Outcomes after laser thermal destruction of pilonidal cysts in children

BACKGROUND: A large number of surgical techniques have been proposed for treating pilonidal cysts, but a gold standard has not yet been selected. However, minimally invasive methods, in particular laser ones, are gaining popularity. The purpose of the study is to evaluate the effectiveness of treating pilonidal cysts using laser thermal destruction.

AIM: To evaluate the efficiency of treating pilonidal cysts with laser thermal destruction.

METHODS: A comparative non-randomized trial included 190 children with pilonidal cysts without abscessing who underwent surgical treatment in 2019–2024. 70 participants from the prospective part of the trail (studied group) had laser thermal destruction of their pilonidal cysts and fistulous openings under local anesthesia at outpatient settings. 120 participants in the retrospective part were divided into two comparison groups: in patients from Group 1 (n=50), pilonidal cysts and fistulous openings were excised, postoperative wounds were sutured tightly along the intergluteal cleft; in Group 2 (n=70), minimally invasive treatment (destruction) of the pilonidal cyst and fistulous openings without wound suturing was done. Evaluation criteria were: age, body mass index, gender, cyst size by ultrasound examination, surgery duration; length of hospital stay, antibacterial therapy and wound healing, as well as pain severity after surgery by the visual analog scale (VAS) and frequency of complications and relapses.

RESULTS: There were no statistically significant differences in gender, age, body mass index, surgery duration, and postoperative complications. Patients in the studied group had low postoperative pain (2±1 point; p <0.001), the least number of (abs. 15.8%, 8.5% in the group; p=0.01), and did not require hospitalization. In Group 1, there were rapid wound healing (14±7 days; p <0.001), with the highest level of postoperative pain (3.5±0.5 points; p <0.001), the longest antibacterial therapy (5±2 days; p <0.001), prolonged hospital stay (6.5±2.5 days; p <0.0001), as well as the highest number of relapses (abs. 47.4%, 28% in the group; p=0.01). In Group 2―the longest wound (31.1±3.9 days; p <0.001), the lowest percentage of relapses (abs. 38.6%, in the group 21.4%; p=0.01). The size of pilonidal cyst of 50 mm by ultrasound examination in the studied group predicted a high probability of relapses.

CONCLUSION: Laser thermal destruction of pilonidal cysts and fistulous openings in children is a promising method with low level of complications and relapses.