Sequential, ultrasound-guided, minimally invasive pit-picking procedure with Nd:YAGlaser epilation treatment for pilonidal disease

Purpose: The purpose of this retrospective study was to evaluate our combinatorytreatment using ultrasonography, minimally invasive pit-picking, and Nd:YAG lasertherapy against pilonidal disease in adolescent patients.Methods: From June 2017 to December 2020, 147 patients were treated. Thetreatment cycle lasted 6-12 months. In this time, patients underwent pit-pickingprocedures and 6 to 10 Nd:YAG treatments. The remnants of the cyst were removedby laser therapy, which provided easy epilation. Each patient underwent multipleultrasound examinations during the therapy to discover any possible newly formedasymptomatic sinuses. When those sinuses were located, the pit-picking procedurewas repeated. The mean follow-up time for the program was 6 months.Results: Of the total 147 patients who were treated, the first 52 were included in thisstudy with a one-year follow-up post procedure. There were 49 symptom-free patients(96%). One patient underwent surgery in another hospital because of a recurrence andone had a pilonidal disease relapse (4%). Asymptomatic cysts were found in two otherpatients by ultrasound examination. They were all treated in the outpatient departmentwith pit-picking method with good results.Conclusions: Performing sequentially repeated pit-picking procedures combined withthe Nd:YAG laser therapy is an effective treatment method for adolescent pilonidaldisease. Repeatable ultrasonography examinations allow for early diagnosis ofpilonidal sinus relapse. Simultaneous Nd:YAG laser therapy enables efficaciousepilation of the intergluteal cleft and prevents recurrences.Level of evidence - IV