Comparison
The method according to Karydakis is a surgical method in which the tissue ends are sutured together again under general anesthesia after removal of the complete fistula system, or the wound heals openly. This type of surgery is possible for almost every patient, while pit-picking is not always possible.The pit-picking method also determines how long the fistula has existed, because the earlier it is treated with this surgical method, the lower the relapse rate. With Karydakis surgery, the time period is not important and fistulas of any age can be treated.
After a conventional operation (after Karydakis), an inpatient hospital stay of about three to four days is almost always necessary. Only on discharge is the drainage tube (the tube that conducts secretion from the surgical wound) inserted during the operation removed. If stitches were sewn in, they are removed 10 days later by the family doctor.
If the operation wound is not closed and the wound is treated openly, a very long therapy period must be planned. The dressing must be changed at short intervals by a large amount of wound secretion or the sponge must be replaced in the case of vacuum wound treatment (NPWT). For a time determined by the doctor, the patient will not be allowed to sit or lie on his back.
Sitting baths can be taken to aid wound healing, and after defecation the wound should be carefully washed out with water. If the procedure was performed under general anesthesia, patients are not allowed to drive a car or drive other vehicles or machines on that day or for 24 hours. A healing time of about 4 weeks is scheduled for pit-picking.
After this time, a control examination should also take place. After these four weeks, after a successful surgery, there should be no wound secretion in the underwear or the pad, before that it is completely normal, even if it sometimes contains pus. During the healing period after the pit-picking, patients are allowed to do everything in terms of sports, bathing, sauna, etc.
However, shaving at the treated area should be avoided. Since the wounds are comparatively small due to the small pits, special wound treatment is usually unnecessary. Only cleanliness should be taken care of.
If a coccyx fistula occurs again, pit picking can be repeated. Especially minimally invasive procedures such as pit-picking or other outpatient procedures can be relatively painless for the patient. Intraoperatively, the area is anaesthetized either under regional or local anaesthesia, so that there is no pain even when the patient is awake during the operation.
Occasionally one feels some kind of pressure, but pain is not. With general anesthesia, the patient is also free of pain during the procedure. Postoperatively, especially the minimally invasive procedures are rather painless.
If necessary, ibuprofen is usually prescribed to relieve pain. During open surgery or complicated wound healing, stronger pain may be experienced, but this is not necessarily the case. Whether pain is present and how severe it is varies greatly from patient to patient and should be discussed individually with the treating physician.
In the case of good wound healing, a need medication with ibuprofen is usually sufficient. The intensity of pain is then at its greatest in the first post-operative days and subsides significantly after about 3 to 4 days. Often the pain only occurs on the second postoperative day.
However, there are also many patients whose healing process is largely painless, so that great pain is not necessarily to be expected. The size of the wound also shows no linear relationship with the intensity of pain. However, if very heavy bleeding, pain or other complications such as wound infection occur, it is advisable to contact the treating physician immediately and discuss this.
Postoperative bleeding can occur during the postoperative wound care of a pilonidal sinus. They are more frequent during secondary (open) wound healing. If the wound is closed intraoperatively with a suture, secondary bleeding is somewhat less frequent and postoperative follow-up is easier.
However, the rate of recurrence is significantly higher in primary wound closure (wound closed with a suture) than in open wound healing, so the latter is often preferred. Careful and cautious wound care is important to avoid or prevent secondary bleeding. As a rule, this is showered out once a day or creamed with an octenisept ointment and freshly dressed.
There are sometimes different opinions regarding the care of the wound. Some doctors do not recommend showering the wound, as this leads to mechanical stress on the healing tissue and thus to possible bleeding. It is important to loosen the dressing carefully to protect the wound.Postoperative care is often carried out on an outpatient basis in the treating practice or clinic to ensure good wound management and minimize the number of postoperative bleedings.
If care is provided at home and uncertainties in care arise, it is advisable to contact the treating physicians. In addition, strict abstinence from nicotine should be maintained for good wound healing. This also promotes fast and good wound healing.
For the healing of an operated coccyx fistula, it is necessary to care for and protect the wound as much as possible. Otherwise, wound infections, pain and secondary bleeding can occur. In postoperative care and rest periods, there are differences in the treatment of open wounds in comparison to primarily closed wounds.
It is not possible to make any precise predictions in advance as to how long the definitive healing process will take. It usually takes at least two weeks for medium and small wounds to heal. In addition, however, care should also be taken during sports activities to ensure that the tissue is not subjected to excessive stress.
In the case of open wound healing, however, wound closure can also take up to 8 weeks. In the first weeks after the operation, the healing process can be better assessed, so that more precise statements can be made about the duration of the sports leave if necessary. In the case of a “pit-picking” operation, however, it is possible to resume sports activities immediately after the operation. However, not all fistulas are suitable for this. In particular, patients who have been operated on in the past with coccyx fistulas are less suitable for this procedure, since recurrences can occur in up to 20% of cases.
