Laser ablation of pilonidal sinus: Safe joule ranges and effects on recurrence

Objectives: Pilonidal sinus is a chronic inflammatory disease that usually occurs in the sacrococcygeal region. Although there is no consensus on the exact treatment method, laser ablation is becoming increasingly popular as a minimally invasive technique. However, there is no standardized treatment protocol for laser ablation. In this study, the relationship between the amount of energy used during laser ablation and sinus tract length and its effect on postoperative discharge and recurrence were retrospectively evaluated. Methods: 152 patients who underwent laser ablation treatment in our clinic were retrospectively analyzed. Patients were evaluated according to age and gender, sinus tract length, amount of energy applied, postoperative discharge, and recurrence rates. Laser ablation was performed with a radial diode laser device with a wavelength of 1470 nm. Sinus discharge lasting longer than three weeks was considered a recurrence. Results: The mean age of the patients was 15.34 ± 1.57 years; 42.1% were female and 57.9% were male. It was determined that 19.7% of patients with sinus tract length less than 5.5 cm and 74.7% of the patients with sinus tract length 5.5 cm or more developed discharge. Recurrence occurred in 8.4% of patients with sinus tract length below 6.5 cm and 59.5% of patients with sinus tract length 6.5 cm and above. When the applied laser energy was above 625 Joules, the risk of discharge development increased significantly, while the recurrence rate was significantly higher when the laser energy was above 1007 Joules (p<0.001). Conclusions: Laser ablation is an effective and minimally invasive method in the treatment of pilonidal sinus. However, it is important to determine safe energy limits to increase the efficacy of this method. Controlled adjustment of the amount of energy applied during laser ablation is critical to prevent complications.