From the Guidelines
Packing after drainage of a pilonidal cyst should not be used as its effectiveness is unclear and it may cause additional pain and healthcare expense. The use of packing after drainage of an anorectal abscess, which is similar to a pilonidal cyst in terms of wound management, has been debated in the medical community. According to a recent Cochrane review 1, the use of internal dressings (packing) for the healing of perianal abscess cavities does not have a clear influence on time to healing, wound pain, development of fistulae, abscess recurrence, or other outcomes. Some key points to consider when managing a pilonidal cyst include:
- The primary treatment of anorectal abscesses, and by extension pilonidal cysts, remains surgical drainage, with the timing being dictated by the severity and nature of any sepsis 1.
- The incision should be kept as close as possible to the anal verge to minimize the length of a potential fistula, while still providing adequate drainage and avoiding sphincteral damage 1.
- The high recurrence rate of anorectal abscesses, which can be as high as 44% 1, emphasizes the need for a complete and accurate drainage of the abscess.
- A recent multi-center observational study found that packing is costly and painful and does not add benefit to the healing process 1. It is essential to prioritize the patient's clinical condition and comorbidities when deciding on the management of a pilonidal cyst. In the absence of sepsis or other severe conditions, the surgical drainage should ideally be performed within 24 h 1. The wound should be gently cleaned with saline solution during each dressing change, and patients should monitor for signs of infection, such as increased pain, fever, excessive bleeding, foul odor, or increased swelling. Complete healing typically takes 3-8 weeks, though this varies based on wound size and individual healing factors.
From the Research
Pilonidal Cyst Drainage and Packing
- The provided studies do not specifically address the duration for which packing should be left in place after drainage of a pilonidal cyst 2, 3, 4, 5.
- The studies focus on the evaluation and management of pilonidal disease, including nonoperative and operative treatment options 2, systematic reviews of management strategies 3, and complications such as pyomyositis 4.
- Minimally invasive techniques for the management of pilonidal disease are discussed, including endoscopic pilonidal sinus treatment (EPSiT) and other alternatives to excision surgery 5.
- However, none of the studies provide guidance on the specific question of how long to leave packing in place after drainage of a pilonidal cyst.
Treatment Options and Considerations
- The management of pilonidal disease involves various treatment options, including nonoperative and operative approaches 2, 3.
- Minimally invasive techniques have been developed to minimize morbidity and improve healing rates 5.
- The choice of treatment may depend on the severity of the disease, patient preferences, and the risk of complications 3, 4.
- Further research is needed to determine the most effective treatment strategies for pilonidal disease, including the optimal duration for packing after drainage 3, 5.