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Pilonidal Sinus Management Using 980nm Diode Laser

Abstract
. Background: Pilonidal sinus is a chronic, debilitating disease of the natal cleft. It mainly involves the sacrococcygeal region and the presentation varies from asymptomatic pits to painful abscesses or sinuses. Treatment options vary from observation to wide excision. Unfortunately, surgical treatment may result in recurrence. Many conservative methods had being described for treatment of pilonidal sinus, photocoagulation using laser is one of them.

. The aim of study: To assess the efficacy of laser (diode) as a therapy to the pilonidal sinus.

. Design: A cohort of five patients with a provisional diagnosis of pilonidal sinus (unbranched) were treated by photocoagulation of sinus tract by diode laser 980 nm, between 17 and 25 year old (20.6±2.58), were diagnosed clinically and by sinogram to know the exact length of the tract and to exclude branching tract. The average length of the tracts were (5 cm) ranging (3-7) cm. Only one patient had recurrent sinus after surgical excision.

. Result: The mean operative time was (10.10) min. (range of 6.10-14.10 min.). All patient were seen the day after the procedure and then weekly, only one patient had pus discharge at day nine and was treated with ciprofloxacin and metronidazole for ten days and tract closed after 21 days of the procedure. The average time for closure was (10.4) day ranging (6-21).

. Conclusion: Diode laser as a surgical tools in the treatment of pilonidal sinus offers the following benefits: Reducing hospital stay, minimizing tissue assault by avoiding unduly extensive procedures with the attendant complications, early resumption of work by the patient and preventing recurrence of the disease.

. Keywords: pilonidal, diode 980nm, diode laser


Introduction
Pilonidal (nest of hair) sinus (PNS) is believed to arise from frictional impact on hair shafts in the intergluteal folds or sacrococcygeal cleft (figure 1).1 It's acquired condition, usually seen in young adults, manifest by midline pits in the natal cleft and associated with hair.2 Usually affect young adults from puberty to early thirties & rare after 40 years. Male: Female ratio is 4:1 due to their more hirsute nature .Onset of disease is earlier in female, which may be due to earlier puberty in female (3).The track is lined with granulation tissue (i.e. chronic inflammation) and contains hair. Commonly, it lies in the cleft between the buttocks, but may also be found elsewhere (4). A deep abscess cavity with surrounding moist conditions and abundant bacteria, hair, debris and friction cause recurrent infection, associated with chronic pain and discharge(2). Malignant change is a relatively rare complication of pilonidal disease, If it happens, squamous cell carcinoma is the most common presentation it carries bad prognosis(5) PNS was first described by Hodges in 1880...