Pilonidal Sinüs Hastalığında Cerrahi Tedavi ve Lazer Ablasyonun Erken ve Orta Dönem Sonuçlarının Karşılaştırılması

Öz

Amaç: Bu çalışmada pilonidal sinüs hastalığında farklı cerrahi ve minimal invaziv tedavi yöntemlerinin yara iyileşmesi, postoperatif komplikasyonlar, kronik postoperatif ağrı ve nüks açısından erken ve orta dönem sonuçlarının karşılaştırılması amaçlandı. Gereç ve Yöntem: Temmuz 2021-Mayıs 2025 tarihleri arasında sakrokoksigeal pilonidal sinüs hastalığı nedeniyle opere edilen 173 hastanın verileri retrospektif olarak değerlendirildi. Hastalar uygulanan yönteme göre Karydakis flep, primer kapama ve lazer ablasyon gruplarına ayrıldı. Demografik veriler, yara iyileşmesi, komplikasyonlar, kronik ağrı ve nüks oranları karşılaştırıldı. Ayrıca geçirilmiş abse veya önceki cerrahi öyküsü olmayan primer olgularda alt grup analizi yapıldı. Bulgular: Hastaların 96’sına (%55,5) Karydakis flep, 42’sine (%24,3) primer kapama ve 35’ine (%20,2) lazer ablasyon uygulandı. Ortalama yatış süresi lazer grubunda daha kısa bulundu (p=0,0002). Tam yara iyileşme süresi lazer grubunda anlamlı olarak daha uzundu (p<0,001). Toplam nüks oranı %9,8 idi ve nüks oranı Karydakis grubunda %4,2, primer kapama grubunda %14,3 ve lazer grubunda %20,0 olarak saptandı (p=0,014). Ancak primer olgular üzerindeki alt grup analizinde gruplar arasındaki fark anlamlılığını kaybetti (p=0,118). Erken yara komplikasyonu gelişen hastalarda kronik ağrı ve nüks oranları daha yüksekti. Sonuç: Minimal invaziv yöntemler kısa yatış süresi ve düşük yara ayrışması oranı gibi avantajlar sağlayabilir. Bununla birlikte hasta seçimi, hastalık şiddeti ve yara iyileşme süreci uzun dönem sonuçlar üzerinde önemli rol oynamaktadır.

Anahtar Kelimeler

• Pilonidal sinüs
• Karydakis flep
• lazer ablasyon
• nüks
• yara iyileşmesi

Comparison of Early- and Mid-Term Outcomes of Surgical Treatment and Laser Ablation for Pilonidal Sinus Disease

Öz

Objective: This study aimed to compare the early- and mid-term outcomes of different surgical and minimally invasive treatment methods for pilonidal sinus disease in terms of wound healing, postoperative complications, chronic postoperative pain, and recurrence. Materials and Methods: Data from 173 patients operated on for sacrococcygeal pilonidal sinus disease between July 2021 and May 2025 were retrospectively evaluated. Patients were divided into Karydakis flap, primary closure, and laser ablation groups according to the surgical method performed. Demographic characteristics, wound healing, complications, chronic pain, and recurrence rates were compared. Subgroup analyses were also performed in primary cases without previous abscess attacks or prior surgery. Results: Karydakis flap was performed in 96 (55.5%) patients, primary closure in 42 (24.3%), and laser ablation in 35 (20.2%). Mean hospital stay was shorter in the laser group (p=0.0002). Complete wound healing time was significantly longer in the laser group (p<0.001). The overall recurrence rate was 9.8%, with recurrence rates of 4.2% in the Karydakis group, 14.3% in the primary closure group, and 20.0% in the laser group (p=0.014). However, subgroup analysis in primary cases showed no significant difference between groups (p=0.118). Chronic pain and recurrence rates were higher in patients with early wound complications. Conclusion: Minimally invasive methods may provide advantages such as shorter hospital stay and lower wound dehiscence rates. However, patient selection, disease severity, and wound healing process play an important role in long-term outcomes.

Anahtar Kelimeler

• Pilonidal sinus
• Karydakis flap
• laser ablation
• recurrence
• wound healing

Kaynakça

1. Johnson EK, Vogel JD, Cowan ML, Feingold DL, Steele SR. The American Society of Colon and Rectal Surgeons’ clinical practice guidelines for the management of pilonidal disease. Dis Colon Rectum. 2019;62(2):146–157. doi:10.1097/ DCR.0000000000001262.
2. Iesalnieks I, Ommer A. The management of pilonidal sinus disease: a systematic review. Langenbecks Arch Surg. 2019;404(1):1–14. doi:10.1007/s00423- 018-1736-8.
3. Gojayev A, Erkent M, Aydin HO, Aydoğan C, Avci T, Tırnova İ, et al. Comparative Outcomes of Surgical Techniques for Pilonidal Sinus: A Turkish Retrospective Study. Med Sci Monit. 2025;31:e947466. doi:10.12659/MSM.947466.
4. Enriquez-Navascues JM, Emparanza JI, Alkorta M, Placer C. Meta-analysis of randomized controlled trials comparing different techniques for pilonidal sinus. Ann Surg. 2014;259(2):218–227. doi:10.1097/ SLA.0b013e31828b8a0d.
5. Dessily M, Charara F, Ralea S, Allé JL. Pilonidal sinus destruction with a radial laser probe: technique and first Belgian experience. Tech Coloproctol. 2017;21(11):949– 953. doi:10.1007/s10151-017-1701-1.
6. Karita K, Adalia L, Tuija P, Jukka H, Kethe H. Long-term follow-up of pilonidal sinus disease treated by radial laser surgery. Langenbecks Arch Surg. 2024;409(1):260. doi:10.1007/s00423-024-03455-0.
7. Zubaidi AM, Alali MN, AlShammari SA, Zikry AH, Habib M, AlSalem AS, et al. Outcomes of Sinus Laser Therapy in Sacrococcygeal Pilonidal Sinus Disease: A Single-Center Experience. Cureus. 2022;14(9):e29388. doi:10.7759/ cureus.29388.
8. Emile SH, Elfeki H, Shalaby M, Sakr A, Sileri P, Wexner SD. Endoscopic and laser treatment of pilonidal sinus disease: a systematic review and meta-analysis. Surg Endosc. 2018;32(9):3754–3762. doi:10.1007/ s00464-018-6213-5.

9. Almajid FM, Alabdrabalnabi AA, Almulhim KA. The risk of recurrence of pilonidal disease after surgical management. Saudi Med J. 2017;38(1):70–74. doi:10.15537/ smj.2017.1.15892.
10. Bi S, Sun K, Chen S, Gu J. Surgical procedures in the pilonidal sinus disease: a systematic review and network meta-analysis. Sci Rep. 2020;10(1):13720. doi:10.1038/ s41598-020-70641-7.
11. Sluckin TC, Hazen SJA, Smeenk RM, Schouten R. Sinus laser-assisted closure (SiLaC®) for pilonidal disease: results of a multicentre cohort study. Tech Coloproctol. 2022;26(2):135–141. doi:10.1007/ s10151-021-02550-4.
12. De Decker M, Sels T, Van Hoof S, Smets Q, Hendrickx T, Van Dessel E, et al. 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(1):33. doi:10.1007/s00384-023- 04324-w.
13. Hemmingsson O, Binnermark F, Odensten C, Rutegård M, Franklin KA, Haapamäki MM. Excision and suture in the midline versus Karydakis flap surgery for pilonidal sinus: randomized clinical trial. BJS Open. 2022;6(2):zrac007. doi:10.1093/bjsopen/ zrac007.
14. Yildiz T, Elmas B, Yucak A, Turgut HT, Ilce Z. Comparison of Karydakis flap reconstruction versus primary midline closure in sacrococcygeal pilonidal disease. J Pediatr Surg. 2022;57(2):321–326. doi:10.1016/j. jpedsurg.2021.06.021.
15. Emral AC, Koc B, Acar T, Kamer E. Evaluation of laser ablation for recurrent pilonidal sinus disease. Lasers Med Sci. 2025;40(1):118. doi:10.1007/s10103-025- 04218-4.
16. Kaba I, Yildiz T, Cetin DA, et al. New factors affecting wound healing and recurrence after pilonidal sinus surgery. Int Wound J. 2024;21(3):e14789. doi:10.1111/ iwj.14789.
17. Doll D, Orlik A, Maier K, Kauf P, Schmid M, Diekmann M, et al. Impact of geography and surgical approach on recurrence in global pilonidal sinus disease. Sci Rep. 2019;9(1):15111. doi:10.1038/s41598- 019-51159-z.