¹Consultant Surgeon, ³DNB, Department of Surgery, Apollo Hospital Navi Mumbai, Maharashtra, INDIA.

²Associate Professor, Department of Medicine, Dypatil Medical College Nerul Navi Mumbai, Maharashtra, INDIA

Email: drmanishpendse@gmail.com

Table 1: Patient and operative characteristics

VAS score analysis was done and a significant change in VAS score was noted between day 1 and day 7.

Table 2: VAS score analysis.

DISCUSSION

Excessive hair growth has a pivotal pathogenetic role due to the penetration of broken terminal hairs into the subcutaneous tissue with subsequent inflammatory granuloma development and potential secondary infection. Discomfort and pain are common symptoms after debridement without skin closure and marsupialization. This procedure require repeated change of dressing which results in delayed healing.⁵ Excision of pilonidal sinus and primary midline closure has high rates of recurrence and infection and longer hospitalization.⁶ There are many surgical methods described, varying from the simple incision, drainage, unroofing, curettage and spontaneous secondary healing to excision-flap sliding, Karydakis, Bascom, and MacFee methods. The standard treating pilonidal sinus (PNS) is surgical intervention with excision of sinus. Although surgical intervention is acutely effective, but the recurrence of pilonidal sinus is high.⁴ The aim of laser treatment is to use high energy at the tip of the probe to destroy the squamous epithelium of the pilonidal sinus and induce contraction/ obliteration of the tract.⁷ Laser pilonidoplasty is a simple, reasonable, feasible, minimal invasive, reproducible technique and competitive alternative to other surgical intervention. It is, however, more common in young adult men, a population with an incidence of 1.1%. Affected patients are typically in their middle to late 20s and have had symptoms for 4 to 5 years at initial presentation.⁸ The onset of disease in adolescent can be correlated with pubertal hormonal effect as well as skin and hair changes.⁸ Ashwin P⁹ studied laser pilonidotomy in 228 patients. Mean duration of Procedure was 33 ± 11 min, mean duration of Hospital Stay was 12 ± 3 h, resumption of normal activity within 4 ± 2 days , mean duration for Complete Wound Healing by secondary intention 6 ± 1.25 Weeks. Among complications, infection reported in 1.08%. The difference between the mean pre and post-operative VAS score was statistically highly significant (p < 0.0001). Recurrence rate was 3.24%. Success rate was 96.75% and Overall patient’s satisfaction was 97.84%. Laser Pilonidotomy is effective in destruction of a pilonidal cyst with good success rate, fewer complications and with high patient’s satisfaction. Similar findings were noted in present study. Oram et al.¹⁰ reported a 13.3% recurrence rate of pilonidal sinus after a mean number of 2.7 Alexandrite laser treatments. Recurrence rate after excision and primary closure was high (38%) and excision and flap reconstruction provided the best results with a relapse rate of only 7.3%. Therefore, it is attractive to speculate that the choice of surgical technique influences pilonidal sinus recurrence rate.¹⁰ Patil AM,¹¹ studied pilonidal sinus destruction with Neo V Laser Probe The success rate was 87.5% (35 patients/40). Recurrence rate was 2.9% (1/35). Alferink M et al.,¹² studied 50 patients operated with radial laser probe (Sinus Laser-Assisted Closure, SiLaCTM, Biolitec, Germany). The median follow up duration was 120 days. The initial success rate was 92% (45/50). There were no complications during or after surgery. Mean patient satisfaction was 9.0 (3.0 to 10.0). Thirteen percent of patients did not require any analgesia, 37% used only when needed, of which 32% for less than one week and 10% for one to two weeks. In a retrospective series of 40 patients treated with the FILAC™ radial laser probe and documented an 87.5% success rate with 2.9% recurrence. The mean follow-up period was 234 days. Four patients presented with complications: 2 hematomas (5%) and 2 abscesses (5%), which were all medically treated.⁷ In a meta-analysis and merged-data analysis¹³, recurrence after Limberg/Dufourmentel operations was as low as 0.6% at 12 months and 1.8% at 24 months postoperatively. Recurrence after Karydakis/Bascom procedures was 0.2% at 12 months and 0.6% at 24 months postoperatively. Primary midline closure after 240 months was associated with recurrence rates of 67.9%. CO₂ laser able to seal lymphatic and blood vessels up to 1mm diameter and can reduce intraoperative bleeding and the occurrence of postoperative swelling. It also offers more comfort to patients by reducing intraoperative bleeding and postoperative edema, facilitating the process of wound healing after surgery.¹⁴ Major limitations of present study were small sample, relatively short median follow-up duration. A prospective study with larger sample size and longer median follow-up is required to establish recurrence rates more accurately.

CONCLUSION

Laser treatment in primary pilonidal disease is minimal invasive surgery, is easy to perform with major advantages such as shorter hospital stay, less post-operative pain and care and the final aesthetic aspect. It is accompanied by a reduction in pain, early resuming work with decreased rate of recurrence.

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