Efficacy and Outcomes of Laser Treatment in Pilonidal Sinus Disease

Yıl 2024, , 120 - 123, 22.01.2025

Merter Gülen , Ahmet Cihangir Emral

https://doi.org/10.20492/aeahtd.1535436

Öz

AIM: In recent years, minimally invasive treatment methods have introduced significant innovations in the surgical management of pilonidal sinüs disease. This study aims to comprehensively evaluate the efficacy of laser treatment for pilonidal sinus disease, focusing on treatment success, recurrence rates, complications, and patients' return to normal life.
MATERIAL AND METHOD: In this study, data from patients treated with laser ablation for pilonidal sinus disease between August 2020 and August 2023 were retrospectively analyzed. Patients aged 18-40 who were treated with laser for pilonidal sinus disease were included in the study. Patients with recurrence, those who had undergone chemotherapy/radiotherapy in the anorectal or sacrococcygeal region, those with concurrent malignancies, those with a history of inflammatory bowel disease, those on chronic steroids, diabetics, and patients with autoimmune diseases were excluded from the study.
RESULTS: A total of 49 patients (5 females, 44 males) who underwent laser ablation for pilonidal sinus disease were included in the study. It was found that 16 (32.7%) of the included patients had a history of abscess drainage due to pilonidal sinus disease. In the postoperative period, the median (min-max) wound healing time was 28 (20-52) days. A total of 4 patients (8.3%) experienced recurrence.
CONCLUSION: Considering pilonidal sinus disease as a subcutaneous infectious condition, laser ablation should be regarded as one of the primary treatment options for pilonidal sinus surgery, given its acceptable recurrence rates, low complication risk, rapid return to normal activities, and cosmetic advantages.
Keywords: laser, pilonidal sinus disease, minimally invasive

Anahtar Kelimeler

laser, pilonidal sinus disease, minimally invasive

Pilonidal Sinüs Hastalığında Lazer Tedavisinin Etkinliği ve Sonuçları

Öz

AMAÇ: Son yıllarda, minimal invaziv tedavi yöntemleri pilonidal sinüs hastalığının cerrahi yönetiminde önemli yenilikler getirmiştir. Bu çalışmanın amacı, pilonidal sinüs hastalığında lazer tedavisinin etkinliğini, tedavi başarısı, nüks oranları, komplikasyonlar ve hastaların normal yaşantıya dönüş süresi açısından kapsamlı bir şekilde değerlendirmektir.
GEREÇ VE YÖNTEM: Bu çalışmada, Ağustos 2020 ile Ağustos 2023 arasında pilonidal sinüs hastalığı nedeniyle lazer ablasyon yöntemiyle tedavi edilen hastaların verileri retrospektif olarak incelendi. 18-40 yaş arası pilonidal sinüs hastalığı nedeniyle lazer ile tedavi edilen hastalar çalışmaya dahil edildi. Nüks yaşayan hastalar, anorektal veya sakrokoksigeal bölgede kemoterapi/radyoterapi uygulanan hastalar, eş zamanlı malignitesi olan hastalar, inflamatuar barsak hastalığı öyküsü bulunan hastalar, kronik steroid kullanan hastalar, diabeti olan hastalar ve otoimmün hastalığı bulunan hastalar çalışma dışı bırakıldı.
BULGULAR: Toplamda 49 hasta (5 kadın, 44 erkek) pilonidal sinüs hastalığı nedeniyle lazer ablasyon tedavisi uygulandı. Dahil edilen hastalardan 16'sında (%32.7) daha önce abse drenajı öyküsü olduğu belirlendi. Postoperatif dönemde, median (min-maks) yara iyileşme süresi 28 (20-52) gün olarak görüldü. Toplamda 4 hastada (%8.3) nüks gözlemlendi.
SONUÇ: Pilonidal sinüs hastalığını subkutanöz enfeksiyöz bir durum olarak değerlendirildiğinde, lazer ablasyon, kabul edilebilir nüks oranları, düşük komplikasyon riski, hızlı normal yaşantıya dönüş ve kozmetik avantajları nedeniyle pilonidal sinüs cerrahisi için ilk tercih edilecek tedavi yöntemlerinden biri olarak kabul edilebilir.
Anahtar kelimeler: lazer, pilonidal sinüs hastalığı, minimal invaziv

Anahtar Kelimeler

lazer, pilonidal sinüs hastalığı, minimal invaziv

Kaynakça

• 1) da Silva JH. Pilonidal cyst: cause and treatment. Dis Colon Rectum. 2000 Aug;43(8):1146-56. doi: 10.1007/ BF02236564. PMID: 10950015.
• 2) Moran DC, Kavanagh DO, Adhmed I, Regan MC. Excision and primary closure using the Karydakis flap for the treatment of pilonidal disease: outcomes from a single institution. World J Surg. 2011 Aug;35(8):1803-8. doi: 10.1007/ s00268-011-1138-z. PMID: 21553200.
• 3) Sit M, Aktas G, Yilmaz EE. Comparison of the three surgical flap techniques in pilonidal sinus surgery. Am Surg. 2013 Dec;79(12):1263-8. PMID: 24351353.
• 4) Johnson EK, Vogel JD, Cowan ML, Feingold DL, Steele SR; Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons’ Clinical Practice Guidelines for the Management of Pilonidal Disease. Dis Colon Rectum. 2019 Feb;62(2):146-157. doi: 10.1097/ DCR.0000000000001237. PMID: 30640830.
• 5) 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 Mar 1;38(1):82. doi: 10.1007/s10103-023-03741-1. PMID: 36856904; PMCID: PMC9977879.
• 6) Kalaiselvan R, Bathla S, Allen W, Liyanage A, Rajaganeshan R. Minimally invasive techniques in the management of pilonidal disease. Int J Colorectal Dis. 2019 Apr;34(4):561- 568. doi: 10.1007/s00384-019-03260-y. Epub 2019 Feb 27. PMID: 30810799.
• 7) Grabowski J, Oyetunji TA, Goldin AB, Baird R, Gosain A, Lal DR, Kawaguchi A, Downard C, Sola JE, Arthur LG, Shelton J, Diefenbach KA, Kelley-Quon LI, Williams RF, Ricca RL, Dasgupta R, St Peter SD, Sømme S, Guner YS, Jancelewicz T. The management of pilonidal disease: A systematic review. J Pediatr Surg. 2019 Nov;54(11):2210-2221. doi: 10.1016/j.jpedsurg.2019.02.055. Epub 2019 Mar 19. PMID: 30948198.
• 8) Şahin AG, Alçı E. Use of the laser in the pilonidal sinus alone or in combination with phenol. Rev Assoc Med Bras (1992). 2023 Nov 13;69(12):e20230740. doi: 10.1590/1806- 9282.20230740. PMID: 37971129; PMCID: PMC10645176.
• 9) Emile SH, Khan SM, Barsom SH, Wexner SD. Karydakis procedure versus Limberg flap for treatment of pilonidal sinus: an updated meta-analysis of randomized controlled trials. Int J Colorectal Dis. 2021 Jul;36(7):1421-1431. doi: 10.1007/s00384-021-03922-w. Epub 2021 Apr 10. PMID: 33839888.
• 10) Taşkin AK, Özçetin B. Comparison of the effectiveness of laser and crystallized phenol in the treatment of sacrococcygeal pilonidal sinus. Cir Cir. 2023;91(3):297-303. English. doi: 10.24875/CIRU.22000461. PMID: 37440707.
• 11) Dessily M, Dziubeck M, Chahidi E, Simonelli V. The SiLaC procedure for pilonidal sinus disease: long-term outcomes of a single institution prospective study. Tech Coloproctol. 2019 Dec;23(12):1133-1140. doi: 10.1007/s10151-019- 123 02119-2. Epub 2019 Nov 26. PMID: 31773347.
• 12) Pappas AF, Christodoulou DK. A new minimally invasive treatment of pilonidal sinus disease with the use of a diode laser: a prospective large series of patients. Colorectal Dis. 2018 Aug;20(8):O207-O214. doi: 10.1111/codi.14285. Epub 2018 Jun 27. PMID: 29878584.
• 13) Yardimci VH. Outcomes of Two Treatments for Uncomplicated Pilonidal Sinus Disease: Karydakis Flap Procedure and Sinus Tract Ablation Procedure Using a 1,470 nm Diode Laser Combined With Pit Excision. Lasers Surg Med. 2020 Nov;52(9):848-854. doi: 10.1002/lsm.23224. Epub 2020 Feb 17. PMID: 32064640.
• 14) Huurman EA, Galema HA, de Raaff CAL, Wijnhoven BPL, Toorenvliet BR, Smeenk RM. Non-excisional techniques for the treatment of intergluteal pilonidal sinus disease: a systematic review. Tech Coloproctol. 2023 Dec;27(12):1191- 1200. doi: 10.1007/s10151-023-02870-7. Epub 2023 Nov 6. PMID: 37930579; PMCID: PMC10638206.