Laser ablation of pilonidal sinus

The standard for treating pilonidal sinuses is surgery, but this approach can be painful, resulting in a large wound, a longer recovery period, and no guarantee against recurrence. Laser ablation, as described in this article by a consultant in general surgery, can lead to more desirable outcomes for pilonidal sinus treatment.

What is pilonidal sinus disease?

A pilonidal sinus is a tract or cavity of the natal cleft (the crease between the two buttocks) characterised by repeated infection and chronic inflammation. It presents like a small hole or tunnel in the skin.

The formation of a pilonidal sinus is caused by hair becoming embedded in the skin crevices, causing irritation and lesions that can later lead to infection, which is when most patients will discover they have one. The infection typically takes the form of an abscess with pus.

Pilonidal sinus disease is more common in young men who have lots of body hair and who have a high BMI, usually occurring between puberty and the age of 40.

What are the symptoms of pilonidal sinuses?

The symptoms of a pilonidal sinus include:

• a small dimple in the skin
• irritation or discomfort
• severe pain
• a painful mass, which may be an abscess
• smelly discharge
• drainage from the area, which may be pus or blood, accompanied by foul odour and hair protruding from the lesion

There could be more than one pilonidal sinus tract or hole in the skin.

How are pilonidal sinuses diagnosed?

Pilonidal sinuses are usually diagnosed by physical examination of the affected area. A doctor may also ask about the patient’s symptoms and medical history.

In more complex situations, imaging tests such as an ultrasound or an MRI may be ordered to help confirm the diagnosis, especially to differentiate pilonidal sinus from an anal fistula.

How are pilonidal sinuses treated?

Typically, antibiotics and ointments are often not sufficient to treat pilonidal sinuses. Surgery ranges from minor procedures where the abscess is drained of pus, to operations in which the sinus and surrounding tissues, including the culpable hairs, are removed, and the wound is either left open to heal or closed with a skin flap.

The issue with pilonidal sinus surgery is that it can be difficult for the wound to heal due to the location in the cleft of the buttocks and the possible exposure to faeces; in 20% of patients, they can have recurrent sinuses within three years.

Laser ablation for pilonidal sinuses

A novel approach to pilonidal surgery utilises lasers. In a short, outpatient procedure of about 30 minutes that is performed under a general anaesthetic, a laser probe is inserted into the sinus and engaged so that it destroys infected tissue whilst preserving healthy tissue. As the probe is removed, the tunnel of tissue of the sinus collapses and seals from within, meaning that the size of the wound is minimal and doesn’t warrant sutures.

The outcomes of laser ablation of a pilonidal sinus show that patients experience less postoperative pain, and can return to work within a couple of days. As the wound is already sealed, patients do not need to do postoperative care like wound dressing and ointments, and there is only a small scar with fewer risks of recurrence and reinfection.