Pilonidal Sinus Surgery in Brisbane
Definitive treatment for pilonidal disease — from minimally invasive pit-picking to low-recurrence flap repair — by Brisbane general surgeon Dr Goutham Sivasuthan, across Brisbane, Redland, Moreton Bay and Logan.
Expert treatment for pilonidal disease
A pilonidal sinus is a small tunnel or cavity under the skin near the top of the buttock crease, usually containing hair and debris. It commonly causes recurrent infections, and surgery is the definitive treatment for persistent or recurrent disease.
Pilonidal disease most often affects teenagers and young adults — particularly men and people with coarse body hair or sedentary lifestyles. Left untreated, it can develop into a painful abscess, a chronic draining wound or repeated infections. Dr Goutham offers personalised treatment, from minimally invasive procedures through to advanced low-recurrence surgical techniques, for lasting relief.
What causes pilonidal disease?
- Trapped hair — loose hairs work into the skin of the natal cleft, triggering inflammation and infection.
- Prolonged sitting — increases pressure and friction over the area.
- Coarse or dense body hair — more likely to become embedded.
- Moisture and friction — weaken the skin barrier, making infection more likely.
- Excess weight and deep skin folds — create a favourable environment.
- Hormonal changes in adolescence — increase oil and hair growth.
Signs and symptoms
- Pain and tenderness in the buttock crease, especially when sitting
- A small pit, lump or swelling near the tailbone
- Redness and warmth over the area
- Pus or bloody discharge from a skin opening
- Foul-smelling drainage if an abscess forms
- Fever and feeling unwell in more severe infections
How pilonidal disease is diagnosed
Pilonidal disease is usually diagnosed by examination — Dr Goutham looks for the characteristic midline pits and any swelling, tenderness or discharge. Imaging is rarely needed, but in complex or recurrent cases an MRI may be used to map the extent of the sinus tracts before surgery.
Treatment options
Treatment is matched to the severity of the disease, from simple drainage of an acute abscess to definitive surgery for recurrent disease:
Abscess drainage (I&D)
A small incision releases the infection, easing pain and swelling. Modern approaches often need no packing, and the area heals over a few weeks.
Pit-picking
Tiny incisions remove hair and debris from the sinus tracts, with less downtime and a faster return to activity — ideal for mild to moderate disease.
Excision ± closure
The affected tissue is removed; the wound is either left to heal naturally or closed, depending on the case.
Flap repair (Karydakis / cleft-lift)
A flap technique that flattens the cleft and moves the scar off the midline, promoting faster healing and significantly lowering recurrence — valuable for severe or recurrent disease.
Recovery and wound care
Recovery depends on the procedure. Minimally invasive options allow a quicker return to activity, while wounds left to heal naturally take longer but need only simple dressing changes. Good wound care is essential to a durable result: keep the area clean and dry, attend dressing reviews, avoid prolonged sitting early on, and keep the surrounding skin free of hair (by clipping or other methods) as advised. Dr Goutham provides a personalised aftercare plan and follow-up.
Preventing recurrence
Pilonidal disease can return, so prevention is part of treatment. Keeping the natal cleft clean and dry, removing or reducing hair in the area, avoiding long periods of unbroken sitting, and maintaining a healthy weight all reduce the chance of recurrence. Low-tension flap techniques further lower recurrence for those who have had repeated problems.
Lasting relief, lower recurrence
- ✓Advanced techniques — minimally invasive and low-recurrence flap repair.
- ✓Tailored treatment — matched to your disease and lifestyle.
- ✓Recurrence prevention — practical strategies to keep it from returning.
- ✓Rapid recovery focus — quicker healing and return to daily life.
- ✓Care close to home — Brisbane, Redland, Moreton Bay and Logan.
Pilonidal disease FAQs
Will my pilonidal disease come back after surgery?+
Recurrence is possible, but low-tension flap techniques such as the Karydakis or cleft-lift significantly reduce it compared with traditional midline excision. Good wound care and hair control also help.
Is pit-picking better than excision?+
For mild to moderate disease, pit-picking offers less downtime and faster recovery. More severe or recurrent disease is often better treated with excision or flap repair. The choice is individualised.
How long is recovery?+
Minimally invasive procedures allow a faster return to activity, while open wounds left to heal naturally take several weeks. Dr Goutham will explain the timeline for your specific procedure.
Does a pilonidal abscess always need surgery?+
An acute abscess is first treated with incision and drainage. If you have had repeated abscesses, definitive surgery is then recommended for a long-term solution.
Can I sit normally after surgery?+
Prolonged sitting is limited early in recovery to protect the wound. Most people gradually return to normal sitting over a few weeks as healing progresses.
How do I stop it coming back?+
Keep the area clean and dry, reduce hair in the cleft as advised, avoid long unbroken periods of sitting, and maintain a healthy weight.
Is the surgery painful?+
The procedure is done under anaesthetic so it is not painful at the time. Afterwards, discomfort is usually well managed with simple pain relief.
Will I need time off work?+
Most people need some time off depending on their job and the procedure — desk-based workers usually return sooner than those whose work involves prolonged sitting or physical activity.
Caring for South-East Queensland
Dr Goutham consults and operates across Brisbane, Redland, Moreton Bay and Logan — care close to home, wherever you are in South-East Queensland.
Trusted resources
Last medically reviewed by Dr Goutham Sivasuthan, specialist surgeon — June 2026.
Recurrent pilonidal infections or discomfort?
Book a consultation with Dr Goutham to discuss the best treatment and a permanent solution.