Wednesday, 21 March 2012

Modifed Karyidakis Procedure for treatment of PIlonidal Sinus Day 1-3

I have a pilonidal sinus.

I've had this problem for about 7 years now. I still remember my first flare up when I innocently when to the GP for some cream believing it was a haemorrhoid. Boy, was I wrong.

The facts from here forward are from the Pilonidal Support Alliance which have been an amazing resource for all fellow Pilonidal sinus sufferers. For those who don't know:

"A Pilonidal (Abscess, Cyst, Sinus, Dimple) is an abscess in the natal cleft (more commonly referred to as your butt crack) that tends to become infected and cause intense pain and drainage. Sometimes a Pilonidal contains hair and sometimes they don't."

After having 2 surgeries for it: excision with primary closure (stitches in the midline), followed by excision with open healing (daily wound packing for 5 weeks), both of which i recovered well, unfortunately for the sinus to reoccur promptly after. I decided to self fund a procedure called the Cleft lift or Modified Karyidakis procedure through a private general surgeon in Melbourne.

"What it is - These are both very similar procedures developed in-line with discoveries by Karydakis about the origins of pilonidal disease. In the Cleft Lift, the actual shape of the cleft is changed to be more shallow and allow for better healing. The surgery was originally developed to deal with surgeries that had failed to heal or continued to recur and is now being done more and more as a first surgery.With the both techniques, the surgeon removes an ellipse as he/she excises the pilonidal. The resulting defect, a football shaped ellipse or "cavity", lies parallel to the midline but to one side. The surgeon removes the medial edge of the buttock. To cover the "cavity" the surgeon undercuts the other side and pulls across the midline a flap of skin and thick fat becomes shallow and the single suture line lies in open air to the left of the midline. By almost flattening the cleft, the gathering of loose hairs is less likely, and the there is no portal of entry left for hair entry (they always enter a midline hole, not one on the side), thus greatly reducing the risk of recurrence.. The now less-deep cleft is also less of a happy harbor for anaerobic bacteria. One of the key elements to both the Cleft Lift and the Modified Karydakis are that all incisions are made to the side of the midline, never right down the middle. All wounds are closed with sutures and tissue removal is minimal."

 So on the 19th of March, I headed off to a private hospital in Melbourne's north for the procedure. I am both optimstic and skeptical of this procedure. Optimistic because of the great rapt I've heard about it online. Skeptical because all prior operations I've had to date have failed me. The operation will cost me approx 850 dollars, with close to half of that claimable through Medicare. Theatre and day case bed will be completely out of pocket=$1400.

My room

IV Cannula in the L)cubical fossa.

 I waited from 0730 till about 1030 before I was taken to theatre. Surprisingly, I wasn't too nervous. I've never had issues with anaesthetic and in fact find them quite pleasant. My anaesthetist was lovely and told me that I shouldn't be expecting a bill from him as I am a nurse. He gave me a shot of Midazolam in the IV and I was off to lala land. When I woke up, I spent a few hours in recovery, mainly because the ward was too busy to look after me. For your information, I am told nurse patient ratios at a private hospital is 1:5 or 1:6. When you have to do half hourly observations on a post op patient, that becomes a lot of hard work. I waited a long time on the ward for my pain relief or even water to be given. A division 2 nurse did my observations a few times but I found her to be pretty useless.

Anyway, the next 2 days I spent quietly at home. I am able to sit for short periods and generally have no pain at all. One issue is that I got my period the day after my operation which made it all a little less pleasant. I have been put on two different antibiotics, Flagyl and Keflex, prophlactically and thankfully have had no issues so far. In fact, I have just taken part of the dressing off as per my surgeon's advise and had my first shower in 2 days! It feels soo damn good!

Day 7 or Monday will be my follow up appointment with the surgeon. There I will have my dressing and sutures removed and hopefully, there will be no sinus, a shallower cleft and no pain!

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