Pilonidal Sinus Laser Surgery - Procedure, Benefits, Recovery

A pilonidal sinus is a small tunnel or tract in the skin near the tailbone, typically in the cleft between the buttocks. Our skin contains hair follicles, which are tiny openings where hair grows. 

In the area near the tailbone, these hair follicles can sometimes become clogged with hair and debris. It can create a warm and moist environment under the skin, which is ideal for bacteria to thrive. 

Bacteria can trigger an inflammatory response from the immune system. This causes the affected area to become red, swollen, and painful. 

In some cases, the inflammation can lead to a pus-filled abscess beneath the skin. This abscess can continue to grow, causing more discomfort. Over time, as the abscess drains or is treated, a small tunnel or sinus may form beneath the surface of the skin. 

This tunnel can become a recurring issue as hair and debris may continue to accumulate, causing inflammation, pain, and infection. In some cases, surgical intervention may be required to address the problem. 

Laser treatment for pilonidal sinus is a minimally invasive method that effectively treats the condition. It utilises a laser to eliminate sinus tracts through several incisions. 

This approach promotes quicker healing and lowers the chances of complications. Patients can resume normal activities shortly after the procedure. This makes laser treatment suitable for those preferring a less invasive option for pilonidal sinus treatment.

Laser surgery for pilonidal sinus is a procedure to address both acute and chronic cases. A doctor recommends surgery when the pilonidal sinus is recurrent and becomes infected. The indications of pilonidal sinus laser surgery are:

1. Pain or discomfort in the lower back or buttock cleft
2. Swelling, redness, or a small lump in the tailbone area
3. Drainage of pus or blood from an opening in the skin
4. Soreness or tenderness in the affected region
5. Formation of abscesses (painful, swollen pockets of infection)
6. Recurrent infections in the same area

Laser surgery for pilonidal sinus is a modern approach to treating this condition. It offers multiple advantages that can significantly enhance the quality of life. These benefits are:

1. Minimal to no pain
2. No need for incisions or stitches
3. Reduced risk of bleeding
4. Swift recovery
5. The ability to return home on the same day
6. Low cases of recurrence
7. Decreased risk of infection

Patients often have concerns about what happens during the laser surgery. This section provides insight into the preparations before and on the day of the procedure.

Before Pilonidal Sinus Laser Surgery

Prior to laser treatment for pilonidal sinus, the medical team follows a set of protocols to guarantee the safety of the patient.

On the Day of Pilonidal Sinus Laser Surgery

The patient can expect to go through the following required preparations on the day of the surgery:

Laser pilonidal sinus surgery takes around 30 to 45 minutes. This procedure is carried out under local anaesthesia to ensure the patient's comfort. The procedure is performed by a general surgeon as below:

1. Positioning: The patient lies on their abdomen with the head and feet lower than the middle portion. This position allows the surgeon to see the pilonidal sinus clearly.
2. Anaesthesia: Regional or spinal anaesthesia is administered by an anesthesiologist to prevent any discomfort during the surgery.
3. Incision: The surgeon makes a cross-shaped incision on the abscess, removing damaged tissue and identifying the sinus.
4. Clearing the Sinus: The surgeon clears the sinus tract with iodine solution.
5. Laser Treatment: Using a diode laser (8W with 1470 nm), the surgeon removes damaged tissue along the entire sinus tract.
6. Fluid Drainage: After the laser treatment, the surgeon squeezes the tract to remove any fluid, flushing it with a saline and hydrogen peroxide solution.
7. Sealing: The surgeon uses a fibre to seal the entire sinus tract.
8. Dressing: The wound may be left open for drainage, or they may choose closed healing with instructions for using sanitary pads to absorb drainage.

Most patients can go home on the same day as their surgery, but in certain situations, a hospital stay of 2 to 3 days may be necessary. On average, patients spend about 12 hours in the hospital after the surgery. 

Recovery Process at Hospital

The patient is transferred to the recovery room for close monitoring, including vital signs and anaesthesia effects. 

Below are the steps of the recovery process in the hospital:

1. Immediate Post-Surgery Care: Depending on the complexity of the procedure, the patient may be placed in the ICU, a private room, or a general ward for further recovery.
2. Pain Management and Infection Control: Pain is managed with prescribed medications to ensure comfort. Infection risk is closely monitored and treated if necessary.
3. Mobility: Patients are encouraged to resume mobility as they feel comfortable gradually. Walking and light movement are beneficial for recovery.
4. Discharge and Home Care: Follow provided home-care instructions, which may include wound care and medication schedules.

At-Home Recovery

The complete recovery time varies from person to person. Many individuals can expect to resume normal activities within a few weeks to a couple of months. Adhere to the doctor's guidance at home.

1. Expect some pain and discomfort, managed with prescribed pain medications.
2. Focus on wound care, including keeping the surgical area clean and changing dressings as instructed.
3. Avoid strenuous exercises and demanding activities for approximately two weeks post-surgery.
4. Make sure to:

1. Get sufficient rest and sleep when tired.
2. Refrain from sitting on hard surfaces until the incision is fully healed.
3. Stay hydrated and choose low-fat foods like plain rice, broiled chicken, and yoghurt.
4. Prevent constipation and straining during bowel movements.
5. Steer clear of fried, spicy foods, alcohol, and smoking.
6. Hold off on swimming or soaking baths for 2 to 3 weeks following the surgery.
7. Avoid sexual intercourse for two weeks after laser surgery for the pilonidal sinus.

First Follow-up Appointment

The first follow-up appointment is typically scheduled 4 to 6 days after surgery. Compliance with follow-up visits is crucial for a successful recovery.

1. During this follow-up visit, the doctor will check the surgical site.
2. If necessary, the doctor may drain excess fluid from the cyst during the follow-up.
3. Depending on the progress and how well the surgical area is healing, the doctor might adjust the medication.

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

1. Infection: There's a possibility of infection at the surgical site, which may require further treatment.
2. Pain and Discomfort: Some level of pain and discomfort is common after surgery, but it's usually manageable with medications.
3. Bleeding: While bleeding is rare, it can occur during or after the procedure and might need medical attention.
4. Recurrence: In some cases, the pilonidal sinus can return, necessitating additional treatment.
5. Numbness: Temporary or permanent numbness in the surgical area can occur due to nerve damage during the procedure.

When to See a Doctor?

The patient should get in touch with the doctor if they encounter any of the following issues:

1. Pain
2. Swelling or redness
3. Signs of infection around the surgical area
4. Bleeding
5. Pus draining from the surgical site

When a pilonidal sinus isn't treated promptly, it can cause discomfort and disrupt daily life. Risks associated with postponing laser surgery for pilonidal sinus may involve:

1. Worsening Symptoms: The existing condition in the pilonidal sinus can worsen, causing increased pain and discomfort.
2. Abscess Formation: Delay may lead to painful abscesses, requiring more extensive treatment.
3. Increased Discomfort: Waiting may result in more significant discomfort and inconvenience due to the persistent condition.
4. Longer Recovery: The longer the surgery is postponed, the longer it may take for a patient to recover after the procedure.
5. Potential for Complications: There is an increased risk of complications during and after surgery.
6. Risk of Recurrence: Delayed treatment may raise the risk of the condition coming back in the future.

Laser pilonidal sinus surgery ranges from ₹ 40,000 to ₹ 90,000. Several key factors determine the cost. It includes:

1. Consultation fee
2. Diagnostic tests required for laser surgery
3. Admission fees
4. The type of hospital 
5. Choice of hospital recovery room
6. Location or city of the hospital

A pilonidal sinus can disrupt your daily life when it becomes infected.

If you experience severe pain and extreme discomfort, laser surgery for the pilonidal sinus can be an option.

For advice on the most suitable non-surgical and surgical treatments for pilonidal sinus, you can reach out to the experts at HexaHealth. We'll guide you from the initial assessment to post-surgery care.

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