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Dainius E, Vaiciute MK, Parseliunas A, Latkauskas T, Venskutonis D. Surgical treatment of pilonidal disease - Short-term follow up results of minimally invasive pit-picking surgery versus radical excision without suturing: A prospective randomised trial. Heliyon 2024; 10:e31497. [PMID: 38845858 PMCID: PMC11153105 DOI: 10.1016/j.heliyon.2024.e31497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 06/09/2024] Open
Abstract
Background In this study we compared the potential benefits of surgical treatments for chronic symptomatic pilonidal disease (PD) - minimally invasive pit-picking surgery and radical excision without wound suturing. Materials and methods A total of 100 adult patients with chronic symptomatic PD were enrolled in this study at the Kaunas Hospital of the Lithuanian University of Health Sciences. They were randomly divided into two groups: pit-picking surgery (n = 50) and radical excision with open healing (n = 50). Recurrent PD patients were not excluded. The comparison of the techniques was based on pain within the first postoperative week, failed surgery rates, and wound healing time. Additionally, pain levels at different time intervals following the treatment, analgesic consumption, and time off work, were assessed and compared. Results A total of 89 patients (89 %) were available for follow-up after 6 months. Pain levels the first postoperative week were significantly lower in the pit-picking group compared to the radical excision group, with median scores of 10.0 and 20.0, respectively (p = 0.002). The complete wound healing time was longer in the radical excision group (60 days) versus the pit-picking group (17 days), with a significant difference noted (p = 0.00). No significant difference was observed between the type of surgery and the rate of failed surgery, with 5 (11.9 %) cases in the pit-picking group and 4 (8.5 %) in the radical excision group. Conclusion Based on our short-term findings, minimally invasive pit-picking surgery is a better option regarding pain, wound healing time and failed surgery rate. In cases where this approach is not suitable, other alternatives should be contemplated, as radical surgery without wound suturing should not be employed as a treatment method for PD. Additionally, the relationship between PD and recurrence rates should be investigated further.
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Affiliation(s)
- Edvinas Dainius
- Lithuanian University of Health Sciences, Department of Surgery, Josvainių g. 2, LT-47144, Lithuania
| | | | - Audrius Parseliunas
- Lithuanian University of Health Sciences, Department of Surgery, Josvainių g. 2, LT-47144, Lithuania
| | - Tadas Latkauskas
- Lithuanian University of Health Sciences, Department of Surgery, Lithuania
| | - Donatas Venskutonis
- Lithuanian University of Health Sciences, Department of Surgery, Josvainių g. 2, LT-47144, Lithuania
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Draullette M, de Parades V, Alam AA, Fathallah N, Rentien AL, Benfredj P, Aubert M, Pommaret É, Beaussier H, Fels A, Spindler L. SiLaT: A paradigm shift in the treatment of pilonidal disease? J Visc Surg 2024; 161:167-172. [PMID: 38849230 DOI: 10.1016/j.jviscsurg.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
BACKGROUND Pilonidal disease (PD) is a common condition for which the global incidence is increasing. Surgery is the currently preferred approach to treatment but there is a growing interest in new minimally invasive techniques, such as sinus laser therapy (SiLaT). AIM Our primary objective was to assess the efficacy of SiLaT for the treatment of pilonidal disease. The secondary objectives were to evaluate morbidity and patient satisfaction and identify predictive factors of success. METHODS All adult patients, who underwent SiLaT in our department for a primary or recurrent pilonidal sinus from June 1, 2018, to December 31, 2020, were included in the study. Healing was defined as the closure of cutaneous orifices and the absence of seepage or abscesses. RESULTS In total, 111 consecutive patients, for whom the male/female sex ratio was 2.1 and the mean age 28.8 (± 9.4) years, were included in this study. Eighteen (16.2%) patients had already undergone prior surgery for PD. The mean follow-up was 339.2 (± 221.4) days. A healing rate of 78.4% was observed, with a median time to healing of 20.0 days (15.0-30.0). The median time to return to usual activities was three days (1-7). The only postoperative complication was bleeding, which occurred for two patients (1.8%). Eighty-two patients (88.2%) reported being "very satisfied" with the treatment. Multivariate analysis showed no predictive factors for healing among the studied variables. CONCLUSION SiLaT is an efficient and safe procedure for the treatment of PD, with a high level of patient satisfaction. It will now be necessary to position it within the therapeutic algorithm.
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Affiliation(s)
- Mélanie Draullette
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Institut Léopold Bellan, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - Vincent de Parades
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Institut Léopold Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Amine Antonin Alam
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Institut Léopold Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Nadia Fathallah
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Institut Léopold Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Anne-Laure Rentien
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Institut Léopold Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Paul Benfredj
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Institut Léopold Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Manuel Aubert
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Institut Léopold Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Élise Pommaret
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Institut Léopold Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
| | - Hélène Beaussier
- Department of Clinical Research, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Audrey Fels
- Department of Clinical Research, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Lucas Spindler
- Department of MedicoSurgical Proctology, Groupe Hospitalier Paris Saint-Joseph, Institut Léopold Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
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Paz Oliveira FD, Time SCC, Blitzkow ACB, Boarini LR, Munhóz AA, Mont'Alverne RED. Minimum energy laser pilonidotomy (MELPi): a multicenter study of a novel method in pilonidal disease. Updates Surg 2024; 76:1025-1030. [PMID: 38704463 DOI: 10.1007/s13304-024-01848-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 04/10/2024] [Indexed: 05/06/2024]
Abstract
Laser surgery, a minimally invasive procedure for the definitive approach to pilonidal disease (PD), has been frequently studied in recent years. This study aims to describe a new pilonidotomy method using minimal laser energy and evaluate its initial results. This is a retrospective multicenter study. We included 47 consecutive patients who underwent 50 "minimal energy pilonidotomies (MELPi)" between 2019 and 2023 in four centers in Brazil. Age, BMI, gender, smoking, diabetes, Guner classification, duration of illness, energy, hospitalization time, complications, recurrence, wound closure, pain, and return to activities were analyzed. The median age was 27; 61.7% were men, and 38.3% were women. The median BMI was 25.7. Smoking was evident in 14.9%, and diabetes in 2.1%. The average duration of the disease was 3 years. Most operations (36%) were performed on stage R disease. The median hospitalization time was 6 h, and the median healing time was 15 days. The average energy used in procedures was 433 J. The median postoperative pain was 2. Secretion occurred in 14% on the 60th day. Complications (cellulitis) occurred in 4% of cases. The median time to return to work was 7 days. The average following time was 12 months; recurrence occurred in 5 (10%)-in 3 patients, a second MELPi procedure was performed and was effective. MELPi shows promising initial results: low pain, low complication rates, and a fast activity return. It is a good option in recidivate cases and can be done more than once if necessary.
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Affiliation(s)
- Fabrício Doin Paz Oliveira
- Center for Inflammatory Bowel Diseases and Coloproctology- Sao Camilo Hospital Concordia, Concordia, Santa Catarina, Brazil
| | - Sonia Cristina Cordero Time
- Coloproctology Department, Pilar Hospital, Curitiba, Paraná, Brazil
- Coloproctology Departament, Vita Batel Hospital, Curitiba, Paraná, Brazil
| | | | - Lucas Rodrigues Boarini
- Coloproctology and Inflammatory Bowel Disease, Service Hospital São Luiz Rede Do'r São Caetano, São Paulo, Brazil
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Tam A, Steen CJ, Chua J, Yap RJ. Pilonidal sinus: an overview of historical and current management modalities. Updates Surg 2024; 76:803-810. [PMID: 38526695 PMCID: PMC11129967 DOI: 10.1007/s13304-024-01799-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/25/2024] [Indexed: 03/27/2024]
Abstract
Pilonidal disease is a common condition that commonly affects the younger adult population and is often seen in both the general practice and the hospital setting. Multiple treatment methods have gained and lost popularity over the last several decades, but more recent intervention principles show promising results. This article details the different methods of managing acute and chronic pilonidal disease ranging from treatments in the primary care setting to those in hospital theatres, with special attention to newer modalities of minimally invasive interventions. As a chronic illness that often affects those of working age, pilonidal disease can confer significant morbidity especially, but not limited to, a substantial amount of time off work. Treatment of chronic disease in particular, has evolved from midline techniques to off-midline techniques, with more recent developments offering promising solutions to reduce acute flare ups and hasten recovery time.
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Affiliation(s)
- Adrian Tam
- Department of General Surgery, Eastern Health, Maroondah Hospital, 1-15 Davey Drive, Ringwood, Victoria, 3135, Australia
| | - Christopher J Steen
- Department of Surgery, Cabrini Monash University, Melbourne, Victoria, Australia.
- Department of Surgery, Cabrini Monash University, Cabrini Health Australia, Melbourne, Australia.
| | - Jonathan Chua
- Department of General Surgery, Eastern Health, Maroondah Hospital, 1-15 Davey Drive, Ringwood, Victoria, 3135, Australia
| | - Raymond J Yap
- Department of Surgery, Cabrini Monash University, Melbourne, Victoria, Australia
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Dutta J. Bio-thermal response during laser haemorrhoidoplasty: an exclusive analytical and numerical approach for theoretical investigation. Lasers Med Sci 2024; 39:108. [PMID: 38647731 DOI: 10.1007/s10103-024-04046-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Abstract
Haemorrhoidal disease is identified by declension of the inflamed and bleeding of vascular tissues of the anal canal. Traditionally, haemorrhoids are associated with chronic constipation and the most common symptoms are irritation in anus region, pain and discomfort, swelling around anus, tender lumps around the anus and rectal bleeding (depending upon the grade of haemorrhoid). Among the several conventional treatment procedures (commonly mentioned as, rubber band litigation, sclerotherapy and electrotherapy), laser haemorrhoidoplasty is an out-patient and less-invasive laparoscopic procedure. From literature survey it has been observed that an exclusive theoretical model depicting the impact of 1064 nm wavelength laser wave on living tissues subjected to haemorrhoid therapy is not available. This research work is a pioneering attempt to develop a theoretical study attributing specifically on laser therapy of haemorrhoid treatment based on Pennes' biological heat transfer model. The corresponding mathematical model has been solved by analytical method to establish thermal response of tissue during the treatment and also the same has been solved a numerical approach based on finite difference method to validate the feasibility of former method due to unavailability of any theoretical model. Impact of variation of blood perfusion term, laser pulse time and optical penetration depth on temperature response of skin tissue is captured. The tissue temperature decreases along with time of laser exposure with increasing the blood perfusion rate as it carries away large amount of heat. With the increase in laser pulse time, tissue temperature declines due to shorter pulse time resulting in higher energy consumed by electrons. The research outcome is successfully validated with less than 1% of error observed between the appointed analytical and numerical scheme.
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Affiliation(s)
- Jaideep Dutta
- Branch of Mechanical Science, Department of Basic Science and Humanities, St. Thomas' College of Engineering and Technology, 4, Diamond Harbour Road, Kidderpore, Kolkata, 700023, West Bengal, India.
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Gratiashvili E, Akhmeteli L, Ivanishvili T, Kobadze S, Giorgadze N. Efficacy of laser obliteration with limited excision of pilonidal sinus. J Int Med Res 2024; 52:3000605241236057. [PMID: 38530042 DOI: 10.1177/03000605241236057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
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.
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Affiliation(s)
- Erekle Gratiashvili
- Department of Surgery, Todua Clinic, Tbilisi State Medical University, Tbilisi, Georgia
| | - Lali Akhmeteli
- Department of Surgery, Todua Clinic, Tbilisi State Medical University, Tbilisi, Georgia
| | - Teimuraz Ivanishvili
- Department of Surgery, Todua Clinic, Tbilisi State Medical University, Tbilisi, Georgia
| | - Salome Kobadze
- Department of Surgery, Todua Clinic, Tbilisi State Medical University, Tbilisi, Georgia
| | - Nodar Giorgadze
- Department of Surgery, Todua Clinic, Tbilisi State Medical University, Tbilisi, Georgia
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Tyrväinen E, Nuutinen H, Savikkomaa E, Myllykangas HM. Comparison of laser ablation, simple excision, and flap reconstruction in the treatment of pilonidal sinus disease. Lasers Med Sci 2024; 39:52. [PMID: 38291247 PMCID: PMC10827894 DOI: 10.1007/s10103-024-03993-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Abstract
Pilonidal sinus disease (PSD) is a common condition that typically affects young adults. PSD may cause significant morbidity due to its chronic nature and tendency to recur. Laser ablation has recently shown promising results in the treatment of PSD, but comparative studies are sparse. We aimed to compare laser ablation with two conventional treatment options: simple excision with direct closure and excision with flap reconstruction. This retrospective study material included patients who underwent PSD surgery in the plastic surgery department of a single academic teaching hospital. Patients were divided into three groups based on the operation technique: laser group, direct closure group, and flap group. Preoperative and postoperative data were compared between the groups including patient characteristics, residual disease, recurrent disease, complications, and re-operations. Among the 278 patients, 66 underwent laser treatment, 134 excision with direct closure, and 78 excision with flap closure. The follow-up time ranged from 15.4 ± 7.6 months in the laser group to 87.6 ± 29.3 months in the flap group. Eventless healing occurred in 67.7% of the patients in the laser group, 66.4% of the patients in the direct closure group, and 56.4% of the patients in the flap group. There was significantly more residual disease in the laser group whereas significantly more complications were found in the direct closure and flap groups. The advantages of laser treatment include fast postoperative recovery and reduced risk of complications.
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Affiliation(s)
- Emmi Tyrväinen
- Department of Surgery, University of Eastern Finland, Yliopistonranta 8, 70210, Kuopio, Finland
| | - Henrik Nuutinen
- Department of Surgery, University of Eastern Finland, Yliopistonranta 8, 70210, Kuopio, Finland
- Department of Plastic Surgery, Kuopio University Hospital, PL 1711, 70211, Kuopio, Finland
| | - Elina Savikkomaa
- Department of Plastic Surgery, Kuopio University Hospital, PL 1711, 70211, Kuopio, Finland
| | - Heidi-Mari Myllykangas
- Department of Plastic Surgery, Kuopio University Hospital, PL 1711, 70211, Kuopio, Finland.
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Zhuang Y, Feng WZ. Platelet-rich plasma for pilonidal disease: a systematic review. J Int Med Res 2023; 51:3000605231216590. [PMID: 38141657 DOI: 10.1177/03000605231216590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2023] Open
Abstract
OBJECTIVE To examine the use of platelet-rich plasma (PRP) for treatment of pilonidal disease (PD) and thus provide a reference for clinical application. METHODS A systematic review of PubMed and the Cochrane Library was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We considered all studies that reported the use of PRP for treatment of PD. Extracted data included the first author's name, year of publication, study type, number of included patients, inclusion and exclusion criteria, interventions, anesthesia, application of PRP (source, preparation, dose, and operation), antibiotics, follow-up time, therapeutic outcomes, and adverse events. RESULTS In total, eight randomized controlled trials and one prospective cohort study involving 809 patients were included. PRP reduced pain, accelerated healing, and reduced adverse events. The application of combined minimally invasive surgery achieved better results. However, overfilling of the wound with PRP in minimally invasive surgeries was shown to potentially increase the risk of adverse events. CONCLUSION PRP can be used as an adjuvant treatment in PD surgery to improve the therapeutic effect and reduce adverse events. The optimal combination of PRP and various factors is an important direction of future research.INPLASY registration number: INPLASY2023100070.
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Affiliation(s)
- Yu Zhuang
- Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Wen-Zhe Feng
- Department of Anorectal Surgery, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
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Şahin AG, Alçı E. Use of the laser in the pilonidal sinus alone or in combination with phenol. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230740. [PMID: 37971129 PMCID: PMC10645176 DOI: 10.1590/1806-9282.20230740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/26/2023] [Indexed: 11/19/2023]
Abstract
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.
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Affiliation(s)
- Azad Gazi Şahin
- Balikesir University, School of Medicine, Department of General Surgery – Balikesir, Turkey
| | - Erman Alçı
- Balikesir University, School of Medicine, Department of General Surgery – Balikesir, Turkey
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Bilgin IA, Tanal M, Ramoglu N, Ozben V, Sahin I, Aghayeva A, Sahar AA, Saylik O, Baca B, Hamzaoglu I, Karahasanoglu T. Short- and mid-term results of diode laser treatment in pilonidal sinus disease and the role of endoscopic camera use on outcomes. Tech Coloproctol 2023; 27:921-928. [PMID: 37356014 DOI: 10.1007/s10151-023-02831-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/01/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Nowadays, surgical treatment of pilonidal sinus disease (PSD) with novel techniques is a topic of interest since conventional methods are associated with longer return to daily life and higher complication and recurrence rates. Recently, use of laser as a minimally invasive approach has become popular in the surgical treatment of PSD. In this study, we analyze the short- and mid-term results after laser treatment and the effect of endoscopic camera use on outcomes. METHODS A total of 106 patients with PSD who underwent laser treatment between November 2017 and September 2021 were included in this study. All patients were treated with a 1470-nm diode laser. Endoscopic camera was used in 73 patients and results of these were compared with those in whom camera was not used. Follow-up period was determined as a minimum of 1 year. Data were analyzed retrospectively. RESULTS There were 80 (75%) male and 26 female patients. The median age was 26 (range 13-50) years. On the first postoperative day, 26 (26.5%) patients did not have any pain and 42(42.8%) patients reported low-grade pain. The mean time to return to daily life was 4.5 ± 5.5 (median 2, range 1-30) days. The complication rate was 10.4%. Eighty-six (87.8%) patients completely recovered and the mean complete recovery time was 27.4 ± 15.9 days. The patient satisfaction rate was 99.0%. The recurrence rate was 11.0%. Neither history of previous surgery nor abscess was associated with recurrence. Use of an endoscopic camera had no effect on postoperative pain, complete recovery, complications, patient satisfaction, and recurrence (p < 0.05). CONCLUSION Laser treatment for PSD is a promising approach with the advantages of less postoperative pain, early return to daily life, high patient satisfaction, and acceptable complication and recurrence rates. Nevertheless, further studies are needed to investigate the role of endoscopic camera use in this procedure since its possible advantages could not be clarified.
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Affiliation(s)
- I A Bilgin
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
| | - M Tanal
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - N Ramoglu
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - V Ozben
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - I Sahin
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - A Aghayeva
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - A A Sahar
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - O Saylik
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - B Baca
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - I Hamzaoglu
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - T Karahasanoglu
- Department of General Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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Abstract
Importance The management of pilonidal disease continues to be a challenge due to high rates of recurrence and treatment-associated morbidity. Observations There is a heterogeneous repertoire of treatment modalities used in the management of pilonidal disease and wide practice variation among clinicians. Available treatment options vary considerably in their level of invasiveness, associated morbidity and disability, risks of complications, and effectiveness at preventing disease recurrence. Conservative nonoperative management strategies, including persistent improved hygiene, depilation, and lifestyle modification, focus on disease prevention and minimization of disease activity. Epilation techniques using both laser and intense pulse light therapy are also used as primary and adjunct treatment modalities. Other nonoperative treatment modalities include phenol and fibrin injection to promote closure of pilonidal sinuses. The traditional operative management strategy for pilonidal disease involves excision of affected tissue paired with a variety of closure types including primary midline closure, primary off-midline closure techniques (ie, Karydakis flap, Limberg flap, Bascom cleft lift), and healing by secondary intention. There has been a recent shift toward more minimally invasive operative approaches including sinusectomy (ie, trephination or Gips procedure) and endoscopic approaches. Overall, the current evidence supporting the different treatment options is limited by study quality with inconsistent characterization of disease severity and use of variable definitions and reporting of treatment-associated outcomes across studies. Conclusions and Relevance Pilonidal disease is associated with significant physical and psychosocial morbidity. Optimal treatments will minimize disease and treatment-associated morbidity. There is a need for standardization of definitions used to characterize pilonidal disease and its outcomes to develop evidence-based treatment algorithms.
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Affiliation(s)
- Lindsay A Gil
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus
| | - Katherine J Deans
- Department of Surgery, Nemours Children's Health, Delaware Valley, Wilmington, Delaware
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus
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Williams MD, Sullivan GA, Nimmagadda N, Gulack BC, Madonna MB, Hayden DM, Govekar H, Shah AN. Laser Ablation of Pilonidal Sinus Disease: A Pilot Study. Dis Colon Rectum 2023; 66:e224-e227. [PMID: 36877001 DOI: 10.1097/dcr.0000000000002745] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Pilonidal disease is classically treated with wide local excision, although a number of minimally invasive approaches are currently under investigation. We aimed to determine the safety and feasibility of laser ablation of pilonidal sinus disease. IMPACT OF INNOVATION Laser ablation provides a minimally invasive means of obliterating pilonidal sinus tracts without a need for excessive tract dilation. Laser ablation can be performed more than once on the same patient if necessary. TECHNOLOGY MATERIALS AND METHODS This technique uses the NeoV V1470 Diode Laser (neoLaser Ltd, Caesarea, Israel) with a 2-mm probe. We performed laser ablation in adults and pediatric patients. PRELIMINARY RESULTS We performed 27 laser ablation procedures in 25 patients, with a median operative time of 30 minutes. Eighty percent of patients reported either no pain or mild pain at the 2-week postoperative visit. The median time to return to work or school was 3 days. Eighty-eight percent of patients reported being satisfied or very satisfied with the procedure at their most recent follow-up (median, 6 mo). Eighty-two percent of patients were healed at 6 months. CONCLUSIONS AND FUTURE DIRECTIONS Laser ablation of pilonidal disease is safe and feasible. Patients experienced short recovery time and reported low levels of pain and high levels of satisfaction.
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Affiliation(s)
- Michael D Williams
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
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13
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Li Z, Jin L, Gong T, Qin K, Cui C, Wang Z, Wu J. An effective and considerable treatment of pilonidal sinus disease by laser ablation. Lasers Med Sci 2023; 38:82. [PMID: 36856904 PMCID: PMC9977879 DOI: 10.1007/s10103-023-03741-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
The treatment of sacrococcygeal pilonidal disease (SPD) is still challenging. Although many non-surgical and surgical methods exist, no consensus has been reached on the best treatment. This study aimed to evaluate the efficacy of laser ablation using 1470-nm radial diode laser fiber in treating SPD. We retrospectively studied the data of our 48 patients who operated on this technique between March 2019 and July 2022. All patients were treated with laser ablation using 1470-nm radial diode laser fiber. The healing rate and recurrence rate, demographic and surgical data, postoperative pain, complications (wound infection, wound bleeding), the time of returning to regular work and life, and the time of wound healing were recorded. Postoperative pain was measured based on the visual analog scale (VAS) score. Postoperative follow-up was performed in the outpatient clinic every 1 week for 1 month. Among the 48 patients, 41 males and 7 females, with a mean age of 27.7 years (range 14-42), the healing rate was 100%, and the average healing time was 28.3 ± 5.5 days. Mean operative time was 15.5 ± 3.3 min. The recurrence rate was 2.1%. One patient relapsed 3 months after the operation. The patient underwent laser ablation again, and the sinus tract was closed. The median visual analog scale (VAS) score on the day of operation was 0(0,2). The median VAS score on the first, third, seventh, and fourteenth day after operation was 0(0,2), 0(0,1), 0(0,1), and 0(0,0), respectively. There was no wound infection or bleeding after the operation. The mean time to normal work/life was 7.1 ± 3.2 days. Almost all the patients felt very satisfied with the operation. Laser ablation using 1470-nm radial diode laser fiber is effective in SPD treatment. It is associated with minor wounds and mild postoperative pain. It is a simple, safe, and minimally invasive technique and its clinical application for acute and chronic SPD in the absence of abscess is promising.
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Affiliation(s)
- Zhicheng Li
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Lei Jin
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Tianyun Gong
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Kaijian Qin
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Can Cui
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Zhenyi Wang
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
| | - Jiong Wu
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
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De Decker M, Sels T, Van Hoof S, Smets Q, Hendrickx T, Van Dessel E, Komen N. Does minimally invasive laser-assisted treatment of pilonidal sinus disease live up to its expectations: a multi-center study with 226 patients. Int J Colorectal Dis 2023; 38:33. [PMID: 36763170 DOI: 10.1007/s00384-023-04324-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE The minimally invasive character, the possibility to perform under local anesthesia, and the ease to repeat have led to increasing popularity of laser-assisted treatment of pilonidal sinus disease. Hereby, potentially avoiding prolonged need for medical care at home, incapacity to work, and high expenses for patients and society. This retrospective, multi-center study is aimed at evaluating the feasibility of laser-assisted treatment for pilonidal sinus disease. METHODS The patient population is comprised of all patients undergoing laser-assisted treatment of pilonidal sinus disease at three Belgian hospitals between January 2017 and December 2021. Data were retrospectively collected. The primary endpoint was overall wound healing after one or more laser assisted procedures. RESULTS A total of 226 patients were included with a mean follow-up time of 129 days [7-1120]. The healing rate after one laser procedure was 78.8%. Some of these patients were healed by a second or third procedure adding up to an overall healing rate of 85.4% after one or more laser procedures. Wound infections were the main postoperative complication (8.0%) of which 5 patients required drainage (2.2%). For 29 patients (12.8%), laser-assisted treatment was insufficient, leading to a secondary operation (drainage, excision, or flap). CONCLUSION This study shows that laser-assisted treatment is feasible for pilonidal sinus disease. The minimally invasive character of this technique might make up for a higher non-healing rate compared to other techniques like flap repair. However, care must be taken that healing rate might be related to the presentation of the sinus and expectations should be lowered as presumed high healing rates are not always achieved.
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Affiliation(s)
- Marjolein De Decker
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium.
| | - Toon Sels
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium
| | - Sander Van Hoof
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium
| | - Quinten Smets
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium
| | - Tom Hendrickx
- Department of General and Abdominal Surgery, AZ Turnhout, 2300, Turnhout, Belgium
| | - Els Van Dessel
- Department of General and Abdominal Surgery, GZA Hospitals, 2018, Antwerp, Belgium
| | - Niels Komen
- Department of Abdominal, Pediatric and Reconstructive Surgery, Antwerp University Hospital, Drie Eikenstraat 566, 2650, Edegem, Belgium
- Antwerp ReSURG, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium
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15
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Dönmez M, Uludag M. Evaluation of the Early Outcomes of Laser-Endoscopic Pilonidal Sinus Treatment Combination and Comparison With the Combination of Cautery-Phenol-Endoscopic Pilonidal Sinus Treatment. Cureus 2022; 14:e26948. [PMID: 35989794 PMCID: PMC9378937 DOI: 10.7759/cureus.26948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Although there are several methods used in the treatment of pilonidal sinus, research is still ongoing for the most effective method. Minimally invasive surgical methods, alone or in combination, are currently considered the closest treatment modalities to the ideal. The purpose of this study was to evaluate the early outcomes of laser-endoscopic pilonidal sinus treatment combination and compare it with the combination of phenol-cautery-endoscopic pilonidal sinus treatment. Materials and methods This is a retrospective study of 42 patients with pilonidal sinus disease treated between September 2020 and April 2022. A total of 26 participants in group one were treated with the laser-endoscopic pilonidal sinus treatment combination, and the remaining 16 in group two were treated with the cautery-phenol-endoscopic pilonidal sinus treatment combination. Both primary and recurrent patients over 16 years of age without active infection were included. In the postoperative period, each patient was followed up at the outpatient clinic. Perioperative and follow-up data were recorded. Results Patients were predominantly male. There was no significant difference between the two groups with regards to the time to return to daily life, pain-free walking, recovery time, and recurrence. However, in group one, the operation time was statistically shorter (p = 0.02), and the rate of sitting on the toilet without pain on the day of surgery was significantly higher (p = 0.029). In addition, none of the patients in this group needed painkillers and all returned to work earlier. Conclusion The combination of laser-endoscopic pilonidal sinus treatment is a feasible procedure with a 92.3% complete recovery rate according to the early results. However, studies with a larger sample size and longer follow-up period are required to confirm the validity of our results.
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Sluckin TC, Hazen SMJA, Smeenk RM, Schouten R. Sinus laser-assisted closure (SiLaC®) for pilonidal disease: results of a multicentre cohort study. Tech Coloproctol 2022; 26:135-141. [PMID: 34993686 DOI: 10.1007/s10151-021-02550-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND An emerging and promising minimally invasive treatment for pilonidal disease (PD) is sinus laser-assisted closure (SiLaC®). Previous studies have shown encouraging results concerning safety, patient satisfaction, wound healing and acceptable recurrence rates. This study investigated outcomes for a large cohort of PD patients treated with SiLaC®. METHODS A multicentre cohort study with a prospective design and partial retrospective data collection for patients with PD treated with SiLaC® in three hospitals in the Netherlands (Albert Schweitzer Hospital, Flevoziekenhuis and Medical Centre Zuiderzee) from January 1st 2017 to March 1st 2020. The primary outcome was recurrence. Secondary outcomes were incidence of complete wound closure, time until wound closure, postoperative complications, ability to perform daily activities and reported patient satisfaction. RESULTS A total of 311 patients were included with a median follow-up of 10 months (range 1-52 months). The recurrence rate after one SiLaC® treatment was 26% with 7% experiencing incomplete wound closure, resulting in an initial success rate of 66% after one SiLaC® procedure. This increased to 92% and 98% after two and three SiLaC® procedures, respectively. Mean time until wound closure was 6 weeks (range 1-24 weeks). Seven patients (2%) were still unsuccessfully treated after three SiLaC® treatments and required additional and extensive surgery. Mean time to perform regular daily activities including working was 6 days (range 0-42 days) and the vast majority of patients (84%) did not require painkillers or only paracetamol. Twelve patients (4%) developed a postoperative wound infection. The mean satisfaction score was 9 (range 5-10). CONCLUSIONS SiLaC® is a promising minimally invasive treatment for PD with high patient satisfaction and an acceptable success rate. These results suggest that SiLaC® could be used as a safe and effective primary treatment for PD.
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Affiliation(s)
- Tania C Sluckin
- Department of Surgery, Flevoziekenhuis, 1 Hospitaalweg, 1315 RA, Almere, The Netherlands
| | | | - Robert M Smeenk
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Ruben Schouten
- Department of Surgery, Flevoziekenhuis, 1 Hospitaalweg, 1315 RA, Almere, The Netherlands.
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17
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Bogdanic B. Laser treatment of umbilical pilonidal sinus. Lasers Med Sci 2022; 37:687-689. [PMID: 34981271 DOI: 10.1007/s10103-021-03485-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Branko Bogdanic
- Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia. .,School of Medicine, University of Zagreb, 10000, Zagreb, Croatia. .,St. Catherine Specialty Hospital, 10000, Zagreb, Croatia.
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