Surgery No.1 – Excision with simple primary closure [NHS]

Surgery: 06/12/05

The quick summary
This first surgery wasn’t very successful. I was in and out the same day and came away with a very neat scar stitched with permanent stitches about 8cm long straight down the mid-line of my buttock cleft. Everything went downhill rapidly after about two weeks. I got a post surgical infection, the skin healed fine but the wound partially broke down underneath. I had the stitches out successfully, but the wound never healed up and after about 5 months I was back for op no.2. The whole experience with the NHS also wasn’t too good for me. I don’t want to knock the NHS and the doctors and nurses who I saw were very nice to me, but unfortunately the severe lack of staff and funding is still a huge problem and everything happened far too slowly, which was very frustrating.

The detailed account
My first Pilonidal surgery was done as an outpatient at the Royal Surrey County Hospital. I had private medical cover but at the time I believed that my insurance wouldn’t cover the surgery, for reasons I won’t go into. I’m not going to talk about the day of the surgery and the experience because it’s pretty much the same as everyone’s experience of surgery, except to say that it was done under general anaesthetic, I was about 7 hours late going down for surgery because the Surgeon wasn’t available (good old NHS) and I went home after a few hours of recovery.

I was surprised by how painful it wasn’t. Compared to the constant dull pain of the sinus before. I was optimistic, I could feel that it had gone. I didn’t dare sit for a few days, in fact the only time I sat was to go to the toilet which was quite painful, not to mention rather tricky with a huge bandage taped over a large part of my buttocks, and I dreaded it every day. I was given Lactulose to “soften the stool” which initially I didn’t take – big mistake. Laxatives are good for post surgery. My first appointment with the nurse at my surgery was about 5 days post op, it should have been sooner with the district nurse and I’m going to say this once but not dwell on the point. At this time I did not had a good experience at all with the whole district nurse thing. My advice is be pro-active and be pushy. If you’re going to have surgery on the NHS as an outpatient, book your first appointment with the nurse for a day or two after the op BEFORE you go in for surgery. Local authorities and GP practices differ and you’ll know what it’s like in your area but generally they’re booked up a good few days in advance at least. If you can’t get an appointment, be pushy tell them you really need the wound looked at. Closed wounds are particularly vulnerable to infection, is the consensus, I concur. In the NHS system when you’re discharged from hospital after an operation that’s it, they don’t want to have anything more to do with you. You’re in the care of your GP from then on, but GP’s surgeries are generally very busy and you can end up being left in limbo land, where because they haven’t seen you yet, nobody really cares about you. The hospital tells you your district nurse will come out to you, but they don’t know that at all, it seems to me that the two organisation’s don’t communicate. Again this may vary from PCT to PCT but in Surrey this was my experience.

So week 1 and 2, went well, the nurses said the incision was very neat, about 8cm long I’d say. Pretty much straight down the mid-line of my buttock cleft. I didn’t get it wet and the dressing was changed every few days. The incision had a small section at the base which wasn’t stitched closed, this was to enable the wound to drain if necessary I was told. 2 Weeks and one day and the nurse changing the dressing was alarmed by the fact that there was a large amount of fluid coming from the wound. She asked me whether it hurt, I didn’t think that it hurt any more than I expected. After all I’d just had an operation. However after subsequent surgeries, I now know that it did, it hurt a lot compared to my subsequent surgeries but I didn’t realise what it should feel like at the time. The doctor was summoned and I was told I had an infection in the wound given antibiotics and told the wound may break down completely. It didn’t, but that was pretty much game over from then on.

I had the stitches out after just over two weeks, it bled a lot at the time. The wound continued to heal after a fashion but that hole at the base of the wound never closed and would break down inside tracking upward, heal a bit, then break down again. I started to get pain at the original site of my abscess, I told this to everyone at my surgery who saw the wound, they were sympathetic but not too worried and were convinced it would heal eventually, so I went through about 4 months of wound packing with Aquacel (which is amazing stuff) and many courses of antibiotics. This was a pretty low period, but I didn’t really know what else to do, I trusted the staff at my GP practice that it would eventually heal, even though it still hurt. I knew that keeping the area free of hair was important, though this wasn’t something I was told after the operation at the hospital, and the nurses at my surgery were happy to shave it for me or use depilatory cream, but the consultant didn’t seem that bothered about it when he removed the stitches. He agreed that it would be a good idea but didn’t stress the point. After about 4 months of this I and the nurses decided I should try to get another appointment with the consultant at the Royal Surrey, though the nurses said it was unlikely that the consultant would suggest anything different that could be done (they were right). Getting the appointment involved being re-referred by my GP, because of the ridiculous NHS bureaucracy, it took a long time but eventually I got an appointment for the 24th April. All this time I was off work or working from home. The day of my appointment at the hospital came, the consultant looked at it, didn’t even remove the packing, and assured me that it would heal eventually, the whole consultation took about 2 minutes. I was pretty peeved.

I then decided to explore the possibility of getting an appointment to see the same consultant privately, and worked out that in fact I would be covered by my health insurance. So I booked a private appointment, which was a wholly different experience, and to cut a rather boring long story short I was scheduled in for a re-excision of the area, about a week later.

Surgery No. 2