During pilonidal cyst removal surgery, doctors apply anaesthesia, cut the cyst open, and remove all the pus, debris, and infected hair follicles, says MedlinePlus. Removing the cyst in its entirety is difficult, and even with surgery, the cyst may return. After surgery, the wound is either sewn shut, left open, or the skin is stitched into a pouch over the wound.
Generally, the first attempted procedure is incision and drainage, with the wound left open to allow drainage, according to MedlinePlus. This requires extensive care and changes of gauze packing over the following weeks, and can take up to four weeks to heal. Doctors can perform this type of incision and drainage in a doctor's office rather than a hospital or surgical center. When the doctors leave a pouch rather than a fully open wound, the procedure requires a hospital or dedicated surgery center, and takes up to six weeks to heal.
Surgery is always required to treat an infected pilonidal cyst, as antibiotic medications are unable to cure it, states MedlinePlus. If there is no infection, the cyst does not require surgical treatment. In these cases, patients may shave the hair in the area or have laser hair removal treatments. Doctors may also inject surgical glue into the cyst cavity to prevent infection.