily. Perform againas there is hardly any scarring. It is therefore a gentle first attempt for early cases.  
• Endoscopic fistula therapy (EPSiT – Endoscopic Pilonidal Sinus Treatment): This is an innovative procedure that uses a fine endoscope to fine endoscope is performed. Under spinal or short general anaesthesia, the surgeon inserts a miniaturized camera system directly into the fistula tract. Under visualization, the Hair, pus and deposits in the duct cleared out and the fistula tracts are burned out from the inside or cut out with mini probe scissors. So you work from the inside outwithout a large skin incision. At the end, the inner fistula wall is sclerosed, e.g. with a coagulation probe. The outer skin openings remain very small. Advantage: The doctor can Targeted all ramifications under camera view; healthy tissue is hardly damaged.
  Healing takes place with minimal pain. After a few days, the patient can often sit again with virtually no pain. Initial studies on EPSiT also show recurrence rates in the range of 15-20%, sometimes even lower if the technique is applied correctly. However, EPSiT is somewhat more complex (requires special equipment and experience) and is not available in all clinics. At our VenaZiel Day Clinic, we rely on such modern technologies in order to offer our patients the most gentle treatment possible. 
• Laser therapy (FiLaC®/SiLaC): Similar to the endoscopic method, the fistula tract is treated from the inside – but using laser fibers. With the FiLaC method (Fistula Tract Laser Closure), a flexible laser fiber is inserted into the duct. By slowly retracting the fiber, the inner wall of the fistula is Scabbed and sealed using laser energy. The surrounding tissue contracts and the canal should heal. This procedure is performed under local anesthesia or brief anesthesia. The outer openings are often scraped out beforehand (similar to pit-picking) and then also closed with a laser if necessary.
  Advantages: minimal tissue damage and a relatively quick recovery. Initial experience shows success rates that are comparable with other minimally invasive methods. Official long-term data is still pending, so for the time being laser is considered to be Supplementary option. However, it may be worth a try for patients who do not want major surgery, as the stress involved is low. If a laser attempt is unsuccessful, surgery can still be performed.  
• Other procedures: In some cases Chemicals (phenol) is used to obliterate the fistula tract. Crystalline phenol is injected into the cleaned fistula, which is supposed to cause hardening and scarring. However, this method is rarely used today as it is unreliable and phenol can also have side effects on the open wound. Also experimental are Bonding techniques (e.g. fibrin glue) to close the duct – their success is limited. Overall, pit-picking, endoscopic and laser methods have emerged as the most common minimally invasive options.

Success rate and selection: In general, classic procedures (complete excision with open or flap closure) have the lowest recurrence rates, while minimally invasive procedures have the higher Patient protection but need to be repeated somewhat more often. The choice of method should be made on an individual basis. Small, first-time fistulas – especially in patients who are reluctant to have a long downtime – can initially be treated using a minimally invasive approach. Larger or complex fistulas and those that have already had one or more recurrences are often better treated with a more extensive operation (possibly with flap surgery) in order to achieve final peace of mind. The experience of the treating surgeon with the respective techniques is also important. In specialized centers (such as our proctology day clinic), minimally invasive methods are routinely offered and mastered – whereas in less specialized facilities, a large excision is sometimes used straight away.

Aftercare, healing and prognosis

Regardless of the procedure chosen, the aftercare of a coccyx fistula is crucial for successful healing. After an operation – whether large or small – patients receive precise instructions:

• The wound (or wounds in the case of multiple cuts) must be kept clean become. Daily careful Showers rinsing the wound area with clear water is usually recommended to rinse off secretions. Sitz baths with disinfectant additives can provide relief for open wounds (seek medical advice).
• Wound checks visits to the doctor at regular intervals are important. In the case of open wounds, the dressing is often changed by medical staff at the beginning to check healing. In the case of sutured wounds, the stitches are removed after approx. 10-14 days (if not absorbable).
• Pressure relief: Pressure on the coccyx region should be avoided, especially with fresh sutures. Patients are advised to sit as far to the side as possible or to use a soft cushion. Avoid pressing hard (during bowel movements) and heavy physical work during the first two weeks in order to prevent the wound from tearing open.
• Hygiene & hair removal: Once the wound has healed, it is advisable to keep the area keep the area free of hair (as discussed above, preferably using moderate methods). Care should also be taken to ensure meticulous cleanliness – a daily shower is essential to prevent hair and dirt nests from forming in the first place.
• Check-ups: Many surgeons ask for a follow-up visit after a few months, as recurrences often appear within the first year. An inspection of the coccyx region some time after healing can detect any neoplasms at an early stage so that countermeasures can be taken in good time.

The healing time varies greatly depending on the procedure:

• After pit-picking or minor operations, patients are often fit again after just a few days. The wounds close within 1-3 weeks.
• After major excision with suture After an operation, a recovery period of around 2-4 weeks is expected (until stitches are removed and the wound is stable). Office activities are often possible again earlier, physically strenuous activities a little later.
• For open wound healing complete epithelialization can take 6-8 weeks or more, as mentioned above. Here you need to be more patient and consistently care for the wound. However, absence of several months is rather rare – often at least limited activity is possible again after a few weeks as long as the wound is cared for.

The forecast is overall goodprovided the fistula has been treated correctly. A coccyx fistula is annoying and can flare up again and again, but it is benign and – properly addressed – also curable. As discussed, the recurrence rates depend heavily on the method. Open procedures sometimes offer recurrence rates of less than 10 %, while primary central occlusions have higher rates of around 15-20 %. Minimally invasive methods are roughly in between or sometimes higher (e.g. ~20-30 % with a pure pit-picking strategy).

Important to know: A relapse (recurrence) does not necessarily mean failure – sometimes you simply have to “go one step further” and apply the next level of therapy. For example, after unsuccessful pit-picking, a classic operation can still be performed, or the minimally invasive procedure can be repeated. Experience shows that with increasing consistency, a final cure is usually achieved at some point.

Conclusion: Modern treatment of coccyx fistula in Berlin

The Pilonidal Sinus (pilonidal sinus) is a common but easily treatable disease in the field of proctology. The decisive factor is, See a specialist in good time instead of waiting a long time – because early interventions can often be smaller than late operations. Thanks to modern techniques, it is now possible to treat many coccyx fistulas Minimally invasive and outpatient which enables patients to recover quickly. Conservative measures such as hygiene and hair removal can help, but are no substitute for surgery once a fistula has developed.

At our VenaZiel DayClinic in Berlin we focus on the complete spectrum of therapy: from gentle minimally invasive procedures (pit-picking, endoscopic fistula removal, laser therapy) to plastic surgery operations plastic surgery operations for complicated cases. We decide which method is right for you individually after a precise diagnosis – true to the motto: As little as possible, as much as necessary. Our experienced team of proctologists will provide you with comprehensive advice and guide you through the treatment so that you can get back to sitting and enjoying your everyday life as quickly as possible. Your health and quality of life are our top priority.

Please contact us for a consultation at our proctology center in Berlin – We are here for you to successfully close the chapter on coccyx fistula.

Sources:

• Iesalnieks I, Ommer A. The Management of Pilonidal Sinus. Dtsch Arztebl Int. 2019; 116(1-2):12-21.
• VenaZiel Health Center: Pilonidal sinus – causes, symptoms and the need for surgery.
• Pilonidal Sinus Center Berlin: Information portal Pilonidal Sinus Fistula – Causes, risk factors and prevention.
• NetDoktor.de: Pilonidal sinus (Pilonidal sinus) – Patient information on symptoms and treatment.
• Mayo H: Observations on Injuries and Diseases of the Rectum. London, 1833 (first mention of the disease). (Historical reference)