jseboly

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Hi everyone,
Wanted to add to the great collection of cleft lift stories in this forum. I had cleft lift surgery with Dr. George Wadie in Raleigh, NC on May 27, 2021. There are a lot of these recovery logs for Dr. Immerman and several other doctors but not many for Dr. Wadie so I thought I would add one. I have to say I am very grateful that I found this forum as it was probably the main factor in me choosing to do cleft lift instead of excision surgery and therefore saved me potentially months, even years of pain. So I'd like to thank everyone who has posted their stories before I add mine. I'm two weeks post op so it's too late to do a day-by-day log, so I'm going to go topic-by-topic instead.

Background: 23 year old male, slightly overweight, graduate student so lots of sitting. I had my first abcess in April 2020; managed to catch it before it got too bad and it drained on its own after a course of strong antibiotics (no lancing required). No more problems until November, when slight discomfort in the area returned but no drainage or swelling. Discovered multiple sinus openings in February 2021; these got more painful and drained increasingly more fluid from February through May.

Planning: After reading this forum and other websites from Pilonidal doctors, I decided that I would not consider a traditional excision surgery and would either get a cleft lift or just try to live with it. As my symptoms got worse throughout the spring, despite several antibiotic treatments, it became more clear that I would need the surgery. Another consideration is that as I am graduating in spring 2022, this would be my last summer break and most likely my best chance to have the surgery and recover while not missing school/work and messing up my career path. So on April 22 I sent pictures to Dr. Wadie. I chose him because he was the closest in-network cleft lift surgeon who has had very strong and consistent results. He was very prompt and helpful in responding and by the next day we had a surgery scheduled for May 27. After that I had to fill out a few forms and Dr. Wadie's office took care of getting insurance approval and scheduling with the hospital.

Surgery Day: I had a consultation with Dr. Wadie the afternoon before surgery. He described in detail what he was going to do, answered my questions, showed me postop photos, and gave instructions for after-surgery care. This meeting helped me feel a lot more confident about the whole thing. Because of the general anesthesia, I don't remember much about surgery day. I do know that I was extremely nauseated for the rest of the day to the point where I could not even lift my head without feeling sick. I was able to walk very slowly that day, and Dr. Wadie encouraged me to sit some but it was really too painful to do that the first day.

After-surgery care: At first I had a thick, bulky dressing over the whole thing and an active drain; pretty much the same drain that Dr. Immerman uses. Each morning and evening my wife emptied it and recorded the amount. I was supposed to keep the drain in for at least 4 days and until the drainage was less than 20 ml/day. For me, surgery day was the only day that I drained over 20 mL. After days 1-4 postop were all less than 20 mL, Dr. Wadie cleared me to take the drain out. He provides an instruction video so that a family member can remove it at home, and it's really pretty easy to do. You just cut one stitch and then pull the tube out. No need to have a nurse do it in my opinion, but obviously you can if you're more comfortable that way. I did not feel anything when the drain came out.
After the drain came out, I was instructed to paint the wound with Betadine once daily after my shower. Other than a small piece of gauze over the drain hole, no more dressing was required. However, I put a pad on my underwear to avoid staining it with the Betadine.
At this point, we had kind of a hiccup in the healing process. After removing the drain tube, the drain hole closed up quickly with a scab. I had a slow but steady increase in pain from days 4 through 7 and I was panicking because it should have been healing, not getting worse. It turns out there was a buildup of fluid that could not escape. On day 7 my wife kind of opened up the scab and fluid started pouring out. Tons of fluid came out over the next 1-2 hours and I felt much better after that. In hindsight, we probably should have left the drain in a few more days. For the second week of recovery, we made sure the drain hole stayed open and a little bit came out each day. So if you have a steady increase in pain after the drain comes out, don't panic and instead see if you can find a way to get excess fluid out.
It's now 14 days post-op and we're still doing the daily Betadine routine. Some of the steri-strips have fallen off at the bottom of the incision but the rest are still on and I'm waiting for instructions from Dr. Wadie on whether I should pull them off myself. Will update.

Pain: I needed two Percocet tablets the day of surgery, one the day after, and then two more two days after. After that, it was fine with just ibuprofen. Even from the start, I had no pain except when sitting on the area and walking. For the first seven days, sitting and walking were pretty painful though so I stuck to either standing up or laying on my side or stomach. After the fluid buildup issue was over, I had almost no pain no matter the position. Now, at 14 days, the only pain I have is a brief, intense soreness when getting up from a seated position. Overall, it's been very manageable and much better than an excision surgery or even a lancing would have been.

Travel: This is one area where I would have done it differently if I could go back. We live 12 hours away from Raleigh and decided to drive it. We decided to split the trip home between day 1 and day 2 after surgery, doing 4 hours on day 1 and 8 hours on day 2. This car ride was miserable. Obviously it still hurt too much to sit straight up so I reclined the front seat and laid on my left side. This position meant no pain from the incision site but soon the left side of my body became extremely sore, even with stopping every hour or so. I could not wait to get home and get off of that side. I tried laying on my stomach across the back seat but couldn't because of motion sickness; however, that might be a good option for someone else after surgery. If I had stayed in Raleigh a few more days, I could have probably sat more comfortably on the incision and could have changed up positions to avoid the soreness. While the trip home was difficult, I don't think it caused any longer-term problems with the healing process.

Sitting: For the first week it was painful, even with a tailbone cushion, but per Dr. Wadie's advice I made myself do it a little each day. On day 8 and after it was much better. I started sitting on hard chairs without the cushion on day 9, softer chairs without the cushion on day 11, and also felt comfortable lying on my back in bed by day 11. Today, 14 days after surgery, I can sit or lay anywhere I want without pain. There is still a weird, uncomfortable, numb kind of feeling in the area when I sit, as has been described by many others on this forum. But no pain.

Bowel movements: They have not been a problem at all. The hardest part was probably bending down to sit on the toilet. I've been taking stool softener so that I don't have to push. One thing to note though: I did not have a perianal case and my incision ends about 3-4 inches above the anus. I know it gets a lot closer for some people and they might have a harder time.

Exercise: I could walk the day of surgery but very slowly. This gradually improved, especially the second week. I started taking daily 30-minute walks on day 8 and will gradually ramp up. Although today I am cleared for full exercise, I don't think I would feel comfortable doing anything more than walking. Some of the other cleft lift doctors like Dr. Immerman are more conservative with exercise in the first six weeks so I'll probably go ahead and follow their advice.

Costs: Will provide an update with the costs once all the bills come back.

That's it! So far I'm very glad I had it done and already feel better than before the surgery. I would point out that a lot of the people on here who had failed excision surgeries before the cleft lift talk like the cleft lift recovery is a piece of cake, and I understand why they would say that given what they've been through. However, keep in mind that it is still a major surgery and you will have pain and have to slow things down for a while. Also, don't panic if some people on the forum seem to be recovering faster than you. Statistically, almost everyone who has the cleft lift will heal fine and never have this problem again.
 
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