Treatment of pilonidal disease

Pilonidal sinus typically begins as a small pit or opening in the skin over the tailbone (sacrococcygeal area). Hair fragments, skin debris, and bacteria can enter this pit, leading to inflammation, infection, and the formation of a sinus tract or abscess.

Common symptoms include:

• Pain or tenderness in the lower back or tailbone area, especially when sitting
• Swelling and redness over the affected area
• Pus or bloody discharge from one or more small openings in the skin
• Foul odour from the draining sinus
• Fever and malaise if an abscess develops
• Recurrent episodes of infection and drainage

Factors that may contribute to pilonidal sinus development include:

• Prolonged sitting or driving (occupational risk)
• Deep natal cleft (buttock crease)
• Excess body hair, particularly coarse or curly hair
• Obesity or sedentary lifestyle
• Local trauma or friction
• Family history of pilonidal disease

Accurate diagnosis is essential. Dr. Lassu will perform a physical examination during your consultation and, if indicated, may arrange imaging studies to assess the extent of the sinus tracts.

Our treatment approach follows a logical progression.

For patients with mild symptoms or a first episode of pilonidal sinus, conservative measures may be sufficient. Dr. Lassu may recommend:

• Good hygiene practices – keeping the area clean and dry
• Regular hair removal – shaving or laser hair removal around the affected area to prevent hair ingress
• Sitting modifications – using a cushion or avoiding prolonged sitting
• Warm compresses or sitz baths – to reduce discomfort and promote drainage of superficial infections
• Oral antibiotics – when signs of cellulitis or infection are present

If an abscess has formed, Dr. Lassu may perform incision and drainage (I&D) in the clinic to relieve pressure and remove infected material. This is a simple procedure performed under local anaesthesia.

 

• SiLaC (Sinus Laser Assisted Closure) – a fibre‑optic laser technique that delivers 360° radial laser energy directly into the cleaned sinus tract. The laser energy ablates the diseased epithelial lining, shrinks and seals the tract, and stimulates collagen contraction. A thin flexible laser fibre is inserted through a small portal, and as it is slowly retracted, it emits controlled energy that closes the sinus cavity.

SiLaC is minimally invasive, leaves only small entry wounds, and offers a significantly shorter recovery period compared to traditional excision.

In selected cases – such as very large, complex, or recurrent sinuses that have not responded to minimally invasive techniques – traditional surgical excision may be recommended. This involves removing the entire sinus tract and surrounding diseased tissue, followed by either open healing (left to granulate) or primary closure (suturing the wound).

While this approach has a longer recovery period (typically 4‑6 weeks) and more postoperative discomfort, it may be the most appropriate option for extensive disease. Dr. Lassu performs these procedures in a hospital setting when required, ensuring your safety and optimal surgical conditions.

Choosing ELEMENTAL means receiving expert care in a discreet, professional, and patient‑centred environment. We understand that pilonidal sinus can be an embarrassing and frustrating condition, and we prioritise your comfort, privacy, and long‑term well‑being.

• Minimally invasive focus: Dr. Lassu prioritises tissue‑preserving, scar‑sparing techniques such as SiLaC, which offer less pain, faster recovery, and excellent cosmetic outcomes compared to traditional open surgery. Whenever clinically appropriate, he will recommend  modern approaches
• DHA‑licensed, same‑day facility: Our day surgical centre is fully accredited by the Dubai Health Authority and equipped with state‑of‑the‑art endoscopic and laser equipment. Most procedures are performed on an outpatient basis – you return home the same day.
• Seamless diagnostic pathway: If colonoscopy or other investigations are needed to rule out associated colorectal conditions, we can arrange them on‑site without long waiting times
• Transparent care, clear communication: Dr. Lassu explains every diagnosis, treatment option, and expected outcome in simple, clear language, so you can make informed decisions. No misleading claims, no guarantees of specific results – only honest, professional advice

Before the procedure

During your initial consultation, Dr. Lassu will take a detailed medical history, perform a physical examination, and discuss your symptoms. If an abscess is present, he may perform incision and drainage. For planned minimally invasive procedures, you will receive specific preparation instructions, which may include fasting for anaesthesia.

During the procedure

• SiLaC – performed under light general anaesthesia or sedation. The procedure typically takes around 30 minutes. Dr. Lassu makes one or two tiny incisions, inserts the endoscope or laser fibre and ablates the diseased tissue
• Traditional excision – performed under general anaesthesia. 

Aftercare and recovery

• SiLaC recovery – Most patients experience minimal pain and can return to light activities within a few days. Full healing typically takes 2‑4 weeks. Dr. Lassu will advise on wound care, hygiene, and when to resume sitting, driving, or exercise
• Traditional excision recovery – Longer recovery period (4‑8weeks). You will receive detailed wound care instructions
• Follow‑up – Dr. Lassu will schedule a postoperative visit to assess healing and discuss long‑term results

Take the First Step Towards Lasting Relief

Living with the pain, discharge, and recurrent infections of pilonidal sinus is not necessary. Modern, minimally invasive treatments can effectively resolve the condition and restore your quality of life with minimal disruption to your daily routine.

Schedule your confidential consultation with Dr. Peter Lassu at ELEMENTAL Day Surgical Center, Dubai, today.