Treatment of epithelial coccygeal duct

Excision of the epithelial coccygeal duct is one of the treatment options for pilonidal disease, in which the affected tissue and ducts are removed. The extent of the operation depends on the location of the holes, inflammation, previous interventions and the chosen technique. Long-term inflammation in very rare cases can be accompanied by malignant changes, however, the statement that any unremoved cyst necessarily turns into cancer is incorrect. Tactics are determined by symptoms and examination data; an abscess may require drainage first.

Indications

Treatment of the disease is surgical only. Conservative therapy delays the timing of surgical intervention and leads to the development of complications: infection of surrounding tissues (phlegmon), spontaneous opening with the breakthrough of pus into the rectum or pelvis, osteomyelitis (damage to the bone structures of the coccyx and sacrum), sepsis. The abscess (limited purulent melting of the cyst) increases in size, breaking out (fistula) and forming secondary openings.

Surgical treatment is prescribed regardless of the stage, acute or chronic, and the severity of pathological changes. One- or two-stage surgical intervention is performed. In case of inflammation, a course of antibiotic therapy, anti-inflammatory drugs, daily dressings are prescribed, the abscess is opened and drained. Having eliminated acute symptoms, a date for surgical treatment is set.

Contraindications

ECX resection may be refused in the following clinical situations:

• uncorrected diabetes mellitus, glycemia >10 mmol/l (risk of accumulation of secondary microflora);
• severe concomitant pathology (cardiovascular, respiratory failure, limitation of detoxification and excretory function of the liver and kidneys);
• hemostasis disorders (increased bleeding, tendency to thrombosis);
• active tuberculosis (isolation of mycobacteria with sputum, biological fluids);
• pelvic neoplasms with invasion into the peri-sacral region;
• malignant arterial hypertension (BP >180/100 mmHg while taking >3 medications, risk of intra- and postoperative myocardial and cerebral infarction);
• acute infectious diseases.

Absolute restrictions on surgical treatment are set by the therapist and anesthesiologist-resuscitator after consultation.

Preparation

Before surgery, the patient undergoes a series of examinations:

• General analysis of blood and urine;
• Biochemical blood test (total protein, albumin, urea, creatinine, bilirubin, ALT, AST, sodium, potassium, chlorine);
• Coagulogram (APTT, PT, fibrinogen, INR);
• Blood group according to the ABO system;
• Digital examination of the rectum (exclusion of inflammatory and purulent changes in the pararectal area, tumors, damage to bone structures);
• Electrocardiogram (ECG);
• X-ray of the OGK;
• Consultation with a proctologist;
• Anoscopy;
• Sigmoidoscopy;
• Gynecologist (women);
• Fistulography (indication – recurrent abscesses).

According to indications, the list is supplemented by ultrasound of the abdominal cavity and retroperitoneal space, CT and MRI of the abdominal cavity. By staining the tracts with methylene blue, the prevalence of pathological changes is clarified.

Cleansing enema – the day before and on the day of surgery. Hair is removed locally.

Procedure progress

The patient’s position is on the left side or on the stomach (the patient raises the pelvis, lowers and spreads the legs).

General procedure:

1. The doctor inserts a fistula probe.
2. Exposes the epithelial tract and stained tissue.
3. Removes pathological areas with surrounding healthy tissue (skin and subcutaneous fat).
4. Provides hemostasis (coagulation or suturing of blood vessels).
5. Washes the wound with antiseptic solutions.

Surgical treatment techniques:

• With blind suturing of the wound along the midline. Indications: minimal severity of inflammation, no infiltrates, distant location of the passages from the anus.
• With partial suturing of the wound.
• Without suturing the wound. Low risk of disease relapse. Long rehabilitation period (up to 1 year).
• With transfer of a flap of skin. A complex operation using plastic surgery techniques. Indication: extensive wounds and lack of tissue.

Manipulation time is 20-120 minutes. Depends on the severity and extent of pathological changes, the general condition of the patient, and concomitant diseases.

Depending on the scope of the operation and the patient’s condition, general or regional anesthesia is used. When administered spinally, the drug acts in the subarachnoid space; The epidural technique involves a different insertion site and sometimes a catheter. These techniques are selected by the anesthesiologist, taking into account contraindications and medications. They can provide high-quality pain relief, but do not guarantee the absence of pneumonia, thromboembolism and other complications. Early activation and risk prevention are included in a separate postoperative care plan.

Rehabilitation period

• The patient is transferred to the intensive care unit for dynamic observation for 1 day.
• Antibiotic therapy with broad-spectrum drugs – 5-7 days. Physiotherapeutic procedures (UV irradiation, UHF, microwave therapy) up to 2 weeks
• Getting out of bed is prohibited for 1 day. Walking is allowed from 2 days, sitting down only after a week.
• Drainage – washed for 1-2 days, removed on the 3rd day. Stitches are removed after 10-14 days.
• Wound healing – within 1 month.
• Work capacity is restored in 10-20 days.

Recommendations:

• compliance with hygiene rules;
• baths with antiseptic solutions (chamomile infusion, furatsilin, potassium permanganate) for up to 2-3 weeks;
• physical exercises and heavy lifting are allowed after 1-2 months;
• active lifestyle after wound healing;
• pain syndrome is relieved by taking NSAIDs (non-steroidal anti-inflammatory drugs);
• visiting a proctologist or surgeon – once every 1-2 months;
• wear loose underwear;
• up to six months, local hair removal once every 2-3 weeks;
• the diet is developed by the attending physician.

Before discharge, the attending physician will tell you in detail about the rehabilitation period.

Healing may take several weeks or longer depending on the method, size of the wound and individual recovery. Previously stated dates are not a guarantee. The estimated cost of the operation is given on the pricing page; The full calculation and care plan will be agreed upon with the surgeon.