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Sinus laser therapy versus sinus layopen in the management ofsacrococcygeal pilonidal diseaseDr. Mohamed ArnouseAssistant lecturer of general andcolorectal surgery
3Iesalnieks I, Ommer A. The management of pilonidal sinus. Dtsch Arztebl Int. 2019; 116(1–2): 12– 21.
Management When patients present with acute infection or abscess, definitivetreatment is usually delayed until the infection has resolved. Epilation and hair removal using shaving, waxing, laser and depilatorycreams have been associated with improvement in the recurrencerates of SPND .Nixon AT, Garza RF. Pilonidal cyst and sinus. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2020. [cited 2020 Aug]
Non surgical management Injection of different materials inside the cavity of the sinus has beendevised as primary treatment or adjunct therapy with variabledegrees of success. Liquid and crystallized phenol have been used with success ratesreaching 95% . Fibrin glue has also been used for the treatment of chronic SPND witha success rate of up to 96% .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 ofColon and Rectal Surgeons’ Clinical Practice Guidelines for the Management of Pilonidal Disease. Dis Colon Rectum. 2019; 62(2): 146– 57.
Non surgical management Thrombin gelatin matrix with a reported success rate exceeding 90% . Application of platelet-rich plasma is considered a promisingtreatment and has been reported to be associated with a recurrencerate of 8.2%Sevinç B, Damburacı N, Karahan Ö. Long term results of minimally invasive treatment of pilonidal disease by platelet rich plasma. J Visc Surg. 2020; 157(1): 33– 5.
Surgical management Is the mainstay of treatment of chronic SPND & includes : Curettage, Lay open Wide excision with closing the defect primarily, with a flap or graft, or leaving thedefect open to heal with secondary intention Recently, minimally invasive procedures were introduced were associatedwith promising outcomes and good patient satisfaction. These methods include : Endoscopic pilonidal sinus treatment (EPSiT) Sinus laser therapy (SiLaT) with success rates over 90%Emile SH, Elfeki H, Shalaby M, Sakr A, Giaccaglia V, Sileri P, et al. Endoscopic pilonidal sinus treatment: a systematic review and meta-analysis. SurgEndosc. 2018; 32(9): 3754– 62. https://doi.org/10.1007/s00464-018-6157-5
Aim 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 wereretrospectively reviewed. The main outcome measures were the success of surgery in terms ofcomplete healing at 12 months postoperatively, time to completehealing, complications, operation time and quality of life (QoL)
SilaT
SilaT
SilaT
SilaT
SilaT
Lay Open
Lay Open
Lay open
Lay open
Lay open
Lay open
Lay open
Primary outcome Complete healing of sinus without recurrence, wasrecorded in all patients in the sinus lay open group and in56 patients in the SiLaT group with a statistically significantdifference between the two groups in favor of the lay opentechnique (100% vs. 90.3%; P 0.007)
Operative timeChart Title302520151050Operative timesilaTLay open
Recurrence90Chart Title80706050403020100SilaTLay openTotalRecurrence
Healing timeChart Title6050403020100WalkReturn to workSilaTLay openComplete wound healing
Cosmetic SatisfactionChart Title109876543210Cosmetic SatisfactionSilaTLay open
CostSeries 1120001000080006000400020000SilaTLay openSeries 1
Postoperative pain assessed using the visual analogue score (VAS): (A) box and whisker plot for postoperativepain after SiLaT; (B) box and whisker plot for postoperative pain after lay open
Take home message Sinus lay open was associated with better success than SiLaT. On theother hand, SiLaT was associated with quicker healing, bettercosmesis, better QoL and longer operation time. The complicationrate of the two procedures was comparable
Thank you
Sinus laser therapy (SiLaT) with success rates over 90% Emile SH, Elfeki H, Shalaby M, Sakr A, Giaccaglia V, Sileri P, et al. Endoscopic pilonida
