LASER ABLATION FOR PILONIDAL DISEASE

AIM: to evaluate short-term results of pilonidal disease treatment using different methods: the excision of pilonidal sinus and fistula with open wound healing, the primary closure of the wound and the laser ablation (2017-2019).
PATIENTS AND METHODS: ninety patients with pilonidal disease without abscess were included in the comparative non-randomized study. The control group included 30 patients with excision and open wound healing. The first main group included 30 patients with the excision of pilonidal sinus and fistula with primary wound closure. The second main group included 30 patients with laser ablation of pilonidal sinus and fistula. The evaluation criteria included gender, age, BMI, number of previous procedures, operative time, hospital stay, postoperative pain intensity (VAS), cosmetic result (VAS), complication rate and recurrence rate.
RESULTS: all three groups were homogeneous in gender, age, BMI. The control group showed no complications (р<0.0001) and no recurrence (р<0.0001) rate but had more intensive pain (mean 5.9 points; р<0.0001) and worse cosmetic result (mean 4.4 points; р<0.0001). The group with primary wound closure (1^st main group) had the highest complication rate (23.4%; р=0.004) and recurrence rate (16.7%; р=0.02). The group with laser ablation had significantly shorter hospital stay (1.1 days; р<0.0001), good cosmetic result (mean 8.9 points; р<0.0001) and less postoperative pain (1.4 points; р<0.0001) with low recurrence rate (3.3%; p=0.32).
CONCLUSION: the laser ablation of pilonidal sinus and fistula provides less postoperative pain intensity and low recurrence rate, better cosmetic result and short hospital stay. It can be used for outpatient treatment.

1. Guner A, Cekic A. Pilonidal sinus – challenges and solutions. Open Access Surgery. 2015;2015:8:67-71. doi:10.2147/oas.s54939.

2. Aldaqal S, Kensarah A, Alhabboubi M, Ashy A. A New Technique in Management of Pilonidal Sinus, a University Teaching Hospital Experience. Int Surg. 2013;98(4):304-306. doi:10.9738/intsurg-d-13-00064.1

3. Popkov O.V., et al. Epitelial’nyy kopchikovyy khod. Metody khirurgicheskogo lecheniya. Voennaja medicina. Minsk. 2017; no. 1(42), pp. 101-106. (In Russ).

4. Khubezov D.A., Puchkov D.K., Serebryanskii P.V., Lukanin R.V., et al. Surgical treatment of pilonidal disease (review). Koloproktologiya. 2018;(4):79-88. doi:10.33878/2073-7556-2018-0-4-79-88. (In Russ.).

5. Bascom J. «Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment.» Surgery 1980: 87(5): 567-572.

6. Karydakis G. New Approach To The Problem Of Pilonidal Sinus. The Lancet. 1973;302(7843):1414-1415. doi:10.1016/s01406736(73)92803-1.

7. Karydakis G. Easy And Successful Treatment Of Pilonidal Sinus After Explanation Of Its Causative Process. Anz J Surg. 1992;62(5):385-389. doi:10.1111/j.1445-2197.1992.tb07208.x.

8. Bascom J, Bascom T. Failed Pilonidal Surgery. Archives of Surgery. 2002;137(10). doi:10.1001/archsurg.137.10.1146.

9. Meinero P, Stazi A, Carbone A, Fasolini F, et al. Endoscopic pilonidal sinus treatment: a prospective multicentre trial. Colorectal Disease. 2016;18(5):O164-O170. doi:10.1111/codi.13322

10. Meinero P, Mori L, Gasloli G. Endoscopic pilonidal sinus treatment (E. P. Si. T. ). Tech Coloproctol. 2013;18(4):389-392. doi:10.1007/s10151-013-1016-9.

11. Dessily M, Charara F, Ralea S, Allé J-L. Pilonidal sinus destruction with a radial laser probe: technique and first Belgian experience. Acta Chirurgica Belgica [Internet]. Informa UK Limited; 2017 Jan 6;117(3):164-8. doi:10.1080/00015458.2016.1272285/

12. Georgiou GK. Outpatient laser treatment of primary pilonidal disease : the PiLaT technique. Techniques in Coloproctology [Internet]. Springer Science and Business Media LLC; 2018 Oct;22(10):773-8. http://dx.doi.org/10.1007/s10151-018-1863-5.

13. Pappas A, Christodoulou D. A new minimally invasive treatment of pilonidal sinus disease with the use of a diode laser: a prospective large series of patients. Colorectal Disease. 2018;20(8):O207-O214. doi:10.1111/codi.14285.

14. Milone M, Di Minno M, Musella M et al. The role of drainage after excision and primary closure of pilonidal sinus: a meta-analysis. Tech Coloproctol. 2013;17(6):625-630. doi:10.1007/s10151013-1024-9.

15. Khubezov D.A., Lukanin R.V., Ogoreltsev A.Yu., Puchkov DK, et al. Choice of surgical treatment for pylonide disease without abscission. Pirogov Russian Journal of Surgery. 2019; no. 8-2, pp. 24-31. https://doi.org/10.17116/hirurgia201908224. (In Russ.).