The SiLaC procedure for pilonidal sinus disease: long-term outcomes of a single institution prospective study

Long-term follow-up of pilonidal sinus disease treated by radial laser surgery

PURPOSE

Laser ablation is one of the newest and most advanced minimally invasive techniques in treating pilonidal sinus disease (PSD). Most studies on the subject have small sample sizes and relatively short follow-up times, making evaluation of long-term healing rates and recurrences difficult. Furthermore, long-term results for laser surgery of PSD are still lacking. The aim of this study was to retrospectively report long-term follow-up results for PSD treatment by radial laser surgery.

METHODS

We retrospectively studied the medical records of 83 patients who underwent the radial laser procedure for PSD between January 2017 and September 2019. Our follow-up time was a median of 5.2 years, range 1.5 to 7.4 years.

RESULTS

Twelve patients had a PSD recurrence after their laser procedure, which gives a recurrence rate of 14.5% (95% CI 8.2%-23.2%). These recurrences appeared at a median 12.2 months after the laser procedure, range 4.2 to 51 months. A total of 23 patients (27.7%; 95% CI 19.0-38.0) underwent a reoperation, 11 patients due to postoperative infection or prolonged recovery and 12 patients due to PSD recurrence. Recurrent PSD and spillage of pus during operation were statistically significantly associated with the need for a second operation.

CONCLUSION

Radial laser surgery provides a minimally invasive treatment option with an acceptable recurrence rate in long-term follow-up.

Adolescent pilonidal disease laser treatment (a-PiLaT): a pilot study

BACKGROUND

Pilonidal disease (PD) is an acquired condition related to hair-induced mechanical forces on the skin surface of the intergluteal cleft, with subsequent abscess formation with or without a concomitant draining sinus (pit). While surgical management currently is the mainstay of treatment, pilonidal disease laser treatment (PiLaT) has recently been recognized as a promising treatment option for non-inflammatory diseases. Nonetheless, there is a paucity of available data on adolescent pilonidal disease laser treatment (a-PiLaT).

METHODS

We describe our preliminary experience with PiLaT performed in adolescents aged 10-17 years at our tertiary paediatric surgical hospital from 2019 to 2023. Data on perioperative characteristics and clinical outcomes at follow-up were retrospectively analysed.

RESULTS

A total of 17 consecutive patients (n = 12 female, 71%) underwent a-PiLaT. At the time of treatment, the patients' mean age and body mass index were 13.6 ± 1.6 years and 25.3 ± 5.6 kg m-2, respectively. The mean operative time was 21.5 ± 10.4 min, whereas the mean follow-up period was 24.5 ± 16.8 months, with a complication rate of 24% (n = 4) and recurrence rate of 18% (n = 3). With respect to postsurgical scar assessment, the mean Patient and Observer Scar Assessment Scale scores (score range 6-60, with higher scores indicating worse outcome) were 14.2 ± 6.5 (patients' evaluation) and 11.4 ± 4.7 (observers' evaluation).

CONCLUSION

The a-PiLaT represents a novel approach for managing PD in adolescents. Our preliminary data on the outcomes of a small series of patients with pilonidal sinuses after a-PiLaT indicated complication and recurrence rates comparable to those reported in the literature for adults. This new minimally invasive technique has great potential and is therefore worthy of further research on a larger population.

SiLaT: A paradigm shift in the treatment of pilonidal disease?

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.

Minimum energy laser pilonidotomy (MELPi): a multicenter study of a novel method in pilonidal disease

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.

Pilonidal sinus: an overview of historical and current management modalities

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.

Efficacy of Laser Treatment in Pilonidal Disease: A Single-Arm Meta-Analysis

Objective: This study aimed to collate all published studies on laser therapy for pilonidal disease and demonstrate the safety and effectiveness of minimally invasive techniques. Methods: A comprehensive literature search, with no language limitations, was performed using PubMed, Embase, and Web of Science from inception to April 23, 2023. Two reviewers independently screened the literature according to the inclusion and exclusion criteria and evaluated the bias risk of included studies. Meta-analysis was performed using RevMan software (version 5.4). (PROSPERO Registration ID Number CRD42023420803). Results: The analysis included 1214 patients from 13 studies, who fulfilled the pre-defined inclusion criteria. With a median follow-up of 12 (range, 7.8-25) months, 1000 (84.4%) patients achieved healing after primary laser treatment. The mean complication and recurrence rates were 12.7% and 7.6%, respectively. Conclusions: Laser ablation for pilonidal sinus disease is a new minimally invasive technique with good treatment efficacy, low postoperative recovery, and shorter recovery periods following employment.

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.

Minimally Invasive Pilonidal Sinus Treatment: EPSIT Versus PEBAI Method

PURPOSE

We aimed to compare endoscopic pilonidal sinus treatment (EPSIT) and pit/sinus punch needle excision, brushing, ablation and irrigation (PEBAI) method that was performed with principles similar to EPSIT but without fistuloscope and vision in the treatment of pilonidal sinus disease (PSD).

METHODS

Patients who underwent EPSIT and PEBAI methods for PSD in a single center between January 2020 and October 2021 were retrospectively analyzed. The primary endpoint was healing, the secondary endpoints were operative time, pain, wound closure, quality of life, cosmetic results, and cost.

RESULTS

One hundred 4 patients who underwent EPSIT and 184 patients who underwent PEBAI were included in the study. Age ( P =0.871), sex ( P =0.669), BMI ( P =0.176), number of pits ( P =0.99) were similar in both groups. The operative time for PEBAI [20 min (18 to 32)] was shorter than EPSIT [32 min (24 to 44)] ( P <0.0000, u value=3096, z-score=-9.459). Postoperative first ( P =0.147) and 14th day( P =0.382) pain scores, postoperative analgesic requirements ( P =0.609), time to return to daily activities ( P =0.747), time to return to work ( P =0.345), and wound complications ( P =0.816) were similar, whereas the wound closure time was earlier after EPSIT [32 d (24 to 41)] than after PEBAI [37 d (26 to 58)] ( P <0.00001, u value=5344, z-score=6.22141). The median follow-up was 24 (12 to 34) months. Complete wound healing ( P =0.382), recurrence rate ( P =0.533), quality of life at first month and (Wound evaluation scale score at first year ( P =0.252) were similar in both groups. However, the cost of PEBAI [54.8 € (50.13 to 64.96)] was significantly lower than cost of EPSIT [147.36 € (132.53 to 169.60)] ( P <0.00001, u value=0, z-score=7.210).

CONCLUSIONS

PEBAI method is a cheaper alternative to EPSIT with similar surgical principles and clinical outcomes.

Non-excisional techniques for the treatment of intergluteal pilonidal sinus disease: a systematic review

Non-excisional techniques for pilonidal sinus disease (PSD) have gained popularity over the last years. The aim of this study was to review short and long-term outcomes for non-excisional techniques with special focus on the additive effect of treatment of the inner lining of the sinus cavity and the difference between primary and recurrent PSD. A systematic search was conducted in Embase, Medline, Web of Science Core Collection, Cochrane and Google Scholar databases for studies on non-excisional techniques for PSD including pit picking techniques with or without additional laser or phenol treatment, unroofing, endoscopic techniques and thrombin gelatin matrix application. Outcomes were recurrence rates, healing rates, complication rates, wound healing times and time taken to return to daily activities. In total, 31 studies comprising 8100 patients were included. Non-excisional techniques had overall healing rates ranging from 67 to 100%. Recurrence rates for pit picking, unroofing and gelatin matrix application varied from 0 to 16% depending on the follow-up time. Recurrence rates after additional laser, phenol and endoscopic techniques varied from 0 to 29%. Complication rates ranged from 0 to 16%, and the wound healing time was between three and forty-seven days. The return to daily activities varied from one to nine days. Non-excisional techniques are associated with fast recovery and low morbidity but recurrence rates are high. Techniques that attempt to additionally treat the inner lining of the sinus have worse recurrence rates than pit picking alone. Recurrence rates do not differ between primary and recurrent disease.

Short- and mid-term results of diode laser treatment in pilonidal sinus disease and the role of endoscopic camera use on outcomes

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.

Laser ablation: a unique and beneficial therapeutic option for pilonidal sinus? And the potential for further innovation-a review

Laser has revolutionized the medical field, broadening the diagnostic and therapeutic spectrum, with diode (630-980 nm) and Nd:YAG (1064 nm) lasers being the common choices in ablation procedures. Laser ablation in pilonidal sinus disease is a new minimally invasive technique with good treatment efficacy, low post-op morbidity, and shorter recovery periods following employment. This review study aimed to provide information on the use of lasers in pilonidal sinus disease and their effectiveness compared to other conventional methods. The articles considered were obtained by performing a literature search in PubMed, Cochrane, and Google Scholar, and 44 articles were included in this study. Techniques like sinus laser-assisted closure (SiLaC), sinus laser therapy (SiLaT), pilonidal sinus laser treatment (PiLaT), and laser-assisted endoscopic pilonidal sinus treatment (LEPSiT) were included and reviewed. Diode laser was most commonly used, with local anesthesia preferred over spinal or general anesthesia. The highest healing rate was observed with Nd:YAG laser and the SiLaT technique. Recurrence was low, particularly in patients who underwent multiple procedures. On reviewing the published literature, laser ablation procedures showed lower morbidity and post-op complications. Patient satisfaction was higher, and the overall cost was found to be lower with minimally invasive techniques. Long-term prospective studies comparing lasers with other surgical techniques would help us ascertain the future treatment modality of pilonidal sinus disease.

Outcomes of Laser-Assisted Closure (SiLaC) Surgery for Chronic Pilonidal Sinus Disease

Background: Management of pilonidal sinus (PNS) disease has changed notably in the past decade, with the introduction of novel surgical techniques and technological innovation. In this study, we summarized our initial experience with sinus laser-assisted closure (SiLaC) of pilonidal disease. Methods: A retrospective analysis of a prospective database of all patients who underwent minimally invasive surgery combined with laser therapy for PNS between September 2018 and December 2020 was performed. Patients' demographics, clinical and perioperative data, as well postoperative outcomes were recorded and analyzed. Results: A total of 92 patients (86 males, 93.4%) underwent SiLaC surgery for pilonidal sinus disease during the study period. Patients' median age was 22 (range 16-62 years), and 60.8% of them previously underwent abscess drainage due to PNS. SiLaC was performed under local anesthesia in 85.7% of cases (78 patients) with a median energy of 1081 J (range 13-5035 J). One patient was lost to follow-up, leaving 91 patients for final analysis. The primary outcome was complete healing rate, standing at 81.3% (74/91 patients). In 8 patients (8.8%), there was minor incomplete healing that did not require reintervention. Recurrent/nonhealing disease was seen in 9 patients (9.9%), requiring reoperation in 7 patients (8.4%). Of those, 4 patients underwent repeat SiLaC and 3 patients underwent wide excision. Analysis of risk factors for PNS recurrence demonstrated that general anesthesia (P = .02) was associated with increased risk for recurrence along with a trend for increased risk in patients with significant hairiness (P = .078). No differences were seen in age (P = .621), gender (P = .475), median sinus length (P = .397), and energy used (P = .904). Conclusion: Primary healing rate after SiLaC surgery for chronic PNS was >80% in our series. Ten percent of patients did not achieve complete healing but did not require surgery due to lack of symptoms.

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

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.

Does minimally invasive laser-assisted treatment of pilonidal sinus disease live up to its expectations: a multi-center study with 226 patients

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.

Pilonidal sinus laser-assisted closure (PiLAC) - a low-morbidity alternative to excision with excellent long-term outcomes

INTRODUCTION

Recurrence after surgery for pilonidal sinus disease is a recognised problem and patients often re-present months after discharge. We routinely treat primary and recurrent pilonidal sinus disease with Pilonidal sinus Laser-Assisted Closure (PiLAC). Long-term outcomes following PiLAC surgery was examined following clinical and telephone review.

METHODS

All patients undergoing PiLAC as a day-case between April 2016 and July 2019 were included. Patients were followed up in a nurse-led clinic until complete healing or recurrence. A prospective database and retrospective audit of notes combined with longer-term follow-up by telephone were used.

RESULTS

A total of 35 patients underwent PiLAC, median age 28 (18-53 years), 28 males:7 females. A total of 28 patients had long-term (>60 days) follow-up, mean 407 days (range 67-887 days); 25/28 patients (89.3%) had healed with no recurrence on long-term follow-up. Of these 28 patients, 11 were first presentation of pilonidal disease and underwent PiLAC as their first treatment, with a 91% heal rate long term. A total of 15 patients had seton drainage prior to PiLAC, with a 93% heal rate versus no seton (83%). Fisher's exact test showed no significant difference between sex, new/recurrent pilonidal disease and seton placement (p>0.05).

CONCLUSIONS

Healing after PiLAC for the treatment of primary and recurrent pilonidal sinus disease is preserved with excellent long-term outcomes. We recommend it as an alternative to surgical excision.

Minimally invasive treatment of pilonidal sinus disease in a paediatric population: comparison of two techniques

BACKGROUND

Pilonidal disease (PD) is a common and debilitating inflammatory condition with significant impact on quality of life. Minimally invasive techniques (MIT) have shown promising results comparing to traditional excision. Herein we present a comparison of two MIT techniques -sinusectomy (SE) and pit-picking plus laser ablation (PPL).

METHODS

All cases of paediatric PD treated by PPL and SE at our center between August 2018 and August 2020 were retrospectively reviewed.

RESULTS

One-hundred and six patients were included, with a median age of 16 years (IQR 15-16). PPL was the procedure of choice in 36 patients (34%) and the remaining underwent SE (66%). Median healing time was significantly lower in SE group (20 days), comparing to PPL (30 days) (p = 0.002). Early healing failure occurred more frequently in the PPL group (p = 0.003). Recurrence rate was similar between groups - PPL 17% versus SE 16% (p = 0.89). Overall complication rate was 9% and was significantly higher in PPL (p = 0.03).

CONCLUSIONS

MIT techniques are promising solutions in PD treatment. Although similarly easy and fast to perform, SE technique showed better healing profile and lower complication rate but no significant difference on recurrence rates was observed.

Outcomes of Sinus Laser Therapy in Sacrococcygeal Pilonidal Sinus Disease: A Single-Center Experience

Sacrococcygeal pilonidal sinus disease (SPND) is an acquired chronic disease with no precise etiopathogenesis. The morbidity associated with the disease necessitates the implementation of new techniques, such as sinus laser therapy (SiLaT), to improve disease management. However, surgical techniques as of now are preferred as the mainstay mode of treatment.

A retrospective study was conducted to evaluate and report the healing outcome of the application of SiLaT on patients with SPND at a tertiary center. All patients who underwent SiLaT for primary or recurrent pilonidal sinus from February 2012 to December 2019 were included in the study and followed up for at least six months. Forty-one participants (37 males (90.2%) and four females (9.8%)) were included. Of the participants, 58.5% presented with chief complaints of painful swelling with mucopurulent discharge. Most of the participants were students (43.9%). SiLaT was the primary intervention for 82.9% of the participants. The mean duration of hospital stays, resumption of regular activity, and complete wound healing by secondary intention were 30±21.5 hours, 18.4±14.3 days, and 6.5±6.6 weeks, respectively. Around 95.1% of wounds healed without complications. The overall recurrence rate was 24.4%, while the recurrence rate with SiLaT being the primary intervention was 11.8%. Only three (7.32%) patients experienced wound infections as postoperative complications. The visual analog scale (VAS) score decreased postoperatively in the first and second weeks to 3.9±3.2 and 1.9±1.9, respectively, and 78.1% of the total patients showed satisfaction post-surgical interventions. The current study showed that the SiLaT technique is a feasible technology with promising results to evolve. Further studies are encouraged.

Evaluation of the Early Outcomes of Laser-Endoscopic Pilonidal Sinus Treatment Combination and Comparison With the Combination of Cautery-Phenol-Endoscopic Pilonidal Sinus Treatment

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.

Endoscopic pilonidal sinus treatment vs. laser-assisted endoscopic pilonidal sinus treatment: short-term results from a retrospective case-matched study

BACKGROUND

The aim of this study was to investigate whether the addition of laser to the endoscopic pilonidal sinus treatment (EPSIT), laser-assisted EPSIT (LEPSIT) has an effect on the method and clinical results in the treatment of pilonidal sinus disease (PSD).

METHODS

Between September 2019 and September 2020, patients who underwent LEPSIT and EPSIT procedures for PSD at Bursa Medicana Hospital, Turkey, were matched for age, pit location and number, body mass index (BMI), and sex. The primary endpoint was complete wound healing and the secondary endpoints were quality of life, cosmetic results, and cost.

RESULTS

Twenty-four LEPSIT patients were matched to 72 EPSIT patients. Eighty-one (84.4%) of the included patients were male, and the median age was 26 years (range 16-52 years). The median follow-up time was 9 months (range 3-15 months).Wound healing rates (LEPSIT; 95.8% vs. EPSIT; 93%; p = 0.99) were similar in both groups. In patients who underwent LEPSIT, the operative time (p = 0.00086) was significantly shorter, time taken to return to work (p = 0.03572) and wound closure (p < 0.00001) were significantly less. However, the time taken to return to daily activities and the percentage of wound complications were similar in both groups. The pain scores on postoperative -days 1 7, and 14 were significantly higher after EPSIT (p = 0.0083, p = 0.00054, and p = 0.0479, respectively). The postoperative analgesic requirement was significantly higher after EPSIT (p = 0.01492). The total hospital cost was significantly less in patients who underwent EPSIT (p < 0.00001). Significantly better cosmetic improvement was observed in LEPSIT procedure (p = 0.00694). First month quality of life (evaluated with the Short Form 36 Health Survey Questionnaire) was similar except for bodily pain (better after LEPSIT).

CONCLUSIONS

The success rates of LEPSIT and EPSIT are similar. LEPSIT results in better wound healing and patient comfort, and a shorter time to return to work.

Sinus laser-assisted closure (SiLaC®) for pilonidal disease: results of a multicentre cohort study

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.

Extensive suppuration and being overweight are factors associated with the failure of laser treatment for pilonidal disease: lessons from the first French retrospective cohort

BACKGROUND

The aim of our study was to assess the efficacy of sinus laser therapy (SiLaT) for the treatment of pilonidal disease.

METHODS

All adult patients treated with SiLaT in our department between June 1, 2018, and August 23, 2019, were included in the study. Success was defined as the closure of cutaneous orifices and the absence of discharge or abscesses.

RESULTS

We included 29 consecutive patients (22 males) with a median age of 32.5 ± 10.5 years. Eight patients had already undergone prior surgery for pilonidal disease. The procedure was performed under spinal (55%) or general (45%) anesthesia. The mean follow-up was 370.3 days (± 165.8 days). We observed 2 primary failures (6.9%) and 7 recurrences (24.1%). Ultimately, 20 patients were considered to have been cured (69%). The mean time to healing was 25 days (± 8.1 days). No serious complications were reported. Usual activities were resumed within a mean of 4.9 days (± 7.2), and 86% of patients reported being "very satisfied" with the treatment. The body mass index was lower for patients who were cured (24.0 ± 3.6) than for those who experienced treatment failure (27.6 ± 3.4; p = 0.018). The cured patients were less likely to have one or more secondary openings (35.0 versus 88.9%, p = 0.014).

CONCLUSIONS

Almost 70% of our patients were cured by SiLaT. Complications were rare and mild. The technique appeared to be less effective for overweight patients and those with one or more secondary openings associated with pilonidal pits.

Sinus laser therapy versus sinus lay open in the management of sacrococcygeal pilonidal disease

AIM

There is no standard method for the management of sacrococcygeal pilonidal disease (SPND); however, surgery remains the gold standard treatment. Wide surgical excision of the sinus is the traditional surgical treatment of SPND, yet it is associated with extended healing time and delayed recovery. This study aimed to compare the outcomes of sinus laser therapy (SiLaT) and sinus lay open in the management of SPND.

METHODS

Patients with SPND who were treated with SiLaT or lay open were retrospectively reviewed. The main outcome measures were the success of surgery in terms of complete healing at 12 months postoperatively, time to complete healing, complications, operation time and quality of life (QoL).

RESULTS

A total of 139 patients with a mean age of 25 years were included to the study. Sixty-two patients underwent SiLaT and 77 underwent lay open. Six patients experienced recurrence after SiLaT while there was no recorded recurrence after the lay open technique (P = 0.007). Sinus lay open had a shorter operation time than SiLaT (P < 0.0001). On the other hand, SiLaT was followed by a shorter healing time, lower incidence of delayed wound healing, better cosmetic outcome, and higher QoL scores compared to the lay open group. The complication rates were comparable between the two groups.

CONCLUSION

Sinus lay open was associated with better success than SiLaT. On the other hand, SiLaT was associated with quicker healing, better cosmesis, better QoL and longer operation time. The complication rate of the two procedures was comparable.

Laser treatment of pilonidal disease: a systematic review

Pilonidal disease (PD) is a common condition, and there is still an ongoing debate on ideal management that should be minimally invasive, safe, and efficient. The use of radially emitting laser in the treatment of chronic PD is a novel minimally invasive technique, and initial studies with a small number of patients showed promising results. This study aimed to assess the efficacy and safety of chronic PD treatment with a laser using a systematic review of the published literature. A systematic review was conducted after PubMed, Scopus, Embase, Web of Science, and the Cochrane database search for studies reporting laser treatment of chronic PD. Also, our unpublished prospective single-center study was included in this review. Ten of 87 studies were eligible for the review, including 971 patients. The median age of the patients was 26 (range 13-68), and the median operative time was 26 (range 6-65) min. With a median follow-up of 12 (range 7-25) months, 917 (94.4%) patients achieved primary healing with a weighted mean recurrence rate of 3.8%. The weighted mean complication rate was 10% (95% CI 5.7-14.3%, I2 = 82.28, p < 0.001), and all were minor. The published literature demonstrates that laser treatment is a promising procedure in the management of chronic PD. Furthermore, the review showed that standardized operative techniques and perioperative steps were used. The results were limited to the mild chronic PD. Classification of PD severity and standardized outcome reporting is required to define indications and contraindications for laser PD treatment. Randomized controlled trials are needed to determine the long-term effectiveness and superiority of laser treatment over other methods.

Sinus laser closure (SiLaC) versus Limberg flap in management of pilonidal disease: A short term non-randomized comparative prospective study

INTRODUCTION

Fistula Laser Closure (FiLAC) is a method that was originally applied in the treatment of perianal fistulas. Because of promising results, diode lasers were later on used to treat pilonidal sinus disease in a method called sinus Laser Closure (SiLaC). The aim of this study is to compare between SiLaC and Limberg flap in management of pilonidal disease.

METHODS

A prospective, nonrandomized comparative study. A short-term follow-up of 71 patients with pilonidal disease was analyzed (24 operated on using the SiLaC technique and 47 using the Limberg technique). With a primary outcome is healing rate and recurrence and a secondary outcome is other measures i.e. complications, hospital stay and postoperative pain.

RESULTS

The median operative time in the SiLaC group was 26.45 ± 5.41 min (20-35 min) and in the Limberg group 58.63 ± 7.42 min (50-75 min). In the SiLaC group, the primary healing was achieved in 23 out of 24 patients (95.8%) with a total complication rate of 20.83%. There were two cases of recurrence after initial healing in each group.

CONCLUSION

Sinus laser Closure (SiLaC) is comparable to Limberg flap technique in the terms of healing rate and recurrence with better outcome regarding operative time, hospital stay and post-operative pain.

Laying Open and Curettage under Local Anesthesia to Treat Pilonidal Sinus: Long-Term Follow-Up in 111 Consecutively Operated Patients

(1) Background: Several techniques for the treatment of pilonidal sinus disease (PSD) are in vogue, though none have emerged as the gold standard. Laying open (deroofing) and curettage under local anesthesia is one of the most straightforward procedures to treat PSD. In this study, the long-term follow-up in a large series was analyzed. (2) Methods: The laying open approach was performed for all types of consecutive PSD patients-simple, complicated, and abscess. The primary outcome parameter of the study was the healing rate. The secondary outcome parameters were operating time, hospital stay, time to resumption of normal work, and healing time. (3) Results: 111 (M/F-92/19, mean age-22.9 ± 5.7 years) consecutive patients were operated on and followed for 38 months (6-111 months). Of these, 24 had pilonidal abscesses, 87 had chronic pilonidal disease, while 22 had recurrent disease. Operating time and hospital stay were 24 ± 7 min and 66 ± 23 min, respectively. On average, patients could resume normal work in 3.6 ± 2.9 days and the healing time was 43.8 ± 7.4 days. Three patients were lost to follow-up. Complete resolution of the disease occurred in 104/108 (96.3%) patients, while 4 (3.7%) had a recurrence. One recurrence was due to a missed tract, while three recurrences presented after complete healing had occurred. Two patients with recurrence were operated on again with the same procedure, and both healed completely. Thus, the overall success rate of this procedure was 98.1% (106/108) with a recurrence rate after first surgery of 3.7% over a median follow-up of 38 months. (4) Conclusions: Pilonidal disease managed by laying open (deroofing) with curettage under local anesthesia is associated with a high cure rate. This procedure is effective in treating all kinds of pilonidal disease (simple, complicated, and abscess).

The Bascom Cleft Lift as a Solution for All Presentations of Pilonidal Disease

Objective This study is a report on 700 consecutive patients treated with the Bascom cleft lift as treatment for both simple and complex pilonidal diseases between 1993 and 2020. Patients and methods The Bascom cleft lift was used in patients with primary disease, recurrent disease, perianal disease, and failed flap procedures. Some technical modifications had to be made to accommodate patients with perianal disease, and they are described. All patients were treated by the author in private practice clinics and hospitals between 1993 and 2020 and were entered into a database concomitantly with their treatment. Patients were subsequently surveyed in preparation for this study, by phone, email, or email survey to determine the current status. The procedure consisted of excision of the sinus tracts, cysts, and open wounds; raising a skin and subcutaneous tissue flap; and flattening the gluteal cleft. Failure of the procedure was defined as lack of complete healing or recurrent pilonidal disease requiring revisional surgery. Complications were recorded and are described. Results We found that of the 700 patients, 3.4% required revision of the cleft lift (confidence interval for proportion based on binomial distribution: 2.1%-4.8%). The median follow-up time for patients without recurrence was six months (IQR: 2-19.5). Once primary healing was obtained, there were no late recurrences in the 156 patients followed beyond 24 months. Factors that negatively impacted the success rate were having had previous failed pilonidal surgery (5.3% required revision) and open wounds on the edge of the anus (15.5% required revision). Conclusions The Bascom cleft lift had an overall success rate of 96.6%. There was no category of patients for which this was not a good option, but analysis of this data reveals that patients who have had previous failed surgery, and patients with wounds on the edge of the anus had a higher failure rate than the group as a whole.

Pilonidal Disease Treatment By Radial Laser Surgery (FilaC™): The First Finnish Experience

BACKGROUND AND AIMS

Pilonidal disease is common, and it afflicts especially young adults, causing disability. Several types of treatment methods are applicable, but no consensus exists regarding the best method. The aim of our study was to assess the novel radial laser probe treatment in pilonidal disease and report the success rate and recurrence rate.

METHODS

We studied retrospectively 86 patients who, according to our hospital patient records, underwent radial laser probe surgery between January 2017 and September 2019.

RESULTS

In a mean follow-up time of 14 months, the success rate at 2 months was 86%. Most operations were done under local anesthesia on a day-surgery basis. The recovery time was rapid, and median sick leave was 12 days. Of those initially successfully treated, 3% developed a recurrence. Altogether 17% of the patients underwent a re-operation. Spillage of pus during surgery, however, reduced the success rate to 53%.

CONCLUSION

Radial laser probe treatment is a quick, safe, and minimally invasive treatment choice for pilonidal disease, especially when no active infection is present.