Laser treatment of pilonidal disease: a systematic review

Abstract

Pilonidal disease (PD) is a common condition, and there is still an ongoing debate on ideal management that should be minimally invasive, safe, and efficient. The use of radially emitting laser in the treatment of chronic PD is a novel minimally invasive technique, and initial studies with a small number of patients showed promising results. This study aimed to assess the efficacy and safety of chronic PD treatment with a laser using a systematic review of the published literature. A systematic review was conducted after PubMed, Scopus, Embase, Web of Science, and the Cochrane database search for studies reporting laser treatment of chronic PD. Also, our unpublished prospective single-center study was included in this review. Ten of 87 studies were eligible for the review, including 971 patients. The median age of the patients was 26 (range 13-68), and the median operative time was 26 (range 6-65) min. With a median follow-up of 12 (range 7-25) months, 917 (94.4%) patients achieved primary healing with a weighted mean recurrence rate of 3.8%. The weighted mean complication rate was 10% (95% CI 5.7-14.3%, I2 = 82.28, p < 0.001), and all were minor. The published literature demonstrates that laser treatment is a promising procedure in the management of chronic PD. Furthermore, the review showed that standardized operative techniques and perioperative steps were used. The results were limited to the mild chronic PD. Classification of PD severity and standardized outcome reporting is required to define indications and contraindications for laser PD treatment. Randomized controlled trials are needed to determine the long-term effectiveness and superiority of laser treatment over other methods.

Evaluation of the Early Outcomes of Laser-Endoscopic Pilonidal Sinus Treatment Combination and Comparison With the Combination of Cautery-Phenol-Endoscopic Pilonidal Sinus Treatment

“…In this study, it is clearly evident that the use of minimally invasive methods was successful in terms of shortening the operation time [ 6 ]. In former studies, it was defined that the operation time varied between 20 and 45 minutes in patients who underwent endoscopic pilonidal sinus surgery, and between six and 65 minutes for patients who underwent laser therapy [ 2 , 23 ]. Gulcu and Ozturk found the median operation time as 22 (16-38) minutes in their study in which these two methods were combined and called laser-assisted EPSiT (LEPSIT) [ 20 ].…”

“…Its advantages are as follows: it has a success rate of up to 97% in the first application, it can be used in every case regardless of the number and location of sinus orifices, it has a short learning curve, with an easy and repetitive application, and it can be performed as an outpatient procedure with local anesthesia. Another important advantage is the minimal effect on the surrounding tissue [ 13 , 15 , 16 , 23 , 28 ]. The techniques mentioned above are blind methods, for this reason, recently, researchers have started to apply a combined treatment method by adding video-assisted or EPSiT procedures.…”

Management of Pilonidal Disease

“…22 However, the authors reported an overall lack of well-designed prospective studies with considerable heterogeneity in treatment protocols and a need for a standardized disease severity classification system and outcome definitions in order to perform robust comparisons between groups. 22,33 Results from a larger randomized clinical trial comparing LE with standard hair removal in a broad population of adolescents and young adults with pilonidal disease should be available in the next year. 34…”

“…The effectiveness of LE and IPL therapy in pilonidal disease is promising with a recent systematic review demonstrating recurrence rates ranging from 0% to 28% with mean follow-up ranging from 6 months to 5 years and 4 of 5 comparative studies showing decreased recurrence rates compared with nonepilation cohorts . However, the authors reported an overall lack of well-designed prospective studies with considerable heterogeneity in treatment protocols and a need for a standardized disease severity classification system and outcome definitions in order to perform robust comparisons between groups . Results from a larger randomized clinical trial comparing LE with standard hair removal in a broad population of adolescents and young adults with pilonidal disease should be available in the next year …”

Laser Ablation of Pilonidal Sinus Disease: A Pilot Study

“…Our results with the laser device are also similar to those published in initial European trials. 8 Future comparative studies can better determine how this treatment compares to other minimally invasive techniques.…”