The SiLaC procedure for pilonidal sinus disease: long-term outcomes of a single institution prospective study

In 2014, we started to treat pilonidal sinus disease in our institution with sinus laser-assisted closure (SiLaC) procedure. The aim of the present study was to evaluate the safety and efficacy of the SiLaC procedure in a single institution prospective study on a large cohort of patients and with a long follow-up period, and try to determine what factors that could influence healing and recurrence.

A prospective study was conducted on consecutive patients with primary pilonidal sinus disease operated on with the SiLaC procedure at our institution from March 2015 to August 2017. Demographic and surgical data, outcomes, and complications were prospectively recorded and compared between the healed and not healed/recurrence groups to find factors influencing healing. Postoperative follow-up was performed in the outpatient clinic every 2 weeks for 2 months. In March 2018, patients were questioned by mail or phone to assess long-term recurrences.

There were 200 patients. The healing rate was high (94%) with a mean healing time of 19.5 ± 14.4 days. Mean operative time (9.4 ± 2.6 min) and mean duration of postoperative analgesic therapy (4.72 ± 5.64 days) were short. Postoperative complications (15%) were mainly infection (9.5%). There was a response rate of 77.5% to mail/phone questionnaires about recurrence. The recurrence rate was 14.9%. Mean time until recurrence was 193.5 ± 87.19 days. The incidence of secondary openings, complications, and infection in the healing vs not healed or recurrence groups, was 24.8% vs 56.6%, 19.2% vs 40%, and 8.8% vs 30%, respectively.

SiLaC is an effective, easy to perform, reproducible, and almost painless procedure. Factors influencing healing seem to be the presence of secondary openings, postoperative complications, and, especially, infection. The SiLaC procedure could become one of the treatments of choice for pilonidal sinus disease.