About the Surgery
What Else Should I Know?
The cleft-lift procedure is generally performed under spinal or general anesthesia. With either form of anesthesia, you will be kept sedated so that you sleep throughout the procedure and won’t remember it.
How long is the operation?
The operation typically takes around one hour. There is an additional half hour of set-up after you are in the operating room and sedated. During this time, the operative site is shaved with special surgical clippers, and the skin coverage flap is measured and drawn. Please do not shave your natal cleft before surgery as you may create small cuts that increase your chance of infection.
Most patients experience very little discomfort from the operation. Most individuals experience some numbness on the side of the flap that can take around 6-8 weeks to completely go away. The numbness always goes away.
Most of the discomfort patients experience is related to minor irritation from the drain. The discomfort is typically well controlled with the 2 prescribed pain medications: Motrin and Vicodin or Norco. The Motrin should be taken regularly, three times a day with meals for the first few days, and the Vicodin or Norco only as needed for additional discomfort.
Additionally, you will be prescribed an antibiotic for one week after the procedure to decrease your chance of developing a postoperative infection.
A drain will be placed at the time of surgery. The drain looks like a thin rubber band. The purpose of the drain is to keep the 2 skin openings (at the top and bottom of the flap) from closing early after the procedure so that fluid can drain out from under the skin flap. You will receive instructions on how to take care of the drain at the surgery center or hospital. It’s important to have another person (you can’t possibly see the area well) roll a piece of tightly wound gauze (like a small rolling pin) up and down over the skin flap and drain twice a day to encourage fluid to drain from under the flap. This is important to roll out the fluid in this manner so that that the flap will eventually stick and heal to the underlying tissue.
For the first several days after surgery, there may be a fair amount of drainage (typically pinkish or reddish fluid). Place a thick layer of gauze pads over the drain sites and hold in place with the supplied mesh pants or tight-fitting underwear (boxer shorts won’t work). Please don’t use tape as it can damage your skin. The purpose of the gauze is to protect your clothing and furniture – so be careful to cover the area well for several days to avoid staining your furniture. Change the gauze when it becomes moist to protect your skin by keeping it dry.
After several days the amount of drainage will decrease and you will feel more secure leaving the house and possibly going to work or school.
Please make an appointment for 8-9 days after surgery (the Friday following surgery if it performed on a Wednesday) to have the drain removed. Don’t worry – removing the drain doesn’t hurt at all!
Please don’t exercise while the drain is in place. Walking is okay. You are allowed to sit on the operative site immediately after surgery (it actually helps push fluid from under the flap). Once the drain is removed, you may begin to exercise.
Yes. You can shower the morning after surgery. Make certain to remove all of the gauze first. It’s important to keep the wound dry after showering. Soaking in a bathtub, however, is not permitted for 2 weeks or until the wound is fully healed.
Can I sit down immediately after the procedure?
I recommend that you try and keep the wound clean and dry. Remove the gauze bandages when having a bowel movement or showering. Please clean the wound carefully after a bowel movement. Wet wipes or Balneol lotion on toilet paper works best. After cleaning or showering, blot the wound and your perianal area carefully with a towel, and then dry completely with a hairdryer on the ‘low’ setting.
Tight-fitting underwear is best to wear while recovering from the cleft lift as it helps hold dressings over the wound and compresses the operative site (discouraging fluid accumulation). The dressing applied after surgery is there to protect your clothing. Don’t use tape to hold gauze in place as it can injure your incision – instead use tight-fitting underwear to hold dressings in place.
Steri-strips (thin paper-like tapes with parallel fibers in them) will be placed on the skin across your incision. Don’t remove them. They are intended to support the wound and should be left in place until they fall off.
Will I have a scar?
Yes. The incision is generally 10-14 cm in length (4-5 inches). The length depends on the severity of the pilonidal disease and the shape/dimensions of your natal cleft. Please refer to the cleft lift diagrams for an image of the scar. The scar is cosmetically acceptable and is often difficult to see when standing. The scar will be red at first but fade and become less perceptible over the next 6 months.
When can I go back to sports?
Once your drain is removed (7-10 days after surgery), you will be encouraged to return to most activities. Bike, motorcycle, or horseback riding must be avoided for one month. Swimming or soaking in a tub should be avoided until the drain holes and incision have fully healed (generally a week or 2 after the drain has been removed).
- Around 20% of patients may have some minor incisional separation near the anal end of the wound. This is generally not a problem and should not delay recovery.
- An infected fluid collection can occur under the flap but is rare. It may delay your recovery; however, you should still end up with an excellent result. Since changing the type of drain placed at the time of surgery to one termed a ‘passive’ drain, no such complications have occurred.
Not as a result of the procedure. But – taking Vicodin or Norco can definitely lead to constipation and the prescribed stool softener should be taken also. If you go for a day without a bowel movement please buy Milk of Magnesia. It is available over the counter. Take 2 tablespoons every 8 hours until you have a BM.