General risks

·      Wound infections – This is due to the proximity to the anus. We take precautions. You will receive antibiotics at the time of operation. You will also go home with a course of antibiotics.

·      Pain – We will infiltrate the operative site with local anaesthetic agents and the anaesthetist will give you pain relief intra-operatively. Please take regular pain relief for about 3 -5 days when you are discharged.

·      Chance of recurrence (30%) – Recurrence is a common issue after any operation for pilonidal sinuses or peri-anal fistula. This is mainly due to the disease pathology and the individual risk for pilonidal sinuses. Missing a minuscule sinus/fistulous tract that can’t be demonstrated at the time of the operation will also contribute.

·      Risk of incontinence (only applies to VAAFTs) – As the procedure involves examination of your rectum with finger and proctoscope, there is a small risk of incontinence. This occurs due to stretching of anal muscles. If this occurs, it will be only for air and liquid stools. This will settle with time. However, major incontinence is unlikely – given that if the fistula is traversing anything more than few millimetres of the anal muscles, a lay opening will not be undertaken.

·      Deep venous thrombosis (DVT) and pulmonary embolism (PE) – as it is going to be a day case and you are expected to be mobile soon after you recover, the risks are low. We will use automatic compression boots and stocking to reduce the risks. Please mobilise as much as you can after the operation and drink plenty of water to help. If you smoke, or if you do take contraceptive pills or if you have a history of clots or increased risk of clotting – then you need to be extra causes and it is worthwhile using the stockings for at least 2 weeks after the operation.

·      General anaesthetic (GA) risks - These will be explained to you by the anaesthetist on the day. Risks are low and will depend on your previous medical history

Post op care

·      You will recover in the ward and will be discharged on the same day

·      As you had general anaesthesia – you are expected to be accompanied by an adult for at least 24h

·      Please mobilise as much as you can after the operation and drink plenty of water.

·      Take regular pain relief (will be supplied on discharge) at least for about 5 days

·      You will go home with a course of antibiotics.

·      You will be given a pack of 20 saline vials and 20 syringes. Please syringe the outside opening of your fistula or the pilonidal sinus with about 10 ml of saline twice a day (in the morning after cleaning after going to the toilet and again at bedtime). It is best performed by someone else at home to make sure the wound is syringed properly.

·      Please expect a wound discharge for about 3 months. During this time, keep an absorptive pad (a sanatory towel or a breast pad) over the wound to soak any discharge. Please change these frequently when they are halfway wet.

·      After EPSITs - You will be advised to keep the entire back (from shoulders to bottom crease of your buttocks) hair free. You can resort to shaving, depilating creams of laser. Although this is to prevent a recurrence, this will not guarantee that though!

·      Please don’t drink alcohol for 2 days after the operation

·      You will see me for a post op check-up at the hospital in 3 months. Please meet your GP if you have any concerns unrelated to the operation

·      After discharge - you will receive a telephone call from the nurses to see how you are. However, if you have any concerns after the operation, please ring the Oaks ward (number will be given on discharge) and speak with a nurse who will escalate your concerns directly with me.

·      Please ask the nurses if you need a sick note