Pilonidal Sinus Laser Surgery

Laser pilonidal sinus surgery is a minimally invasive procedure that usually takes 30 to 45 minutes to complete, depending upon the patient’s age, other medical conditions of the patient and severity of the case. The procedure is performed under local anaesthesia to keep the patient comfortable. A trained General Surgeon or a Dermatologist along with other professional staff may perform the laser pilonidal sinus surgery through the following steps:

1. The surgeon will advise the patient to be in a jack-knife position. In this position, the patient lies on the abdomen, and the head and feet of the patient are at a lower level with the middle portion above the level. This position allows the surgeon to clearly visualise the pilonidal sinus cyst and assist in proper surgery.
2. The anesthesiologist will administer local anaesthesia to prevent any discomfort during the surgery. 
3. The surgeon will make a criss-cross incision on the abscess to remove the damaged tissue completely. Following this, the surgeon identifies the connection of the abscess with the sinus.
4. The surgeon scoops the sinus tract as much as possible.
5. The surgeon will then use the radial fibre to remove the damaged tissues from the sinus tract and the abscess wall.
6. The surgeon will then initially deliver the diode laser (8W with 1470 nm) and withdraw the fibre by one centimetre. The surgeon will again deliver the laser until the damaged tissue is removed from the entire length of the sinus tract.
7. After the laser procedure, the surgeon will squeeze the tract to drain out the fluid. The flushing will be done through normal saline and hydrogen peroxide.
8. Fibre will then be used to seal the complete sinus tract.
9. There will be no dressing on the wound, which is kept open for drainage. The surgeon may also prefer closed healing.
10. If the surgeon wishes to have open healing, he/she may ask the patient to use sanitary pads to absorb the drainage.

The patient may expect the following before or on the day of the surgery.

Before Laser Pilonidal Sinus Surgery

A patient may expect the following before the surgery:

1. The surgeon will comprehensively evaluate the lower back, starting from the anal verge to the mid-back. It is to check for all abscesses, pits and cavities. Missing even a single hole or cavity is one of the most common causes of pilonidal sinus recurrence.
2. The surgeon will also recommend some blood tests to look for any infections or allergies.
3. The surgeon will also advise the patient to undergo a pre-anaesthesia check-up. Based on the check-up report, the hospital will confirm the surgery date.
4. The surgeon/doctor will make a file and record vital information related to the surgery. It includes medical history, family history, any specific condition that may alter the outcome of surgery, and allergy to any medications.
5. The doctor may advise the patient to stop medicines that have the potential to cause bleeding, such as aspirin and NSAIDs.
6. The patient may be advised to stop eating or drinking at least one night before the surgery.
7. The doctor will explain the detailed surgery procedures, duration of the surgery and hospital stay, and how to prepare for the surgery.

On the day of the Laser Pilonidal Sinus Surgery

The patient may expect the following on the day of surgery:

1. The patient must reach the hospital before the scheduled time to avoid the last-minute hustle. In addition, it will help the patient to relax before the surgery.
2. The patient will be asked to sign a consent form before the surgery.
3. The staff will instruct the patient to remove jewellery, dentures, and contact lenses before the surgery.
4. The staff will ask the patient to change their clothes and wear gowns.
5. The staff will shave the buttocks area of the patient to make the sinus clearly visible.
6. The patient will be evaluated by clinical examination. It includes a digital rectal examination, Blood tests (CBC), blood urea/sugar, complete blood chemistry, and coagulation profile.
7. The staff or the surgeon will insert an IV line. It will be used to administer fluid and drugs that may be required during the procedure.
8. The patient will then be shifted to the operating room.

A patient who has undergone laser pilonidal sinus surgery can expect the following after the surgery:

The recovery process in the hospital

1. Post-surgery, the patient will be moved to the hospital ward so that he/she can recover.
2. The patient will be kept in observation until the after-effect of anaesthesia wears off.
3. The surgeon will prescribe antibiotics to prevent infection and analgesics to avoid pain and discomfort.
4. Once the patient's condition stabilises, the patient will be discharged after providing detailed information about the home care, scheduled medicines, and initiation of activities.
5. Most patients are discharged from the hospital on the day of the surgery. However, the patient may need to stay at the hospital for 2 to 3 days in some cases. The average time of stay at the hospital after surgery is around 12 hours.

Recovery process/expectation after hospital discharge

1. Instructions provided by the doctor must follow at home.
2. The patient may feel pain for several days. The doctor may prescribe medications for pain management and relief.
3. The patient must avoid strenuous exercises and activities for about two weeks after surgery.
4. The patient must:
   1. Get enough sleep and rest when he/she feels tired.
   2. Avoid sitting on hard surfaces for long periods until the incision has completely healed.
   3. Drink plenty of fluids and try bland, low-fat foods like plain rice, broiled chicken and yoghurt.
   4. Keep the surgical area clean by washing it with warm soapy water.
   5. Avoid constipation and straining with bowel movements
   6. Avoid fried and spicy foods, alcohol and smoking.
   7. Stop swimming or soaking baths for about 2 to 3 weeks after the surgery.
   8. Avoid sexual intercourse until the cyst is completely recovered.

First follow-up appointment

1. The first follow-up appointment post-surgery will be scheduled within 4 to 6 days after the surgery.
2. During the follow-up visit, the doctor will view the surgical site and develop a strategy to manage complications.
3. The doctor may also squeeze the cyst to drain the excess fluid during follow-up.
4. The doctor might also change the medication or advise the patient to continue with the previous medication for some more time, depending on the condition and recovery of the surgical area.
5. The patient will also be informed regarding future visits to examine if the implant is in place and functioning properly.

Laser pilonidal sinus surgery is an advanced method to treat pilonidal sinus. This treatment method has several benefits which help improve the quality of life of an individual. The benefits of laser pilonidal sinus surgery include:

1. No pain
2. No cuts and stitches
3. No bleeding
4. Quick recovery
5. Go home the same day
6. No recurrence of cysts
7. Low chance of infection

Laser pilonidal sinus surgery is minimally invasive and has a quick recovery rate. However, as with any surgical procedure, there are some risks associated with the surgery that a patient may experience while undergoing the procedure. Some of the risks and complications associated with laser pilonidal sinus surgery are:

1. Pain and swelling at the site of surgery
2. Fever and other signs of infection, such as chills
3. Failed or delayed wound healing
4. Recurrence of pilonidal sinus

When is consultation with the doctor needed?

The patient must consult the doctor when he/she experiences:

1. Pain
2. Swelling or inflammation
3. Infection in the surgical area
4. Bleeding
5. Pus discharge from the surgical site

If the pilonidal sinus is not treated in time, it can be uncomfortable and may affect daily activities. Risks of delayed laser pilonidal sinus surgery may include:

1. Acute pilonidal cyst
2. Chronic pilonidal cyst
3. Systemic infection
4. Cancer formation

The cost of laser pilonidal sinus surgery ranges from ₹40,000 to ₹90,000. The cost varies based on the following factors:

1. Patient’s age
2. Other medical conditions that the patient may have
3. The severity of the pilonidal sinus
4. Technique and equipment used
5. The type of hospital facility availed - individual room or shared