1470 nm-diode laser for pilonidal sinus disease
laser for pilonidal sinus
For many years in the treatment of the pilonidal sinus (PS) there was a clear discrepancy between the trauma from the surgical access to the size of the pathological process itself. This has lengthened the recovery time for patients. All minimally invasive techniques proposed to solve this problem (endoscopic, chemical, electrosurgical and others) generally solved the problem of preserving the integrity of the skin over the sinus, but were not without their drawbacks. The main drawbacks are technical complexity, lack of visual control of treatment efficacy, long periods of treatment and high level of discomfort for the patient. These factors, according to many authors, led to a higher percentage of disease recurrences than in traditional methods of treatment.
We have studied the results of 39 patients with pilonidal sinus treatment by Velas II diode laser with a wavelength of 1470 nm. 32 patients had chronic form of the disease and 7 – an acute one. In the treatment of chronic forms of PS, under intravenous anesthesia, all external sinus passages were opened by scalpel using circular incisions. The dimensions of the access were only 1 mm more than the dimensions of the outer holes of PS. PS was investigated using a probe to detect side branches from the central axis. After this, the cavity was cleared of the contents with a Folkman spoon and a “biopsy brush”. Initially about 200 ml of hydrogen peroxide solution was used for rinsing, then - 40 ml 0.2% solution of chlorhexidine bigluconate. Next stage was introducing of laser into the course and, at a power of 10 W with an exposure time of 1 second, PS was coagulated along the entire course. In the presence of lateral branches, similar coagulation was performed in all directions. The areas of PS excised by the scalpel were not processed by the laser. If necessary, hemostasis was performed by laser or electrocoagulation. Intraoperatively, patients were administered ceftriaxone 1000 mg intravenously. Hospitalization of patients was not necessary. During the postoperative period, the surgical access areas were treated with an antiseptic solution 2 times a day, after which an aseptic dressing was applied. Analgesia was prescribed for 3 days: Dexketoprofen 25mg, tablets, 2 times a day, while about 60% of patients refused to undergo analgesia from the second day after surgery. From the third day after the operation, patients were allowed to take a hygienic shower.
Patients with acute PS were treated in the same way. In case of violation of the vitality of the skin a contraperture was performed over the ulcer. Also, additional cuts for the drainage of purulent cavities were performed with the spread of pus in the gluteal region. Wounds from purulent streaks on the buttocks were not treated with a laser. After the operation, a water-soluble antibiotic ointment (Levomecol) was applied into additional wounds.
In the postoperative period, the patients were administered antibiotic ceftriaxone 1000 mg, intramuscularly, 2 times a day for 5 days. Pain relief was used depending on the intensity. Bandages of wounds from drainage of purulent cavities were performed 2 times a day. Cavities of the wound were treated with a solution of hydrogen peroxide, chlorhexidine, followed by the introduction of water-soluble antibiotic ointment (Levomecol). Daily dressings were performed until the moment of complete cleaning of the residual cavity from pus, on average, within three days from the moment of surgery. Further wound management was performed according to general surgical principles. Patients started to take a hygienic shower from 3 to 5 days after surgery.
The treatment of patients with chronic PS, according our observations, took 1 day. During the treatment, patients did not lose their ability to work. They were able to return to sports and other types of activity without any restrictions from the 7th - 10th day. Complete epithelization of wounds from surgical access occurred on the 10th day.
The disability periods of patients with acute forms of PS depended on the nature of their work, the size of wounds through which the purulent cavities drained, but in all cases did not exceed 7 days.
Complications during treatment were not observed. In 1 patient with an acute form of PS on the 16th day after the operation, the residual purulent cavity was opened along the postoperative scar in the area of contraception.
In two patients with chronic PS and one with acute for 7–10 days, seromas with a volume of 0.1-0.3 ml were emptied through wounds from excision of the external course of PS.
Clinically and according to ultrasound studies (10 days after surgery - 55% of patients and 30 days after surgery - 35% of patients) during period of investigation up to 6 months, no recurrences of PS were observed.
The use of a diode laser with a wavelength of 1470 nm for the treatment of PS is an easy-to-use and low-impact method of surgical treatment that does not require hospitalization of the patient, limiting labor and social activity in the postoperative period. The absence of additional skin trauma for surgical access, bleeding, sutures and residual cavities does not require any special wound care in the postoperative period in patients with chronic PS. The terms of treatment in acute forms of PS are determined by the volume of purulent impurities and the size of wounds performed for drainage of abscesses. The healing time of the PS areas treated with a laser in acute PS forms is comparable with similar results in the group of patients with chronic PS. Insufficient time and the number of patients observation in the late postoperative period requires further investigations to assess the PS treatment efficacy by 1470 nm-diode.