Another Cleft Lift Recovery Post (UK with Mr Carapeti)

Hi all - haven't seen too many updates post-procedure with Mr Emin Carapeti of London Colorectal Group, so thought I would post one.

History:
Female patient. Pilonidal sinus first presented around 1999. No further flare-ups until 2012. Recurrent inflammation about twice a year until I&D in 2016. No recurrence until 2019; second sinus formed with approx. biannual abscesses. No further procedures prior to cleft lift with Mr Carapeti in 2023.

Pre-Operation Consult & Scheduling:
I initially went for a consult with Mr Carapeti in May hoping for an EPSIT procedure. He suggested the cleft lift instead, as he cited an approx. 30% recurrence rate for EPSIT patients unless they are in very early stages of the disease (one pit, short tunnel, etc.) and that it wouldn't be his recommendation in my case. According to him my case was very straightforward (two sinuses, well located far from the anus, no prior surgeries other than the I&D to complicate things) so would respond super well to a cleft lift, but be a bit too long in length for EPSIT to be as effective. He said he does a lot of cleft lifts, many of which are complex for recurrent disease and people who have had prior excisions or other procedures that have failed, so I got the sense his experience is quite significant. He cited a 3-5% recurrence rate for cleft lifts, with better outcomes for patients who have not had prior excisions. He said he'd be willing to have his colleague do EPSIT if I preferred that as a less-invasive first step, but the comparatively much lower recurrence rate was enough to convince me to just do the cleft lift and be done with it.

Scheduling (private care) was very easy for the date of my choice in July, which I scheduled in June - he operates on Tuesdays at London Bridge Hospital. All paperwork done in advance online, as well as online payments and scheduling of follow-up appointments at two and eight weeks post-procedure.

Total costs = £250 for initial consult + £5000 for hospital stay and pain meds + £1350 for Mr Carapeti's fee + £275 for anesthetist fee. I am going to claim reimbursement from my private insurance (it's US insurance so not accepted by the hospital) -- if I was fully self-paying the hospital stay would have been £3650. I will have 1-2 more follow-up visits with Mr Carapeti which are a bit cheaper, and he said I can go to my GP to have the drain removed to avoid coming in for that visit.

Day One:
I was assigned a 7am arrival time. Checked into a lovely private room with a gorgeous view of the Thames and St Paul's -- my husband was allowed to come up and wait in my room as long as he wanted. The intake nurse was absolutely lovely and welcoming. Anesthesiologist was really good as well -- friendly, welcoming, and gave good information. Had a check-in with Mr Carapeti and was scheduled as his second surgery of the day for approx. 9:45 start time. He gave me a brief refresher on the procedure, drain removal (Day 4 (Friday) unless it's draining a lot, in which case Day 7 (Monday)), and pain medication and antibiotics regimen. My only real criticism is that he runs through things rather quickly, so had I not taken notes on the notepad in the room I would've left not feeling completely clear on what's expected. He also makes it sound like this surgery is really no big deal, which builds confidence ... time will tell how accurate that is!

We ended up starting at 10:30 because the prior surgery took longer than expected. Hung out in the anesthesia room with a super friendly care assistant who chatted and put my mind at ease; the anesthesiologist and his assisting nurse were also super friendly and helped to relax me as they administered the anesthesia. Anesthesia process was nothing to worry about -- a tiny pinprick when the cannula was inserted on top of my hand, got a bit woozy with the painkilers, then out in seconds once the anesthesia was administered. Was told the anesthesia can be cold or sting a bit but I didn't feel a thing.

Woke up in recovery on my back, which was a little uncomfortable but definitely bearable (pressure more than painful). Another very friendly recovery nurse checked my vitals and monitored, and Mr Carapeti came in for a quick update: he said the procedure went perfectly and that I should have an easy time healing. Also told me the second check-up at eight weeks could be virtual (just send pics) if everything was healing well, but to call if I had any questions or concerns along the way, send pictures, anything I needed and they'd support.

Headed up to my room after 15 mins awake in recovery. Transferred from the gurney to the hospital bed without any pain. Found it more comfortable to lie on my side, and my nurse said I was fine to get up from bed, use the bathroom, whatever was most comfortable. I found it more comfortable to sit than to lie down, and walking around felt good. Getting up and down to pee was surprisingly easy. Was very dehydrated and hungry, and my throat felt a bit sore/raw/scratchy from the breathing tube used while under anesthesia ... my recommendations are to order a soup and several bottles of apple juice!

Discharge was a bit slow -- I was told it would be 3-3:30 but it ended up being after 4:00. Had two visits from the pharmacist to go over meds again, which was helpful. Nurse gave a pretty quick rundown of how to manage the drain -- if you are like me and found Dr Immerman's post-surgery instructions on the Evergreen site, this drain setup is a bit different and doesn't require any management. I have had diluted blood draining fairly steadily today, which the nurse said was normal. I brought a large tote bag for my belongings, which was handy to put the drain tube and container in to be more discreet.

We live a 2-hour drive or 1-hour train ride from the hospital, so were advised that taking the train would be better. Took the Tube to Kings Cross Station without issue; I asked my husband to walk behind me to avoid anyone bumping into me, which made me feel a bit less vulnerable. Walking was fine, as was sitting on the train. I felt a bit more comfortable in the backseat of the car driving home from the train station so I could sit or lie down. A coconut water on my way home really helped soothe the dehydration, major cottonmouth, and my throat -- strongly recommend.

Have felt fine at home since returning around 6pm. Have alternated lying down and sitting on our fairly firm couch and don't feel much discomfort other than the occasional slight achy feeling. Have the drain in a little ultralight tote bag for ease of carrying around the house with me.

Hope this is helpful ... will continue updating as healing progresses, and happy to answer any questions.
 
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Keeping the updates going in case they are helpful, as I found these very useful during my research and preparation for my procedure.

Day Two:
Slept shockingly well last night with no pain whatsoever throughout the night and upon waking. I'm a side and stomach sleeper, so managed to find the right way to position my drain and was good to go overnight. I was prescribed a long-acting NSAID suppository to take before bed ... that seemed to really work well.

Had zero pain for most of the day without any further pain meds. Was able to walk around and sit for long periods (an hour or more) without any discomfort. Started feeling a little bit achy around 8pm after sitting for quite a while, so took a paracetamol (acetaminophen/Tylenol) to try and take the edge off that until bedtime. I'd rate it around a 2 ... just an annoying dull ache, nothing more.

Showered this evening and that was totally uneventful. Still waiting on a BM probably from the lingering effects of the pain meds during surgery, but have had no need for the opioids yet so hopefully that won't be too big an issue.

The drain is a bit annoying to carry around all the time, but not a big deal at all. Draining a fair bit so it's looking like I'll need this thing for another 4-5 days, but if that keeps swelling and infection down I'm good with it.

All in all, a surprisingly easy day today -- this has been much better than I expected so far!
 
Thanks for sharing this experience. I am sure there are people that are initially frightened by surgery and the recovery. It is helpful to read how smooth it can be.
 
Day 3:
Experience today much the same as yesterday. No need for pain meds at all today beyond the long-acting NSAID from before bedtime last night. Definitely feel a bit of pressure while sitting with my weight back on my bum, but truly no actual pain. Took the dog for a walk today and felt quite normal, sat at the dinner table with my husband without issue. Two BMs today which were completely normal and stress-free. Worked a full day today (I work from home anyway) alternating sitting and standing.

Honestly still amazed at how easy this recovery has been so far from a pain, mobility, quality of life perspective.

My only hiccup so far has been drain removal. I did not want to have to travel just from Cambridge to London for a 30-second drain removal, and Mr Carapeti suggested having my GP remove my drain. NHS GP refused to do it because the original procedure was private. I called two local hospitals and one private GP practice locally and all refused to do it as well because Carapeti doesn't have practice privileges with them. So I emailed his secretary and asked if a friend who's a nurse can do it for me -- he was fine with that, so I'll take it out tomorrow or Saturday. But just a note for anyone who sees Mr Carapeti but doesn't live close to London ... you'll want to sort out drain removal somehow. That said, he told me post-op that if the drain gets pulled out accidentally, it's really not a big deal ... and a number of the big US cleft lift surgeons give instructions for at-home removal. So I think you can get someone steady to watch a video and do it for you if you have no other alternative.

I'll probably stop posting daily updates at this point since nothing very interesting is happening other than this being so much more painless and simple than I anticipated, but will come back in periodically to share progress in case it helps others.
 
Day 4:
Quick update! Drain out this afternoon -- didn't feel the stitch come out, quick slight pinch as the drain line came out, over in 2 seconds. Totally no big deal. Nurse friend who removed it advised a hot shower after, cover with a piece of gauze and tape, and said it would be closed up after tonight. Haven't noticed any leakage from where the drain was. It's so nice to have it gone.

Have been more able to sit with my weight fully back today with very little discomfort, currently comfortable on the couch, and have also laid on my back with no discomfort. After sitting a while I will start to just feel a lowkey dull ache, but it's pretty much the same feeling you get if you've been sitting too long under normal circumstances and just need to switch position or get up -- nothing worse than that!

I'll hop back on if/as things change, but so far this has been shockingly easy and I would encourage anyone to give up their reservations about a cleft lift.
 
Day 7:
Just another update as things progress, as I'm a week from the surgery and everything has continued to go really smoothly so far.

I stopped taking any pain medication as of last night, to test where things were at pain-wise ... I still woke up completely pain-free. This morning I've spent several hours sitting on a barstool at my counter working, seated completely normally with zero discomfort. I've laid on my back in bed and on the sofa without issue, and spent several hours last night sitting fully back on the sofa like I normally would. There's a small, barely perceptible amount of pressure there but it's not uncomfortable at all, just something I notice if I'm intentionally looking for it.

The two days after the drain came out, by the end of the evening (when my 18-hour NSAIDs wore off, I guess) I felt a little bit of discomfort. I would describe it as the feeling you get when you've been sitting for too long and need to move around / a dull ache, but which was a little hard to shake no matter what position I was in. On those two nights I took some paracetamol (Tylenol) to take the edge off, but to be honest I didn't really need it and was mostly just restless from the mild discomfort and didn't want it to get any worse and took them as a preventive measure.

I am noticing overall swelling decreasing in the general area of my incision, in that it seems less puffy. There seems to be a small residual bump at the top 2", which I'm not sure is just the scar/flatter cleft itself, inflammation that will take time to decrease, a little bit of fluid, or what, but that's me being picky despite not noticing any drainage, heat, or tenderness. I can touch the incision without any pain and don't feel I have to be overly careful about cleaning/drying it. I am surprised at all of this after just one week -- I feel pretty normal, have found myself jogging up the stairs without realizing it, and basically just going about daily life. The only adjustment is trying to follow my surgeon's instructions not to do much bending.

I have my follow-up appointment in nine days. I think the steri strips come off then, so we'll see how things go without that added layer of protection. But until then, still so far so good ...
 
Day 16:
Checking back in here after the follow-up appointment with Mr Carapeti ...

In the past 10 days everything has continued to be super easy. I've been pretty active (walking, doing a lot of chores around the house as we are moving in a month) and have done an increasing amount of sitting during the workday, watching TV, and going out with friends. On the whole, have had little to no pain -- I would still just describe it as the annoying feeling of needing to switch positions to get comfortable or get up and move around when you've been sitting too long ... kinda like you get ants in your pants during a long flight. The occasional miniscule little twinge, which I gather is the nerve endings regenerating or whatever it is they do, but so minor. I did not have any drainage, major swelling, or other issues -- everything seemed really secure and healthy. I noticed the generalized swelling going down day by day, and less feeling of pressure when putting increasing weight on my butt while sitting. Honestly, the past week has pretty much been completely normal aside from being somewhat careful not to bend much and being a bit more squirmy than usual.

During today's appointment, he removed the steri-strips and was super pleased with the way everything has been healing. Said the scar looks excellent, no issues with seroma or wound separation. He said without the steri-strips I may notice a bit of drainage now, but that it's absolutely nothing to worry about and it will subside over the next 3-4 weeks. Gave the all-clear for exercise (swimming, running, biking) with the exception of squats and yoga, and I have to give horseback riding another 6-10 weeks. Still said to be careful about a lot of bending for the next 3-4 weeks, but otherwise no limitations. No need for an in-person follow-up, just asked for photos in a month and if everything is still healing well, good to go.

I did ask about any potential for wound separation at this point -- he said normally he will see any problems of that sort (or infections, drainage issues, seromas/hematomas, etc.) in the first two weeks, but that it is pretty normal if the wound has to expel any built-up fluid or blood that it doesn't absorb fast enough, and that it's no more worrisome than a blood blister or such and will resolve itself. I know a lot of people have issues with slight wound separation and that kind of drainage, but he was totally unconcerned about this kind of thing.

I'll check back in going forward if I have any further updates that might be helpful to those considering a cleft lift, but on the whole I will say ABSOLUTELY do the surgery if you are diagnosed with pilonidal disease, and do it as quickly as possible -- don't wait around to see if it comes back or gets worse. Mr Carapeti was truly delighted with my outcome -- he said the healthy tissue he had to work with made the procedure so much easier, and the healing so much easier because there was not so much open space below the flap. So don't wait for your sinus to get bigger or end up in places that make the procedure more difficult ... and don't mess around with open surgeries or other procedures that give a cleft lift surgeon less material to work with. The procedure itself and the recovery are so much less painful and arduous than they seem.
 
Oh! One other thing ... now that the steri-strips are off I was able to get a better look at the scar. I had some dread about the appearance of my bum, but the scar is much less ghastly than I expected (pretty minimal compared to expectations, honestly) and the shape doesn't feel drastically different as I expected it would. I expected a bit of a Frankenbutt, but it's truly not that different from previous. Carapeti said that the raised nature of the scar will reduce as it recedes/fades/softens over the next 3-4 months, and the overall area will dip and smooth out more naturally. That all put the last of my concerns to rest about whether this procedure was a good idea!
 
Oh! One other thing ... now that the steri-strips are off I was able to get a better look at the scar. I had some dread about the appearance of my bum, but the scar is much less ghastly than I expected (pretty minimal compared to expectations, honestly) and the shape doesn't feel drastically different as I expected it would. I expected a bit of a Frankenbutt, but it's truly not that different from previous. Carapeti said that the raised nature of the scar will reduce as it recedes/fades/softens over the next 3-4 months, and the overall area will dip and smooth out more naturally. That all put the last of my concerns to rest about whether this procedure was a good idea!
I had a cleft-lift performed by Mr Carapeti around Easter of 2022, so I'm happy to answer any questions you may have, although it seems like everything is going smoothly for you. I had similar apprehensions regarding the cosmetic outcome but, like you, I was pleasantly surprised at how minimal the change actually was. I think it's because if you have had no prior operations, then you will have plenty of healthy, mobile skin for the surgeon to work with, whereas if you've had prior failed operation(s), then you will have less healthy skin and more inflexbile scar tissue, so the surgeon has to take a more aggressive approach. A lot of the before/after pictures you see of cleft lifts online are in patients who've had multiple failed surgical procedures before the cleft lift.

You will find that the cosmetic appearance continues to improve with every month for about 6-12 months. I'm ~18 months post-op, and you can barely tell I had surgery now; I just have a shallower cleft and a faint white scar that you would mistake for my buttcrack at first glance.
 
Just back to update at one month post-procedure ...

Everything has continued to heal amazingly well. I had zero drainage after the steri-strips were removed, and have really had no pain or discomfort at all. Day-to-day life is completely back to normal, no abnormal feelings when sitting for long periods. Got back on the Peloton and felt totally fine. I am still a little bit limited on activity per instructions at my last consult, so haven't been doing things like squats, yoga, or ab workouts, but feel ready to start those back up.
 
Just back to update at one month post-procedure ...

Everything has continued to heal amazingly well. I had zero drainage after the steri-strips were removed, and have really had no pain or discomfort at all. Day-to-day life is completely back to normal, no abnormal feelings when sitting for long periods. Got back on the Peloton and felt totally fine. I am still a little bit limited on activity per instructions at my last consult, so haven't been doing things like squats, yoga, or ab workouts, but feel ready to start those back up.
Hi there. Not sure how often people return to these forums once they have put this behind them with a successful surgery, but if you are still checking in I wonder if I could ask how you are doing 6 months on?
 
By request, coming back with an update. I am six months post-op and everything has continued to go very well. I had a photo sign-off from Mr Carapeti at seven weeks without needing to go for another exam, as healing was continuing to progress without issue. I didn’t have any drainage or infection or wound issues whatsoever. Just back to normal.

Since then, no hint of recurrence, no pain or discomfort ever, no complications with the surgery site — absolutely normal everything. I don’t examine the scar visually very much but as far as I can see it looks much more subtle, and I can feel the scar tissue softening considerably.

I resumed riding horses a couple of months ago and have had no ill effects from that. Now ride almost daily and it’s completely fine; cycling also doesn’t bother it at all. Yoga and strength training have felt normal. Sitting long periods at my desk or in a car/plane is not an issue at all, though honestly I didn’t struggle with that post-surgery the way some others seem to.

All told, 100% glad I did it, no regrets whatsoever, surprisingly easy procedure and recovery, and at this point I hardly notice I ever had this issue or the surgery. Very grateful how this all ended up.

I get emails when folks reply to this thread, so feel free to give me a shout if anyone has a question I can answer!
 
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By request, coming back with an update. I am six months post-op and everything has continued to go very well. I had a photo sign-off from Mr Carapeti at seven weeks without needing to go for another exam, as healing was continuing to progress without issue. I didn’t have any drainage or infection or wound issues whatsoever. Just back to normal.

Since then, no hint of recurrence, no pain or discomfort ever, no complications with the surgery site — absolutely normal everything. I don’t examine the scar visually very much but as far as I can see it looks much more subtle, and I can feel the scar tissue softening considerably.

I resumed riding horses a couple of months ago and have had no ill effects from that. Now ride almost daily and it’s completely fine; cycling also doesn’t bother it at all. Yoga and strength training have felt normal. Sitting long periods at my desk or in a car/plane is not an issue at all, though honestly I didn’t struggle with that post-surgery the way some others seem to.

All told, 100% glad I did it, no regrets whatsoever, surprisingly easy procedure and recovery, and at this point I hardly notice I ever had this issue or the surgery. Very grateful how this all ended up.

I get emails when folks reply to this thread, so feel free to give me a shout if anyone has a question I can answer!
Thank you so much for your reply.
 
By request, coming back with an update. I am six months post-op and everything has continued to go very well. I had a photo sign-off from Mr Carapeti at seven weeks without needing to go for another exam, as healing was continuing to progress without issue. I didn’t have any drainage or infection or wound issues whatsoever. Just back to normal.

Since then, no hint of recurrence, no pain or discomfort ever, no complications with the surgery site — absolutely normal everything. I don’t examine the scar visually very much but as far as I can see it looks much more subtle, and I can feel the scar tissue softening considerably.

I resumed riding horses a couple of months ago and have had no ill effects from that. Now ride almost daily and it’s completely fine; cycling also doesn’t bother it at all. Yoga and strength training have felt normal. Sitting long periods at my desk or in a car/plane is not an issue at all, though honestly I didn’t struggle with that post-surgery the way some others seem to.

All told, 100% glad I did it, no regrets whatsoever, surprisingly easy procedure and recovery, and at this point I hardly notice I ever had this issue or the surgery. Very grateful how this all ended up.

I get emails when folks reply to this thread, so feel free to give me a shout if anyone has a question I can answer!
Hi again. Thank you so much for your reply. My son was booked in for a cleft lift with Mr Carapeti and your in depth posts helped us so much. He is now nearly 8 weeks post surgery and we couldn’t be more pleased.
 
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