Laser Coagulation of the Pilonidal Sinus with Morphological Assessment

Aim: to determine the safest and most effective parameters for the laser coagulation method of uncomplicated pilonidal sinus.

Materials and methods. Three single-center randomized pilot studies were conducted, involving 21 patients with chronic inflammation of the pilonidal sinus. During the operation, depending on the randomization group, fiber laser devices with wavelengths of 970, 1560, and 1940 nm were used, with end or radial light guides and varying amounts of energy. To determine the effectiveness, safety, and characteristics of laser exposure, the sinus tract was excised, and the removed specimen was subjected to morphological examination. This study demonstrated the depth of thermal laser exposure on the structures of the pilonidal sinus at different wavelengths, amounts of energy transferred, and types of fiber instruments.

Results. Lasers with wavelengths of 970, 1560, and 1940 nm can be used for laser coagulation of the pilonidal sinus. The use of end-face and radial light guides is acceptable, but from the point of view of technical characteristics and safety, the use of an end-face type is most justified. The study demonstrated a direct relationship between the level of energy delivered and an increase in the depth of thermal damage, but it is not possible to definitively determine the optimal amount of energy per 1 cm of pilonidal sinus length due to the small sample of patients.

Conclusions. Laser coagulation is a minimally invasive, highly effective method of treating the pilonidal sinus, with an efficiency rate of 90–97 %. The results of the studies showed that lasers of different wavelengths can be used for this surgical method. But considering the penetration depth of laser radiation with a wavelength of 1940 nm, its use is preferable. The use of an end-face light guide is the most appropriate in terms of its technical characteristics, safety, and ease of use. The results of the study also demonstrated a direct relationship between the level of energy delivered and the depth of thermal impact on tissue.

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