An effective and considerable treatment of pilonidal sinus disease by laser ablation

Is it beneficial to add laser ablation to curettage in the treatment of pilonidal sinus disease?

AIM

This study aimed to compare laser application with sinus curettage against only sinus curettage in the treatment of pilonidal sinus disease (PSD) in terms of postoperative complications, wound healing, and recurrence. Additionally, we aimed to investigate factors associated with wound healing and recurrence after PSD surgery.

PATIENTS AND METHODS

This study included patients diagnosed with PSD between February 2019, and September 2022. The patients were randomly assigned to either the laser + curettage (L/C; n = 40) group or the curettage-only (C; n = 40) group. The following data were collected: demographic and anthropometric information, smoking status, comorbidities, number of PSD-related orifices, complicated or uncomplicated disease, prior recurrence, postoperative findings, wound healing problems within 30 days postoperatively, and recurrence within 6 months postoperatively.

RESULTS

The L/C and C groups were similar in terms of age and sex distribution. The groups had similar results for postoperative pain, discharge, bleeding, wound healing problems at 30 days, and recurrence at 6 months. Multivariable logistic regression revealed that, high weight and higher orifice count were independently associated with wound healing problems. Additionally, high weight, higher orifice count and prior recurrence were independently associated with recurrence.

CONCLUSION

Combined curettage and laser therapy showed non-significant but broad benefits over curettage alone, but statistical significance was not achieved in any of the adverse findings, as well as wound healing and recurrence. Higher body weight and higher orifice count were associated with both poor wound healing and recurrence, while prior recurrence was another factor associated with recurrence at 6 months.

Efficacy and safety of laser ablation for recurrent pilonidal sinus: a systematic review and meta‑analysis

BACKGROUND

Recurrence remains a significant challenge following the surgical treatment of sacrococcygeal pilonidal sinus. Unlike patients with primary pilonidal sinus, those with recurrent cases often present with more complex sinus tracts, and scarring from previous surgeries increases the complexity of subsequent procedures. Therefore, selecting the appropriate surgical method for patients with recurrent pilonidal sinus requires greater caution. It is essential to reassess these patients to determine whether surgical techniques suitable for primary pilonidal sinus are equally effective for recurrent cases. Laser ablation, an innovative and minimally invasive technique, has emerged as a promising option for managing pilonidal sinus. This procedure uses a circular laser at the tip of a catheter to deliver energy, effectively destroying and ablating the sinus tract while promoting its closure. Previous studies have demonstrated the safety and efficacy of laser ablation in treating primary pilonidal sinus. The objective of this systematic review and meta-analysis is to assess the efficacy and safety of laser ablation in the management of recurrent pilonidal sinus.

METHODS

This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was carried out using PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov. Additionally, the references of all retrieved studies were screened to identify further eligible data. The search included studies published up to June 11, 2024. The primary outcome measure was the healing rate after laser ablation, which served as the metric for evaluating the efficacy of this technique in treating recurrent pilonidal sinus. Secondary outcome measures included the incidence of severe postoperative complications, which were assessed to determine the safety profile of laser ablation. According to the Clavien-Dindo classification of postoperative complications, we define severe complications as those classified as grade IIIb or higher.

RESULT

A total of seven studies were included in this meta-analysis. With the exception of one study published in 2018, the remaining six were published within the past 3 years. Two studies originated from Middle Eastern countries, while the other five were from European countries. In total, 137 patients with recurrent pilonidal sinus were included, of whom 112 achieved healing following laser ablation treatment. The pooled healing rate across these studies was 81.9% (95% CI, 65.4-94.6%; I2 = 69.12%; p < 0.01). A subgroup analysis based on follow-up duration was also performed. The pooled healing rate for studies with a follow-up period of 12 months or less was 87.2% (95% CI, 63.2-100%; I2 = 78.57%; p < 0.01), while for studies with a follow-up duration exceeding 12 months, the pooled healing rate was 74.5% (95% CI, 51.5-92.7%; I2 = 47.48%; p = 0.15). In addition, five studies performed pit picking before laser ablation, while two studies did not. We conducted a subgroup analysis based on whether pit picking was performed before laser ablation. The results of the subgroup analysis indicated that the difference in efficacy between combined pit picking and laser ablation alone was not statistically significant (random effects model, p = 0.75). This suggests that both treatment methods may have similar effectiveness in the management of recurrent pilonidal sinus disease.

CONCLUSIONS

This meta-analysis demonstrates that laser ablation is an effective and safe method for the treatment of recurrent sacrococcygeal pilonidal sinus in the short term. However, the findings indicate a trend toward a lower healing rate with extended follow-up periods. To better assess the long-term efficacy of laser ablation in managing recurrent pilonidal sinus, high-quality randomized controlled trials with extended follow-up durations are necessary.

Laser versus rhomboid flap for sacrococcygeal pilonidal sinus: multi-centre comparative study

Pilonidal sinus is a condition affecting young people. Several management methods are available. The two popular approaches are laser ablation and open techniques. This study aims to assess the recurrence rate after both techniques. This is a government and private hospital setting. Patients are included if they are diagnosed with pilonidal sinus, between the ages of 16 and 70, and have never had surgery before. Diabetic patients and patients with immune deficiency status who are younger than 16 or older than 70 are excluded. The operations are done by senior consultant surgeons. Patients are seen for 4 weeks or 3 months and discharged if there are no complications. 190 and 184 patients were selected for the laser and open groups, respectively. There are 142 men and 42 women in the open group compared to 140 men and 50 women in the laser group, with p-value: of 0.472. There was no significant difference in age, body mass index, or obesity between the two groups. There is a significantly higher recurrence rate in the laser group value: <0.00001. No significant difference in the recurrence rate for one or more than one opening disease within the open group. The laser technique is associated with a higher recurrence rate compared to the open rhomboid flap technique. One opening pilonidal sinus is significantly showing better results within the laser group but no significant difference in the open group.

Evaluating efficacy and outcomes: comparison of laser treatment and crystallized phenol in pilonidal sinus disease

Objective

The aim of this study is to comprehensively evaluate the efficacy of laser ablation and crystallized phenol application in the treatment of pilonidal sinus disease, focusing on treatment success, recurrence rates, complications, and the patients' return to normal life.

Material and method

Data from patients treated for pilonidal sinus disease with laser ablation and crystallized phenol application at our clinic between January 2020 and September 2023 were retrospectively reviewed. Preoperative data including pit counts, disease stage, preoperative pilonidal abscess history, disease duration (week), treatment success, recurrence/persistent disease, postoperative complications, healing time (days), and visual analogue scale (VAS) scores on postoperative days 1 and 7, as well as return to normal life (days), were analyzed.

Results

A total of 121 patients were included in the study, with 51 receiving laser ablation and 70 receiving crystallized phenol application. The postoperative outcomes revealed that the wound healing period and postoperative VAS values were statistically significantly better in the laser ablation group.

Conclusion

Wound healing was faster and postoperative pain was less in the laser group compared to the phenol group. According to this study, both methods can successfully treat the disease in selected cases.

Sinus laser therapy versus Karydakis flap procedure in the management of pilonidal sinus disease: a comparative analysis of intraoperative parameters and postoperative outcome

BACKGROUND

This study aimed to investigate the utility of minimally invasive sinus laser therapy (SiLaT) versus flap surgery (Karydakis flap procedure) in terms of intraoperative parameters and postoperative outcome in patients with pilonidal sinus disease (PSD).

METHODS

A total of 106 patients with PSD (mean ± SD age: 26.4 ± 7.0 years, 86.8% male) treated with Karydakis flap procedure (KF group; n = 63) or sinus laser therapy (SiLaT group; n = 43) were included in this retrospective study. Data on patient demographics, operative characteristics (number of openings, length of sinus tract, and operative time), and postoperative outcome including postoperative (day 1) pain intensity-visual analog scale (VAS) scores, time to return to work after surgery (days), complication rate, and recurrence rate were recorded in each patient and compared between KF and SiLaT groups.

RESULTS

The SiLaT versus KF procedure was associated with significantly shorter operative time [median (min-max) 17 (12-28) versus 27 (20-44) min, p = 0.001], lower pain scores [3 (1-4) versus 5 (3-7), p = 0.001], and earlier return to work [1 (1-3) versus 10 (5-20) days, p = 0.001]. Although no significant difference was noted in complication and recurrence rates between the KF and SiLaT groups, 6.3% (wound infection only) and 3.2% of patients in the KF group but none of the patients in the SiLaT group developed complication and recurrence, respectively.

CONCLUSIONS

SiLaT seems to be a promising minimally invasive technique for the management of PSD, being comparable to the KF procedure in terms of complications and recurrence, along with added advantages of shorter operative time, reduced postoperative pain, and earlier return to work.

Management of Pilonidal Disease and Hidradenitis Suppurativa

Pilonidal disease and hidradenitis suppurativa affect healthy young adults, causing discomfort and pain that leads to loss of work productivity and should be approached in a personalized manner. Patients with pilonidal disease should engage in hair removal to the sacrococcygeal region and surgical options considered. Hidradenitis suppurativa can be a morbid and challenging disease process. Medical management with topical agents, antibiotics, and biologics should be used initially but wide local excision should be considered in severe or refractory cases of the disease.

Advancements and Innovations in the Surgical Management of Sacrococcygeal Pilonidal Sinus: A Comprehensive Review

Sacrococcygeal pilonidal sinus (SPS) is a common condition characterized by the formation of a sinus tract or cavity in the sacrococcygeal region, often containing hair and debris. Surgical management plays a crucial role in its treatment due to its chronic and recurrent nature. This comprehensive review explores the advancements and innovations in the surgical management of SPS. The review begins with an overview of the historical perspective, anatomy, and pathophysiology of the condition, followed by a discussion of current surgical techniques, including conventional excision, flap procedures, and minimally invasive approaches. Recent advancements, such as laser therapy, radiological guidance techniques, and robotic-assisted surgery, are also examined. The key findings from outcomes research are summarized, including postoperative pain management, recurrence rates, and patient satisfaction. The implications for clinical practice are discussed, emphasizing the importance of staying updated on the latest surgical techniques and adopting a personalized approach to treatment. Recommendations for future research are provided, highlighting the need for prospective studies comparing different surgical techniques, as well as research focusing on minimally invasive approaches and predictive models for recurrence risk. Collaboration among researchers, clinicians, and industry partners is essential to drive innovation and improve outcomes for patients with SPS.

Laser Ablation of Pilonidal Sinus in a Patient With Hemophilia Type A: A Case Report and Review of the Literature

Pilonidal sinus (PNS) is a common occurrence in young men. It is often caused by blockage of the sebaceous glands in the hair follicles in the sacrococcygeal area. Hemophilia type A is a hemorrhagic disorder caused by a deficiency of factor VIII. It presents with excessive bleeding, either spontaneously or secondary to trauma. The mainstay of treatment for PNS is often excision of the sinus; however, recently, laser ablation has started to be commonly used. In this article, we present a case of a young man with hemophilia A presenting with recurrent PNS successfully managed with laser ablation with no complications.

Efficacy of laser obliteration with limited excision of pilonidal sinus

OBJECTIVE

This study was performed to compare the effectiveness of laser obliteration with limited excision (LOLE) versus wide excision (WE) of the pilonidal sinus.

METHODS

A prospective, cross-sectional observational study of 152 patients with chronic pilonidal sinus disease was performed from September 2019 to September 2022. Of the 152 patients, 76 underwent LOLE and 76 underwent WE. The main evaluation criteria were complete wound healing, recurrence, and the complication rate.

RESULTS

Complete healing was achieved in 74 (97.4%) patients in the LOLE group and 76 (100%) patients in the WE group. The duration of wound healing was significantly shorter in the LOLE group than in the WE group (6.5 ± 2.4 vs. 14.5 ± 2.6 weeks, respectively). Recurrence developed in six (7.9%) patients in the LOLE group and one (1.3%) patient in the WE group, with no significant difference.

CONCLUSION

According to our study and the data available in the literature, laser surgery should be included in the guidelines for the treatment and management of pilonidal disease.

Use of the laser in the pilonidal sinus alone or in combination with phenol

OBJECTIVE

We investigated the effectiveness of combining laser treatment with phenol in the management of pilonidal sinus.

METHODS

We present here a retrospective analysis of patients with pilonidal sinus disease who were treated in the general surgery clinic of the Balikesir University Hospital between October 2019 and February 2022.

RESULTS

Recurrence was observed in three patients (13.6%) in the laser treatment group and one patient (4.8%) in the laser-phenol treatment group after the fourth month. Notably, 22 (91.7%) patients in the laser treatment group and 21 (95.5%) patients in the laser-phenol treatment group had complete healing.

CONCLUSION

Although not statistically significant, the laser-phenol treatment group exhibited a lower recurrence rate and a higher complete healing rate.