A New Laser-Assisted Pilonidal Sinus Excision Surgical Technique. Presentation of First 368 Cases: Short- and Mid-Term Results
Main Article Content
Abstract
Pilonidal sinus disease (PSD) is a common skin and soft tissue infection of the gluteal area. Numerous surgical and other less invasive techniques in the treatment of this condition have been proposed over the years. Management of PSD though, remains a challenge for modern surgery due to high rates of recurrence and treatment-associated morbidity. In this study, we present the short and mid-term results of our novel method, Laser assisted Pilonidal Sinus excision (LaPSe method). A total cohort of 368 patients, 310 males and 58 females, median age 21 years, underwent LaPSe surgery for PSD, from January 2018 to January 2024. Follow up was obtained by clinical examination and phone call interview over a six-month period. All patients underwent the operation uneventfully. Short term complications were recorded in 9 patients (5 cases bleeding, 4 cases site infection) all treated conservatively. Delayed healing was documented in 12 patients and 5 of them required re-operation (1,4% recurrence rate). These highly promising results in a large cohort are making LaPSe method a potential treatment of choice for pilonidal disease.
Article Details
How to Cite
KALAITZIS, John.
A New Laser-Assisted Pilonidal Sinus Excision Surgical Technique. Presentation of First 368 Cases: Short- and Mid-Term Results.
Medical Research Archives, [S.l.], v. 12, n. 6, june 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5358>. Date accessed: 02 july 2024.
doi: https://doi.org/10.18103/mra.v12i6.5358.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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2. Iesalnieks I, Ommer A, Herold A, Doll D. German National Guideline on the management of pilonidal disease: update 2020. Langenbecks Arch Surg. 2021 Dec;406(8):2569-2580.
3. Murphy DC, Merson J. Pilonidal disease. JAAPA. 2022 Oct 1;35(10):54-55.
4. Khanna A, Rombeau JL. Pilonidal disease. Clin Colon Rectal Surg. 2011 Mar. 24 (1):46-53.
5. Oetzmann von Sochaczewski C, Gödeke J. Pilonidal sinus disease on the rise: a one-third incidence increase in inpatients in 13 years with substantial regional variation in Germany. Int J Colorectal Dis. 2021 Oct;36(10):2135-2145.
6. Gil LA, Deans KJ, Minneci PC. Management of Pilonidal Disease: A Review. JAMA Surg. 2023 Aug 1;158(8):875-883.
7. Harries RL, Alqallaf A, Torkington J, Harding KG. Management of sacrococcygeal pilonidal sinus disease. Int Wound J. 2019 Apr;16(2):370-378.
8. Kallis MP, Maloney C, Lipskar AM. Management of pilonidal disease. Curr Opin Pediatr. 2018 Jun;30(3):411-416.
9. Obokhare I, Amajoyi RC. Pilonidal Disease: To Flap or Not to Flap. Adv Surg. 2023 Sep;57(1):155-169.
10. Ray K, Albendary M, Baig MK, Swaminathan C, Sains P, Sajid MS. Limberg flap for the management of pilonidal sinus reduces disease recurrence compared to Karydakis and Bascom procedure: a systematic review and meta-analysis of randomized controlled trials. Minerva Chir. 2020 Oct;75(5):355-364.
11. Velotti N, Manigrasso M, Di Lauro K, Araimo E, Calculli F, Vertaldi S, Anoldo P, Aprea G, Simone G, Vitiello A, Musella M, Milone M, De Palma GD, Milone F, Sosa Fernandez LM. Minimally Invasive Pilonidal Sinus Treatment: A Narrative Review. Open Med (Wars). 2019 Aug 7;14:532-536.
12. 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.
13. Tazeoglu D, Dag A. Effect of treatment of pilonidal sinus with phenol on patients' clinical condition and quality of life. Ann Ital Chir. 2022;93:385-390.
14. Harju J, Söderlund F, Yrjönen A, Santos A, Hermunen K. Pilonidal disease treatment by radial laser surgery (FiLaC™): The first Finnish experience. Scand J Surg. 2021 Dec;110(4):520-523.
15. Delshad HR, Dawson M, Melvin P, Zotto S, Mooney DP. Pit-picking resolves pilonidal disease in adolescents. J Pediatr Surg. 2019 Jan;54(1):174-176.
16. Pérez-Bertólez S, Martín-Solé O, Moraleda I, Cuesta M, Massaguer C, Palazón P, Tarrado X. Advantages of endoscopic pilonidal sinus treatment. Cir Pediatr. 2021 Oct 1;34(4):191-199. English, Spanish.
17. Elbanna HG, Emile SH, Youssef M, Thabet W, El-Hamed TM, Ghnnam WM. Novel Approach of Treatment of Pilonidal Sinus Disease With Thrombin Gelatin Matrix as a Sealant. Dis Colon Rectum. 2016 Aug;59(8):775-80.
18. Mahmood F, Hussain A, Akingboye A. Pilonidal sinus disease: Review of current practice and prospects for endoscopic treatment. Ann Med Surg (Lond). 2020 Aug 1;57:212-217.
19. J. Kalaitzis. LaPSe method: A novel laser assisted surgical technique in the treatment of pilonidal disease. Scientific Chronicles 2019; 24(2): 220-227.
20. Hodges RM. Pilonidal sinus. Boston Med Surg J. 1880. 103:485-586.
21. Vartanian E, Gould DJ, Lee SW, Patel KM. Pilonidal Disease: Classic and Contemporary Concepts for Surgical Management. Ann Plast Surg. 2018 Dec;81(6):e12-e19.
22. Wu P, Zhang Y, Zhang Y, Wang S, Fan Z. Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review. Int J Surg. 2023 Aug 1;109(8):2388- 2403.
23. Stauffer VK, Luedi MM, Kauf P, Schmid M, Diekmann M, Wieferich K, Schnüriger B, Doll D. Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep. 2018 Feb 15;8(1):3058.
24. Petersen S, Ommer A, Iesalnieks I, Doll D. Wundheilungsstörungen nach Exzision und offener Behandlung eines Sinus pilonidalis [Wound Healing Disorders after Excision and Open Treatment for Pilonidal Sinus]. Zentralbl Chir. 2021 Aug;146(4):417-426. German.
25. Bubenová M, Konečná D, Kala Z. Pilonidal sinus disease: Karydakis flap procedure in our patients. Rozhl Chir. 2020 Summer;99(8):350-355. English.
26. Imam A, Khalayleh H, Pines G, Khoury D, Mavor E, Pelta A. Pilonidal Sinus Management; Bascom Flap Versus Pilonidal Pits Excision: A Single-Center Experience. Ann Coloproctol. 2021 Apr;37(2):109-114.
27. Özcan B, İlkgül Ö. Contralateral Limberg flap reconstruction for pilonidal disease recurrence. Asian J Surg. 2019 Aug;42(8):787-791
28. Romic I, Augustin G, Bogdanic B, Bruketa T, Moric T. Laser treatment of pilonidal disease: a systematic review. Lasers Med Sci. 2022 Mar;37(2):723-732.
29. Ganduboina R, Sreekumar A, Dutta P, Dhawan A, Adhnon A, Soni A, Sudarsan A, Basu A, Kumar Y, Mukherjee I. Laser ablation: a unique and beneficial therapeutic option for pilonidal sinus? And the potential for further innovation-a review. Lasers Med Sci. 2023 May 18;38(1):124.
30. 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 Jul 17;14(7):e26948.
31. Delshad HR, Dawson M, Melvin P, Zotto S, Mooney DP. Pit-picking resolves pilonidal disease in adolescents. J Pediatr Surg. 2019 Jan;54(1):174-176.
2. Iesalnieks I, Ommer A, Herold A, Doll D. German National Guideline on the management of pilonidal disease: update 2020. Langenbecks Arch Surg. 2021 Dec;406(8):2569-2580.
3. Murphy DC, Merson J. Pilonidal disease. JAAPA. 2022 Oct 1;35(10):54-55.
4. Khanna A, Rombeau JL. Pilonidal disease. Clin Colon Rectal Surg. 2011 Mar. 24 (1):46-53.
5. Oetzmann von Sochaczewski C, Gödeke J. Pilonidal sinus disease on the rise: a one-third incidence increase in inpatients in 13 years with substantial regional variation in Germany. Int J Colorectal Dis. 2021 Oct;36(10):2135-2145.
6. Gil LA, Deans KJ, Minneci PC. Management of Pilonidal Disease: A Review. JAMA Surg. 2023 Aug 1;158(8):875-883.
7. Harries RL, Alqallaf A, Torkington J, Harding KG. Management of sacrococcygeal pilonidal sinus disease. Int Wound J. 2019 Apr;16(2):370-378.
8. Kallis MP, Maloney C, Lipskar AM. Management of pilonidal disease. Curr Opin Pediatr. 2018 Jun;30(3):411-416.
9. Obokhare I, Amajoyi RC. Pilonidal Disease: To Flap or Not to Flap. Adv Surg. 2023 Sep;57(1):155-169.
10. Ray K, Albendary M, Baig MK, Swaminathan C, Sains P, Sajid MS. Limberg flap for the management of pilonidal sinus reduces disease recurrence compared to Karydakis and Bascom procedure: a systematic review and meta-analysis of randomized controlled trials. Minerva Chir. 2020 Oct;75(5):355-364.
11. Velotti N, Manigrasso M, Di Lauro K, Araimo E, Calculli F, Vertaldi S, Anoldo P, Aprea G, Simone G, Vitiello A, Musella M, Milone M, De Palma GD, Milone F, Sosa Fernandez LM. Minimally Invasive Pilonidal Sinus Treatment: A Narrative Review. Open Med (Wars). 2019 Aug 7;14:532-536.
12. 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.
13. Tazeoglu D, Dag A. Effect of treatment of pilonidal sinus with phenol on patients' clinical condition and quality of life. Ann Ital Chir. 2022;93:385-390.
14. Harju J, Söderlund F, Yrjönen A, Santos A, Hermunen K. Pilonidal disease treatment by radial laser surgery (FiLaC™): The first Finnish experience. Scand J Surg. 2021 Dec;110(4):520-523.
15. Delshad HR, Dawson M, Melvin P, Zotto S, Mooney DP. Pit-picking resolves pilonidal disease in adolescents. J Pediatr Surg. 2019 Jan;54(1):174-176.
16. Pérez-Bertólez S, Martín-Solé O, Moraleda I, Cuesta M, Massaguer C, Palazón P, Tarrado X. Advantages of endoscopic pilonidal sinus treatment. Cir Pediatr. 2021 Oct 1;34(4):191-199. English, Spanish.
17. Elbanna HG, Emile SH, Youssef M, Thabet W, El-Hamed TM, Ghnnam WM. Novel Approach of Treatment of Pilonidal Sinus Disease With Thrombin Gelatin Matrix as a Sealant. Dis Colon Rectum. 2016 Aug;59(8):775-80.
18. Mahmood F, Hussain A, Akingboye A. Pilonidal sinus disease: Review of current practice and prospects for endoscopic treatment. Ann Med Surg (Lond). 2020 Aug 1;57:212-217.
19. J. Kalaitzis. LaPSe method: A novel laser assisted surgical technique in the treatment of pilonidal disease. Scientific Chronicles 2019; 24(2): 220-227.
20. Hodges RM. Pilonidal sinus. Boston Med Surg J. 1880. 103:485-586.
21. Vartanian E, Gould DJ, Lee SW, Patel KM. Pilonidal Disease: Classic and Contemporary Concepts for Surgical Management. Ann Plast Surg. 2018 Dec;81(6):e12-e19.
22. Wu P, Zhang Y, Zhang Y, Wang S, Fan Z. Progress in the surgical treatment of sacrococcygeal pilonidal sinus: a review. Int J Surg. 2023 Aug 1;109(8):2388- 2403.
23. Stauffer VK, Luedi MM, Kauf P, Schmid M, Diekmann M, Wieferich K, Schnüriger B, Doll D. Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep. 2018 Feb 15;8(1):3058.
24. Petersen S, Ommer A, Iesalnieks I, Doll D. Wundheilungsstörungen nach Exzision und offener Behandlung eines Sinus pilonidalis [Wound Healing Disorders after Excision and Open Treatment for Pilonidal Sinus]. Zentralbl Chir. 2021 Aug;146(4):417-426. German.
25. Bubenová M, Konečná D, Kala Z. Pilonidal sinus disease: Karydakis flap procedure in our patients. Rozhl Chir. 2020 Summer;99(8):350-355. English.
26. Imam A, Khalayleh H, Pines G, Khoury D, Mavor E, Pelta A. Pilonidal Sinus Management; Bascom Flap Versus Pilonidal Pits Excision: A Single-Center Experience. Ann Coloproctol. 2021 Apr;37(2):109-114.
27. Özcan B, İlkgül Ö. Contralateral Limberg flap reconstruction for pilonidal disease recurrence. Asian J Surg. 2019 Aug;42(8):787-791
28. Romic I, Augustin G, Bogdanic B, Bruketa T, Moric T. Laser treatment of pilonidal disease: a systematic review. Lasers Med Sci. 2022 Mar;37(2):723-732.
29. Ganduboina R, Sreekumar A, Dutta P, Dhawan A, Adhnon A, Soni A, Sudarsan A, Basu A, Kumar Y, Mukherjee I. Laser ablation: a unique and beneficial therapeutic option for pilonidal sinus? And the potential for further innovation-a review. Lasers Med Sci. 2023 May 18;38(1):124.
30. 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 Jul 17;14(7):e26948.
31. Delshad HR, Dawson M, Melvin P, Zotto S, Mooney DP. Pit-picking resolves pilonidal disease in adolescents. J Pediatr Surg. 2019 Jan;54(1):174-176.