My experience with the pilonidal cyst was confusing and painful at first, because I thought it was a deeply buried pimple, and as someone who has suffered from acne all his life, I wrongly normalized it; I'm used to getting those kinds of pimples every now and then that seem like they'll never finish draining. At the beginning, the sensation went from the midline between the buttocks toward the buttocks; my buttocks were even swollen and red. When it drained for the first time it took me by surprise because it was spontaneous and a lot of blood came out at first. I had already had pain for days before when sitting down, but I didn't want to touch it so as not to make the inflammation worse. When it drained I thought the problem had ended there, but no, days later it became inflamed and drained again. As this cycle continued, I felt the inflammation going down until there was only a small lump left that would drain and close, over and over, as the months went by. For various reasons I didn't get it treated sooner; I didn't pay much attention to it because I no longer had discomfort when sitting or felt pain. Talking with my wife, she told me I'd better go to her dermatologist to have it checked, and my wife entered all the symptoms into ChatGPT, I think even a photo too; the AI tool immediately identified it as a pilonidal cyst and said it could be solved with a simple in-office procedure if it wasn't very deep, otherwise it would require surgery. Obviously my first thought was that I hoped it wouldn't require surgery, but that if it was necessary I would do it. The dermatologist confirmed the diagnosis and gave me the order for an MRI, and the radiologist confirmed the diagnosis and mentioned that, because of its depth, I would very likely need surgery, which the dermatologist later confirmed when he saw the results. The dermatologist only prescribed Bactrim as a temporary measure to reduce the inflammation in the area as much as possible so they could do the MRI, but the truth is that at this point the cyst hardly bothered me at all; it was a very tiny lump that was only uncomfortable when it got a little inflamed and drained. Then he referred me to Dr. Meritxell, who, after a physical examination and reviewing the results, confirmed that I did need surgery, with a technique called Karydakis, to practically guarantee there would be no recurrence. She told me it wasn't urgent, that it was elective surgery, but that the sooner the better to keep the problem from getting worse in the future. I felt nervous because it had been many years since I'd had surgery, but Dr. Meritxell gave me confidence and I decided to do it as soon as possible.
When I finally got the authorization letters from the insurance company, the surgery was scheduled. I was nervous, but also grateful for the privilege of being in a good hospital, with insurance coverage and with a doctor who gave me confidence. My experience with the surgery was excellent. When they took me into the operating room, the anesthesiologist gave me medication through the IV, which I assumed was a sedative; she told me I might feel dizzy, tired or sleepy. I just moved onto the operating table and sat up so they could untie my gown and give me the epidural. By the time I lay down I was no longer conscious. I didn't feel it when I lost consciousness, I didn't even get to feel tired or drowsy, I didn't feel them giving me the epidural, or when I turned over. The doctors told me I was still conscious when they gave me the epidural and that I turned over on my own, but I don't remember any of that. In the blink of an eye I went from being in the operating room to being in recovery. The anesthesiologist mentioned that the anesthesia would last 3 hours; I slept for about 4 and a half hours by my calculations. By the time I woke up, I could already move my legs, so I never felt the effect of the epidural, which put me more at ease, since many people say they wake up when they still can't move their legs. When they moved me to my room I felt in good spirits, alert, with no pain.
During the recovery I never felt actual pain at any point, maybe because I have a high pain threshold. For me the postoperative sensation was more a feeling of tension, as if the skin of my lower back were being stretched toward my buttocks (because of the technique that was used), but without stabbing pain or burning, just a little uncomfortable. Besides, it didn't worry me because the doctor took the time to explain the technique to me, which included placing a skin flap, so it was an expected sensation that should ease over the days and weeks. Getting up and sitting down was uncomfortable the first few days, but never painful. The only thing that caused me slight pain was sitting for a long time, especially when putting even a little pressure on the wound. The doctor recommended buying a special orthopedic lumbar cushion and that helped me a lot, although over time I discovered that what caused me the most discomfort wasn't so much putting pressure on the wound, but sitting for a long time, so I started getting up more often. I think what bothered me more was having to look after the catheter they placed to drain the wound, because if I didn't pay attention to where it was when sitting or moving I could pull it or squash it and I felt slight tugs, but nothing out of the ordinary. Little by little I went back to my normal activities. After they removed the catheter at the second follow-up appointment (which, if I remember correctly, was one week after the surgery), I started going out for walks again, a little at first because as I widened my stride it felt a bit uncomfortable where I had the stitches, but nothing I couldn't handle; all I did was take shorter steps and problem solved. I started going to the supermarket again, getting my hair cut, etc., focusing mainly on not doing intense activity, doing my wound care and not putting pressure on the wound. I followed the doctor's instructions to the letter, which helped my wound heal quickly and without complications. About 2 weeks later, the doctor removed the stitches; she prepared me beforehand by telling me that some people could feel pain, but honestly I barely felt anything when they took the threads out, just small tugs, partly because all the tissue in that area was still quite numb. Once the doctor removed the stitches and discharged me, I kept taking precautions with my wound, since the procedure also involved placing internal stitches so the inner tissue would close too, so I preferred to keep taking things easy.
Today, 2 months later, honestly, sometimes I don't even remember I had surgery. I can walk completely normally and I've even started running very lightly, very short distances and only occasionally. My scar is barely noticeable, and besides, nobody sees it, so that's the least of it. Little by little I can stay seated for longer, but I got into the habit of getting up at least once an hour and I keep doing it. The only times I've felt uncomfortable are when I have to sit for a long time, for example: going to the movies or on a flight if the seats are very hard, or plastic chairs, but it's very mild and only happens when I've been sitting for a long time. I usually solve it by getting up and walking a bit or sitting slightly to one side and problem solved, but the truth is that this sensation keeps fading more and more; I think now it only happens if I sit on a very hard surface, like sitting on the floor to exercise, so I'm avoiding that for now. If I could sum up my experience, I'd say the postoperative discomfort was the same as or less than when the cyst was inflamed at its worst, and really the most acute part of the recovery was the first two or three days, but it wasn't a bad experience at all; it was uncomfortable but practically painless. Sometimes sitting hurt more when the cyst's abscess was inflamed.
Lastly, something that really stuck with me: the doctor told me that the tissue that was removed was sent to pathology as a matter of protocol and that I shouldn't worry because pilonidal cysts are usually benign. Of course I still worried, and when I looked into it I read that practically any cyst has the potential risk of developing cancerous cells if you leave it untreated for a long time. Because of this, I think that if I could do it all over again, I would deal with the problem sooner. For a while now I've decided to prioritize my health, and removing that cyst was priority number one. I'm grateful to Dr. Meritxell because she was spot on with the diagnosis and the prognosis, she was very attentive throughout the whole process, even helping me with other ailments I had during the recovery that weren't related to the cyst, and I'm also grateful to all the healthcare staff who looked after me during this process. If I ever needed a good surgeon again, I wouldn't hesitate to go back to the doctor (although hopefully it won't be necessary).
