The treatment depends on the severity of the disease. As long as there is no larger abscess (coccyx abscess), which can be determined by clinical examination, possibly also with the help of an ultrasound examination, the inflammation can initially be treated conservatively, i.e. without surgery.
Externally, moist compresses and regular disinfection of the coccyx furrow help to reduce the infiltration of additional germs through the open pores. Antibiotics are administered internally. In many cases it is possible to calm the situation down. After that, the surgery required for healing can be performed. If the first examination already shows a coccyx abscess with a larger accumulation of pus, the fastest way to heal the inflammation is to make a small incision, which in suitable cases is done painlessly under local anesthesia or, if the findings are more severe, under general anesthesia.
In this procedure, the tissue that has already been destroyed is removed, the pilonidal sinus is not excised and no large wound remains. The wound cavity is regularly rinsed by the doctor over the next few days via the small incision and closes within a few days. A final cure is not yet achieved, but only optimal conditions are created for the plastic surgery required for permanent healing.
The Karydakis operation or its modification according to Bascom is recommended for the final elimination of a sinus pilonidal disease. The principle behind this procedure is to flatten the gluteal fold in the upper third in order to reduce the pumping effect when sitting and standing up. Furthermore, with this procedure, the resulting surgical scar is not placed in the gluteal furrow but next to the gluteal furrow, so that sweat running down from the back does not run over the wound or later scar and can damage it.