Operating procedure in our practice

Patients presentation

A prior examination and discussion of the findings is always important. For this purpose, patients must book an appointment via our online appointment calendar DOCTOLIB in our sinus pilonidalis consultation.


Appointments can be booked online under "Allgemeinchirurg" with Dr. Hertzsch, Dr. von Rüden, Dr. Klage-Kranke, Dr. (Univ. Belgrade Sepe) and PD Dr. Jacob.


After the consultation and examination, the optimal therapy will be discussed and planned. Please keep in mind that not all findings can be operated minimally invasive.


According to German law, planned operations may only take place 24 hours after the operation has been explained, i.e. not on the same day! In the case of acute inflammations (abscesses), however, immediate surgery is possible.


Currently, our operations under local anesthesia take place in the morning on Monday, Tuesday and Wednesday. Operations under general anesthesia are performed only on Thursday. All operations are only carried out at the Lankwitz location.


For operations under general anesthesia, you will need an additional consultation, which we will give you. In addition, after the time in the recovery room, you must be picked up by a trusted person and, according to the law, you are not allowed to spend the first night alone at home. 


Operation day

Operation with local anesthesia

On the day of surgery in LOCAL ANESTHESIA, patients can anesthetize the skin area in the surgical field. For this purpose, we give a prescription for local anesthesia at the time of consultation. For this purpose, please spread the entire tube (e.g. 5g Lidogalen) evenly 30-60 minutes beforehand. Also, an ibuprofen tablet (400-600mg) can be taken beforehand. We also recommend eating and drinking before the procedure (not for general anesthesia!). You do not have to be sober.


Please wear dark underwear, preferably black, in case of minor bleeding.

After registration in our office, we will escort you to the operating room and you will have to lie on your belly. Then the skin is shaved, as hair interferes with wound healing.


Now the local anesthesia with Xylocain is applied, which is a bit unpleasant for 10-20 seconds (feeling of pressure, burning). 


After that, the actual operation takes place. First the disinfection, while cold and pressure are still perceived, which is quite normal. Only the feeling of pain is anesthetized. The covering and the actual operation follows, which takes about 10-20 minutes.


Finally, we apply a tight bandage and the patients have to sit in our waiting room for about 20 minutes after leaving the operating room. After that we check if there is any postoperative bleeding. If the bandages are dry, the patients are allowed to go home. Before that, we will give you prescriptions for wound compresses, painkillers if necessary, and an AU certificate (sick note), if required.


Operation under general anesthesia

On the day of the operation in GENERAL ANESTHESIA, patients must be fasting for 6 hours, so they are not allowed to eat or drink anything. An exception is non-carbonated water, which may be drunk up to 2 hours before anesthesia. However, this has been discussed with the anesthesiologist one day before.


Please wear dark underwear, preferably black, in case of minor bleeding.

After registration in our practice, we will escort you to the recovery room and you will have to put on a surgical shirt. Then you will be given a vein in your arm and a painkiller. You will also have a second consultation with the anesthesiologist. 


After that, you will be in the prone position for the actual surgery, which will take about 20-30 minutes. After the operation, you will be taken to the recovery room to recover from the anesthesia. After one hour you will be allowed to leave our practice accompanied by a pick-up.


Before that, we will give you prescriptions for wound compresses, painkillers if necessary, and an AU certificate (sick note), if required.


First evening/night

We ask you to be very quiet on the first evening and not to sit on a hard chair etc. (no desk activity). A soft surface such as an armchair, sofa or bed would be best. 


If there is too much movement in the buttock area, the dressing may come off and there may be persistent bleeding. If this happens, please take a dark towel and press it on the wound for 10 minutes. Most of the time it will stop bleeding after that. However, if it continues to bleed, we ask you to come back immediately, or after 5 p.m. to the nearest hospital. Even if it looks bad, you will not lose much blood in the process.  


Although the wounds are not too painful, you can take up to 3 tablets of ibuprofen 400-600mg if needed. If you take it for more than 3 days or if you have stomach problems, we will prescribe you a gastric protector (e.g. Pantoprazole), of which you should take one tablet at night.


First day after the operation

On the first day after surgery, you will have an appointment in our practice. Here we make the first dressing change. If the wounds are inconspicuous, there will be no further checks in our practice. Now your body has to do everything else. 


The wound care afterwards is very simple. The small wounds have to be washed out in the shower for 1-2 minutes in the morning, in the evening and after every bowel movement during the first week after the operation. Then dry the wound carefully with a towel and fold a compress in the middle and place it between the buttocks. If necessary, a wound ointment (e.g. panthenol) can be added.


Important: These are open wounds. Therefore, open wound healing occurs, which releases fluid that is orange/red in color. In addition, fibrin is formed as part of the wound healing process, which is equivalent to an endogenous glue. This fibrin is yellowish and slightly slimy, not pus. This is completely normal and no cause for concern. 


What is the next step?

In case of larger wounds we make another control after approx. 3-5 days. After that, there is no scheduled wound control, or if necessary, you can see your family doctor.


The time it takes for a wound to heal completely can vary greatly. With pit picking, small wounds should be completely healed after 6-8 weeks. If a small wound is still open at that time, we will ask to see you again for a checkup. 


You can present at any time if there is a deterioration:

  • The wound suddenly smells bad or is very painful (fibrin is not pus!).
  • There is recurrent bleeding (not the normal wound water)
  • Small wounds have not healed after 8 weeks and larger wounds after 12 weeks.

Please always keep in mind. Despite the great success, the coccygeal fistula can return in 20-25% of cases (recurrence). Wounds that do not heal are considered recurrences. Before a new operation is planned, however, all non-surgical options should be tried.