Laser Ablation Versus Open Karydakis Surgical Excision in Management of Simple Pilonidal Sinus: A Narrative Review

Abstract

The ideal treatment varies according to the clinical presentation of the disease. Although chronic pilonidal sinus has been surgically treated for more than 100 years, there is still no standard treatment approved by all surgeons. Two main lines are accepted in treatment of chronic pilonidal disease: minimally invasive techniques and definitive surgical modalities in chronic pilonidal sinus. First, midline pits are excised with a small amount of skin and the most distal part of the fistula tract is opened. Thereafter, a radial fiber delivering laser energy is introduced into the sinus tract which is cleaned and sealed by withdrawing the fiber. Healing time is generally longer in techniques involving secondary healing than in techniques with primary closure in the absence of wound complications. In order to reshape and flatten the natal cleft to reduce friction, local warmth, moisture and hair accumulation, several flap techniques have been described to cover the defect after radical excision of the sinus. The Karydakis flap procedure was first described by George Karydakis in 1973 and has frequently been used to treat sacrococcygeal pilonidal sinus disease.