Comparison of laser ablation and Karidakis surgery for treating epithelial coccygeal passages

BACKGROUND: Laser ablation is a technique which was originally used to treat various cystic and fistulous structures. Due to promising results, surgeons began to use diode lasers to treat pilonidal cysts. The authors developed their own technique of ultrasonic-guided laser ablation in patients with the discussed pathology.

AIM: To compare outcomes after laser ablation and Karidakis surgery for treating pilonidal cysts.

METHODS: A prospective non-randomized comparative study was performed. Outcomes of surgical interventions were analyzed in 71 patient with pilonidal disease: 24 patients were operated with laser obliteration technique and 47 — with Karidakis technique. The researchers compared: time of wound healing and number of recurrences, complications, length of hospital stay and duration of postoperative pain.

RESULTS: Mean operative time in the laser group was 26.45±5.41 min (20–35 min), while in the Karidakis group — 58.63±7.42 min (50–75 min). In the laser group, primary healing was registered in 23 out of 24 patients (95.8%) with an overall complication rate 20.83%. In each group, there were registered two cases with relapses after discharge. The obtained clinical results, in general, were comparable to those in the world literature. However, the quality of life of patients after laser treatment was significantly better than after traditional surgical intervention which is confirmed by less hospital stay up to 5–7 bed-days; by less surgical time, in average, 25 minutes; faster recovery — within one week after surgery; faster return to everyday life, as well as less pain syndrome in the postoperative period.

CONCLUSION: Laser ablation of the coccygeal tract is comparable to Karidakis surgery in terms of wound healing and recurrences, but it gives better results in terms of surgical time, hospital stay and postoperative pain.