Preparing for pilonidal surgery: it’s pretty simple.
We start all patients on antibiotics before surgery, and continue them for a total of a week. We usually use a combination of ciprofloxin, and metronidazole (Cipro and Flagyl). If we are sure surgery is planned, we will start them orally the evening before surgery. If not – we start them intravenously right before the procedure. Either way, we continue them orally post op for almost a week. We recommend taking a quality probiotic starting before the surgery and continuing for a few months after you finish the antibiotics. We recommend Ther-Biotic Complete, from Klair Labs, one capsule daily, as an excellent choice.
If you are going to have an operation you must not have had anything to eat after midnight the night before the surgery (or eight hours before the surgery if it is late in the day). You can have clear liquids up until three hours before the surgery. Clear liquids include water, juice, Jell-O, tea, black coffee, etc. If these instructions are not followed, the anesthesiologist may cancel the procedure.
It is also important that you go into surgery well nourished, and that you stay nourished during the post-op healing period. This especially means plenty of protein, and certain particular vitamins. This link will take you to a page that discusses certain vitamins and supplements that will promote pilonidal wound healing. Dr Immerman would like you to start these as long before the operation as possible, and continue them for at least six weeks after the operation.
There are no enemas or laxatives given for the procedure, but post op constipation can be a problem because of discomfort in that area coupled with the constipating effect of many pain medications. It is a good idea to start a stool softener a few days before surgery, and continue it for a few days afterwards.
We do NOT recommend that you shave the area before surgery. Shaving has been shown to increase wound infection rates. The operating room staff will use surgical clippers to trim the hairs in the area after you are asleep. We do not recommend shaving the area after surgery either.
There is no specific pre-operative testing needed, as long as you are under 40 and in good health. Of course, if you are on certain medications or have medical problems, appropriate testing will be needed to insure that the anesthetic can be given safely.
This procedure will be peformed with you asleep. A long acting local anesthetic is also injected to help with post operative pain control.
If a cleft-lift is performed, a drain is placed which needs to remain in place a minimum of 4 days. We have had patients stay in Eau Claire for a wound check and drain removal at 4 days; or come back in 5-7 days; or have a surgeon, nurse, or wound-care specialist back home check the incision and remove the drain. We are happy to work with other physicians to make your recovery as easy as possible.
We have had many patients drive several hours to get home the same day as the surgery and that seems to go well, but can make for a long tiring day for everyone involved. The next day might be better. Sitting is not restricted after the surgery, but if the vehicle is roomy enough to allow changes in position, that is optimal.
We do not recommend getting on a plane the day of surgery. We’ve had several patients fly home the next day – but we feel that is pushing it a bit. Our recommendation is that you give yourself a couple of days to recover before attempting to go on a flight.