Video assissted laser ablation of pilonidal sinus valaps -a combined minimal invasive approach for management of pilonidal sinus

Aim: Pilonidal sinus is a common infective process occurring in the natal cleft and sacroccocygeal region. Treatment options range from non-operative modalities, simple incisions and primary closure to wide excision with extensive reconstructive procedures. The aim of our study was to develop a technique that can be carried out in an ambulatory setting with minimal morbidity.
Method: Patients with pilonidal sinus were taken up for Video Assisted Laser Ablation. All patients were operated under spinal anaesthesia in prone position. Corona Radial fibre 360 degree was used with a diode laser of wavelength 1470 nm from NeoV. The procedures were done under vision using a Videoscope. Laser fibre was introduced through the working channel of the scope. The thermal energy was delivered to ablate sinus tract epithelium and granulation tissue with subsequent healing by secondary intention.
Result: A total of 21 patients were treated with video assisted laser ablation (VALAPS) from March 2017 to March 2019. Out of these, 20 patients took part in the follow up for six months. We lost the follow up in one patient. Out of 21 patients, two patients had presented with recurrence after rhomboid flap and 3 patients had presented with pilonidal abscess. In patients with pilonidal abscess, cavity was drained, antibiotic cover was given for 5 days and laser ablation was carried out. The initial success rate was 90.5% as two patients had recurrence. In both these patients, the procedure was repeated with complete cure and hence overall success rate of 95.3%has been reported.