Laser Treatment of Pilonidal Cyst

What is ” Pilonidal Cyst ” ?

It’s called also Ingrown Hair Cyst or Tailbone Cyst orvCoccygeale Fistula , seen mostly in younger patients with the chief complaint of pain in mid buttocks groove, accompanied at times with some swelling, redness and may be some foul smelling discharges. Pilonidal cyst (sinuses) can extend quickly under the skin and branch out to cover larger area than what its small surface opening(s) suggest. It needs to be treated as soon as it is discovered.

We see this condition mostly in young adults, both men and women, 60-70% of the patients are hairy in that area which seems to complicate the issue with excessive amount of hair growth onto and inside these cysts.

Since most of these sinuses are embryonic remnant of incomplete fusion of the buttocks skin, the sinus itself is lined with hair follicles containing skin so the hair can grow in a circular fashion into the sinus lumen and becomes a part of the ‘’cyst’’ content ( a finding that we see in a good percentage but not all of pilonidal cyst ).

The problem with pilonidal cyst is two fold: One; is the patient delay in seeking medical care, most patients come with multiple cyst openings, and two; The cyst expansion is insidious and tricky, it could look like a small little opening (s) on the surface, while it is several centimeters deep and branching in all directions under the surface.

How is Pilonidal Cyst treated ?

The above facts explain the surgeon’s dilemma in treating pilonidal cyst, traditional surgery involves rather unusually large and deep round wound that takes several months to heal or complicated and extensive dissection and Flap closure (cleft life procedure) etc…

All of these procedures are trying to do the same thing, which is to remove ( physically remove ) the entire cyst walls and content, and by enlarging the round area removed, the surgeon hopes he/she did not miss any branch or portion of the cyst. Obviously these traditional surgeries of pilonidal cyst were not popular among patients, they involved long protracted recovery, daily extensive packing of the wound or repeated visits to the hospital or clinic and worse and they still carried 25-35% recurrence rate.

At Veincure clinic, we adapt a treatment that combine the benefits and healing power of Endo laser with the proven methods of traditional surgical experience, we call it the ‘’Aji’s procedure’’ since it was first used by our Director, Dr. Sarmad Aji, an American board certified laser surgeon with more than 1000 pilonidal laser cystectomy successful experiences.

The method involves no additional incision or wounds more than enlarging slightly the existing opening, then utilizing the laser to excise and cauterize all cyst walls, ending up with tiny opening that requires little daily postoperative care, with immediate return to work and daily activities, we do this under simple local anesthesia, in an office setting, in less than half and hour with patient up and running immediately after treatment.

Our recurrence rate is at least 50% better than traditional surgery (5-10%) and our post-operative care is far simple and best of all involves no pain almost at all.

We routinely do limited laser hair removal the cyst area and recommend to repeat it three times (few weeks intervals) postoperatively.

Even in the 5-10% recurrent cyst, we mostly treat them with simple re-lasering of the cyst during normal postoperative visit with complete closure accomplished in almost all cases without difficulties.

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