Minimally Invasive Treatment of Pilonidal Sinus: Laser and Negative Pressure Therapy as a Gentle and Effective Modality
The increasing incidence of pilonidal sinus contributes to the development of new treatment methods. Experiences from AGEL Hospital Přerov show that the methods SiLaC (sinus laser ablation of the cyst) and NPWT (negative pressure wound therapy) represent a gentle and effective approach for pilonidal sinus, accelerating treatment and subsequent recovery.
Characteristics of the Disease and Advances in Its Therapy
Pilonidal sinus is an acute or chronic condition that affects the subcutaneous fat layer, especially in the area of the coccyx. It most commonly occurs in individuals aged 16 to 28 years. The incidence in the Czech Republic is 26 patients per 100,000 inhabitants, and men are more frequently affected. According to MUDr. Karla Janková from AGEL Hospital Přerov, the growing incidence is mainly due to a sedentary lifestyle.
In the past, the treatment of pilonidal sinus primarily involved incision with drainage, antibiotic treatment, and marsupialization (excision of the lesion). This was followed by prolonged healing lasting weeks or months and frequent recurrences. However, newer approaches with minimally invasive treatment methods bring better results and minimal cases of recurrence.
Laser and Negative Pressure Accelerate Treatment
The Wound Healing Clinic at AGEL Hospital Přerov has been using the SiLaC method in combination with NPWT since 2019. The combination of minimally invasive laser surgery with negative pressure therapy accelerates the closure of the cavity and prevents the formation of residual abscesses. The procedure is usually performed under general anesthesia, and the patient lies on their stomach with the pelvis supported. The fistula opening is excised with a circular scalpel, and after cleaning the wound, the cavity is treated with a laser beam. Thin tubing drains are inserted through the fistula openings to remove any remaining secretions, and negative pressure is applied. After 2 days, the drainage is removed, and the negative pressure system (usually set to −90 mmHg) is re-applied for 24 hours. Hospitalization typically lasts 3 days.
Practical Insights
Experiences from the Přerov facility, where 47 pilonidal sinus surgeries have been performed with the SiLaC + NPWT method since 2019, indicate that the healing time with complete scarring of postoperative wounds is 2 to 3 weeks. Recurrence occurred in only 2 cases: in a patient who fell on his buttocks 3 months after surgery and an obese woman for whom the application of NPWT was problematic due to extreme obesity.
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Source: Janková K. Usage of NPWT in Pilonidal Sinus Surgery. AGEL Hospital Přerov, 2023.
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